“What we don’t know is what is the initial signal change that happens. We know there are blood vessel changes, we know there’s trigeminal activation, we know all these areas in the brain are activated…we’ve got, still, so much to learn.”

Since the 1980s and 1990s, the understanding of the biology of migraine has markedly improved, which, in turn, has helped advance the therapeutic development for the condition. Ultimately, it's helped bring about the massive increase in treatments in the past decade, including newly preventive medications and a number of medical devices.

These improvements count among them myriad discoveries of the roles of certain players in migraine, including trigeminal nerve, the serotonin system, cortical spreading depression, and other factors. But for Jessica Ailani, MD, the director of the MedStar Georgetown University Hospital Headache Center, there’s still a long way to go in completely understanding how migraines occur biologically.

Thus far, the search for the initial signal change in migraine has been narrowed down to calcitonin gene-related peptide, or CGRP, and pituitary adenylate cyclase-activating polypeptide, or PACAP. Even with the work with these two peptides, Ailani says there is much more to learn. To discuss the implications of better comprehending the biology of migraine, Ailani sat down with NeurologyLive for an interview.