Magnetic resonance spectroscopy studies in migraine

We describe the method of ³¹phosphorous magnetic resonance spectroscopy and review the results when it is applied to the study of brain and muscle energy metabolism in migraine subjects. Brain energy metabolism appears to be abnormal in all major subtypes of migraine when measured both during and between attacks. Impaired energy metabolism is also documented in skeletal muscle. We suggest that migraine is associated with a generalized disorder of mitochondrial oxidative phosphorylation and that this may constitute a threshold for the triggering of migraine attacks.     

Magnetic resonance spectroscopy in migraine

31-phosphorus Magnetic Resonance Spectroscopy (MRS) is a technique developed for the non-invasive study of energy metabolism in living subjects. It determines the concentrations of high and low energy phosphates in resting and activated conditions, and of intracellular pH. 31P-MRS has been applied to the study of migraine, both during and in between attacks. Intracellular brain pH remains unchanged during the migraine attack, suggesting that ischemia does not play a relevant role in the origin of the neuro-logical signs. During and in-between attacks, migraineurs display abnormalities in energy metabolism of brain and muscle, consisting of reduced levels of phosphocreatine, reduced cellular-free energy and increased rate of ATP biosynthesis. We suggest that these abnormalities in energy metabolism predispose migraineurs to develop an attack under conditions of increased brain energy demand.     

Carnitine palmityltransferase II (CPT2) deficiency and migraine headache: two case reports

BACKGROUND: Migraine headache is common and has multiple etiologies. A number of mitochondrial anomalies have been described for migraine, and mitochondrial dysfunction has been implicated as one potential pathophysiological mechanism. Carnitine is used by mitochondria for fatty acid transportation; its deficiency, however, has not been implicated in migraine pathophysiology. METHODS AND RESULTS: Two adolescent girls presented to the Headache Center at Cincinnati Children's Hospital Medical Center with frequent headaches and were diagnosed with migraine by the International Headache Society (IHS) criteria. Both girls had a history of recurrent fatigue, muscle cramps, and multiple side effects from their prophylactic treatment. Carnitine levels were measured and found to be low. Carnitine supplementation was initiated. Both patients had a reduction in headache frequency, as well as an improvement in their associated symptoms and other complaints. A skin and muscle biopsy obtained from one patient revealed a partial carnitine palmityltransferase II deficiency in the muscle only. CONCLUSIONS: Carnitine palmityltransferase II deficiency may represent another etiology for migraine headache, and may be useful in further defining the pathophysiology of migraine. When properly recognized, supplementation with carnitine may improve the outcome of the migraine as well as the carnitine-associated symptoms.     

Visual system dysfunction in migraine: a review of clinical and psychophysical findings

This paper reviews both clinical and experimental literature relating to visual dysfunction in migraine, starting with the eye and progressing via the retina and visual pathways to the visual cortex. Migraine is associated with (i) a pupillary sympathetic hypofunction, and (ii) a cortical hypersensitivity to visual stimuli (perhaps only in migraine with aura), the pathogenesis of which remains to be determined. Various hypotheses are discussed, and it is proposed that the methods of visual psychophysics may represent a useful approach in the future study of cortical hyperexcitability in migraine. Paradoxically, little research has been directed towards understanding (i) the photophobia of migraine attacks, and (ii) how migraine may be triggered by visual stimuli. Research aimed at elucidating the mechanisms of these phenomena may enhance understanding of the pathogenes is of migraine.     

Subclinical left ventricular dysfunction in migraine attacks

OBJECTIVE: The aim of the present study was to evaluate cardiac performance of patients with migraine attacks during the overload produced by phenylephrine infusion. Background.-It is known that circulatory changes occur during migraine. However, the relationship between this finding and transient cardiac dysfunction is still unknown. METHODS: By means of two-dimensional direct M-mode echocardiography, we measured fractional shortening, ejection fraction, and mean velocity of circumferential fibers shortening in 18 patients with migraine and in 10 normal subjects as a control group. These measures were performed in two different periods: during attack-free intervals and during attacks. Pain intensity of typical migraine attack was evaluated on a 0 to 10 scale. RESULTS: Cardiac size and function were normal at rest in both groups. However, during migraine attacks, phenylephrine infusion provoked significant decrease in fractional shortening, EF, and mean velocity of circumferential fibers shortening, followed by concomitant increase of headache severity. On the other hand, during the attack-free interval and in the control group phenylephrine infusion did not show significant changes in cardiac function parameters. CONCLUSIONS: Our data suggest that left ventricular dysfunction during the phenylephrine test could participate in the complex pathophysiological mechanism of migraine attacks.     

偏头痛的多模态MRI研究进展

偏头痛是一种常见原发性头痛,以单侧或双侧发作的中重度头痛为主要特征,偏头痛患病率高,但其发病机制目前仍不清楚,神经影像学为探索偏头痛的发病机制起到了推动作用,多模态MRI以能综合分析检查部位的形态、功能和代谢状况运用于偏头痛研究中。作者主要基于偏头痛的不同MRI研究方法,综述当前对偏头痛的MRI研究进展。     

The role of cervical dysfunction in migraine: a systematic review

This systematic review evaluates the strength of the evidence for the role of cervical musculoskeletal dysfunction in migraine. In this review, cervical musculoskeletal dysfunction will refer to the abnormal sensory afferentation from cervical region structures contained within the receptive field of the trigeminocervical nucleus. Electronic database searches using MEDLINE, PubMed and CINAHL were performed, and 17 studies investigating cervical musculoskeletal dysfunction in people with migraine were selected for review. The methodological quality of the included studies was assessed by two independent reviewers using a customized checklist. The review found that intersubject differences were inadequately reported and controlled, which resulted in grouping of participants with varying pathologies and symptoms. A diverse range of assessment procedures was used by the reviewed studies, which made comparison of their findings difficult. The assessment procedures were mainly used to quantify the degree of cervical musculoskeletal dysfunction, rather than to identify a cause and effect relationship between cervical structure and migrainous pain. Although animal study evidence proposes a role for cervical musculoskeletal dysfunction in migraine, this systematic review of the literature found that there is currently no convincing evidence to confirm this phenomenon in humans.     

Structural and neurochemical markers of brain injury in the migraine diathesis of systemic lupus erythematosus

Objective : To determine whether migraine in systemic lupus erythematosus (SLE) is associated with accentuated brain injury and disease activity. Methods : Forty SLE patients (11 without headache, 11 with non-migraine headache, and 18 with migraine) underwent clinical evaluation, magnetic resonance imaging (MRI), and spectroscopy (MRS). Results : Recurrent headache occurred in 75% of SLE patients. MRI abnormalities and reduced N -acetylaspartate were common. However, migraine in SLE was not associated with increased disease activity or severity, neuropsychiatric manifestations, or end-organ involvement compared to patients without migraine ( p >0.05). There were no differences in the prevalence or severity of MRI or MRS abnormalities between SLE patients with migraine, with non-migraine headache, or without headache ( p >0.05). Conclusions : Headache does not identify SLE patients at risk for brain injury, increased disease activity, or increased end-organ involvement. Aggressive immunosuppressive therapy for headache alone is not indicated in SLE.     

Brain pH in migraine: An in vivo phosphorus-31 magnetic resonance spectroscopy study

The intracellular pH (pHi) of cerebral cortex was measured in migraine patients by use of in vivo phosphorus-31 NMR spectroscopy. No changes in pHi were measured during a migraine attack. The long-standing concept that the headache of migraine is due to cerebral vasodilation induced by prodromal vasospasm-induced ischemic acidosis is not substantiated.     

Hemiplegic migraine aura begins with cerebral hypoperfusion: imaging in the acute phase

Imaging studies of spontaneous migraine aura have proved challenging because of the episodic and unpredictable nature of migraine attacks. Two patients with signs of acute ischemic stroke were evaluated for thrombolysis and turned out to suffer from familial hemiplegic migraine. It was possible to record the early phase of the hemiplegic aura with computed tomography with perfusion sequences and magnetic resonance imaging. We found cerebral hypoperfusion in the relevant cortical areas within the first hour after onset of aura symptoms. This report supports the concept that migraine aura across the migraine spectrum is caused by similar mechanisms. In a setting with efficient cooperation between headache and stroke neurologists, thrombolysis centers provide the set-up and opportunity to record aura symptoms at an early phase. Furthermore, in the time of ready access to acute systemic thrombolysis treatment, these cases underscore the importance of an accurate headache history, especially in younger patients.     

Vertebral artery dissection onset mimics migraine with aura in a graphic designer

Headache is the most common symptom in patients with cervical artery dissection. This symptom, however, rarely occurs in isolation, and more commonly is associated with other neurological symptoms and signs. Visual symptoms associated with vertebral artery dissection (VD) have also been observed, but do not typically mimic the migraine aura. Here, we report a young patient who presented VD, embolic ischemic lesions, and visual symptoms with the features of aura, followed by migraine headache. The suggestion of VD dissection should be kept in mind in those cases complaining of the first attack of headache that mimics migraine with aura. In these cases, an extensive neuroimaging study is advisable.     

Patterns of functional brain organization and migraine

The purpose of this study was to examine the relationship between the patterns of functional organization of the brain, as evaluated by the number of anomalous brain conditions or phenomena (ABCP), and the prevalence of migraine in a group of 434 women with lifetime major depressive disorder. ABCP are conditions or phenomena which are clearly related to brain function whose prevalence significantly deviates from the statistical mean for the general population. Eighteen ABCP (e.g. mixed or left handedness, enuresis after age 5, learning and speech disorders) were used in this study as 'markers' for their associated patterns of functional brain organization. The relationship between the number of ABCP and the prevalence of migraine was highly significant. The correlation between the number of ABCP and the prevalence of migraine was 0.36 (P < 0.0001, confidence interval 0.26, 0.43). The prevalence of migraine in patients with no ABCP (n = 11) was 9%, while that of those with eight or more ABCP (n = 40) was 85%. This supports the hypothesis that there is a relationship between patterns of functional brain organization and migraine prevalence.     

Mitochondrial dysfunction in cardiovascular disease: Current status of translational research/clinical and therapeutic implications

Mitochondria provide energy to the cell during aerobic respiration by supplying ~95% of the adenosine triphosphate (ATP) molecules via oxidative phosphorylation. These organelles have various other functions, all carried out by numerous proteins, with the majority of them being encoded by nuclear DNA (nDNA). Mitochondria occupy ~1/3 of the volume of myocardial cells in adults, and function at levels of high‐efficiency to promptly meet the energy requirements of the myocardial contractile units. Mitochondria have their own DNA (mtDNA), which contains 37 genes and is maternally inherited. Over the last several years, a variety of functions of these organelles have been discovered and this has led to a growing interest in their involvement in various diseases, including cardiovascular (CV) diseases. Mitochondrial dysfunction relates to the status where mitochondria cannot meet the demands of a cell for ATP and there is an enhanced formation of reactive‐oxygen species. This dysfunction may occur as a result of mtDNA and/or nDNA mutations, but also as a response to aging and various disease and environmental stresses, leading to the development of cardiomyopathies and other CV diseases. Designing mitochondria‐targeted therapeutic strategies aiming to maintain or restore mitochondrial function has been a great challenge as a result of variable responses according to the etiology of the disorder. There have been several preclinical data on such therapies, but clinical studies are scarce. A major challenge relates to the techniques needed to eclectically deliver the therapeutic agents to cardiac tissues and to damaged mitochondria for successful clinical outcomes. All these issues and progress made over the last several years are herein reviewed.     

MRI观察无先兆偏头痛患者大脑活动异常

目的 以MRI观察无先兆偏头痛(MowA)患者大脑异常活动。方法 前瞻性纳入50例MwoA患者(MwoA组)及46名健康志愿者(对照组),以功能MRI(fMRI)观察其脑区动态局部一致性(dReHo);提取组间dReHo值存在差异脑区,与临床量表行相关性分析。结果 相比对照组,MwoA组双侧距状裂周围皮层、右枕中回dReHo值增高,右颞中回、右额中回、左楔叶dReHo值减低(GRF校正,体素水平P均<0.005,簇水平P均<0.05);权重分析显示,权重绝对值排名前3位脑区分别为右距状裂周围皮层、左楔叶及右枕中回。MwoA患者左距状裂周围皮层dReHo值与抑郁自评量表(SDS)呈负相关(r=-0.28,P=0.04)。结论 MwoA患者视觉信息上行传递通路存在异常,特别是右距状裂周围皮层、左楔叶及右枕中回。     

Olfactory hallucinations during migraine in an adolescent with an MRI temporal lobe lesion

OBJECTIVE: To report the first example of an abnormal magnetic resonance imaging (MRI) test in a patient with migraine and olfactory hallucinations and to provide additional evidence for a possible role of the temporal lobe in migraine. BACKGROUND: The relationship between the temporal lobe and migraine with or without hallucinations is unclear and continues to evolve. Clinical and functional neuroimaging studies (positron emission tomography/single photon emission computed tomography) have lent support to the possibility of a relationship. Anatomical neuroimaging with computed tomography has previously been normal. METHODS: The history and findings of an adolescent with migraine and olfactory hallucinations is reported. RESULTS: Brain MRI demonstrated a mass in the temporal lobe. CONCLUSIONS: Magnetic resonance imaging should be considered in patients with olfactory hallucinations and migraine. In addition, the role of the temporal lobe in migraine warrants further study.     

Magnetic resonance imaging of the brain in patients with migraine

Magnetic resonance imaging (MRI) was studied in 91 patients with migraine and in 98 controls. Risk factors known to cause MRI lesions were carefully examined. In 36 patients with migraine (39.6%), small foci of high intensity on T2-weighted and proton-density-weighted images were seen in the white matter. Of patients with migraine who were less than 40 years old and without any risk factor, 29.4% showed lesions on MRI; this was significantly higher than the 11.2% for the group of age-matched controls (n = 98). The lesions were distributed predominantly in the centrum semiovale and frontal white matter in young patients, but extended to the deeper white matter at the level of basal ganglia in the older age group. The side of the MRI lesions did not always correspond to the side of usual aura or headache. Migraine-related variables such as type of migraine, frequency, duration or intensity of headache or consumption of ergotamine showed no significant correlation with the incidence of MRI abnormalities. Our data indicated that migraine may be associated with early pathologic changes in the brain.