Magnetic resonance angiography of the human middle meningeal artery: Implications for migraine

Schoonman, Guus; Bakker, Dick; Schmitz, Nicole; Geest, Rob J. van der; Ferrari, Michael; Buchem, Mark A. van

doi:10.1002/jmri.20708

Cited by 12 publications

(10 citation statements)

References 13 publications

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“…Intravenous infusion of CGRP [33], PACAP-38 [34] and nitroglycerine [35] in healthy non-migraineurs were shown to increase the diameter of the extracranial MMA. These substances are known to induce a headache lacking the migraine-related characteristics in non-migraineurs and this type of pain coincided with the observed vascular dilatation.…”

Section: Discussionmentioning

confidence: 99%

Comparison of the vasodilator responses of isolated human and rat middle meningeal arteries to migraine related compounds

et al. 2014

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BackgroundMigraine attacks occur spontaneously in those who suffer from the condition, but migraine-like attacks can also be induced artificially by a number of substances. Previously published evidence makes the meninges a likely source of migraine related pain. This article investigates the effect of several vasodilators on meningeal arteries in order to find a connection between the effect of a substance on a meningeal vessel and its ability to artificially induce migraine.MethodsA myograph setup was used to test the vasodilator properties of the substances acetylcholine (ACh), sodium nitroprusside (SNP), sildenafil, prostaglandin E2 (PGE2), pituitary adenylate cyclase activating peptide-38 (PACAP-38), calcitonin gene-related peptide (CGRP) and NaCl buffer on meningeal arteries from human and rat. An unpaired t-test was used to statistically compare the mean Emax(%) at the highest concentration of each substance to the Emax(%) of NaCl buffer.ResultsIn the human experiments, all substances except PACAP-38 had an Emax (%) higher than the NaCl buffer, but the difference was only significant for SNP and CGRP. For the human samples, clinically tested antimigraine compounds (sumatriptan, telcagepant) were applied to the isolated arteries, and both induced a significant decrease of the effect of exogenously administrated CGRP. In experiments on rat middle meningeal arteries, pre-contracted with PGF2α, similar tendencies were seen. When the pre-contraction was switched to K+ in a separate series of experiments, CGRP and sildenafil significantly relaxed the arteries.ConclusionsStill no definite answer can be given as to why pain is experienced during an attack of migraine. No clear correlation was found between the efficacy of a substance as a meningeal artery vasodilator in human and the ability to artificially induce migraine or the mechanism of action. Vasodilatation could be an essential trigger, but only in conjunction with other unknown factors. The vasculature of the meninges likely contributes to the propagation of the migrainal cascade of symptoms, but more research is needed before any conclusions can be drawn about the nature of this contribution.

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Section: Discussionmentioning

confidence: 99%

Comparison of the vasodilator responses of isolated human and rat middle meningeal arteries to migraine related compounds

et al. 2014

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“…Meningeal blood vessels proved too small to be investigated quantitatively. With the advent of 3 Tesla magnetic resonance imaging (3T MRA) a sensitive and non-invasive imaging technique has become available to reliably measure intracranial blood flow and diameter changes of cerebral and meningeal blood vessels (Krabbe-Hartkamp et al, 1998) as small as the middle meningeal artery (MMA) (Schoonman et al, 2006).…”

Section: Introductionmentioning

confidence: 99%

Migraine headache is not associated with cerebral or meningeal vasodilatation—a 3T magnetic resonance angiography study

Schoonman

Grond

Kortmann

et al. 2008

Brain

222

158

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Migraine headache is widely believed to be associated with cerebral or meningeal vasodilatation. Human evidence for this hypothesis is lacking. 3 Tesla magnetic resonance angiography (3T MRA) allows for repetitive, non-invasive, sensitive assessment of intracranial vasodilatation and blood flow. Nitroglycerine (NTG) can faithfully induce migraine attacks facilitating pathophysiological studies in migraine. Migraineurs (n = 32) randomly received NTG (IV 0.5 microg/kg/min for 20 min; n = 27) or placebo (n = 5; for blinding reasons). Using 3T MRA, we measured: (i) blood flow in the basilar (BA) and internal carotid arteries (ICA) and (ii) diameters of the middle meningeal, external carotid, ICA, middle cerebral, BA and posterior cerebral arteries at three timepoints: (a) at baseline, outside an attack; (b) during infusion of NTG or placebo and (c) during a provoked attack or, if no attack had occurred, at 6 h after infusion. Migraine headache was provoked in 20/27 (74%) migraineurs who received NTG, but in none of the five patients who received placebo. The headache occurred between 1.5 h and 5.5 h after infusion and was unilateral in 18/20 (90%) responders. During NTG (but not placebo) infusion, there was a transient 6.7-30.3% vasodilatation (P < 0.01) of all blood vessels. During migraine, blood vessel diameters were no different from baseline, nor between headache and non-headache sides. There were no changes in BA and ICA blood flow during either NTG infusion or migraine. In contrast to widespread belief, migraine attacks are not associated with vasodilatation of cerebral or meningeal blood vessels. Future anti-migraine drugs may not require vasoconstrictor action.

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“…The headache model with intravenous NTG 85 has since 1989 been used systematically in Denmark 89,94‐98 and later in other countries 11,12,70,71,99‐102 in order to investigate the pathophysiology of migraine and the effect of drugs in this model 103,104 …”

mentioning

confidence: 99%

Nitroglycerin Headache and Nitroglycerin‐Induced Primary Headaches From 1846 and Onwards: A Historical Overview and an Update

Tfelt‐Hansen

Tfelt‐Hansen²

2009

Headache

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Nitroglycerin (NTG) (glyceryl trinitrate) was synthesized by the Italian chemist Ascanio Sobrero in Paris in 1846. A very unstable explosive, Alfred Nobel while working on explosives, combined it with Kiselguhr and patented it as dynamite in 1867. NTG was introduced in 1879 in medicine in the treatment of angina pectoris by the English doctor William Murrell. NTG-induced headache was quickly recognized as an important adverse event both in the industrial use of NTG, where it was used to produce dynamite, as well as in the use of NTG as drug. This review traces the evolution of our understanding of NTG headache.

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Magnetic resonance angiography of the human middle meningeal artery: Implications for migraine

Cited by 12 publications

References 13 publications

Comparison of the vasodilator responses of isolated human and rat middle meningeal arteries to migraine related compounds

Comparison of the vasodilator responses of isolated human and rat middle meningeal arteries to migraine related compounds

Migraine headache is not associated with cerebral or meningeal vasodilatation—a 3T magnetic resonance angiography study

Nitroglycerin Headache and Nitroglycerin‐Induced Primary Headaches From 1846 and Onwards: A Historical Overview and an Update

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