Migraine changes the brain: neuroimaging makes its mark

Abstract

Purpose of review: This review summarizes key findings of the current literature on functional neuroimaging in migraine and describes how these studies have changed our view of the disorder.

Recent findings: Recent studies have started not only to investigate the global cerebral activation pattern during migraine attacks, but to address specific aspects of migraine attacks such as photophobia, osmophobia as well as pain perception with the aim of disentangling the underlying mechanisms. There is also more and more evidence that the migraine brain is abnormal even outside of attacks and that repeated attacks are leading to functional and structural alterations in the brain, which may in turn drive the transformation of migraine to its chronic form. Some new results are pinpointing toward a potential role of interesting new brain areas in migraine pathophysiology such as the temporal cortex or the basal ganglia.

Summary: Neuroimaging studies are beginning to shed light on the mechanisms underlying the development and evolution of migraine and its specific symptoms. Future studies have the potential to also improve our understanding of established and upcoming treatment approaches and to monitor treatment effects in an objective and noninvasive way.

Figure 1

Metanalysis using activation likelihood estimation method [(ALE; GingerAle 2.1 software, Research Imaging Institute, San Antonio, Texas) [33] of brain activations during migraine attacks as measured in H₂¹⁵O-PET studies. The ALE map was thresholded at p<0.05 FDR corrected. Data were obtained from studies on spontaneous (Weiller 1995, spontaneous migraine [13]; Afridi et al., 2005, spontaneous migraine [17]; Denuelle 2007 spontaneous [22]) or evoked migraine (Afridi 2005, GTN triggered migraine [23]) were used.