Cerebral reactivity in migraine patients measured with functional near-infrared spectroscopy

Abstract

BackgroundThere are two major theories describing the pathophysiology of migraines. Vascular theory explains that migraines resulted from vasodilation of meningeal vessels irritating the trigeminal nerves and causing pain. More recently, a neural theory of migraine has been proposed, which suggests that cortical hyperexcitability leads to cortical spreading depression (CSD) causing migraine-like symptoms. Chronic migraine requires prophylactic therapy. When oral agents fail, there are several intravenous agents that can be used. Understanding underlying causes of migraine pain would help to improve efficacy of migraine medications by changing their mechanism of action. Yet to date no study has been made to investigate the link between vascular changes in response to medications for migraine versus pain improvements. Functional near-infrared spectroscopy (NIRS) has been used as an inexpensive, rapid, non-invasive and safe technique to monitor cerebrovascular dynamics.MethodIn this study, a multi-distance near-infrared spectroscopy device has been used to investigate the cortical vascular reactivity of migraine patients in response to drug infusions and its possible correlation with changes in pain experienced. We used the NIRS on 41 chronic migraine patients receiving three medications: magnesium sulfate, valproate sodium, and dihydroergotamine (DHE). Patients rated their pain on a 1–10 numerical scale before and after the infusion.ResultsNo significant differences were observed between the medication effects on vascular activity from near channels measuring skin vascularity. However, far channels—indicating cortical vascular activity—showed significant differences in both oxyhemoglobin and total hemoglobin between medications. DHE is a vasoconstrictor and decreased cortical blood volume in our experiment. Magnesium sulfate has a short-lived vasodilatory effect and increased cortical blood volume in our experiment. Valproate sodium had no significant effect on blood volume. Nonetheless, all three reduced patients’ pain based on self-report and no significant link was observed between changes in cortical vascular reactivity and improvement in migraine pain as predicted by the vascular theory of migraine.ConclusionNIRS showed the potential to be a useful tool in the clinical setting for monitoring the vascular reactivity of individual patients to various migraine and headache medications.

Retinal Nerve Fiber Layer Thickness and Oxidative Stress Parameters in Migraine Patients without Aura: A Pilot Study

“…Several isoforms of O 2 •− -producing NADPH oxidase exists in the vascular wall [ 60 ]. Many types of vascular diseases appear as being associated with the up-regulation of NADPH oxidase [ 57 ] and evidence suggested that migraine pathophysiology is connected with vascular reactivity [ 61 , 62 ]. Endothelial NOS (eNOS) appears mainly involved in migraine pathophysiology.…”

Functional Near-Infrared Spectroscopy and Its Clinical Application in the Field of Neuroscience: Advances and Future Directions

“…Functional NIRS can be a potential biomarker to assess treatment responses to medication in patients with migraine. A more recent study has shown differences in hemodynamic changes between patients who received valproic acid, magnesium sulfate and dihydroergotamine suggesting their distinctive mechanisms for migraine treatment (Pourshoghi et al, 2015). In the next subsection, the potential of fNIRS as a diagnostic biomarker is further illustrated in mild cognitive impairment.…”

Functional near-infrared spectroscopy study on tonic pain activation by cold pressor test

“…Alternatively, functional near-infrared spectroscopy (fNIRS) has recently been suggested for monitoring cortical hemodynamic response to experimentally and clinically induced acute pain in adults and infants. [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28] fNIRS is an optical imaging tool for noninvasive, continuous monitoring of regional blood flow and tissue oxygenation. [29][30][31] This imaging technique offers several advantages over other hemodynamic-based imaging techniques including being portable and noninvasive, no ionizing radiation or drug injection, measuring two hemodynamic parameters-deoxyhemoglobin (HHb) and oxyhemoglobin (HbO 2 )-simultaneously, and relative robustness to motion artifact, which is desirable for the study of infants, small children, or elders with involuntary movement disorders.…”