Cerebral oxygen extraction, oxygen consumption, and regional cerebral blood flow during the aura phase of migraine.

Friberg, Lars; Olesen, Jes; Lassen, Niels A.; Olsen, Trond E.; Karle, A

doi:10.1161/01.str.25.5.974

Cited by 78 publications

(54 citation statements)

References 18 publications

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“…Our data confirmed previous reports that CSD-like phenomena can be seen with neuroimaging techniques (7,10,12,15,19,20,28). Like those previous studies, our data indicated a slowly spreading area of abnormal blood flow in the occipital lobe during migraine aura.…”

Section: Discussionsupporting

confidence: 92%

Mechanisms of migraine aura revealed by functional MRI in human visual cortex

Hadjikhani

Río

et al. 2001

Proc. Natl. Acad. Sci. U.S.A.

1,330

999

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Cortical spreading depression (CSD) has been suggested to underlie migraine visual aura. However, it has been challenging to test this hypothesis in human cerebral cortex. Using high-field functional MRI with near-continuous recording during visual aura in three subjects, we observed blood oxygenation level-dependent (BOLD) signal changes that demonstrated at least eight characteristics of CSD, time-locked to percept͞onset of the aura. Initially, a focal increase in BOLD signal (possibly reflecting vasodilation), developed within extrastriate cortex (area V3A). This BOLD change progressed contiguously and slowly (3.5 ؎ 1.1 mm͞min) over occipital cortex, congruent with the retinotopy of the visual percept. Following the same retinotopic progression, the BOLD signal then diminished (possibly reflecting vasoconstriction after the initial vasodilation), as did the BOLD response to visual activation. During periods with no visual stimulation, but while the subject was experiencing scintillations, BOLD signal followed the retinotopic progression of the visual percept. These data strongly suggest that an electrophysiological event such as CSD generates the aura in human visual cortex.

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Section: Discussionsupporting

confidence: 92%

Mechanisms of migraine aura revealed by functional MRI in human visual cortex

Hadjikhani

Río

et al. 2001

Proc. Natl. Acad. Sci. U.S.A.

1,330

999

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“…3 Patients who undergo imaging examination during an aura characteristically have hypoperfusion, whereas those who undergo imaging examination during the headache phase characteristically show hyperperfusion. 4,29,30 The findings in this case series provide support for the vascular theory of migraine headaches. However, the more popular migraine theories suggest a contiguously spreading wave of cortical neuronal depression.…”

Section: 28supporting

confidence: 70%

Migraine Associated Cerebral Hyperperfusion with Arterial Spin-Labeled MR Imaging

Pollock¹,

Deibler²,

Burdette³

et al. 2008

AJNR Am J Neuroradiol

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SUMMARY:We present a case series demonstrating abnormal regional cerebral hyperperfusion associated with migraine headache using arterial spin-labeling (ASL). In 3 of 11 patients, regional cortical hyperperfusion was demonstrated during a headache episode that corresponded to previous aura symptoms. Migraine is a common condition affecting 12% of the United States population per year.1 Migraines classically present with unilateral debilitating, painful headaches associated with photophobia, phonophobia, nausea, and vomiting. Less than 30% of migraines are preceded by auras, or focal neurologic deficits. Most commonly, the neurologic deficits are visual, but sensory and motor deficits can also occur. The pathophysiology of a migraine is complex and is not completely understood. The vascular theory proposes that the migraine aura is associated with vasoconstriction and the subsequent headache is associated with vasodilation and hyperperfusion.3,4 The second theory is that a contiguous wave of neuronal depression spreads through the cortex causing the aura symptoms.5-10 The vascular changes have been evaluated with nuclear medicine studies including single-photon emission CT and positron-emission tomography as well as blood oxygen level-dependent functional MR imaging and T2* dynamic susceptibility contrast (DSC) MR perfusion imaging. 3,8,9,[11][12][13] These methods are limited in the evaluation of the patient with migraine because of the dynamic nature of the perfusion abnormalities.Spin tag perfusion imaging is an MR imaging method that measures quantitative cerebral blood flow (CBF).14 The advantages of arterial spin-labeling (ASL) compared with conventional perfusion techniques include repeatability, absolute quantification, and the avoidance of intravenous contrast administration. 15,16 We performed a retrospective analysis of MR imaging examinations including ASL perfusion in patients with an indication of headache from the past 12 months and identified 11 clinical patients with a history of migraine headache. We present the 3 patients with migraine-associated regional cerebral hyperperfusion corresponding to the clinical presentation. Case Reports Patient 1A 55-year-old woman with a history of hemiplegic migraines presented with new-onset right frontal headache, left-sided numbness, weakness, and dysarthria. The patient took prochlorperazine (Compazine) at home without relief of her symptoms. We performed cerebral MR imaging 6 hours after onset of symptoms using our standard stroke protocol including conventional sequences and ASL perfusion. Conventional MR imaging sequences demonstrated subtle sulcal effacement and mild edema in the right frontal cortex without evidence of diffusion abnormality (Fig 1).We generated quantitative CBF maps using quantitative imaging of perfusion and a single subtraction with thin-section inversion time (TI) 1 periodic saturation with a flow-sensitive alternating inversion recovery sequence as described previously.17 This sequence generates 60 tag and control image pairs. Imag...

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“…Vascular features are part of the headache family and this has made it natural to use rCBF methods in the search for pathophysiological mechanisms (Friberg et al 1994;Hachinski et al 1977;Olesen et al 1990). In migraine there is to date no consensus of the signi¢cance regarding the changes in CBF that have been demonstrated, i.e.…”

Section: (A) Headache and Migrainementioning

confidence: 99%

Pain and functional imaging

Ingvar

1999

Phil. Trans. R. Soc. Lond. B

227

152

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Functional neuroimaging has fundamentally changed our knowledge about the cerebral representation of pain. For the ¢rst time it has been possible to delineate the functional anatomy of di¡erent aspects of pain in the medial and lateral pain systems in the brain. The rapid developments in imaging methods over the past years have led to a consensus in the description of the central pain responses between di¡erent studies and also to a de¢nition of a central pain matrix with specialized subfunctions in man. In the near future we will see studies where a systems perspective allows for a better understanding of the regulatory mechanisms in the higher-order frontal and parietal cortices. Also, pending the development of experimental paradigms, the functional anatomy of the emotional aspects of pain will become better known.

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Cerebral oxygen extraction, oxygen consumption, and regional cerebral blood flow during the aura phase of migraine.

Cited by 78 publications

References 18 publications

Mechanisms of migraine aura revealed by functional MRI in human visual cortex

Mechanisms of migraine aura revealed by functional MRI in human visual cortex

Migraine Associated Cerebral Hyperperfusion with Arterial Spin-Labeled MR Imaging

Pain and functional imaging

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