The mysterious link between migraine aura and migraine headache
Fig 2
A simplified overview of proposed mechanisms underlying different phases of a migraine attack.
Premonitory symptoms (green) – symptoms occurring up to 48 h before headache onset in a subset of patients – have been suggested to arise from the hypothalamus or other diencephalic structures, although their origin is largely unknown. The migraine aura (red), which usually precedes the onset of migraine headache, represents spreading depolarization propagating in eloquent cerebral cortex. Migraine headache (blue) may, in a minority of patients, start before the aura symptoms. The head pain of migraine is believed to depend on sensory input from activated meningeal nociceptors, involving the release of vasoactive peptides and vasodilation. Nociceptive signals project to central pain pathways via the trigeminal ganglion and upper cervical sensory ganglia (the latter not depicted). Note that structures believed to be involved in the premonitory and aura symptoms are protected by the blood–brain barrier, while structures involved in the nociceptive pathway are located inside as well as outside of the blood–brain barrier. Created with Biorender.