A critical examination of the evidence for and against dural involvement in migraine pain shows that in spite of the extensive research that has been carried out on dural physiology and pathophysiology, there is no hard evidence that dural changes actually occur in humans during a migraine. On the contrary, the available evidence appears to indicate that it is unlikely that dural changes are part of the migraine pain process.

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The origin of the pain in migraine has not yet been adequately explained and remains the subject of vigorous debate. Current theories implicate changes in the trigeminovascular system, which is defined as comprising the large intracranial vessels, and in particular, the dural meningeal vessels, the dura mater, and their neural connections. Methods.—The anatomical relationships of the dural meningeal arteries to the dura mater and the inner surface of the calvarium are described. Results.—The dural meningeal arteries lie in grooves in the inner table of the calvarium, are encased in the unyielding fibrous dura mater, and are consequently unable to dilate. Conclusion.—The pain of migraine is not related to dilatation of the dural meningeal arteries.

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