New Insights into Migraine Pathophysiology
A visual guide to how cortical spreading depression sets off migraine pain.
CSD Phase
Cortical Spreading Depression (CSD)
CSD Phase
Wave of Brain Activity Suppression
NEW
CSF Phase
CSF Proteome Alterations
~11% of CSF proteome altered after CSD
CSF Phase
Up-regulation of Trigeminal-activating Proteins
CSF Phase
CGRP in CSF
Known to increase during migraine attacks
NEW
Trigeminal Phase
CSF Flow into Trigeminal Ganglion
Newly discovered pathway for pain signaling
NEW
Trigeminal Phase
New Zone without Epineural Sheath
Area in trigeminal ganglion allowing direct CSF contact
NEW
Trigeminal Phase
Nonsynaptic Brain-Trigeminal Signaling
Direct communication between the CNS and PNS via CSF
Trigeminal Phase
Altered CSF Contacts Trigeminal Neurons
Pain Phase
Activation of Trigeminal Nerve Cells
Pain Phase
Headache/Migraine Pain
Pain Phase
Migraine Attack Symptoms Experienced
Resolution Phase
Temporary Process
Resolution Phase
CSF Proteome Normalizes
Resolution Phase
Decrease in Pain Signals
Resolution Phase
Migraine Attack Subsides
Reference: Rasmussen et al. (2024). Cortical spreading depression opens a paravascular space in the trigeminal ganglion. Science, 385(6320), 80-85. DOI: 10.1126/science.adq3498
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