The mechanisms of migraine symptoms, including allodynia, and migraine disease progression

At EAN 2022, Gisela Terwindt, Professor of Neurology, Leiden University Medical Centre, Leiden, The Netherlands, introduced herself and discussed how symptoms of migraine include aura phenomena, caused by cortical spreading depolarization; followed by a severe, throbbing headache; photophobia; nausea; and vomiting. These involve activation of the trigeminal vascular system in the brainstem, with afferents to the meninges, and release of peptides, including calcitonin gene-related peptide. Patients may also experience allodynia, where touching the head and other parts of the body is very painful. This is linked to migraine progression and occurs due to activation of secondary neurons in the brainstem and, in some, the thalamus. Hence, patient descriptions of symptoms match what is happening in the central nervous system during migraine. Professor Terwindt also discussed how triptan-based medications do not work once allodynia has developed, so it’s important to discuss with patients the correct time during a migraine attack course to take these drugs, and how preventive medication might be needed.