Brain activations in the premonitory phase of nitroglycerin-triggered migraine attacks

• Published in: Brain (London, England : 1878) Vol. 137; no. Pt 1; pp. 232 - 241
• Main Authors: FAROOQ HUSAIN MANIYAR, SPRENGER, Till, MONTEITH, Teshamae, SCHANKIN, Christoph, GOADSBY, Peter James
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.01.2014
• Subjects: Adult; Biological and medical sciences; Brain - diagnostic imaging; Cerebral blood flow; Cerebrovascular Circulation - physiology; Data Interpretation, Statistical; Disease Progression; Female; Humans; Hypothalamus - pathology; Image Processing, Computer-Assisted; Infusions, Intravenous; Male; Medical sciences; Middle Aged; Migraine without Aura - chemically induced; Migraine without Aura - diagnostic imaging; Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis; Neurology; Nitroglycerin; Periaqueductal Gray - diagnostic imaging; Positron-Emission Tomography; Tomography, X-Ray Computed; Vascular diseases and vascular malformations of the nervous system; Vasodilator Agents; Young Adult; Radionuclide study; Nervous system diseases; Migraine; Central nervous system; Cardiovascular disease; Hypothalamus; premonitory; Cerebral disorder; Encephalon; Vascular disease; periaqueductal grey; Trigger; Pain; Nitroglycerin; Central nervous system disease; Positron emission tomography; Cerebrovascular disease; PET; Emission tomography; migraine; hypothalamus
• ISSN: 0006-8950; 1460-2156
• DOI: 10.1093/brain/awt320

Our aim was identify brain areas involved in the premonitory phase of migraine using functional neuroimaging. To this end, we performed positron emission tomography scans with H2(15)O to measure cerebral blood flow as a marker of neuronal activity. We conducted positron emission tomography scans at baseline, in the premonitory phase without pain and during migraine headache in eight patients. We used glyceryl trinitrate (nitroglycerin) to trigger premonitory symptoms and migraine headache in patients with episodic migraine without aura who habitually experienced premonitory symptoms during spontaneous attacks. The main outcome was comparing the first premonitory scans in all patients to baseline scans in all patients. We found activations in the posterolateral hypothalamus, midbrain tegmental area, periaqueductal grey, dorsal pons and various cortical areas including occipital, temporal and prefrontal cortex. Brain activations, in particular of the hypothalamus, seen in the premonitory phase of glyceryl trinitrate-triggered migraine attacks can explain many of the premonitory symptoms and may provide some insight into why migraine is commonly activated by a change in homeostasis.