1
|
Park S, Lee DA, Lee H, Shin KJ, Park KM. Brain networks in migraine with and without aura: An exploratory arterial spin labeling MRI study. Acta Neurol Scand 2022; 145:208-214. [PMID: 34633068 DOI: 10.1111/ane.13536] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/13/2021] [Accepted: 09/22/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVES The aim of this exploratory study was to investigate the underlying pathomechanisms of migraine with aura (MA) and migraine without aura (MO) in the interictal phase using a connectivity analysis. METHODS We prospectively enrolled patients who were newly diagnosed with migraine. All patients underwent brain MRI, including diffusion tensor imaging and arterial spin labeling perfusion MRI. We analyzed the differences between patients with MA and those with MO in structural connectivity based on diffusion tensor imaging and functional connectivity based on arterial spin labeling perfusion MRI using a graph theoretical analysis. RESULTS We enrolled 58 patients with migraine (11 patients with MA and 47 patients with MO). There were no differences between patients with MA and those with MO in the network measures of global structural connectivity. However, differences in global functional connectivity were found between the two groups. The assortative coefficient was lower in patients with MA than in those with MO (-0.050 vs. -0.012, p = .017). There were no differences in local structural and functional connectivity between patients with MA and those with MO. CONCLUSION We found differences in global functional connectivity between patients with MO and those with MA. The study of MA and MO using a connectivity analysis may shed light on migraine pathophysiology. We suggest it is worthwhile to investigate if changes in functional connectivity may serve as novel biomarkers in MA. In this regard, ASL MRI appears to be valuable in the context of network analysis, but further studies are needed to confirm our findings.
Collapse
Affiliation(s)
- Seongho Park
- Department of Neurology Haeundae Paik Hospital Inje University College of Medicine Busan Korea
| | - Dong Ah Lee
- Department of Neurology Haeundae Paik Hospital Inje University College of Medicine Busan Korea
| | - Ho‐Joon Lee
- Department of Radiology Haeundae Paik Hospital Inje University College of Medicine Busan Korea
| | - Kyong Jin Shin
- Department of Neurology Haeundae Paik Hospital Inje University College of Medicine Busan Korea
| | - Kang Min Park
- Department of Neurology Haeundae Paik Hospital Inje University College of Medicine Busan Korea
| |
Collapse
|
2
|
Gil Y, Lee MJ, Cho S, Chung C. Effect of caffeine and caffeine cessation on cerebrovascular reactivity in patients with migraine. Headache 2022; 62:169-175. [DOI: 10.1111/head.14263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 11/23/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Young‐Eun Gil
- Department of Neurology Ajou University School of Medicine, Ajou University Medical Center Suwon South Korea
| | - Mi Ji Lee
- Department of Neurology Neuroscience Center Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Soohyun Cho
- Department of Neurology Uijeongbu Eulji Medical Center Eulji University School of Medicine Uijeongbu Korea
| | - Chin‐Sang Chung
- Department of Neurology Neuroscience Center Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| |
Collapse
|
3
|
Migraine and Neuroticism: A Scoping Review. Behav Sci (Basel) 2022; 12:bs12020030. [PMID: 35200282 PMCID: PMC8869701 DOI: 10.3390/bs12020030] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 01/10/2022] [Accepted: 01/26/2022] [Indexed: 02/07/2023] Open
Abstract
Headache is the first cause of consultation in neurology, and one of the most frequent reasons for consultation in general medicine. Migraine is one of the most common, prevalent, and socioeconomically impactful disabling primary headache disorders. Neuroticism can be conceptualized as a disposition to suffer anxiety and emotional disorders in general. Neuroticism has been associated with various mental and physical disorders (e.g., chronic pain, depression), including migraine. With the aim to explore in depth the relationship between migraine and neuroticism, and contribute to the understanding of this relation in order to provide a better treatment for migraine patients based on a personalized and more comprehensive approach, a scoping review was performed using PubMed, Scopus, and Web of Science. Databases were searched independently by the two researchers, reaching a final set of 18 articles to be included. The search terms were: migraine and neuroticism. Neuroticism seems to be highly prevalent in migraine patients. Findings reveal that migraine patients with comorbid depression and anxiety showed higher levels of neuroticism. Depression has been associated with an increased risk of transformation from episodic to chronic migraine whereas neuroticism might be a mediator factor. Neuroticism also might be a mediator factor between childhood maltreatment and migraine. The revision conducted confirms that: (1) Migraine patients usually have a higher level of neuroticism and vulnerability to negative affect, compared to non-migraineurs and tension-type headache patients. (2) Neuroticism is associated with migraine. Nonetheless, more research is needed to clarify potential moderators of this relationship and the role of neuroticism itself in this disease. This knowledge might be useful in order to promote a better management of negative emotions as part of intervention programs in migraine.
Collapse
|
4
|
Chen Y, Wang S, Wang Y. Role of herbal medicine for prevention and treatment of migraine. Phytother Res 2021; 36:730-760. [PMID: 34818682 DOI: 10.1002/ptr.7339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/06/2021] [Accepted: 11/02/2021] [Indexed: 01/18/2023]
Abstract
Migraine is a disabling neurovascular disease with unilateral or bilateral pulsatile headache, which intensively affects human health and quality of life due to high morbidity worldwide. Migraine is commonly accompanied by abnormal pain sensitization, neuroinflammatory response, and vasomotor dysfunction. Owing to the management dilemmas of migraine, there is an urgent need to develop effective and low-cost therapies. In recent years, herbal medicines as a promising strategy with analgesic activity and minor side effect, have been proposed for the prevention and treatment of migraine. Considering the lack of a review integrating experimental studies regarding the herbal treatment of migraine, this review systematically summarizes the important potential applications of herbal medicines in ameliorating migraine via multiple therapeutic targets and pathways, as well as provides a reference for further development of novel antimigraine drugs.
Collapse
Affiliation(s)
- Yulong Chen
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Shengpeng Wang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Yitao Wang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China.,Macau Centre for Research and Development in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| |
Collapse
|
5
|
Dzator JS, Howe PR, Wong RH. Profiling cerebrovascular function in migraine: A systematic review and meta-analysis. J Cereb Blood Flow Metab 2021; 41:919-944. [PMID: 33086920 PMCID: PMC8054723 DOI: 10.1177/0271678x20964344] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Previous studies have investigated whether migraine is a circulatory disorder, as migraineurs are at heightened risk of cerebrovascular disease. However, in most cases, systemic vascular function was evaluated, which may not reflect abnormalities in the cerebral circulation. Therefore, we aimed to determine whether cerebrovascular function differs between migraineurs and controls. A systematic literature search was conducted across three electronic databases to search for studies that compared cerebrovascular function in migraineurs to controls. Where applicable, meta-analyses were used to determine standardised mean differences (SMD) between migraineurs and controls. Seventy articles were identified, 40 of which contained quantitative data. Meta-analyses showed pulsatility index (PI) was higher (SMD = 0.23; 95%CI = 0.05 to 0.42, P = 0.01) and cerebrovascular responsiveness (CVR) to hypercapnia was lower (SMD=-0.34; 95%CI=-0.67 to -0.01, P = 0.04) in the posterior circulation of migraineurs, particularly those without aura. The meta-analyses also indicated that migraineurs have higher resting mean blood flow velocity in both anterior (SMD = 0.14; 95%CI = 0.05 to 0.23, P = 0.003) and posterior circulations (SMD = 0.20; 95%CI = 0.05 to 0.34, P = 0.007). Compared to healthy controls, migraineurs have altered cerebrovascular function, evidenced by elevated PI (representing arterial stiffness) and impaired CVR to hypercapnia (representing cerebral vasodilator function). Future studies should investigate whether improvement of cerebrovascular function is able to alleviate migraine.
Collapse
Affiliation(s)
- Jemima Sa Dzator
- Clinical Nutrition Research Centre, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Australia
| | - Peter Rc Howe
- Clinical Nutrition Research Centre, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Australia.,Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Queensland, Australia.,UniSA Allied Health & Human Performance, University of South Australia, Adelaide, Australia
| | - Rachel Hx Wong
- Clinical Nutrition Research Centre, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Australia.,Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Queensland, Australia
| |
Collapse
|
6
|
Altamura C, Vernieri F. Commentary: Enhanced Hemodynamic and Clinical Response to αCGRP in Migraine Patients-A TCD Study. Front Neurol 2021; 12:663818. [PMID: 33815263 PMCID: PMC8012904 DOI: 10.3389/fneur.2021.663818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 02/22/2021] [Indexed: 12/20/2022] Open
Affiliation(s)
- Claudia Altamura
- Headache and Neurosonology Unit, Neurology, Università Campus Bio-Medico di Roma, Rome, Italy
| | | |
Collapse
|
7
|
Huang Y, Ni N, Hong Y, Lin X, Feng Y, Shen L. Progress in Traditional Chinese Medicine for the Treatment of Migraine. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2020; 48:1731-1748. [DOI: 10.1142/s0192415x2050086x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Migraine is a recurrent disease with complex pathogenesis and is difficult to cure. At present, commercially available western migraine drugs are prone to generate side effects while treating the disease. Traditional Chinese medicine (TCM) avoids side effects via treatment with the principles of “treating both symptoms and root causes”, “overall adjustment”, and “treatment based on syndrome differentiation”. Three strategies of drug treatment were developed based on the syndromes, i.e., removing stasis, calming liver Yang, and reinforcing deficiency. Prescriptions of removing stasis mostly contain Chuanxiong rhizome (Chuan Xiong) to remove blood stasis by promoting blood circulation and improve properties of hemorheology, and Da Chuan Xiong Formula (DCXF) is a traditional prescription widely used in clinical practice. Prescriptions of calming liver Yang usually take Ramulus Uncariae cum Uncis (Gou Teng) as the main herb, which can calm the liver Yang via improving vasomotor function, and Tian Ma Gou Teng Decoction (TMGTD) is the representative drug. For reinforcing deficiency, Chinese doctors frequently utilize Angelica Sinensis (Dang Gui) and Astragali Radix (Huang Qi) to nourish blood and Qi in order to improve the weak state of human body; Dang Gui Bu Xue Decoction (DGBXD) is the commonly used prescription. These strategies not only treat the symptoms of diseases but also their root causes, and with the features of multiple targets, in multiple ways. Therefore, TCM prescriptions have obvious advantages in the treatment of chronic diseases such as migraine. In this review, we provided an overview of the pathogenesis of migraine and the function of representative TCM preparations in therapy of migraine as well as the mechanism of action according to effective researches, in order to provide reference and clue for further researches.
Collapse
Affiliation(s)
- Yanleng Huang
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, P. R. China
| | - Ni Ni
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, P. R. China
| | - Yanlong Hong
- Health Service Collaborative Innovation Center of Shanghai, Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, P. R. China
| | - Xiao Lin
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, P. R. China
| | - Yi Feng
- Engineering Research Center of Modern Preparation Technology of Traditional Chinese Medicine of Ministry of Education, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, P. R. China
| | - Lan Shen
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, P. R. China
| |
Collapse
|
8
|
Petrušić I, Podgorac A, Radojičić A, Zidverc-Trajković J. Transcranial Doppler Evaluation of the Cerebral Vasculature in Women Patients who Have Migraine with Aura. PAIN MEDICINE 2020; 21:3012-3017. [PMID: 32918482 DOI: 10.1093/pm/pnaa292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Previous studies suggest that increased cerebrovascular reactivity might be a feature of patients who have migraine with aura (MwA). The correlation between the clinical presentation of migraine with aura and transcranial Doppler parameters remains unclear. OBJECTIVE The main aim of this study was to explore cerebral blood flow, vascular resistance, and cerebrovascular reactivity in women MwA. Also, the relationships between hemodynamic conditions and aura characteristics are examined. DESIGN Cross-sectional study. SETTING Headache Center, Neurology Clinic, Clinical Center of Serbia. SUBJECTS Fifty-four women MwA and 49 healthy controls (HCs). METHODS Transcranial Doppler sonography examination was used to determine blood flow mean velocity (MV) and pulsatility index (PI), as well as breath-holding index (BHI), in 15 arterial segments comprising the circle of Willis. RESULTS A total of 54 women MwA and 49 HCs were studied. The PIs of all segments of the left and right middle cerebral arteries and the left and right anterior cerebral arteries were significantly higher in MwA with regards to HCs. Also, both the left and right BHIs were significantly higher in MwA than HCs. In addition, MVs of the right vertebral artery and the first segment of the basilar artery were significantly lower in MwA than HCs. Longer duration of migraine aura showed a weak negative correlation with the PI of the left posterior cerebral artery. CONCLUSIONS Our findings suggest increased vessel pulsatility, abnormal cerebrovascular reactivity, and decreased cerebral blood flow velocity in several arterial segments of the Willis circle in women MwA.
Collapse
Affiliation(s)
- Igor Petrušić
- Laboratory for Advanced Analysis of Neuroimages, Faculty of Physical Chemistry, University of Belgrade, Belgrade, Serbia
| | | | | | - Jasna Zidverc-Trajković
- Headache Center, Neurology Clinic, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| |
Collapse
|
9
|
Ornello R, Frattale I, Caponnetto V, Pistoia F, Sacco S. Cerebral vascular reactivity and the migraine-stroke relationship: A narrative review. J Neurol Sci 2020; 414:116887. [PMID: 32407982 DOI: 10.1016/j.jns.2020.116887] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Revised: 04/14/2020] [Accepted: 05/04/2020] [Indexed: 12/26/2022]
Abstract
Migraine, and especially migraine with aura, is associated with an increased risk of stroke and vascular events; however, the reasons for this association are unclear. Several studies evaluated cerebral autoregulation and vasomotor reactivity in patients with migraine compared with non-migraineurs, with conflicting results. Our narrative review aimed at summarizing their results to find the most reliable evidence in the field. Studies which used visual stimuli to evoke vascular responses consistently showed an increased vascular reactivity in migraineurs compared with non-migraineurs, while studies which used systemic stimuli such as hyper- or hypocapnia showed inconsistent results. Therefore, central neural mechanisms might be more important than peripheral vascular mechanisms in determining the cerebral vascular responses of patients with migraine. However, a large body of evidence supports the existence of peripheral vascular dysfunction in patients with migraine. Further studies are needed to explain the complex interactions between central neural and peripheral vascular mechanisms in determining migraine and its vascular risk. Migraine preventive treatments, and especially the most recent ones with a peripheral action, might provide important insights in this field.
Collapse
Affiliation(s)
- Raffaele Ornello
- Neurology Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy.
| | - Ilaria Frattale
- Neurology Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy
| | - Valeria Caponnetto
- Neurology Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy
| | - Francesca Pistoia
- Neurology Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy
| | - Simona Sacco
- Neurology Section, Department of Applied Clinical Sciences and Biotechnology, University of L'Aquila, Italy
| |
Collapse
|
10
|
Kincses ZT, Veréb D, Faragó P, Tóth E, Kocsis K, Kincses B, Király A, Bozsik B, Párdutz Á, Szok D, Tajti J, Vécsei L, Tuka B, Szabó N. Are Migraine With and Without Aura Really Different Entities? Front Neurol 2019; 10:982. [PMID: 31632329 PMCID: PMC6783501 DOI: 10.3389/fneur.2019.00982] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Accepted: 08/28/2019] [Indexed: 11/13/2022] Open
Abstract
Background: Migraine research is booming with the rapidly developing neuroimaging tools. Structural and functional alterations of the migrainous brain were detected with MRI. The outcome of a research study largely depends on the working hypothesis, on the chosen measurement approach and also on the subject selection. Against all evidence from the literature that migraine subtypes are different, most of the studies handle migraine with and without aura as one disease. Methods: Publications from PubMed database were searched for terms of "migraine with aura," "migraine without aura," "interictal," "MRI," "diffusion weighted MRI," "functional MRI," "compared to," "atrophy" alone and in combination. Conclusion: Only a few imaging studies compared the two subforms of the disease, migraine with aura, and without aura, directly. Functional imaging investigations largely agree that there is an increased activity/activation of the brain in migraine with aura as compared to migraine without aura. We propose that this might be the signature of cortical hyperexcitability. However, structural investigations are not equivocal. We propose that variable contribution of parallel, competing mechanisms of maladaptive plasticity and neurodegeneration might be the reason behind the variable results.
Collapse
Affiliation(s)
- Zsigmond Tamás Kincses
- Department of Neurology, Faculty of Medicine, Interdisciplinary Excellent Centre, University of Szeged, Szeged, Hungary
- Department of Radiology, University of Szeged, Szeged, Hungary
| | - Dániel Veréb
- Department of Neurology, Faculty of Medicine, Interdisciplinary Excellent Centre, University of Szeged, Szeged, Hungary
| | - Péter Faragó
- Department of Neurology, Faculty of Medicine, Interdisciplinary Excellent Centre, University of Szeged, Szeged, Hungary
| | - Eszter Tóth
- Department of Neurology, Faculty of Medicine, Interdisciplinary Excellent Centre, University of Szeged, Szeged, Hungary
| | - Krisztián Kocsis
- Department of Neurology, Faculty of Medicine, Interdisciplinary Excellent Centre, University of Szeged, Szeged, Hungary
| | - Bálint Kincses
- Department of Neurology, Faculty of Medicine, Interdisciplinary Excellent Centre, University of Szeged, Szeged, Hungary
| | - András Király
- Department of Neurology, Faculty of Medicine, Interdisciplinary Excellent Centre, University of Szeged, Szeged, Hungary
- Brain and Mind Research, Central European Institute of Technology, Brno, Czechia
| | - Bence Bozsik
- Department of Neurology, Faculty of Medicine, Interdisciplinary Excellent Centre, University of Szeged, Szeged, Hungary
| | - Árpád Párdutz
- Department of Neurology, Faculty of Medicine, Interdisciplinary Excellent Centre, University of Szeged, Szeged, Hungary
| | - Délia Szok
- Department of Neurology, Faculty of Medicine, Interdisciplinary Excellent Centre, University of Szeged, Szeged, Hungary
| | - János Tajti
- Department of Neurology, Faculty of Medicine, Interdisciplinary Excellent Centre, University of Szeged, Szeged, Hungary
| | - László Vécsei
- Department of Neurology, Faculty of Medicine, Interdisciplinary Excellent Centre, University of Szeged, Szeged, Hungary
- MTA-SZTE, Neuroscience Research Group, Szeged, Hungary
| | - Bernadett Tuka
- Department of Neurology, Faculty of Medicine, Interdisciplinary Excellent Centre, University of Szeged, Szeged, Hungary
- MTA-SZTE, Neuroscience Research Group, Szeged, Hungary
| | - Nikoletta Szabó
- Department of Neurology, Faculty of Medicine, Interdisciplinary Excellent Centre, University of Szeged, Szeged, Hungary
- Brain and Mind Research, Central European Institute of Technology, Brno, Czechia
| |
Collapse
|
11
|
Hansen JM, Schankin CJ. Cerebral hemodynamics in the different phases of migraine and cluster headache. J Cereb Blood Flow Metab 2019; 39:595-609. [PMID: 28857642 PMCID: PMC6446414 DOI: 10.1177/0271678x17729783] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 07/19/2017] [Accepted: 08/04/2017] [Indexed: 12/31/2022]
Abstract
Headache is one of the most common ailments; migraine is one of the most prevalent and disabling neurological disorders and cluster headache presents as one of the most excruciating pain disorders. Both are complex disorder characterized by recurrent episodes of headache. A key feature is that various triggers can set off an attack providing the opportunity to explore disease mechanisms by experimentally inducing attacks. This review summarizes neuroimaging and hemodynamic studies in human in provoked and spontaneous attacks of migraine and cluster headache. Cerebral hemodynamics during different phases of the migraine attack demonstrate alterations in cerebral blood flow and perfusion, vessel caliber, cortical and sub-cortical function, underscoring that migraine pathophysiology is highly complex. Migraine attacks might begin in diencephalic and brainstem areas, whereas migraine aura is a cortical phenomenon. In cluster headache pathophysiology, the hypothalamus might also play a pivotal role, whereas the pattern of cerebral blood flood differs from migraine. For both disorders, alterations of arterial blood vessel diameter might be more an epiphenomenon of the attack than a causative trigger. Studying cerebral hemodynamics in provocation models are important in the search for specific biomarkers in the hope to discover future targets for more specific and effective mechanism-based anti-headache treatment.
Collapse
Affiliation(s)
- Jakob M Hansen
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, University of Copenhagen, Glostrup, Denmark
| | - Christoph J Schankin
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| |
Collapse
|
12
|
Lee MJ, Park BY, Cho S, Park H, Chung CS. Cerebrovascular reactivity as a determinant of deep white matter hyperintensities in migraine. Neurology 2019; 92:e342-e350. [PMID: 30610094 DOI: 10.1212/wnl.0000000000006822] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 09/27/2018] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To evaluate the association between the cerebrovascular reactivity to carbon dioxide (CO2-CVR) and the deep white matter hyperintensity (WMH) burden in patients with migraine. METHODS A total of 86 nonelderly patients with episodic migraine without vascular risk factors and 35 headache-free controls underwent 3T MRI. Deep WMHs were quantified with a segmentation method developed for nonelderly migraineurs. The interictal CO2-CVR was measured with transcranial Doppler with the breath-holding method. The mean breath-holding index of the bilateral middle cerebral arteries (MCA-BHI) was square root transformed and analyzed with univariate and multivariate logistic regression models to determine its association with the highest tertiles of deep WMH burden (number and volume). RESULTS A low MCA-BHI was independently associated with the highest tertile of deep WMH number in patients with migraine (adjusted odds ratio [OR] 0.02, 95% confidence interval [CI] 0.0007-0.63, p = 0.026). In controls, the MCA-BHI was not associated with deep WMH number. Interaction analysis revealed that migraine modified the effect of MCA-BHI on deep WMH number (p for interaction = 0.029). The MCA-BHI was not associated with increased deep WMH volume in both patients and controls. Age was independently associated with deep WMH volume in patients (adjusted OR 1.07, 95% CI 1.004-1.15, p = 0.037). CONCLUSIONS In this study, we found a migraine-specific association between a reduced CVR to apnea and increased number of deep WMHs in healthy, nonelderly patients with migraine. A dysfunctional vascular response to apnea may predispose migraineurs to an increased risk of WMHs.
Collapse
Affiliation(s)
- Mi Ji Lee
- From the Department of Neurology (M.J.L., S.C., C.-S.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Neuroscience Center (M.J.L., C.-S.C.), Samsung Medical Center, Seoul; Department of Electrical and Computer Engineering (B.-Y.P.) and School of Electronic and Electrical Engineering (H.P.), Sungkyunkwan University; and Center for Neuroscience Imaging Research (B.-Y.P., H.P.), Institute for Basic Science, Suwon, Korea
| | - Bo-Yong Park
- From the Department of Neurology (M.J.L., S.C., C.-S.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Neuroscience Center (M.J.L., C.-S.C.), Samsung Medical Center, Seoul; Department of Electrical and Computer Engineering (B.-Y.P.) and School of Electronic and Electrical Engineering (H.P.), Sungkyunkwan University; and Center for Neuroscience Imaging Research (B.-Y.P., H.P.), Institute for Basic Science, Suwon, Korea
| | - Soohyun Cho
- From the Department of Neurology (M.J.L., S.C., C.-S.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Neuroscience Center (M.J.L., C.-S.C.), Samsung Medical Center, Seoul; Department of Electrical and Computer Engineering (B.-Y.P.) and School of Electronic and Electrical Engineering (H.P.), Sungkyunkwan University; and Center for Neuroscience Imaging Research (B.-Y.P., H.P.), Institute for Basic Science, Suwon, Korea
| | - Hyunjin Park
- From the Department of Neurology (M.J.L., S.C., C.-S.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Neuroscience Center (M.J.L., C.-S.C.), Samsung Medical Center, Seoul; Department of Electrical and Computer Engineering (B.-Y.P.) and School of Electronic and Electrical Engineering (H.P.), Sungkyunkwan University; and Center for Neuroscience Imaging Research (B.-Y.P., H.P.), Institute for Basic Science, Suwon, Korea.
| | - Chin-Sang Chung
- From the Department of Neurology (M.J.L., S.C., C.-S.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Neuroscience Center (M.J.L., C.-S.C.), Samsung Medical Center, Seoul; Department of Electrical and Computer Engineering (B.-Y.P.) and School of Electronic and Electrical Engineering (H.P.), Sungkyunkwan University; and Center for Neuroscience Imaging Research (B.-Y.P., H.P.), Institute for Basic Science, Suwon, Korea.
| |
Collapse
|
13
|
Tekgöl Uzuner G, Uzuner N. Neurovascular coupling in patients with relapsing-remitting multiple sclerosis. Clin Neurol Neurosurg 2016; 146:24-8. [PMID: 27136094 DOI: 10.1016/j.clineuro.2016.04.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 03/16/2016] [Accepted: 04/25/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Also to the inflammatory demyelinating lesions and degenerative process, altered cerebrovascular reactivity or neurovascular coupling (NVC) might be considered as playing another role in the pathogenesis of multiple sclerosis. The objective of this study is to assess the NVC of patients with relapsing-remitting multiple sclerosis (RRMS) during the acute exacerbation period. PATIENTS AND METHODS Four hundred fifty-eight patients with RRMS and 160 healthy subjects were screened for this study during the last 14 years. We performed transtemporal transcranial Doppler recordings from the P2-segments of both posterior cerebral arteries simultaneously during simple or complex visual stimulation. The NVC was defined as a relative increase of the blood flow velocities as a percentage change of the baseline values during visual stimulation. RESULTS The NVC to simple visual stimulation was significantly higher in the patients on both sides (37.2±13.5% and 36.0±14.8%; right and left side, respectively) from those of the controls (30.9±9.9% and 30.0±8.8%; right and left side, respectively) (p<0.01). Similarly, the NVC to complex visual stimulation was significantly higher in the patients (43.3±14.1% and 41.7±13.5%; right and left side, respectively) from those of the controls (38.6±14.2% and 37.6±14.1%; right and left side, respectively) (p<0.05). CONCLUSION Our results suggest that patients with RRMS during exacerbation period have more reactive neurovascular units in the occipital cortex.
Collapse
Affiliation(s)
- Gulnur Tekgöl Uzuner
- Eskisehir Osmangazi University, Faculty of Medicine, Department of Neurology, Eskisehir, Turkey.
| | - Nevzat Uzuner
- Eskisehir Osmangazi University, Faculty of Medicine, Department of Neurology, Eskisehir, Turkey.
| |
Collapse
|
14
|
Fabjan A, Zaletel M, Žvan B. Is there a persistent dysfunction of neurovascular coupling in migraine? BIOMED RESEARCH INTERNATIONAL 2015; 2015:574186. [PMID: 25705673 PMCID: PMC4331400 DOI: 10.1155/2015/574186] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 12/02/2014] [Indexed: 12/21/2022]
Abstract
Changes in cerebral blood flow are one of the main features of migraine attack and have inspired the vascular theory of migraine. This traditional view has been reshaped with recent experimental data, which gave rise to the neural theory of migraine. In this review, we speculate that there might be an important link between the two theories, that is, the dysfunction of neurovascular coupling.
Collapse
Affiliation(s)
- Andrej Fabjan
- Institute of Physiology, Medical Faculty, University of Ljubljana, Zaloška Cesta 4, 1000 Ljubljana, Slovenia
| | - Marjan Zaletel
- Department of Vascular Neurology, University Clinical Centre, Zaloška Cesta 2, 1000 Ljubljana, Slovenia
| | - Bojana Žvan
- Department of Vascular Neurology, University Clinical Centre, Zaloška Cesta 2, 1000 Ljubljana, Slovenia
| |
Collapse
|
15
|
Fabjan A, Bajrović FF, Musizza B, Vidmar J, Štrucl M, Zaletel M. Study of neurovascular coupling during cold pressor test in patients with migraine. Cephalalgia 2014; 35:692-701. [PMID: 25330769 DOI: 10.1177/0333102414554661] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 09/13/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Altered neurovascular coupling in migraineurs could be a consequence of impaired function of modulatory brainstem nuclei. The cold pressor test (CPT) should activate brainstem structures. We measured visually evoked cerebral blood flow velocity response (VEFR) to CPT in migraine. METHODS Twenty-three healthy volunteers and 29 migraineurs participated in the study. We measured arterial blood pressure, end-tidal CO2, heart rate and cerebral blood flow velocity in posterior and middle cerebral artery using transcranial Doppler. VEFR was calculated as cerebrovascular reactivity to photic stimulation before, during and after CPT. RESULTS In healthy individuals, there was a significant decrease in peak systolic VEFR from CPT phase to recovery phase (p < 0.05). There was an increase in mean VEFR from basal to CPT phase and a decrease from CPT to recovery phase, both significant (p < 0.05). End-diastolic VEFR increased from basal to CPT phase and decreased in recovery phase below the basal phase values, all changes significant (p < 0.05). In migraine, no statistically significant changes in peak systolic, mean or end-diastolic VEFRs were observed between phases (p > 0.05). The differences in phases in mean and end-diastolic VEFRs between the basal phase and the CPT phase and between the CPT phase and the recovery phase were significantly higher in healthy individuals (p < 0.05). CONCLUSIONS The absence of the effect of CPT on VEFR in migraine is likely to be a consequence of impaired subcortical modulation of neurovascular coupling.
Collapse
Affiliation(s)
- Andrej Fabjan
- Institute of Physiology, Medical Faculty, University of Ljubljana, Slovenia
| | - Fajko F Bajrović
- Institute of Pathophysiology, Medical Faculty, University of Ljubljana, Slovenia University Medical Centre of Ljubljana, Department of Vascular Neurology, Slovenia
| | | | - Jernej Vidmar
- Institute of Physiology, Medical Faculty, University of Ljubljana, Slovenia
| | - Martin Štrucl
- Institute of Physiology, Medical Faculty, University of Ljubljana, Slovenia
| | - Marjan Zaletel
- University Medical Centre of Ljubljana, Department of Vascular Neurology, Slovenia
| |
Collapse
|
16
|
Abstract
Cortical spreading depression (CSD), a slowly propagated wave of depolarization followed by suppression of brain activity, is a remarkably complex event that involves dramatic changes in neural and vascular function. Since its original description in the 1940s, CSD has been hypothesized to be the underlying mechanism of the migraine aura. Substantial evidence from animal models provides indirect support for this hypothesis, and studies showing that CSD is common in humans with brain injury clearly demonstrate that the phenomenon can occur in the human brain. Considerable uncertainty about the role of CSD in migraine remains, however, and key questions about how this event is initiated, how it spreads, and how it might cause migraine symptoms remain unanswered. This Review summarizes current concepts of CSD and its potential roles in migraine, and addresses ongoing studies aimed at a clearer understanding of this fundamental brain phenomenon.
Collapse
Affiliation(s)
- Andrew C Charles
- Headache Research and Treatment Program, Department of Neurology, David Geffen School of Medicine at UCLA, Neuroscience Research Building 1, Room 575, 635 Charles Young Drive South, Los Angeles, CA 90095-7335, USA
| | | |
Collapse
|
17
|
Griebe M, Flux F, Wolf ME, Hennerici MG, Szabo K. Multimodal Assessment of Optokinetic Visual Stimulation Response in Migraine With Aura. Headache 2013; 54:131-41. [DOI: 10.1111/head.12194] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2013] [Indexed: 01/05/2023]
Affiliation(s)
- Martin Griebe
- Department of Neurology; UniversitätsMedizin Mannheim; University of Heidelberg; 68167 Mannheim Germany
| | - Florian Flux
- Department of Neurology; UniversitätsMedizin Mannheim; University of Heidelberg; 68167 Mannheim Germany
| | - Marc E. Wolf
- Department of Neurology; UniversitätsMedizin Mannheim; University of Heidelberg; 68167 Mannheim Germany
| | - Michael G. Hennerici
- Department of Neurology; UniversitätsMedizin Mannheim; University of Heidelberg; 68167 Mannheim Germany
| | - Kristina Szabo
- Department of Neurology; UniversitätsMedizin Mannheim; University of Heidelberg; 68167 Mannheim Germany
| |
Collapse
|
18
|
Charles A. The evolution of a migraine attack - a review of recent evidence. Headache 2012; 53:413-9. [PMID: 23278169 DOI: 10.1111/head.12026] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2012] [Indexed: 01/07/2023]
Abstract
A migraine attack is an extraordinarily complex brain event that takes place over hours to days. This review focuses on recent human studies that shed light on the evolution of a migraine attack. It begins with a constellation of premonitory symptoms that are associated with activation of the hypothalamus and may involve the neurotransmitter dopamine. Even in the premonitory phase, patients experience sensitivity to sensory stimuli, indicating that central sensitization is a primary phenomenon. The migraine attack progresses to a phase that in some patients includes aura, which involves changes in cortical function, blood flow, and neurovascular coupling. The aura phase overlaps with the headache phase, which is associated with further changes in blood flow and function of the brainstem, thalamus, hypothalamus, and cortex. Serotonin receptors, nitric oxide, calcitonin gene-related peptide, pituitary adenylate cyclase-activating polypeptide, and prostanoids are demonstrated specific chemical mediators of migraine based on therapeutic and triggered migraine studies. A number of migraine symptoms persist beyond resolution of headache into a postdromal phase, accompanied by persistent blood flow changes in several brain regions. Although these phases of migraine have substantial temporal, neurochemical, and anatomical overlap, each represents an important window onto the pathophysiology of migraine as well as a target for therapeutic intervention. A comprehensive approach to migraine requires an understanding of the entire range of mechanisms and resultant symptoms that occur throughout the evolution of an attack.
Collapse
Affiliation(s)
- Andrew Charles
- Headache Research and Treatment Program, Department of Neurology, David Geffen School of Medicine at University of California, Los Angeles, Los Angeles, CA 90095, USA
| |
Collapse
|
19
|
Wallasch TM, Weinschuetz T, Mueller B, Kropp P. Cerebrovascular response in migraineurs during prophylactic treatment with acupuncture: a randomized controlled trial. J Altern Complement Med 2012; 18:777-83. [PMID: 22888768 DOI: 10.1089/acm.2011.0308] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The study objective was to evaluate the effect of acupuncture on cerebrovascular response in migraineurs by transcranial Doppler ultrasound. DESIGN This study was a randomized, quasi double-blinded, placebo-controlled study. SUBJECTS Thirty-five (35) migraineurs were diagnosed according to the International Headache Society criteria. The stimulus paradigm was performed in 18 verum and 17 placebo acupuncture patients. INTERVENTIONS Participants were treated with acupuncture according to Traditional Chinese Medicine recommendations. All patients received one session of acupuncture each week for 8 weeks. OUTCOME MEASURES To evaluate the clinical effect of acupuncture treatment, headache frequency and intensity was monitored by a headache diary. Cerebral blood flow velocity data were analyzed with a validated technique based on automated stimulus-related averaging. Vasotonus was determined by systolic and mean flow velocities and pulsality index in right and left middle cerebral arteries during rest. Cerebrovascular response was evaluated by detecting the cerebrovascular Valsalva ratio by maximum end-diastolic flow velocity acceleration during the straining phase of a Valsalva maneuver. Additionally, the centroperipheral Valsalva ratio was determined by the quotient of the cerebrovascular ratio to the corresponding blood pressure acceleration. RESULTS Pre-/post-acupuncture treatment comparisons between verum- and placebo- acupuncture groups demonstrated a significant decrease of days with migraine headache in the verum group (-52.5%; p<0.001), whereas placebo-acupuncture patients profited to a smaller extent and the duration of headache attack (hours/month) did not decrease significantly. Pretreatment recordings showed increased vasotonus and exaggerated cerebrovascular response in migraineurs. Pre-/post-treatment comparisons demonstrated no significant differences in vasotonus between groups, while cerebrovascular response patterns to Valsalva stimulus were significantly (p<0.001) diminished in verum-acupuncture patients, but not in the placebo group. CONCLUSIONS The findings indicate that prophylactic treatment of migraineurs by standardized acupuncture might positively influence the dysfunction of the cerebrovascular response to autonomic stimuli, but not the cerebral vasotonus during rest.
Collapse
|
20
|
Borsook D, Maleki N, Becerra L, McEwen B. Understanding migraine through the lens of maladaptive stress responses: a model disease of allostatic load. Neuron 2012; 73:219-34. [PMID: 22284178 DOI: 10.1016/j.neuron.2012.01.001] [Citation(s) in RCA: 250] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2012] [Indexed: 12/12/2022]
Abstract
The brain and body respond to potential and actual stressful events by activating hormonal and neural mediators and modifying behaviors to adapt. Such responses help maintain physiological stability ("allostasis"). When behavioral or physiological stressors are frequent and/or severe, allostatic responses can become dysregulated and maladaptive ("allostatic load"). Allostatic load may alter brain networks both functionally and structurally. As a result, the brain's responses to continued/subsequent stressors are abnormal, and behavior and systemic physiology are altered in ways that can, in a vicious cycle, lead to further allostatic load. Migraine patients are continually exposed to such stressors, resulting in changes to central and peripheral physiology and function. Here we review how changes in brain states that occur as a result of repeated migraines may be explained by a maladaptive feedforward allostatic cascade model and how understanding migraine within the context of allostatic load model suggests alternative treatments for this often-debilitating disease.
Collapse
Affiliation(s)
- David Borsook
- Center for Pain and the Brain, McLean, Massachusetts General, and Children's Hospitals, Harvard Medical School, Boston, MA 02115, USA.
| | | | | | | |
Collapse
|
21
|
Affiliation(s)
- T. Freilinger
- Neurologische Klinik und Poliklinik, Klinikum der Universität München
- Institut für Schlaganfall- und Demenzforschung, Klinikum der Universität München
| | - M. Dichgans
- Institut für Schlaganfall- und Demenzforschung, Klinikum der Universität München
| |
Collapse
|
22
|
De Simone R, Ranieri A, Bonavita V. Advancement in idiopathic intracranial hypertension pathogenesis: focus on sinus venous stenosis. Neurol Sci 2010; 31 Suppl 1:S33-9. [PMID: 20464580 DOI: 10.1007/s10072-010-0271-z] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Roberto De Simone
- Department of Neurological Sciences, Headache Centre, University of Naples Federico II, via Pansini, 5, 80131, Naples, Italy.
| | | | | |
Collapse
|