Putting the STING in the Arresting: Novel Immune Mechanism Linking Migraine Aura and Headache
Published in Neuroscience, Protocols & Methods, and Biomedical Research
Spreading depolarization (SD) is a massive wave of cellular depolarization that propagates through the brain's gray matter at a velocity of 2–5 mm/min. Because it spreads across the cortex akin to a tsunami wave over the ocean, it is colloquially termed as a “brain tsunami”. SD can be triggered by the collective depolarization of cells within a certain brain volume. Once initiated, it wreaks havoc on the affected tissue by causing near-complete depolarization of neurons and glial cells, which leads to a severe disruption of ionic and neurotransmitter homeostasis. Consequently, this causes transient suppression in the brain activity and demands a significant amount of metabolic energy for recovery.
SD is heavily implicated in a range of neurological disorders, such as ischemic stroke and traumatic brain injury, where it plays a critical role in secondary tissue damage and lesion expansion. It is also tied to migraine pathophysiology, where it is considered the underlying cause of the migraine aura. Furthermore, experimental studies show that SD can evoke behaviors associated with head pain in rodents, suggesting it is involved in the initiation of migraine headache. One potential mechanism linking SD to headache initiation is neuroinflammation. SD has been shown to trigger a robust, sterile inflammatory response in both the brain parenchyma and the overlying meninges. This inflammatory activation is initiated and maintained by a complex interplay among neurons, astrocytes, and microglia within the parenchyma, which subsequently drives inflammation in the meninges. The resulting release of inflammatory substances in the meninges activates trigeminal nerve endings, which transmit pain signals that ultimately generate the sensation of a headache.
Our study aimed to investigate SD-associated neuroinflammation and its role in headache initiation through a previously unrecognized immune pathway: the cyclic GMP-AMP synthase (cGAS)-Stimulator of Interferon Genes (STING) pathway. The cGAS-STING pathway is a component of the innate immune system with established roles in neuroinflammation across a wide range of neurological disorders. Because this pathway is closely linked to key drivers of SD-associated neuroinflammation and has demonstrated robust modulatory effects on nociception in both acute and chronic pain conditions, we questioned whether it is also involved in SD-associated neuroinflammation and migraine-like nociceptive behaviors in rodents.
To investigate this, we employed optogenetic stimulation to non-invasively induce SD in the cerebral cortex of mice. We then assessed cGAS-STING pathway activation in the cortex and evaluated its cell-type-specific effects on neurons, microglia, and astrocytes using immunofluorescent staining and capillary Western blotting. Additionally, we pharmacologically targeted the cGAS-STING pathway to determine its effects on SD characteristics and associated nociceptive behaviors by evaluating SD susceptibility and behavioural testing with von Frey test to assess periorbital pain sensitivity.
Our results demonstrate that a single SD wave activates the cGAS-STING pathway in the cerebral cortex for up to 24 hours, with predominantly strong activation observed in neurons. This pathway activation also contributed to microglial activation, as pharmacological inhibition of the pathway prevented microglial activation following SD. Interestingly, activating the pathway with specific agonists decreased both SD susceptibility and periorbital pain sensitivity. Importantly, pathway activation prior to SD induction prevented the development of periorbital allodynia (pain response to a normally non-painful stimulus) typically observed after multiple SD waves.
In conclusion, our findings reveal the cGAS-STING pathway as a key driver of SD-associated neuroinflammation. Its robust activation in neurons and clear role in microglial activation underscore its significance in SD induced neuroinflammatory processes. Moreover, the acute modulatory effects of pathway activation on SD susceptibility and headache-like behaviors position this pathway as a promising therapeutic target for migraine and other SD-related neurological disorders. This study marks the beginning of identifying a novel neuroimmune mechanism in migraine pathophysiology. Future studies investigating the specific role of the cGAS-STING pathway in trigeminovascular system activation and employing other clinically relevant migraine models will be essential next steps to fully unraveling its role in headache mechanisms.
Follow the Topic
-
The Journal of Headache and Pain
The Journal of Headache and Pain is a peer-reviewed open access journal specifically dedicated to researchers involved in all aspects of headache and related pain syndromes, including epidemiology, public health, basic science, translational medicine, clinical trials and real-world data.
Related Collections
With Collections, you can get published faster and increase your visibility.
Community pharmacy and headache care
In the sustainable development goals (SDG) context of seeking universal health coverage, the expanding gap between the supply of specialized and primary providers of headache-related health care on the one hand and the care needs of the very large number of people affected by headache on the other is a formidable but not insoluble public-health challenge. Structured headache services provide a cost-effective framework for provision of care but may still be overwhelmed by demand. Community pharmacists are an underutilized resource, potentially well able to provide the solution. This collection aligns with UN SDG-3 (Ensure healthy lives and promote well-being for all at all ages), and more specifically with SDG-3.8 (Achieve universal health coverage ..., access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines ... for all). The collection may include reports (especially comparative studies) on current pharmacy practice (scope, responsibilities and regulatory and other restrictions) relevant to headache care in countries worldwide — especially, but not restricted to, low and lower-middle-income countries; studies of pharmacists' knowledge and understanding of headache disorders and their management, theoretically argued proposals for change that, through educational initiatives, expansion of community pharmacists' scope of practice or by other means, might relieve strained headache-care systems; and studies of workload-shifting in headache care from medical to community pharmacy services (economic evaluations, theoretical or empirical assessments of benefits versus harms, and reports of pilot implementations either in headache care or in other therapeutic areas that might be pathfinders for headache care).
This Collection supports and amplifies research related to SDG 3, Good Health & Well-Being.
All submissions in this collection undergo the journal’s standard peer review process. Similarly, all manuscripts authored by a Guest Editor(s) will be handled by the Editor-in-Chief. As an open access publication, this journal levies an article processing fee (details here). We recognize that many key stakeholders may not have access to such resources and are committed to supporting participation in this issue wherever resources are a barrier. For more information about what support may be available, please visit OA funding and support, or email OAfundingpolicy@springernature.com or the Editor-in-Chief.
Publishing Model: Open Access
Deadline: Aug 01, 2026
Chronobiology of Headaches
The recurrence and associated clinical features of headaches are significantly affected by circadian rhythms and internal biological cycles in our bodies. Changes in the operation of our hypothalamus master clock and the periodic release of hormones due to genetic predisposition are likely to influence the cyclical manifestation of headache pain. There exists a bidirectional association between the frequency of headaches and the recurrence of the seasons. In this regard, headaches resemble other functional diseases, including mood disorders, anxiety, unpleasant gastrointestinal illnesses, and sleep disorders, among others. Circadian disruption is a significant contributor to headache recurrence. Irregular sleep-wake patterns, night shift work, and jet lag can lead to a state of circadian misalignment, where the body's internal clock is out of sync with external time cues.
This thematic series aims to investigate the neurological, genetic, and hormonal foundations, along with the clinical and morpho-functional correlations, of the association between chronobiological rhythms and the rhythmic occurrence of primary and secondary headache attacks. This is also considering the cyclical manifestation of other systemic and central illnesses that are significantly associated with headaches. Nonetheless, it will be intriguing to investigate novel behavioural strategies, potentially transdisciplinary, and pharmaceutical methods aimed at addressing these chronobiological factors. The exploration of how circadian entrainment and resetting can alleviate headache burden presents an important new frontier in treatment.
This Collection supports and amplifies research related to SDG 3, Good Health and Well-Being.
All submissions in this collection undergo the journal’s standard peer review process. Similarly, all manuscripts authored by a Guest Editor(s) will be handled by the Editor-in-Chief. As an open access publication, this journal levies an article processing fee (details here). We recognize that many key stakeholders may not have access to such resources and are committed to supporting participation in this issue wherever resources are a barrier. For more information about what support may be available, please visit OA funding and support, or email OAfundingpolicy@springernature.com or the Editor-in-Chief.
Publishing Model: Open Access
Deadline: Oct 31, 2026
Please sign in or register for FREE
If you are a registered user on Research Communities by Springer Nature, please sign in
Great post!