New Insights into Migraine Pathophysiology

CSD Phase

Cortical Spreading Depression (CSD)

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CSD Phase

Wave of Brain Activity Suppression

NEW
🧬
CSF Phase

CSF Proteome Alterations

~11% of CSF proteome altered after CSD

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CSF Phase

Up-regulation of Trigeminal-activating Proteins

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CSF Phase

CGRP in CSF

Known to increase during migraine attacks

NEW
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Trigeminal Phase

CSF Flow into Trigeminal Ganglion

Newly discovered pathway for pain signaling

NEW
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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

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Trigeminal Phase

Altered CSF Contacts Trigeminal Neurons

⚠️
Pain Phase

Activation of Trigeminal Nerve Cells

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Pain Phase

Headache/Migraine Pain

😣
Pain Phase

Migraine Attack Symptoms Experienced

Resolution Phase

Temporary Process

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Resolution Phase

CSF Proteome Normalizes

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Resolution Phase

Decrease in Pain Signals

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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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