Structural and Functional Neuroimaging in Migraine: Insights From 3 Decades of Research

Authors

  • Shaheen E. Lakhan MD, PhD, MEd, MS,

    Corresponding author
    1. From the Center for Headache and Pain, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA (S.E. Lakhan and S.J. Tepper); Biosciences Department, Global Neuroscience Initiative Foundation, Beverly Hills, CA, USA (S.E. Lakhan and M. Avramut).
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  • Mihaela Avramut MD, PhD,

    1. From the Center for Headache and Pain, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA (S.E. Lakhan and S.J. Tepper); Biosciences Department, Global Neuroscience Initiative Foundation, Beverly Hills, CA, USA (S.E. Lakhan and M. Avramut).
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  • Stewart J. Tepper MD

    1. From the Center for Headache and Pain, Neurological Institute, Cleveland Clinic, Cleveland, OH, USA (S.E. Lakhan and S.J. Tepper); Biosciences Department, Global Neuroscience Initiative Foundation, Beverly Hills, CA, USA (S.E. Lakhan and M. Avramut).
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  • Conflict of Interest Statement: Drs. Lakhan and Avramut report no conflicts of interest. Dr. Tepper reports the following conflicts of interest.

  • Grants/Research Support (no personal compensation): ATI, BristolMyerSquibb, GSK, MAP, Merck, NuPathe, Zogenix.

  • Consultant: Allergan, GSK, Helsinn, MAP, Merck, Nautilus, NuPathe, Zogenix.

  • Speakers Bureau: Allergan, GSK, Merck, Nautilus, Zogenix.

  • Advisors Board: Allergan, GSK, Merck, MAP, Nautilus, NuPathe, Pfizer, Zogenix.

  • Stock Options: ATI.

  • Royalties: University of Mississippi Press, Peoples Publishing House of Peking, Springer.

S.E. Lakhan, Neurological Institute, Cleveland Clinic, 9500 Euclid Avenue, S100A, Cleveland, OH 44195, USA, email: lakhans2@ccf.org.

Abstract

Modern imaging methods provide unprecedented insights into brain structure, perfusion, metabolism, and neurochemistry, both during and between migraine attacks. Neuroimaging investigations conducted in recent decades bring us closer to uncovering migraine as a multifaceted, primarily central nervous system disorder. Three main categories of structural and functional brain changes are described in this review, corresponding to the migrainous aura, ictal headache, and interictal states. These changes greatly advance our understanding of multiple pathophysiologic underpinnings of migraine, from central “migraine generating” loci, to cortical spreading depression, intimate mechanisms underlying activation of neuronal pain pathways in vulnerable patients, central sensitization, and chronification. Structural imaging begins to explain the complex connections between migraine and cerebral vascular events, white matter lesions, grey matter density alterations, iron deposition, and microstructural brain damage. Selected structural and functional alterations of brain structures, as identified with imaging methods, may represent the foundation of new diagnostic strategies and serve as markers of therapeutic efficacy.

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