Cyclic migraine. From pathophysiological understanding to therapeutic opportunities in patients with migraine attacks showing predictable periodicity

This article retraces the dyschronic hypothesis of primary headaches formulated by Giuseppe Nappi in 1983 – a hypothesis that, in addition to an explanation of the mechanisms underlying some forms of headache, also offers new perspectives on some of the functions of the central nervous system. The hypothesis was based on the observation that these headache forms involve not only a dysfunction in pain control systems, but also a vulnerability of the rhythmic physiological organisation of the central nervous system. Hence the idea that the hypothalamus plays a key role. Over several decades, and thanks to the advent of new technologies (such as functional neuroimaging and neurophysiological studies), scientific data have been produced in support of this hypothesis. On the basis of the above it has since been possible to focus on therapeutic support for one of the main diseases responsible for generating disability worldwide: migraine.