Purpose of review: This article describes current knowledge regarding headache, especially migraine, and includes information on genetics, anatomy, pathophysiology, and pharmacology in order to demonstrate their relevance to clinical phenomenology.
Recent findings: Animal models show that drugs effective in migraine prevention may work by raising the threshold for initiating cortical spreading depression and may also attenuate the response to simulation.
Summary: Great advances have been made in diagnosing and understanding migraine over the past several decades. Tools such as the International Classification of Headache Disorders assist in making diagnoses. Although blood vessel changes do occur in migraine, they are not timelocked to the occurrence of head pain. Cortical spreading depression is at least one trigger for the events that occur in migraine. Migraine may be due to the interplay of host susceptibility and various triggers. Nitric oxide and calcitonin gene-related peptide are important mediators, and estrogen seems to "ramp up" the system.