Sk Gupta Biochemistry 43.pdf NEW!
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The evidence so far points to migraine as a biochemically complex disorder involving several neurotransmitter systems which converge in their synaptic pathways. The general trend observed is that migraine patients have alterations of neurotransmitters in biological fluids with different biochemistry from controls, however the interpretation of the biological significance of these peripheral changes is unresolved. At present, despite the observation of biochemical alterations, specific diagnostic markers are lacking for this disorder. In addition MA and MO sufferers may exhibit varying degrees and types of neurotransmitter dysfunction due to differing neurological features of both migraine types which may be related to the aetiology and underlying genetic component of each migraine subtype. Insufficient serotonergic input due to changes in synthesis, release, receptor function/expression, reuptake and transport in the brain and throughout the body may contribute to vulnerability to migraine. Genetic studies have highlighted involvement of the serotonin transporter gene SERT in migraine susceptibility. However, serotonergic biochemistry is complex and evidently a multiplicity of factors, rather than any single one, combine to result in migraine phenotypes. More research is required to shed light on the course of these various biochemical phenomena and enable more robust conclusions on causal relationships. The absence of modern biochemical studies underscores the need for more rigorously conducted research utilizing larger sample sizes, updated IHS classification criteria and more sensitive bioassays and instruments and standardized methods for sample collection, preparation/analysis. Novel approaches for investigating the serotonergic system using PET imaging technology integrated with a metabolomics and systems biology platform may help to better understand the biochemical milieu and metabolome of migraineurs and establish if the biochemical changes are linked to the clinical presentation of the disease process. In conclusion, given the therapeutic efficacy of triptans, investigating the functionality of the serotonergic system in the migraine brain remains on the agenda to illuminate disease pathomechanisms and new lines of treatment to enable a superior understanding of the disease process that will further aid in the diagnosis, treatment and management of migraine and headache related disorders. d2c66b5586
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