A Positron Emission Tomographic Study in Spontaneous Migraine

Abstract

Background: Functional brain imaging in acute migraine has proved challenging because of the logistic problems associated with an episodic condition. Since the seminal observation of brainstem activation in migraine, there has been only a single case substantiating this finding.Objective: To test the hypothesis that brainstem activation could be detected in migraine and to refine the anatomic localization with higher-resolution positron emission tomography than previously used.Design: Using positron emission tomography with radioactive water (H 2 15 O), we studied acute migraine attacks occurring spontaneously. Five patients underwent imaging in ictal and interictal states, and the differences were analyzed by means of statistical parametric mapping.Setting: Tertiary referral center.Patients: Six volunteers with episodic migraine were recruited from advertisements in migraine newsletters. One patient was excluded because of use of preventive medication.Main Outcome Measure: Brainstem activation during migraine state vs interictal state.Results: Two patients had a typical migrainous aura before the onset of the headache. All of the attacks studied fulfilled standard diagnostic criteria for migraine. Comparing the migraine scans with interictal scans, there was significant activation in the dorsal pons, lateralized to the left (small volume correction, P=.003). Activation was also seen in the right anterior cingulate, posterior cingulate, cerebellum, thalamus, insula, prefrontal cortex, and temporal lobes. There was an area of deactivation in the migraine phase also located in the pons, lateralized to the right. Conclusions:Our findings provide clear evidence of dorsal pontine activation in migraine and reinforce the view that migraine is a subcortical disorder modulating afferent neural traffic.

The anterior insula shows heightened interictal intrinsic connectivity in migraine without aura

“…[14][15][16][17] This region, hypothesized to correspond to either the locus coeruleus or pontine tegmental neurons close to it, 14,16 showed increased connectivity in migraineurs with the ventral anterior insula, an area that activates during interoception and pain and most likely has a general role in representing emotional salience across all stimulus domains. 4 This heightened intrinsic functional connection could predispose to migraine attacks or could represent an epiphenomenon of the migrainous state.…”

“…external stimuli, 4 and primary visual and auditory networks, as well as with a region in the dorsal pons previously shown to activate ipsilaterally to pain during spontaneous and triggered migraine attacks. [14][15][16][17] METHODS Subjects. Fifteen subjects between the ages of 21 and 52 years who met International Headache Society criteria for episodic migraine without aura 18 and 15 age-and sex-matched healthy controls were included in the study.…”

Resting state connectivity between default mode network and insula encodes acute migraine headache

“…Most studies have assessed functional brain changes in response to experimentally induced noxious stimuli or during induced migraine attacks by nitric oxide donors, various other vasodilating chemicals or hypoxia (2)(3)(4)(5). PET recordings during spontaneous attacks have focused on brain stem and photophobia-related activations (6)(7)(8)(9)(10), but the central nervous system underpinnings of headache intensity were not assessed.…”

Didactic Migraine Education in US Doctor of Pharmacy Programs

“…An evolving body of evidence illustrates that migraine is a progressive disease with identifiable brain pathology, including dysfunction of inhibitory pain pathways within the cortex, brainstem hyperexcitability, and impaired iron homeostasis in the periaqueductal gray matter, all of which can contribute to the development of altered pain perception and chronic daily headache. [36][37][38][39][40] Acute medication overuse is a factor that may facilitate this organic brain damage. Therefore, we believe more indepth pathology information should be taught to pharmacy students, highlighting that medication misuse can be seriously detrimental to patients' health and emphasizing the need to avoid excessive acute medication consumption.…”