Migraine research commonly turns altruism on its head, upside down. Just like an inebriated person tries different keys to open the same lock, the history of migraine is replete with examples of fishing expeditions, frequently invasive procedures with misleading outcomes.
Common carotid puncture was used to study cerebral blood flow 4-5 decades previously in migraine patients before the CT/MRI neuroimaging era dawned, at a time when pathophysiology of migraine was not even infantile and far from nascent.
Carotid artery puncture has consistently been reported as a trigger of aura. [Linblad, et al., Cephalalgia. 2017;37(1):74-88. doi: 10.1177/0333102416636097]
It is truly tragic that the ethical impropriety of carotid puncture in migraine research is not underscored prominently in the Abstract or even the text as late as the 3rd decade of the 21st century. [Karsan and Goadsby, The Journal of Headache and Pain (2023) 24:106. https://doi.org/10.1186/s10194-023-01617-x]
It is not even known whether the external carotid circulation or the internal carotid circulation is critically involved in migraine. [Shevel E. The extracranial vascular theory of migraine--a great story confirmed by the facts. Headache. 2011;51(3):409-417. doi: 10.1111/j.1526-4610.2011.01844.x].
Nor are migraine researchers at tertiary-care centres interested in establishing this key feature. Truly tragic.
The scintillating scotoma of migraine has been clearly established as a non-homonymous phenomenon never involving the nasal visual field, thereby excluding visual cortical origin. [Gupta VK, Pathophysiology of migraine: an increasingly complex narrative to 2020 - Future Neurology, 2019 - Future Medicine2006; Gupta VK. Monocular and" binocular" scintillating scotomata in migraine: a semantic and theoretical paradox. http://www.cmaj.ca/content/173/12/1441.short/reply#cmaj_el_6490 ]
Research also involves accountability and responsibility, not merely an unlimited mandate or carte blanche to simplistically just carry on with favoured hypotheses, data, and opinion.
Quo vadis?
ORCID ID: https://orcid.org/0000-0002-6770-5916 15-August-2023
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