Evidence for a vascular factor in migraine
Version of Record online: 17 MAR 2011
Copyright © 2010 American Neurological Association
Annals of Neurology
Volume 69, Issue 4, pages 635–645, April 2011
How to Cite
Asghar, M. S., Hansen, A. E., Amin, F. M., van der Geest, R. J., Koning, P. v. d., Larsson, H. B. W., Olesen, J. and Ashina, M. (2011), Evidence for a vascular factor in migraine. Ann Neurol., 69: 635–645. doi: 10.1002/ana.22292
- Issue online: 22 APR 2011
- Version of Record online: 17 MAR 2011
- Accepted manuscript online: 28 OCT 2010 07:31AM EST
- Manuscript Accepted: 1 OCT 2010
- Manuscript Revised: 28 AUG 2010
- Manuscript Received: 20 JUL 2010
It has been suggested that migraine is caused by neural dysfunction without involvement of vasodilatation. Because dismissal of vascular mechanisms seemed premature, we examined diameter of extra- and intracranial vessels in migraine without aura patients.
A novel high-resolution direct magnetic resonance angiography imaging technique was used to measure arterial circumference of the extracranial middle meningeal artery (MMA) and the intracranial middle cerebral artery (MCA). Data were obtained at baseline, during migraine attack, and after treatment with the migraine abortive drug sumatriptan (a 5-hydroxytryptamine agonist).
We found dilatation of both MMA and MCA during migraine attack (p = 0.001). Sumatriptan administration caused amelioration of headache (p< 0.001) and contraction of MMA (p < 0.001), but MCA remained unchanged (p = 0.16). Exploratory analysis revealed that in migraine attacks with half-sided headache, there was only dilatation on the headache side of MMA of 12.49% (95% confidence interval [CI], 4.16–20.83%) and of MCA of 12.88% (95% CI, 3.49–22.27%) and no dilatation on the nonheadache side of MMA (95% CI, −4.27 to 11.53%) and MCA (95% CI, −6.7 to 14.28%). In double-sided headache we found bilateral vasodilatation of both MMA and MCA (p< 0.001).
These data show that migraine without aura is associated with dilatation of extra- and intracerebral arteries and that the headache location is associated with the location of the vasodilatation. Furthermore, contraction of extracerebral and not intracerebral arteries is associated with amelioration of headache. Collectively, these data suggest that vasodilatation and perivascular release of vasoactive substances is an integral mechanism of migraine pathophysiology. ANN NEUROL 2011