2021 AMI Online Salon
- Entrant Name: Natalie Koscal
- Client: The New England Journal of Medicine
- Copyright: The Massachusetts Medical Society, 2020
- Medium/software used: Adobe Photoshop and Adobe Illustrator
- Final presentation format: Printed and online journal
- Primary Audience: Physicians, especially neurologists and migraine specialists
The goal of this piece is to demonstrate the origin and propagation of migraines as we currently understand it based on clinical research over the last ten years. The top panel depicts the propagation of nociceptive signals from the trigeminovascular system to the somatosensory cortex and other cortical regions, where the signals are interpreted as migraine pain. Activation of the trigeminal centers releases a number of key signaling molecules within vascular smooth muscle cells and others, which trigger vasodilation of meningeal vessels. Panel B highlights several of these signaling pathways involved in migraine formation, discovered through provocation models using drugs like glyceryl trinitrate and others (white text boxes), and implicates the opening of ATP-sensitive potassium channels as a possible unifying mechanism. Understanding these pathways has helped researchers find potential therapeutic targets to treat migraines.