The pathophysiology of migraine.

Although the neurobiological causative factors are now beginning to be unde rstood, to a large extent the complex mechanisms involved in migraine remai n an enigma, with the appearance of a transient unilateral cephalic pain, p ossibly preceded by a protean aura and associated with several other sympto ms. The factors involved include three clinical signs or symptoms, ie., pai n, the aura (focalized neurological and neurosensory signs), and accompanyi ng symptoms (e.g., sensory, psychological, or digestive); and three anatomi cal sites, i.e., the brain, the meningeal or intracranial vessel and a peri pheral cranial nerve, the trigeminus (V). Familial hemiplegic migraine (FHM ) has led to a consideration of the genetic origin of ionic channel-depende nt pathologies (channelopathies), while certain other arguments which are f or the most part indirect favor the hypothesis of abnormalities, again poss ibly of genetic origin, in the central neurotransmitters (including seroton in), which are involved in the transmission of pain messages and in vasomot or control. However, the main point is that each of the sites involved has its specific pharmacopoeia, which can contribute towards the treatment of m igraine. (C) 2000 Editions scientifiques et medicales Elsevier SAS.