Vasodilation and Migraine – The fall of a theory

Blood vessels have sometimes been described as "smart pipes".  Not only does blood move through them, they are also involved directly in controlling the rate of flow.  They can get bigger and smaller, processes known as vasodilation and vasoconstriction.

Once upon a time, migraine was known as a "vascular" disorder.  In fact, some form of this theory has been around for 350 years.

Migraine and Vasodilation in The Lewiston Daily Sun 1974
The Lewiston Daily Sun, May 1974

The idea was that the dilation of blood vessels directly led to the pain of migraine.  And so, some treatments focused on constricting the blood vessels.

There were various clues that led researchers to buy into the theory.  For example, ergotamine treatments also seemed to constrict the blood vessels, as it calmed the migraine attack.  And, in fact, the very popular Triptan drugs were developed as vasoconstrictors!  Now we believe that they work for a totally different reason.

But in recent years, the vasodilation theory has been falling apart.

First, we discovered that the migraine process was much more complex.  Though vasodilation may happen, there’s much more to a migraine attack than just changes in the blood vessels.

So vasodilation is not the key element of migraine.  It’s not enough to explain migraine symptoms.

Not only is this not a sufficient cause, we now know it’s not even necessary.

Migraineur advocate Teri Robert, reporting on a presentation of the American Headache Society in November, summed it up this way – Vasodilation may occur as part of the disorder, but is not required for Migraine pain.  (Read Vasodilation Not Necessary for Migraine)

In other words, vasodilation may not happen at all in a migraine attack!

That doesn’t mean it doesn’t happen commonly, simply that it’s not required.  It may often still be a part of the process, but it’s not they key aspect, and certainly not the cause of all migraine pain.

The report at the AHS meeting, presented by Dr. Andrew Charles, also pointed out that some drugs that cause vasodilation do not cause migraine attacks.

What does this mean for the patient?

  1. We can now know that information claiming migraine is a "vascular disorder" caused by vasodilation of the blood vessels is out-dated.
  2. We can give a lower priority to treatments that claim to stop migraine by vasoconstriction.
  3. We don’t need to be afraid of medication just because it may cause vasoconstriction.
  4. We can be glad that the medical community is being freed from this erroneous idea.  This is actually opening the doors to new treatments that focus on other more foundational aspects of migraine.

Further reading: The vascular theory of migraine—a great story wrecked by the facts

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2 comments… add one

  • Stephen Jan 24, 2011

    Reading a book by David Buchholz called the “123 program.” He said that nueropeptides are a cause for the vaso dilation in the blood vessels in the brain. He says on page 13 that vaso constriction in the eyes and ears also causes debilitating symptoms in migraines and pain. It’s likely that vasoconstriction will solve a major pain problem in a common ground but add to the pain in this area. I would consider vaso-constriction and dilation control to be a necessary evil to try control and consider and to abandon it would be juvenile and impulsive action based on the excitement of ambition and new information. Developing theories on the migraines should build on treatment methods and only abandon them if it is grossly out of line. I believe there is still not enough evidence to abandon vaso constriction. Give me and different treatment method that does better and we’ll talk.

  • James Jan 24, 2011

    Hi Stephen,

    Thanks for your comment! :)

    First of all, there are better treatment methods for many people. I take it from what you’re saying that Dr. Buchholz’s method has worked well for you – that’s great! But for many people, it does not work well. Just for the record.

    Secondly, I agree in principle with your statement that it would be a “juvenile and impulsive action” to abandon a treatment “based on the excitement of ambition and new information.” But nobody is doing that. That is not the point of this post at all.

    The “new information” here is simply that vasodilation is not necessarily a part of a migraine. That’s all. So what does that mean?

    Well, in part that’s a matter of opinion. But we do know that it means that not all migraine attacks involve vasodilation. So, if for example you try to treat a migraine by fighting vasodilation, when there may not be any, you’re setting yourself up for failure.

    It doesn’t mean that no migraine attack involves vasodilation. It also doesn’t mean that any given treatment doesn’t work.

    Dr. Buchholz’ book is now almost a decade old. There is a huge amount of useful information that we’ve learnt since then. Does that mean we consider all his ideas as worthless? No, they have worked for many people (though not all). But it may be that his methods work for a different reason than what he originally thought. Or, it could be – no, it is the case that he doesn’t have the full picture (no one does).

    The evidence from this study is extremely strong – migraine simply does not always involve vasodilation. But by no means are we throwing out all the progress that’s been made in treatments over the past many years.

    And let’s remember that this is not exactly all “new” information! It’s been a very long time since migraine experts have thought that migraine is simply caused by vasodilation. That theory was gone long before this study came along.

    If these methods are working for you, keep right on with them. Different treatments work for different people. Unless we find out somehow that this method is extremely harmful to you, there’s no reason for you to abandon it. I hope you continue to be in good health.

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