Migraine changes the brain

Abstract

Purpose of review To summarize key findings of the current literature on functional neuroimaging in migraine and to describe how these studies have changed our view of the disorder. Recent findings: Recent studies have started to investigate not only the global cerebral activation pattern during migraine attacks, but to address specific aspects of migraine attacks such as photophobia, osmophobia as well as pain perception with the aim of disentangling the underlying mechanisms. There is also more and more evidence that the migraine brain is abnormal even outside of attacks and that repeated attacks are leading to functional and structural alterations in the brain, which may in turn drive the transformation of migraine to its chronic form. Some new results are pinpointing towards a potential role of interesting new brain areas in migraine pathophysiology such as the temporal cortex or the basal ganglia. Summary Neuroimaging studies are beginning to shed light on the mechanisms underlying the development and evolution of migraine and its specific symptoms. Future studies have the potential to also improve our understanding of established and upcoming treatment approaches and to monitor treatment effects in an objective and non-invasive way.

Sex and the migraine brain

“…Puberty, which begins between the ages of 8-14 years in girls and 9-15 years in boys, is associated with pulsatile release of gonadotropin releasing hormone (GnRH) from the hypothalamus, and peak cortical gray matter (26) and white matter (27) volume. In the context of migraine, there are ample examples of sex differences in brain structure (28-30) and brain function, such as default mode brain connectivity, language, and visual systems (31, 32) (see Figures 3A-D). …”

Thalamo-cortical network activity between migraine attacks: Insights from MRI-based microstructural and functional resting-state network correlation analysis

“…Recently, several independent research groups showed that changes can also be demonstrated at rest, i.e. without any sensory input, in the microstructure of several brain areas [8], including the thalamus [9, 10]. The conjunction of neuroimaging and neurophysiological data can be considered as robust evidence favouring morphological and functional brain alterations as prominent features of migraine pathophysiology.…”

Upregulation of inflammatory gene transcripts in periosteum of chronic migraineurs: Implications for extracranial origin of headache

“…When the headaches include migrainous features, they are diagnosed as chronic migraine (CM) and when migrainous features are absent and the headaches are not attributed to medication overuse, they are diagnosed as chronic tension-type headache (CTTH) 3–5 . Regarding migraine, current thinking suggests that attacks are initiated centrally, in brain areas capable of generating the classical neurological symptoms of premonitory symptoms 6 and aura 7 , that the headache phase begins with consequential activation of meningeal nociceptors at the origin of the trigeminovascular system 8, 9 , and that the chronification of disease involves structural and functional alterations in multiple cortical and subcortical regions 10 . Regarding TTH, little is known about the origin of disease, whereas chronification is attributed to sensitization of central pain pathways 11 .…”