title: Are cortical spreading depression and headache in migraine causally linked?
abstract: During the past few decades, much controversy has surrounded the pathophysiology of migraine. Cortical spreading depression (CSD) is widely accepted as the neuronal process underlying visual auras. It has been proposed that CSD can also cause the headaches, at least in migraine with aura. We describe three patients, each fulfilling the International Headache Society criteria for migraine with aura, who suffered from headaches 6-10 days per month. Two patients were treated with flunarizine and the third patient with topiramate for the duration of 4 months. All patients reported that aura symptoms resolved completely, whereas the migraine headache attacks persisted or even increased. These observations question the theory that CSD (silent or not) is a prerequisite for migraine headaches.
authors.affiliation: Department of Neurology, University of Hamburg, Hamburg, Germany.
authors.forename: J
authors.initials: J
authors.lastname: Wolthausen
authors.forename: S
authors.initials: S
authors.lastname: Sternberg
authors.forename: C
authors.initials: C
authors.lastname: Gerloff
authors.forename: A
authors.initials: A
authors.lastname: May
mesh_terms: D000293:Adolescent; D001921:Brain / Q000187:drug effects / Q000503:physiopathology*; D013181:Cortical Spreading Depression / Q000187:drug effects*; D005260:Female; D005444:Flunarizine / Q000627:therapeutic use; D005632:Fructose / Q000031:analogs & derivatives / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D020325:Migraine with Aura / Q000188:drug therapy* / Q000503:physiopathology*; D020326:Migraine without Aura / Q000503:physiopathology; D000077236:Topiramate
chemical_list: D000077236:Topiramate; D005632:Fructose; D005444:Flunarizine