Heterogenous migraine aura symptoms correlate with visual cortex functional magnetic resonance imaging responses

Objective Migraine aura is sparsely studied due to the highly challenging task of capturing patients during aura. Cortical spreading depression (CSD) is likely the underlying phenomenon of aura. The possible correlation between the multifaceted phenomenology of aura symptoms and the effects of CSD o...

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Published inAnnals of neurology Vol. 82; no. 6; pp. 925 - 939
Main Authors Arngrim, Nanna, Hougaard, Anders, Ahmadi, Khazar, Vestergaard, Mark Bitsch, Schytz, Henrik Winther, Amin, Faisal Mohammad, Larsson, Henrik Bo Wiberg, Olesen, Jes, Hoffmann, Michael B., Ashina, Messoud
Format Journal Article
LanguageEnglish
Published United States Wiley Subscription Services, Inc 01.12.2017
Subjects
Brain
Brain mapping
Cortical spreading depression
Functional magnetic resonance imaging
Headache
Hypoxia
Magnetic resonance imaging
Migraine
Neuroimaging
NMR
Nuclear magnetic resonance
Oxygenation
Patients
Phenomenology
Physical exercise
Resonance
Retina
Visual cortex
Visual signals
Visual stimuli
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Summary:Objective Migraine aura is sparsely studied due to the highly challenging task of capturing patients during aura. Cortical spreading depression (CSD) is likely the underlying phenomenon of aura. The possible correlation between the multifaceted phenomenology of aura symptoms and the effects of CSD on the brain has not been ascertained. Methods Five migraine patients were studied during various forms of aura symptoms induced by hypoxia, sham hypoxia, or physical exercise with concurrent photostimulation. The blood oxygenation level–dependent (BOLD) functional magnetic resonance imaging (fMRI) signal response to visual stimulation was measured in retinotopic mapping–defined visual cortex areas V1 to V4. Results We found reduced BOLD response in patients reporting scotoma and increased response in patients who only experienced positive symptoms. Furthermore, patients with bilateral visual symptoms had corresponding bihemispherical changes in BOLD response. Interpretation These findings suggest that different aura symptoms reflect different types of cerebral dysfunction, which correspond to specific changes in BOLD signal reactivity. Furthermore, we provide evidence of bilateral CSD recorded by fMRI during bilateral aura symptoms. Ann Neurol 2017;82:925–939
Bibliography:N.A. and A.H. contributed equally. K.A. and M.B.V. contributed equally. M.A. and M.B.H. contributed equally.
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ISSN:0364-5134
1531-8249
DOI:10.1002/ana.25096