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March 1987, Vol 44, No. 3 >
Article | March 1987

The Ischemic Hypotheses of Migraine

Jes Olesen, MD
[+] Author Affiliations

Accepted for publication July 10, 1986.

Reprints not available.


Arch Neurol. 1987;44(3):321-322. doi:10.1001/archneur.1987.00520150061023
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According to the traditional view,1 migraine is due to spasm in one or more major cerebral arteries causing cerebral ischemia, which as the spasm disappears, gives way to hyperperfusion. In this phase, atonic arteries, especially extracranially, cause the pain experience. For many years, there was little experimental evidence in favor of this theory but also little evidence against it. Hence, it remained for decades in virtually every textbook of medicine or neurologogy. Due to its appealing simplicity, the hypothesis has easily been grasped by students, and it has been very useful as patient information. It has also caused the search for new migraine drugs to be directed exclusively toward vasoactive compounds.

With ample new evidence at hand, it now becomes necessary to reevaluate the classic hypothesis, and to discuss common migraine and classic migraine separately.

COMMON MIGRAINE  It has always been difficult, not to say impossible, to encompass the

REFERENCES

1 +
Wolff HG: Headache and Other Head Pain . New York, Oxford University Press Inc, 1963;.
2 +
Sakai F, Meyer JS:  Regional cerebral hemodynamics during migraine and cluster headaches measured by the 133-Xe inhalation method . Headache 1978;;18:122-133.
3 +
Bès A, Guell A, Victor G, et al:  Effects of a dopaminergic agonist on CBF in migraine patients , in Heistad DD, Marcus ML (eds): Cerebral Blood Flow: Effects of Nerves and Neurotransmitters . New York, Elsevier Biomedical, 1982;, pp 163-168.
4 +
Juge O, Gauthier G:  Measures de debit sanguin cerebral regional (DSCR) par inhalation de xenon-133: Applications cliniques . Bull Schweiz Akad Med Wiss 1980;;36:101-115.
5 +
Gulliksen G, Enevoldsen E:  Prolonged changes in rCBF following attacks of migraine accompagnée . Acta Neurol Scand 1984;;69( (suppl 98) ):270-271.
6 +
Lauritzen M, Olesen J:  Regional cerebral blood flow during migraine attacks by Xenon-133 inhalation and emission tomography . Brain 1984;;107:447-461.
7 +
Olesen J, Tfelt-Hansen P, Henriksen L, et al:  The common migraine attack may not be initiated by cerebral ischemia . Lancet 1981;;2:438-440.
8 +
Olesen J:  Significance of trigger factors in migraine , in Rose FC (ed): Progress in Migraine Research . London, Pitman Books, 1984;, vol 2, pp 18-20.
9 +
Langemark M, Olesen J:  Drug abuse in migraine patients . Pain 1984;;19:81-86.
10 +
Tfelt-Hansen P, Eickhoff JH, Olesen J:  The duration of the biological effect of ergotamine tartrate , in Critchley M, Friedman AP, Sicuteri F, et al (eds): Advances in Neurology . New York, Raven Press, 1982;, vol 33, pp 315-319.
11 +
Skinhøj E, Paulson OB:  Regional blood flow in internal carotid distribution during migraine attack . Br Med J 1969;;3:569-570.
12 +
Skinhøj E:  Hemodynamic studies within the brain during migraine . Arch Neurol 1973;;29:95-98.
13 +
Edmeads J:  Cerebral blood flow in migraine . Headache 1977;;17:148-152.
14 +
Mathew NT, Hrastnik F, Meyer JS:  Regional cerebral blood flow in the diagnosis of vascular headache . Headache 1976;;15:252-260.
15 +
Janzen R, Tänzer A, Zschocke ST, et al:  Postangiographische Spätreaktionen der Hirngefässe bei Migränekranken . Z Neurol 1972;;201:24-42.
16 +
Olesen J, Larsen B, Lauritzen M:  Focal hyperemia followed by spreading oligemia and impaired activation of rCBF in classic migraine . Ann Neurol 1981;;9:344-352.
17 +
Lauritzen M, Skyhøj Olsen T, Lassen NA, et al:  The changes of regional cerebral blood flow during the course of classical migraine attacks . Ann Neurol 1983;;13:633-641.
18 +
Lauritzen M, Skyhøj Olsen T, Lassen NA, et al:  The regulation of regional cerebral blood flow during and between migraine attacks . Ann Neurol 1983;;14:569-572.
19 +
Leao AAP:  Spreading depression of activity in cerebral cortex . J Neurophysiol 1944;;7:359-390.
20 +
Lauritzen M, Balslev Jørgensen M, et al:  Persistent oligemia of rat cerebral cortex in the wake of spreading depression . Ann Neurol 1982;;12:469-474.
21 +
Herold S, Gibbs FM, Jones AKP, et al:  Oxygen metabolism in migraine . J Cereb Blood Flow Metab 1985;;5( (suppl 1) ):445-446.

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1 +
Wolff HG: Headache and Other Head Pain . New York, Oxford University Press Inc, 1963;.
2 +
Sakai F, Meyer JS:  Regional cerebral hemodynamics during migraine and cluster headaches measured by the 133-Xe inhalation method . Headache 1978;;18:122-133.
3 +
Bès A, Guell A, Victor G, et al:  Effects of a dopaminergic agonist on CBF in migraine patients , in Heistad DD, Marcus ML (eds): Cerebral Blood Flow: Effects of Nerves and Neurotransmitters . New York, Elsevier Biomedical, 1982;, pp 163-168.
4 +
Juge O, Gauthier G:  Measures de debit sanguin cerebral regional (DSCR) par inhalation de xenon-133: Applications cliniques . Bull Schweiz Akad Med Wiss 1980;;36:101-115.
5 +
Gulliksen G, Enevoldsen E:  Prolonged changes in rCBF following attacks of migraine accompagnée . Acta Neurol Scand 1984;;69( (suppl 98) ):270-271.
6 +
Lauritzen M, Olesen J:  Regional cerebral blood flow during migraine attacks by Xenon-133 inhalation and emission tomography . Brain 1984;;107:447-461.
7 +
Olesen J, Tfelt-Hansen P, Henriksen L, et al:  The common migraine attack may not be initiated by cerebral ischemia . Lancet 1981;;2:438-440.
8 +
Olesen J:  Significance of trigger factors in migraine , in Rose FC (ed): Progress in Migraine Research . London, Pitman Books, 1984;, vol 2, pp 18-20.
9 +
Langemark M, Olesen J:  Drug abuse in migraine patients . Pain 1984;;19:81-86.
10 +
Tfelt-Hansen P, Eickhoff JH, Olesen J:  The duration of the biological effect of ergotamine tartrate , in Critchley M, Friedman AP, Sicuteri F, et al (eds): Advances in Neurology . New York, Raven Press, 1982;, vol 33, pp 315-319.
11 +
Skinhøj E, Paulson OB:  Regional blood flow in internal carotid distribution during migraine attack . Br Med J 1969;;3:569-570.
12 +
Skinhøj E:  Hemodynamic studies within the brain during migraine . Arch Neurol 1973;;29:95-98.
13 +
Edmeads J:  Cerebral blood flow in migraine . Headache 1977;;17:148-152.
14 +
Mathew NT, Hrastnik F, Meyer JS:  Regional cerebral blood flow in the diagnosis of vascular headache . Headache 1976;;15:252-260.
15 +
Janzen R, Tänzer A, Zschocke ST, et al:  Postangiographische Spätreaktionen der Hirngefässe bei Migränekranken . Z Neurol 1972;;201:24-42.
16 +
Olesen J, Larsen B, Lauritzen M:  Focal hyperemia followed by spreading oligemia and impaired activation of rCBF in classic migraine . Ann Neurol 1981;;9:344-352.
17 +
Lauritzen M, Skyhøj Olsen T, Lassen NA, et al:  The changes of regional cerebral blood flow during the course of classical migraine attacks . Ann Neurol 1983;;13:633-641.
18 +
Lauritzen M, Skyhøj Olsen T, Lassen NA, et al:  The regulation of regional cerebral blood flow during and between migraine attacks . Ann Neurol 1983;;14:569-572.
19 +
Leao AAP:  Spreading depression of activity in cerebral cortex . J Neurophysiol 1944;;7:359-390.
20 +
Lauritzen M, Balslev Jørgensen M, et al:  Persistent oligemia of rat cerebral cortex in the wake of spreading depression . Ann Neurol 1982;;12:469-474.
21 +
Herold S, Gibbs FM, Jones AKP, et al:  Oxygen metabolism in migraine . J Cereb Blood Flow Metab 1985;;5( (suppl 1) ):445-446.

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