Evidence for a vascular factor in migraine

Authors

  • Mohammad S. Asghar MD,

    1. Danish Headache Center and Department of Neurology, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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  • Adam E. Hansen PhD,

    1. Functional Imaging Unit, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
    2. Department of Radiology, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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  • Faisal M. Amin MD,

    1. Danish Headache Center and Department of Neurology, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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  • R. J. van der Geest MS,

    1. Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
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  • Patrick van der Koning MS,

    1. Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands
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  • Henrik B. W. Larsson MD, DMS,

    1. Functional Imaging Unit, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
    2. Department of Clinical Physiology and Nuclear Medicine, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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  • Jes Olesen MD, DMS,

    1. Danish Headache Center and Department of Neurology, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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  • Messoud Ashina MD, PhD, DMS

    Corresponding author
    1. Danish Headache Center and Department of Neurology, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
    • Danish Headache Center and Department of Neurology, Glostrup Hospital, University of Copenhagen, Faculty of Health Sciences, Nordre Ringvej 57, DK-2600 Glostrup, Copenhagen, Denmark
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Abstract

Objective

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.

Methods

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).

Results

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).

Interpretation

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

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