Migraine commonly dominates headache research; although, by raising general interest in headache, advances in migraine benefit other primary headache disorders.Familial hemiplegic migraine is an autosomal dominant disorder with weakness as part of the aura. Migraine aura is a set of neurological symptoms, typically visual disturbances such as scintillating scotoma, and occurs in about 30% of patients. Hemiplegic migraine is especially worrying for patients and physicians because the aura can mimic stroke. Dichgans and colleagues1 reported a missense mutation in SCN1A in three German families, thus characterising the genetic defect in familial hemiplegic migraine III. This mutation leads to a. Glnl489Lys substitution in a part of the channel that contributes to rapid closure after opening in response, to membrane depolarisation (fast inactivation). Instead of rapidly closing allowing the membrane to repolarise fully after an actionpotential, the mutated channel allows a persistent sodium influx. The new data lend support to the notion that at least the aura component of migraine might have a fundamentally ionopathic basis and renew optimism in the search for genes implicated in the more common forms of the disorder.
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