Abstract
For centuries, it has been debatable if migraine should be regarded as a nervous or a vascular disorder. Sometimes, theories favoured nervous mechanisms while at other times the vascular ones prevailed. To date, mainstream thinking points to a somewhere in-between point of view, with migraine being deemed to be a neurovascular disorder. This book brings us new insights on the matter.
In its preface it is stated that the ‘book contains reviews by a renowned group of clinicians and scientists, that consider in great depth the potential involvement of neurogenic inflammation in the pathogenesis of migraine and inhibition of this putative mechanism as a possible mode of action of antimigraine medication’.
The editors have assembled 12 authors to write 10 chapters covering different aspects in order to link neurogenic inflammation and migraine. Some chapters are written by leading headache specialists, and thus there is no surprise about the their quality. Nevertheless, most chapters are by a new generation of experts whose knowledge allows us to foresee new shining days in migraine research.
The first chapter concerns migraine pathogenesis, with a historic review of its mechanisms ranging from Wolff's vascular theory to the studies of cerebral blood flow, to more recent studies using high-field magnetic resonance imaging, and of course the putative role of neurogenic inflammation. The second chapter offers us a clear and a very up-to-date view of the impact of migraine on personal and societal levels, and is one of the most comprehensive articles I have read on this subject. The third chapter, about clinical aspects, pathogenesis and treatment is also written in clear and user-friendly language.
From this point on one enters the core subjects of the book. One can observe the richness of detail regarding the exact actions of the different peptides, such as substance-P, CGRP, neurokinins A and B, endothelins, on their respective receptors. The relevance of neurogenic vasodilatation and plasma-protein extravagation in the pathogenesis of migraine headache is also dealt with in detail.
Besides the commonly known participation of CGRP and substance-P in neurogenic inflammation, less studied areas such as the parasympathetic system and prostaglandins are reviewed, and an entire chapter is devoted to the involvement of mast cells in the process.
In spite of being a very interesting book, it is missing a detailed history about the origins of neurogenic inflammation, since the first concepts appeared more than a century ago. Further, many papers are repeatedly cited in different chapters, and perhaps tighter editorial control would have been helpful in this volume. However, it is noteworthy that out of 169 pages there are 50 pages of references, most chapters with more than 100, suggesting this book may be a benchmark for those interested in a more in-depth study about the underlying mechanisms of migraine.
I would recommend this book for specialists dealing with patients on a daily basis, as they would more easily be in a position to understand the literature and conference presentations regarding this increasingly complex field, the pathogenesis of migraine. It may also be recommended to basic scientists, less familiar with migraine, because they can become familiar with clinical aspects of this disorder and at the same time receive comprehensive information about the related basic science of migraine. I do not think it is a book for novices. In short, I enjoyed reading it, and assure anyone who obtains this volume that I learned a lot from it.