Transcranial Doppler Evaluation of Common and Classic Migraine. Part I. Ultrasonic Features During the Headache‐Free Period

Abstract

To study vascular abnormalities in migraine, transcranial Doppler (TCD) was used for evaluation of 100 consecutive patients with either common or classic migraine during the headache-free period. We insonated the basal cerebral arteries and the internal carotid artery (ICA) in the neck. Particular ultrasonic features in migraineurs included intracranial elevations of mean flow velocity (MFV) above 3 standard deviations of normal values in 16%, probably reflecting increased vasotonus. Marked asymmetry of MFV in corresponding intracranial arteries was found in 12%, and could represent "asymmetrical" vascular tone. Characteristic vascular bruits of low frequency and sometimes harmonic quality were detected in 56%. When compared to TCD findings in 40 young controls, MFV were significantly higher in all intracranial arteries in migraineurs, but not in the cervical ICA. Marked differences were also found for incidence of MFV elevations and vascular bruits (p less than 0.0001). Vascular reactivity in response to eye closing as measured by flow changes in the posterior cerebral artery (visually evoked flow) was significantly greater in migraineurs than in controls (%MFV change, 14.1 +/- 5.4 vs 11.4 +/- 4.8; p = 0.004). TCD features did not discriminate common from classic migraine. Taken together, our results support the view of intracranial vascular abnormality in migraineurs reflecting, in particular, a narrower and more reactive arterial tree. The value of TCD in the differential diagnosis of "vascular headache" and in the study of migraine pathophysiology will have to be determined in the future.

Abnormal Cerebrovascular Reactivity in Headache-Free Migraineurs

“…Alternatively, it has been suggested that vascular changes and ocular sym pathetic dysfunction may result from the activation of trigeminovascular reflexes or the antidromic release of va soactive substances from trigeminal nerve terminals [23. 24], Whatever the reason, cerebral blood asymmetries have been reported as more frequent in headache-free migraineurs than in normals using the l33Xe inhalation technique [5], and asymmetries of MFV greater than 20cm/s in corresponding intracranial arteries have been detected on TCD in 12 of 100 consecutive headache-free migraineurs [25], These findings are in agreement with the idea, pro posed by Friberg ct al. [16] that in migraineurs the insta bility of cerebrovascular tone is the prime pathological condition affecting blood vessels.…”

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

“…They reported that all intracranial arteries in the migraine patients had higher average flow rates, and that the vascular reactivity in the PCAs in response to eye closing was significantly higher in the migraine group than in the control group (26 Kastrup et al studied 20 migraine patients and 30 controls using TCD of both MCAs and PCAs, and reported that mean cerebrovascular blood flow velocity and CO2 reactivity were higher in the patients with migraine (15). The same year Kastrup et al investigated metoprolol treatment and reported that it had no effect on reactivity in migraine patients that had elevated reactivity before treatment (16).…”

Transcranial Doppler in spontaneous attacks of migraine.

“…6 -8 Recently, transcranial Doppler ultrasonography (TCD), a noninvasive technique used to assess the dynamics of the intracranial circulation in various physiological and pathological conditions, 9 has been used to study migraine. The CO 2 reactivity of the cerebral arteries 10 and the blood flow velocity during the migraine-free phase 11 have been measured and the flow velocity values estimated during both attack and headache-free periods. 12 The present study compares blood flow velocities using TCD in the headache-free period and within the first 6 hours of the attack in cases of migraine with and without aura.…”