Cerebral perfusion changes in migraineurs: a voxelwise comparison of interictal dynamic susceptibility contrast MRI measurements

Abstract

Introduction: The increased risk of cerebro- and cardiovascular disease in migraineurs may be the consequence of a systemic condition affecting whole body vasculature. At cerebrovascular level, this may be reflected by interictal global or regional cerebral perfusion abnormalities. Whether focal perfusion changes occur during interictal migraine has not been convincingly demonstrated.

Methods: We measured brain perfusion with dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) in 29 interictal female migraineurs (12 migraine with aura (MA), 17 migraine without aura (MO)), and 16 female controls. Perfusion maps were compared between these groups with a voxelwise (p < 0.001, uncorrected, minimum cluster size 20 voxels) and a region-of-interest approach.

Results: In whole brain voxelwise analyses interictal hyperperfusion was observed in the left medial frontal gyrus in migraineurs and in the inferior and middle temporal gyrus in MO patients, in comparison with controls. Hypoperfusion was seen in the postcentral gyrus and in the inferior temporal gyrus in MA patients and in the inferior frontal gyrus in MO patients. Additional focal sites of hyperperfusion were noted in subgroups based on attack frequency and disease history. Region-of-interest analyses of the pons, hypothalamus, occipital lobe, and cerebellum did not show interictal perfusion differences between migraineurs and controls.

Conclusions: We conclude that interictal migraine is characterized by discrete areas of hyper- and hypoperfusion unspecific for migraine pathophysiology and not explaining the increased vulnerability of particular brain regions for cerebrovascular damage.

Figure 1

Statistical parametric maps demonstrating increases (yellow) and decreases (blue) in DSC-MRI measured cerebral blood flow (CBF). Increases in CBF between migraineurs and controls in the medial frontal gyrus (A) and between MO patients and controls in the inferior temporal gyrus (B) and decreases in CBF between MA patients and controls in the inferior temporal gyrus (C) and postcentral gyrus (D) and between MO patients and controls in the inferior frontal gyrus (E) are superimposed on a single subject T1 template coregistered to the standard SPM5 PET template. Color bars represent Z-values. The left side of each picture is the right side of the brain.

Figure 2

Statistical parametric maps demonstrating increases in DSC-MRI measured cerebral blood volume (CBV) in MO patients compared to headache-free control subjects in the middle temporal gyrus (A) and inferior temporal gyrus (B, C), superimposed on the single subject T1 template coregistered to the standard SPM5 PET template. The color bar represents Z-values. The left side of each picture is the right side of the brain.