Arguments against the role of cortical spreading depression in migraine

Figures & data

Table 1. Differences between the characteristics of cortical spreading depression (CSD) and migraine aura.

Cortical spreading depression	Migraine aura
Water diffusion leading to cell swelling	No change in water diffusion
Blood–brain barrier disrupted	Blood–brain barrier intact
Somatosensory neuronal silencing	Only positive symptoms in many aura cases
Cerebral metabolism is enhanced	Cerebral metabolism remains unchanged
Regional cerebral blood flow is only moderately reduced to non-ischemic levels	Regional cerebral blood flow may fall to ischemic levels
Symptoms immediately after initiation	Premonitory symptoms up to 72 hours before the onset of aura
Little to no cerebral damage after CSD	Localized deficits in the visual field and subcortical white matter
EEG flattened	No EEG flattening
MEG: positive or negative shifts immediately after CSD initiation	MEG: positive or negative shifts at approximately 10 minutes after the initiation of the aura

Table 2. Differences between the characteristics of cortical spreading depression (CSD) and migraine headache.

Cortical spreading depression	Migraine headache
Protein leakage	No protein leakage
Neurogenic inflammation	No neurogenic inflammation
CGRP not increased in jugular vein blood	CGRP increased in jugular vein blood
sTMS fails to inhibit CSD	sTMS abolishes pain
Unilateral	Unilateral and bilateral

Note:

CGRP: calcitonin gene-related peptide; sTMS: single transcranial magnetic stimulation.