Structural and Functional Brain Changes in Migraine

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Abstract

Migraine is a prevalent primary headache disorder and is usually considered as benign. However, structural and functional changes in the brain of individuals with migraine have been reported. High frequency of white matter abnormalities, silent infarct-like lesions, and volumetric changes in both gray and white matter in individuals with migraine compared to controls have been demonstrated. Functional magnetic resonance imaging (MRI) studies found altered connectivity in both the interictal and ictal phase of migraine. MR spectroscopy and positron emission tomography studies suggest abnormal energy metabolism and mitochondrial dysfunction, as well as other metabolic changes in individuals with migraine. In this review, we provide a brief overview of neuroimaging studies that have helped us to characterize some of these changes and discuss their limitations, including small sample sizes and poorly defined control groups. A better understanding of alterations in the brains of patients with migraine could help not only in the diagnosis but may potentially lead to the optimization of a targeted anti-migraine therapy.

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Pathophysiology of Migraine: A Disorder of Sensory Processing.

Peter J Goadsby, Philip Holland, Margarida Martins-Oliveira … (2017)

Plaguing humans for more than two millennia, manifest on every continent studied, and with more than one billion patients having an attack in any year, migraine stands as the sixth most common cause of disability on the planet. The pathophysiology of migraine has emerged from a historical consideration of the "humors" through mid-20th century distraction of the now defunct Vascular Theory to a clear place as a neurological disorder. It could be said there are three questions: why, how, and when? Why: migraine is largely accepted to be an inherited tendency for the brain to lose control of its inputs. How: the now classical trigeminal durovascular afferent pathway has been explored in laboratory and clinic; interrogated with immunohistochemistry to functional brain imaging to offer a roadmap of the attack. When: migraine attacks emerge due to a disorder of brain sensory processing that itself likely cycles, influenced by genetics and the environment. In the first, premonitory, phase that precedes headache, brain stem and diencephalic systems modulating afferent signals, light-photophobia or sound-phonophobia, begin to dysfunction and eventually to evolve to the pain phase and with time the resolution or postdromal phase. Understanding the biology of migraine through careful bench-based research has led to major classes of therapeutics being identified: triptans, serotonin 5-HT1B/1D receptor agonists; gepants, calcitonin gene-related peptide (CGRP) receptor antagonists; ditans, 5-HT1F receptor agonists, CGRP mechanisms monoclonal antibodies; and glurants, mGlu5 modulators; with the promise of more to come. Investment in understanding migraine has been very successful and leaves us at a new dawn, able to transform its impact on a global scale, as well as understand fundamental aspects of human biology.

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Migraine prevalence, disease burden, and the need for preventive therapy.

R Lipton, M. Bigal, M. Diamond … (2007)

1) To reassess the prevalence of migraine in the United States; 2) to assess patterns of migraine treatment in the population; and 3) to contrast current patterns of preventive treatment use with recommendations for use from an expert headache panel. A validated self-administered headache questionnaire was mailed to 120,000 US households, representative of the US population. Migraineurs were identified according to the criteria of the second edition of the International Classification of Headache Disorders. Guidelines for preventive medication use were developed by a panel of headache experts. Criteria for consider or offer prevention were based on headache frequency and impairment. We assessed 162,576 individuals aged 12 years or older. The 1-year period prevalence for migraine was 11.7% (17.1% in women and 5.6% in men). Prevalence peaked in middle life and was lower in adolescents and those older than age 60 years. Of all migraineurs, 31.3% had an attack frequency of three or more per month, and 53.7% reported severe impairment or the need for bed rest. In total, 25.7% met criteria for "offer prevention," and in an additional 13.1%, prevention should be considered. Just 13.0% reported current use of daily preventive migraine medication. Compared with previous studies, the epidemiologic profile of migraine has remained stable in the United States during the past 15 years. More than one in four migraineurs are candidates for preventive therapy, and a substantial proportion of those who might benefit from prevention do not receive it.

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Migraine

Allan Ropper, Messoud Ashina (2020)

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Contributors

Sait Ashina:

ORCID: http://orcid.org/0000-0003-3973-6640

sashina@bidmc.harvard.edu

Journal

Journal ID (nlm-ta): Pain Ther

Journal ID (iso-abbrev): Pain Ther

Title: Pain and Therapy

Publisher: Springer Healthcare (Cheshire )

ISSN (Print): 2193-8237

ISSN (Electronic): 2193-651X

Publication date (Electronic): 16 February 2021

Publication date PMC-release: 16 February 2021

Publication date (Print): June 2021

Volume: 10

Issue: 1

Pages: 211-223

Affiliations

[1 ]GRID grid.239395.7, ISNI 0000 0000 9011 8547, Department of Neurology and Department of Anesthesia, Critical Care and Pain Medicine, , BIDMC Comprehensive Headache Center, Beth Israel Deaconess Medical Center, Harvard Medical School, ; Boston, MA USA

[2 ]GRID grid.5254.6, ISNI 0000 0001 0674 042X, Department of Clinical Medicine, Faculty of Health Sciences, , University of Copenhagen, ; Copenhagen, Denmark

[3 ]GRID grid.7841.a, Internal Medicine and Emergency Medicine, , Sant’Andrea Hospital, Sapienza University, ; Rome, Italy

[4 ]GRID grid.7841.a, Department of Clinical and Molecular Medicine, , Sapienza University, ; Rome, Italy

[5 ]GRID grid.38142.3c, ISNI 000000041936754X, Department of Radiology, Massachusetts General Hospital, , Harvard Medical School, ; Boston, MA USA

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Sait Ashina http://orcid.org/0000-0003-3973-6640

Article

Publisher ID: 240

DOI: 10.1007/s40122-021-00240-5

PMC ID: 8119592

PubMed ID: 33594593

SO-VID: 73333123-015a-4bde-ad8b-3cd13ee167e7

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Open Access This article is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License, which permits any non-commercial use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc/4.0/.

History

Date received : 7 December 2020

Date accepted : 2 February 2021

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Keywords: brain,functional,migraine,mri,neuroimaging,pet,spectroscopy,structural

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Keywords: brain, functional, migraine, mri, neuroimaging, pet, spectroscopy, structural

Structural and Functional Brain Changes in Migraine

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Most cited references 116

Pathophysiology of Migraine: A Disorder of Sensory Processing.

Migraine prevalence, disease burden, and the need for preventive therapy.

Migraine

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