Cerebrovascular Reactivity Measured By Transcranial Doppler in Migraine

Abstract

Changes in the diameter of intracranial arteries might have a major role in the pathophysiology of migraine. Though several studies have found alterations in velocity of blood flow and in cerebral vasomotor reactivity of intracranial arteries in migraineurs in headache-free periods, as well as during migraine attacks, the results are inconclusive. To determine if intracranial hemodynamic characteristics of patients with migraine differ from those of controls, we measured baseline velocity of blood flow by transcranial Doppler in the middle cerebral arteries in headache-free periods in 51 migraine patients and in 101 age-matched controls. Cerebrovascular reactivity was measured after intravenous administration of acetazolamide in 12 migrainous patients and in 19 controls. Baseline mean velocity was significantly higher in the migraine group (70 versus 65 and 72 versus 65 cm/s with P = 0.02 and P = 0.0007 on the left and right sides, respectively). The difference stayed significant during acetazolamide stimulation, but the course of response did not differ between controls and migraineurs. Despite statistical significance, absolute differences were small. Therefore, middle cerebral artery velocity measurements and the acetazolamide test are not useful for the diagnosis of migraine in the interictal period.

A transcranial doppler study in interictal migraine and tension‐type headache

“…The higher velocity in the middle cerebral artery 2-5 of migraine patients suggests either downstream vasodilatation, especially in arterioles (arteriolar vasodilatation theory), or a lower lumen diameter in the insonated part of the middle cerebral artery. 2,3,7,25 Other TCD sonography studies demonstrating lower PI 7 and an enhanced response to hypocapnia and to other vasoconstrictor stimuli 4,7-9,26 suggest some basal level of arteriolar vasodilatation and support the first explanation.…”

“…Previously published studies using TCD have shown that patients with migraine demonstrate, during headache-free intervals, a moderately greater (5-7 cm/sec) blood flow mean velocity of basal cerebral arteries than controls. [2][3][4][5] These differences are small, which means that only a large number of patients would provide statistical significance. [6][7][8] The pulsatility index (PI) is a nondimensional parameter that is calculated on the Doppler waveform and approximates the value of peripheral resistance to flow (although it can be affected by other hemodynamic factors).…”

The effects of topiramate therapy on cerebral metabolism in migraine with aura patients

“…TCD can be used to evaluate the flow characteristics of intracranial arteries, microemboli, and vasomotor reactivity (VMR). The acoustic window is the cranial bone's thinnest region for using TCD and the transtemporal window facilitates insonation of the ipsilateral middle cerebral artery (MCA), anterior cerebral artery (ACA), and posterior cerebral artery (PCA) (13,15,30,31). Neuronal activity is correlated with changes in local cerebral blood flow.…”

Cerebrovascular Response in Migraineurs During Prophylactic Treatment with Acupuncture: A Randomized Controlled Trial

“…Increased baseline flow velocities were recorded in the basal cerebral arteries in migraine patients with (and without) aura. [5][6][7][8][9] Especially, studies with f-TCD demonstrated altered interictal cerebrovascular reactivity to several stimuli, such as CO 2 , 10,12-15 visual stimulation, [16][17][18][19][20] Valsalva maneuver, 21,22 or others. [23][24][25] These methods are suggested to reflect interictal vasomotor changes of pathophysiologic interest and could be used as a monitoring tool under prophylactic migraine treatment.…”