Brain stem activation in spontaneous human migraine attacks

Abstract

Evidence from animal experiments shows that the brain stem is involved in the pathophysiology of migraine. To investigate human migraine, we used positron emission tomography to examine the changes in regional cerebral blood flow as an index of neuronal activity in the human brain during spontaneous migraine attacks. During the attacks, increased blood flow was found in the cerebral hemispheres in cingulate, auditory and visual association cortices and in the brain stem. However, only the brain stem activation persisted after the injection of sumatriptan had induced complete relief from headache and phono- and photophobia. These findings support the idea that the pathogenesis of migraine is related to an imbalance in activity between brain stem nuclei regulating antinociception and vascular control.

Calcitonin gene-related peptide (CGRP) and its receptor components in human and rat spinal trigeminal nucleus and spinal cord at C1-level

“…These fibers from the trigeminal ganglion extend further to the brainstem. Several studies point to the involvement of the brainstem in migraine pathophysiology [1,19] and a region within the brainstem has been demonstrated to be active during attacks in migraine patients [14,20]. …”

“…A migraine active region has been demonstrated in the brainstem with positron emission tomography (PET) [14-16]. It has been hypothesized that brainstem stimulation can cause activation of the trigeminovascular system, resulting in CGRP-dependent vasodilatation [17].…”

The role of BOLD-fMRI in elucidating migraine pathophysiology

“…Because historical nuclear medicine studies [6,7], a plethora of functional magnetic resonance (fMRI) studies has been performed to investigate the neural circuitry involved into the pathogenesis of migraine [8]. The most commonly used method among fMRI techniques is the measurement of blood oxygen level dependent (BOLD) signal, based on the differences between magnetic characteristics of oxy-hemoglobin (diamagnetic) and deoxyhemoglobin (paramagnetic).In the brain, neuronal activity increases consistently with blood flow and oxy-hemoglobin and could be hence visualized by changes in the BOLD contrast.…”

Understanding the relationship between pain and emotion in idiopathic headaches

“…There is also evidence that the brainstem control of pain is altered in migraine, in particular, activation of the periaqueductal grey matter (PAG)-implicated in defence reactions, and together with the hypothalamus in the regulation of the autonomic system-has been demonstrated during a migraine attack [14].…”