New Insights into Migraine Pathophysiology

Cerebral Torque

⚡
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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