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Old theories do not die; they fade beyond recognition. This controversy purported to examine the viability of the theory that migraine is a cerebral ischemic disorder, ie, cerebral arterial vasoconstriction causing the aura and extracranial vasodilatation producing the pain. Both Dr Olesen and Dr Welch acknowledge that decreased cerebral perfusion occurs during classic migraine, but neither subscribes to this once classic view. Both contributors also recognize that patients with classic migraine may occasionally suffer infarction in the areas of the brain from which their aura arises. Dr Welch ventures the explanation that spreading oligemia may enhance accumulation of platelets in low-flow areas, releasing vasoactive substances and further decreasing blood flow, perhaps to ischemic levels.
The differences between the contributors are largely conceptual. Dr Olesen with forcefulness derived from his own findings, argues that common and classic migraine are different entities and that "the painful phase of the attack remains essentially
-VLADIMIR Hachinski. The Nature of Migraine. Arch Neurol. 1987;44(3):327. doi:10.1001/archneur.1987.00520150067025