migraine: a dynamical disease

Migraine: A dynamical disease

Markus A. Dahlem

HU Berlin, Research group: Dynamics and Neuromodulation of Migraine

23 min

Visual hemifield Primary visual cortex

nucleationcritical

“Theorie-Seminar”, Johann Wolgang Goethe University of Frankfurt

13. Mai 2014

Outline

Preface: Dynamical disease — Migraine — Models fill a gap

Mathematical migraine models: two (out of four) examplesModeling macroscopic fMRI dataModeling pain / central sensitisation

Towards therapeutic intervention

Outline

“Dynamical disease”

Leon Glass and Michael Mackey coined the termdynamical disease to identify diseases that occur dueto an abrupt change in the natural rhythms of thebody and rhythms become abnormal. In particular,chronic disorders with episodic manifestations.

“The significance of identifying a dynamical disease isthat it should be possible to develop therapeuticstrategies based on our understanding of dynamicscombined with manipulations of the physiologicalparameters back into the normal ranges.”

(Belair, Glass, an der Heiden, & Milton, Chaos, 5, 1995)

Migraine 6= Headache

The International Headache Classification – All types

1.1. 1.2. 1.4. 1.5. 1.6.1.3.

1.2.1. 1.3.1. 1.5.1. 1.6.1.

Migraine

Subtypes

2 symptom, 3 combinations: both or either of them(more detailed: 64% only MWoA, 18% only MWA, 13% MWoA and MWA, 5% MxWA (without pain))

The International Headache Classification – Major types

with aura

w/o aura

typical aura

without headache

1.1. 1.2.

1.2.1.

Subtypes

Migraine

1.2.1.

1.2.3.

MWoA 70%

MWA 30%

2 symptom, 3 combinations: both or either of them(more detailed: 64% only MWoA, 18% only MWA, 13% MWoA and MWA, 5% MxWA (without pain))

What is a migraine aura?

based on: • Dahlem & Muller Biol. Cybern. 88,419 (2003)

based on:

• Dahlem et. al. Eur. J. Neurosci. 12,767 (2000).

Multiscale disease: From molecules to entire brain

Functional mutations Spreading depression (SD)

(e.g. FHM2: sodium-potassium pump)

Maagdenberg, et al., Ann. Neurol., 67 (2010)

Tottene, et al., Neuron, 61 (2009)

Freilinger, et al. Nature Genetics 44 (2012),

Dahlem, et al PeerJ, 2,379 (2014)

during a migraine attack

Atlas of Migraine and Other Headaches, Silberstein

et al (Editors)

Models fill the ‘gaps’ in the multiscale framework

outsid

sensory aura (15min)

visual aura (0min)

behavior, perceptionsensory processing

(a) Functional mutations, either FHM, CADASIL, ... or GWAS.

(b) Hodgkin-Huxley type, single cell electrophysiology models.

(c) Neural mass/fields population models, with subpopulationshaving specific synaptic receptor distribution.

(d) From local circuits to reaction-diffusion and larger networks(migraine generator network).

(e) Throbbing pain, aura symptoms, mental dysfunctions,impared sensory and cognitive processing.

0 5 10 15 20 25 30 35

time (s)

seizure-likeafterdischarges

depolarization block

dominance pump current

m-gatedeactivation

begin I -drivenrepolarizationNa

outsid

visual aura (0min)

VI0 5 10 15 20 25 30 35

time (s)

m-gatedeactivation

outsid

visual aura (0min)

balanced excitation and inhibition in ion-based models

VI0 5 10 15 20 25 30 35

time (s)

m-gatedeactivation

outsid

off on

cortex

cranial circulation & innervation

cortico-thalamicaction

release noxious agentse

visual aura (0min)

balanced excitation and inhibition in ion-based models

an level

Outline

Reseach interests – overview

Cortical architecture Ion-based cellular models

Current distribution

Extrac

ellula

Osmotic force

I Na,P

I K ,DR

I K ,A

I NM DA

I Na,T

[Na+]i

inside cell

outside cellI

P PP P

Voltage(mV)

–120 –110 –100 –901

Time(ms)

1 10 100

1·0Wild-typeMutant

Mutant GLN1478Lys

Wild-typeSCN5A

0·5nA

Macroscopic patterns in migraine Pain pathways & modulation

��

MRN Amyg

PFC ThPPC

Insula

HH-type conductance-based

toconductance- & ion-based models (2nd generation model)

∂t= −INa − IK − Ileak

−Ipump

+Iapp (1)

INa = gNam3h(V − ENa)

IK = gKn4(V − EK )

Ileak = gleak(V − Vrest)

∂t= αn(1− n)− βn,

∂t· · · (2)− (4)

∂[ion]e∂t

= − A

FVoloIion

∂[ion]i∂t

FVoliIion (5)− · · ·

HH: Hodgkin-Huxley

From HH-type conductance-based toconductance- & ion-based models (2nd generation model)

ion reservoirs

isolated boundary

surroundingsenergysource

extracellular

intracellular

∂t= −INa − IK − Ileak−Ipump+Iapp (1)

INa = gNam3h(V − ENa)

IK = gKn4(V − EK )

Ileak = gleak(V − Vrest)

∂t= αn(1− n)− βn,

∂t· · · (2)− (4)

∂[ion]e∂t

= − A

FVoloIion

∂[ion]i∂t

FVoliIion (5)− · · ·

HH: Hodgkin-Huxley

The neuron in analogy to a heat engineFour processes make up a spreading depression “cycle”

−60 −40 −20 0 20 400

60 resting state

ion gain through reservoire / (mM)

M) ion

reservoirs

isolated boundary

extracellular

intracellular

• Dreier et al., Neuroscientist 19, (2012)• Hubel et al., PLOS Comp. Biology. 10, e1003551 (2014)

• Hubel & Dahlem, arXiv:1404.3031 (under review in PLOS Comp. Biology )

−60 −40 −20 0 20 400

60m fluxes across membrane

resting state

M) ion

reservoirs

isolated boundary

extracellular

intracellular

−60 −40 −20 0 20 400

r fluxes from reservoir

resting state

M) ion

reservoirs

isolated boundary

extracellular

intracellular

−60 −40 −20 0 20 400

resting state

M) ion

reservoirs

isolated boundary

extracellular

intracellular

−60 −40 −20 0 20 400

resting state

cyclic process

M) ion

reservoirs

isolated boundary

extracellular

intracellular

−60 −40 −20 0 20 400

resting state

cyclic process

folded

fixed point

branch

ion reservoirs

isolated boundary

extracellular

intracellular

Reaction-diffusion model

The Hodgkin-Grafstein modelof SD (1963)

(cf. Zeldovich-Frank-Kamenetskii,

Schlogl, ...)

u = [K +]e

−60 −40 −20 0 20 400

resting state

cyclic process

folded

fixed point

branch

u = (u − urest) (u − uceiling ) (u − umax) + D∇2u (1)

‘Obvious’ extension (add FitzHugh-Nagumo inhibitor equations)

(u − u3

3− v

)+ D∇2u (2)

ε−1v = (u + β − γv) (3)

Reaction-diffusion modelThe Hodgkin-Grafstein modelof SD (1963)

Schlogl, ...)

u = [K +]e −60 −40 −20 0 20 400

resting state

cyclic process

folded

fixed point

branch

(u − u3

3− v

)+ D∇2u (2)

ε−1v = (u + β − γv) (3)

Reaction-diffusion modelThe Hodgkin-Grafstein modelof SD (1963)

Schlogl, ...)

u = [K +]e −60 −40 −20 0 20 400

resting state

cyclic process

folded

fixed point

branch

(u − u3

3− v

)+ D∇2u (2)

ε−1v = (u + β − γv) (3)

What is Spreading Depression on macro-scale?

SD: massive perturbation of ion homeostasis in gray matter

log [cat] , M

(mM)VeNa+

0 10 20 30 s

1506050

unitact.

M. Lauritzen, Trends in Neurosciences 10,8 (1987).

A controversial debate but

“...essential view of a reaction-diffusion process still holds ...”

Herreras (2005) J. Neurophysiol. 94:3656

Somjen & Strong (2005) J. Neurophysiol. 94:3656

What is Spreading Depression on macro-scale?

SD: massive perturbation of ion homeostasis in gray matter

log [cat] , M

(mM)VeNa+

0 10 20 30 s

1506050

unitact.

any textbook

from ~2004

many websites

M. Lauritzen, Trends in Neurosciences 10,8 (1987).

A controversial debate but

“...essential view of a reaction-diffusion process still holds ...”

Herreras (2005) J. Neurophysiol. 94:3656

Somjen & Strong (2005) J. Neurophysiol. 94:3656

Migraine full-scale attack is more confined

(a) (b)

affected areatemporarily

• Dahlem et al. ”2D wave patterns ... ”. Physcia D 239 (2010) Special issue: Emerging Phenomena.

Migraine visual field defects reported in 1941 by K. Lashley

visual field defect pattern on primary visual cortex

5min7min

0 10 20 30 40 50mm

5min7min

9min11min

Only about 2-10% but not 50% cortical surface area is affected!• Dahlem & Hadjikhani (2009) PLoS ONE 4: e5007.

Tracking migraine aura symptoms

Vincent & Hadjikhani (2007) Cephalagia 27

Confined spatial patterns of spreading depression

Hadjikhani et al. (2001) PNAS

neighboring points

collapse

16 min

31 min

nucleationrecordedslice not

Hadjikhani et al. (2001) PNAS

Migraine full-scale attack is more confined

(a) (b)

affected areatemporarily

• Dahlem et al. ”2D wave patterns ... ”. Physcia D 239 (2010) Special issue: Emerging Phenomena.

Excitable media – Traveling wave solutionsCanonical RD eqs.

(in weak limit, β large but not too large)

∂tu = f (u)− v +∇2u

∂tv = ε(u + β)

Schenk et al. Phys. Rev. Lett. 78, 3781 (1997)

Excitable media – Traveling wave solutions

Canonical RD eqs.

∂tu = f (u)− v +∇2u

∂tv = ε(u + β)

1.3 1.32 1.34 1.36 1.38 1.4

threshold β

∂R∞

super-threshold stim

ulation

sub-thresholdstim

ulation

threshold

homogeneous steady state

traveling wave

critical nucleactionsolution

Canonical RD eqs.

∂tu = f (u)− v +∇2u

∂tv = ε(u + β)

1.3 1.32 1.34 1.36 1.38 1.4

threshold β

∂R∞

ulation

sub-thresholdstim

ulation

threshold

traveling wave

nucleationcritical

Canonical RD eqs.

∂tu = f (u)− v +∇2u

∂tv = ε(u + β)

1.3 1.32 1.34 1.36 1.38 1.4

threshold β

∂R∞

ulation

sub-thresholdstim

ulation

threshold

traveling wave

nucleationcritical

Canonical RD eqs.

∂tu = f (u)− v +∇2u

∂tv = ε(u + β)

1.3 1.32 1.34 1.36 1.38 1.4

threshold β

∂P1D∂R∞

ulation

sub-thresholdstim

ulation

threshold

traveling wave

nucleationcritical

Canonical RD eqs.

∂tu = f (u)− v +∇2u

∂tv = ε(u + β)

1.3 1.32 1.34 1.36 1.38 1.4

threshold β

∂P1D∂R∞

ulation

sub-thresholdstim

ulation

threshold

traveling wave

nucleationcritical

Migraine waves look like unstable nucleation solutions

nucleationcritical

What are we missing?

Kapitza’s pendulum

Mapped visual symptoms on cortex via fMRI retinotopy

27 min

• Dahlem & Hadjikhani (2009) PLoS ONE 4: e5007.

Mapped visual symptoms on cortex via fMRI retinotopy

23 min

• Dahlem & Hadjikhani (2009) PLoS ONE 4: e5007.

Individual ‘hot spots’ and ‘labyrinth’ determine attack

positive

negative

Principles• simulations on simpler shapes• analytical results with isothermal

coordiantes (toroidal coordinates)

Validate• uploading patient’s MRI scanner readings• finite element analysis

• polygon mesh processing

Excitation waves on curved surfaces

Paradigmatic SD model on gyrified cortex.

∂t= u − 1

3u3 − v + Du

∂αi

(gij√

∂αi

∂t= ε(u + β)

SD in weakly excitable cortex posses critical properties.

First approximation: localized SD follows shortest path.

Effect of intrinsic curvature of the medium

1. Lower threshold for SD if cortex is (intrinsically) negatively curved.

2. Stable wave segments: center being at positive curvature while the open ends extend into negative curvature.

nucleationcritical

1.3 1.32 1.34 1.36 1.38 1.4

threshold β

torus outside

torus inside2

ring wave

∂P1D∂R∞

neg. curvaturelower threshold

bifucation analysison torus pos. curvature

stabilization

• Kneer, Scholl & Dahlem, New J Phys, 16 053010 (2014)

Hot spots left visual field

23 min

Cooperation with Andrew Charles, UCLA.

Hot spots right visual field

27 min

Labyrinth path in reverse direction

27 min

Reaction-diffusion with augmented transmission

The extended Hodgkin-Grafstein model (1963) of SD(+ FHN inhibitor equations + nonlocal term)

(u − u3

3− v

)+ D∇2u

ε−1v = (u + β) + KF [u] (4)

Global controlF [u] = Su(t − τ)− S0

Su(t) =

∫Θ(u(r, t)− ue) dr,

cf. K. Krischer and A. Mikhailov, (1994) PRL 73, 3165

Sakurai et al., (2002) Science 296, 2009

Reaction-diffusion with augmented transmission

The extended Hodgkin-Grafstein model (1963) of SD(+ FHN inhibitor equations + nonlocal term)

(u − u3

3− v

)+ D∇2u

ε−1v = (u + β) + KF [u] (4)

Global controlF [u] = Su(t

− τ

)− S0

Su(t) =

∫Θ(u(r, t)− ue) dr,

cf. K. Krischer and A. Mikhailov, (1994) PRL 73, 3165

Sakurai et al., (2002) Science 296, 2009

Cortical homeostasis is excitable (bistabe)

Hypothesis: Cortical susceptibility to SD depends on the size ofthe momentarily affected tissue.

nucleationcritical

Inhib. global feedback: long transient (ghost behavior)

slow dynamicstransient and

neighboring points

collapse

16 min

31 min

neighboring points

16 min

31 min

recordedslice not

neighboring points 16 min

31 min

recordedslice not

31 min

recordedslice not

31 min

recordedslice not

time / m

Modeled spatio-temporal signatures

50 (1)

2.5 6.25to

maximal instantaneous area MIA 0 3 6 9 12 15 18 21 24 27

no attack

cortextop view

abovepainthreshold

(a) (b)

neighboring points

collapse

16 min

31 min

with aura

w/o aura

typical aura

without headache

1.1. 1.2.

1.2.1.

Subtypes

Migraine

1.2.1.

1.2.3.

MWoA 70%

MWA 30%

• Dahlem & Isele: J. Math. Neurosci. 3,7 (2013).

Outline

History of electrical & magnetic stimluation

Non-drug treatment for headaches (AD 47)

Scribonius Largus, court physician to the Roman emperor Claudius 47 AD usedthe black torpedo fish (electric rays) to treat migraine.

Non-drug treatment for headaches (1788)

P. J. Koehler and C. J. Boes, A history of non-drug treatment in headache,particularly migraine. Brain 133:2489-500. 2010

First steps in miniaturization

(1985) Zeitschrift EEG-EMG, Georg Thieme Verlag Stuttgart

Disclosure: Conflict of interest

Consulting services for Neuralieve Inc. (trading as eNeuraTherapeutics)

Modern neuromodulation (invasive)

Neuromodulation in migraine

I hypothalamic deep brain stimulation (hDBS),

I sphenopalatine ganglion stimulation (SPGS)

I occipital nerve stimulation (ONS),

I cervical spinal cord stimulation (cSCS),

I hypothalamic deep brain stimulation (hDBS),

I vagus nerve stimulation (VNS),

I transcutaneous electrical nerve stimulation (TENS),

I transcranial magnetic stimulation (TMS),

I transcranial direct current stimulation (tDCS),

I transcranial alternate current stimulation (tACS).

Old problems remain

“Uber die physiologischen Wirkungen der elektrischen Bader liegen eine Reihe von Angaben [...] vor.[...]Im allgemeinen haben faradische Bader einen erfrischenden Einfluß, galvanische sollen mude machen.Es kommt fur die Wirkung entschieden auf die Dauer der Bader an, kurzere werden mehr anregend, langere mehrerschlaffend wirken.Durchsichtig ist jedenfalls die physiologische Begrundung dieser Bader durchaus nicht, man wird sich vorstellen,daßsie im allgemeinen die eines indifferenten Bades, mit dem ein milder Hautreiz verbunden ist, haben.Es mogen dadurch Aenderungen in unseren Allgemeingefuhlen, also Wohlbehagen, Erfrischung oder Mudigkeitbedingt werden. Nach meiner Ansicht liegt aber die Hauptwirkung dieser elektrischen Bader in erster Linie aufsuggestivem Gebiete, und das rechtfertigt ihre Anwendung und ihre unleugbaren Erfolge auf dem Gebiete dernervosen Allgemeinleiden, wie Hysterie, Neurasthenie etc.”

(Lehrbuch der klinischen Hydrotherapie, Max Matthes)

Migraine Generator Network & Dynamical Network Biomarker

attack-free

headache

prodrome

postdrome

magnetic

cortex

cranial circulationbone

ON OFF

cranial innervation 1

day 5-60min

days to m

dynamical network biomarkers

migraine cycle

• M. A. Dahlem, Migraine generator network and spreading depression dynamics as neuromodulation targets inepisodic migraine. Chaos, 23, 046101 (2013).

Karatas H et al., Spreading depression triggers headache by activating neuronal Panx1 channels. Science,339:1092-5 (2013).• M. A. Dahlem, S. Rode, A. May, N. Fujiwara, Y. Hirata, K. Aihara, J. Kurths, Towards dynamical networkbiomarkers in neuromodulation of episodic migraine, Translational Neuroscience, 4,282-294 (2013).

attack-free

headache

prodrome

postdrome

cortex

day 5-60min

days to m

migraine cycle

attack-free

headache

prodrome

postdrome

cortex

day 5-60min

days to m

migraine cycle

attack-free

headache

prodrome

postdrome

cortex

day 5-60min

days to m

migraine cycle

attack-free

headache

prodrome

postdrome

cortex

day 5-60min

days to m

migraine cycle

Karatas H et al., Spreading depression triggers headache by activating neuronal Panx1 channels. Science,339:1092-5 (2013).

• M. A. Dahlem, S. Rode, A. May, N. Fujiwara, Y. Hirata, K. Aihara, J. Kurths, Towards dynamical networkbiomarkers in neuromodulation of episodic migraine, Translational Neuroscience, 4,282-294 (2013).

attack-free

headache

prodrome

postdrome

cortex

day 5-60min

days to m

migraine cycle

attack-free

headache

prodrome

postdrome

cortex

day 5-60min

days to m

migraine cycle

attack-free

headache

prodrome

postdrome

magnetic

cortex

ON OFF

day 5-60min

days to m

migraine cycle

attack-free

headache

prodrome

postdrome

magnetic

cortex

ON OFF

day 5-60min

days to m

migraine cycle

attack-free

headache

prodrome

postdrome

magnetic

cortex

ON OFF

day 5-60min

days to m

migraine cycle

Cortical homeostasis is excitable (bistabe)

nucleationcritical

Inhib. global feedback: long transient (ghost behavior)

slow dynamicstransient and

Phase-dependend neuromudulation

0 5 10 15 20 25 30 35time

aslow dynamics

cf. Karatas H et al., Spreading depression triggers headache by activating neuronal Panx1 channels. Science,339:1092-5 (2013).cf. Charles AC, Baca SM., Cortical spreading depression and migraine. Nat Rev Neurol. 9:637-44, (2013)

• M. A. Dahlem and T. Isele: Transient localized wave patterns and their application to migraine. J. Math.

Neurosci. 3,7 (2013).

0 5 10 15 20 25 30 35time

aslow dynamics

AP: acute phaseIP: ignition phase

Neurosci. 3,7 (2013).

0 5 10 15 20 25 30 35time

aslow dynamics

arachnoid

sensory innervation

small MIA

large MIA

dural sinuses

cortex

Neurosci. 3,7 (2013).

0 5 10 15 20 25 30 35time

aslow dynamics

IP Stim.

AP Stim.

arachnoid

sensory innervation

small MIA

large MIA

dural sinuses

cortex

Neurosci. 3,7 (2013).

Single pulse stimulation (current TMS strategy)

0 5 10 15 20 25 30 35

noise sample 1 k=0.010noise sample 1 k=0.100noise sample 1 k=0.300noise sample 2 k=0.010noise sample 2 k=0.100noise sample 2 k=0.300

without noise

noise on

Constant noise stimulation

0 5 10 15 20 25 30 35

noise sample 1 k=0.030noise sample 1 k=0.040noise sample 1 k=0.050noise sample 2 k=0.030noise sample 2 k=0.040noise sample 2 k=0.050

without noise

noise on

Spatio-temporal waves need spatio-temporal control

Old paradigm��

��

New paradigm: opens up new strategies, eg, transcranial randomnoise stimulation (tRNS) at special locations

Feedback control of spreading depression

From bench to bedside

!"#$%&'$()'#"*(

+,-+,."(!"#$%&/*#(

0&1'2(3"'$#(

4#&5$1"(!"#$%&'$()'#"*( 6/&'7/2%1"(!"#$%&'$()'#"*(

Cooperation with Stephen Schiff & Bruce Gluckman

Dept. Biomedical Engineering, Penn State (CRCNS)

Courtesy Neuralieve

Feedback control with Kalman filter TMS (external forcing)

Conclusions

I We need more non-invasiveimaging data of migraine with aurato test predictions.

I Sef-organizing patterns provide aunifying concept including silent aura,migraine w or w/o headache/aura

I Dynamical cocepts may refineneuromodulation strategies:

I Being close to a saddle-nodebifurcation (”ghost” plateau)

I Design (feedback) control tointelligently target certain propertiesof SD in migraine

27 min

Conclusions

50 (1)

2.5 6.25

maximal instantaneous area MIA 0 3 6 9 12 15 18 21 24 27

no attack

cortextop view

abovepainthreshold

(a) (b)

Conclusions

Cooperation & Funding

Niklas Hubel, Julia Schumacher,Thomas IseleBernd Schmidt

Steven Schiff(Penn State Center for Neural Engineering)

Jens Dreier(Department of Neurology, Charite; University Medicine, Berlin)

berlin

Migraine Aura Foundation

Additional slides

Many, many, parameters, but most fixed by experiments

Table: Parameters for ion–based model – Part 2

Name Value & unit Description

Cm 1 µF/cm2 membrane capacitanceφ 3/msec gating time scale parameterg lNa 0.0175 mS/cm2 sodium leak conductance

g gNa 100 mS/cm2 max. gated sodium conductance

g lK 0.05 mS/cm2 potassium leak conductance

g gK 40 mS/cm2 max. gated potassium conductance

g lCl 0.02 mS/cm2 chloride leak conductance

Na0i 25.23 mM/l intracell. sodium conc.

Na0e 125.31 mM/l extracell. sodium conc.

K 0i 129.26 mM/l intracell. potassium conc.

K 0e 4 mM/l extracell. potassium conc.

Cl0i 9.9 mM/l intracell. chloride conc.

Cl0e 123.27 mM/l extracell. chloride conc.

E 0Na 39.74 mV sodium Nernst potential

E 0K -92.94 mV potassium Nernst potential

E 0Cl -68 mV chloride Nernst potential

Including cell swelling

Electrophysiology Thermodynamics

break down of ion grandients

cell swelling

Normal neuron in healthy brain

ECV 20%

ECV 5%

AMPA/kainate

–70 mV

–10 mV

Ca2+ Na

Swollen neuron during spreading depolarization

Nonspecific

cation channelsInsufficient

sodium pump

J.P. Dreier Nature Medicine 17 2011

massive release of Gibbs free energy

J.P. Dreier et al. Neuroscientist 19 2012

Modeling the migraine aura–ischemic stroke continuum

0 1 2 3 4 5 6time (s)

age (m

−gate deactivation Hopf

−gatemembrane voltage

Recovery

eletrogenic pump

FoldSeizure−like activity

in ischaemic stroke

hypoxic tissue

Spreading depression

(ceiling level)

Ipump[K+]o

[K+]o = 10mM

Modeling the migraine aura–ischemic stroke continuum

I Ischemia-inducedmigraine,

I Migrainous infarction,

I Persistent migraine w/oinfarction (see below).

Dahlem et al. Physica D 239, 889 (2010)

0 1 2 3 4 5 6time (s)

age (m

−gate deactivation Hopf

−gatemembrane voltage

Recovery

eletrogenic pump

FoldSeizure−like activity

in ischaemic stroke

hypoxic tissue

Spreading depression

(ceiling level)

Ipump[K+]o

[K+]o = 10mM

Mainly two neural theories of migraine

”Migraine generator”-theory

Amyg Insula

”Spreading depression”-theory

SD triggers trigeminal meningeal afferents, ie, headache

see e.g.: Bolay et al. Nature Medicine 8, 2002Review: Eikermann-Haerter & Moskowitz, Curr Opin Neurol. 21, 2008

Figure: Dodick & Gargus SciAm, August 2008

Common etiology or 2 mechanisms in MWoA and MWA?

headacheprodrome aura

trigger

edsusceptibility

delayed trigger

1.Only one upstream trigger?2.MWoA & MWA share same pain phase? 3. Silent aura? 4.Even prevalent?

5.Delayed headache link? 6.Missing the pain phase?

SD: Spreading Depression, see next slide

SD does not curl-in in human cortex

10 min

Only about 2-10% but not 50% cortical surface area is affected!

right: modified from Hadjikhani et al. PNAS 98:4687 (2001).• Dahlem & Hadjikhani, PLoS ONE, 4: e5007 (2009).

• Dahlem & Muller, Exp. Brain Res. 115,319, (1997).

SD does not curl-in in human cortex

10 min

SD curls in to formspirals with T=2.45min!

spiralcore

Only about 2-10% but not 50% cortical surface area is affected!

right: modified from Hadjikhani et al. PNAS 98:4687 (2001).• Dahlem & Hadjikhani, PLoS ONE, 4: e5007 (2009).

• Dahlem & Muller, Exp. Brain Res. 115,319, (1997).

Re-entrant SD waves with functional block

Z-type rotation causes a wave break in the spiral core.

Dahlem & Muller (1997) Exp. Brain Res. 115:319

Re-entrant SD waves with anatomical block

Reshodko, L. V. and Bures, J Biol. Cybern. 18,181 (1975)

Drugs adjust excitability:retracting & collapsing waves

Dahlem et al. 2D wave patterns ... . (2010) Physcia D

Nucleation failure on torus

Transient times in flat and curved geometry

1.3 1.32 1.34 1.36 1.38

with controlwithout control

torus outside

torus inside

ring wave

∂R∞

0 10 20 30 40 50 60 70 80

outside

inside

outside

inside

torus, without controltorus, with control

flat, without control

Simulation of transient SD wave segment

gray = cortical surface; red = SD wave

Simulation of an engulfing SD wave

In cooperation with Bernd Schmidt,

MagdeburgIn cooperation with Jens Dreier &

Denny Milakara, Charite

Minimum threshold in a flat geometry

1.3 1.32 1.34 1.36 1.38 1.4

wave s

threshold β

torus inside1

∂P1D∂R∞

1.3 1.32 1.34 1.36 1.38 1.4

wave s

threshold β

torus outside

torus inside

∂P1D∂R∞

1.3 1.32 1.34 1.36 1.38 1.4

wave s

threshold β

torus outside

torus inside

∂P1D∂R∞

1.3 1.32 1.34 1.36 1.38 1.4

wave s

threshold β

torus outside

torus inside

ring wave

∂P1D∂R∞

1.3 1.32 1.34 1.36 1.38 1.4

wave s

threshold β

torus outside

torus inside

ring wave

∂P1D∂R∞

Migraine scotoma reveal functional properties

Pattern matching

”Curved” retinotopic mapping

• Dahlem & Tusch, J. Math Neuroscie. 2,14 (2012)

Pattern matching ”Curved” retinotopic mapping

m lv u10Ælingual gyrus uneus CS

Pattern matching ”Curved” retinotopic mapping

2 4 6 8 10 12 14

20406080

100120140

2 4 6 8 10 12 14

1a 60Æ6Æ M=(a�1 )

HM�=(%)K=(mm2 ) �=(rad)a�2 00:20:40:60:8

migraine: a dynamical disease

migraine aura

visual aura

aura symptoms

aura wo aura typical

neuromodulation of migraine

ionbased models

multiscale disease

e throbbing pain

Science

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