Vascular changes have a primary role in migraine

In the ongoing debate about migraine pathogenesis it is crucial whether vascular factors are of primary importance or the blood vessels are just ‘bystanders’. In Edward Liveing’s the first monograph on migraine entitled ‘On Megrim, Sick-headache, and Some Allied Disorders: A Contribution to the Pathology of Nerve-Storms’ (1) he proposed the neural theory of migraine, ascribing the problem to ‘disturbances of the autonomic nervous system’, and that ‘vasomotor disturbance is secondary in origin’. The ‘neural’ theory has been revived in recent decades and some researchers have even proposed that migraine pain is caused by abnormal central interpretation of normal sensory input in the trigeminal sensory system. However, no scientific evidence supporting the theory of ‘abnormal central interpretation’ has yet emerged. Following a debate format I would like to present the scientific evidence supporting a primary role of vascular changes in migraine.