Kanikah Mehndiratta, MSc, University of Glasgow
Migraine is considered to be the most prevalent amongst chronic headaches globally, but its pathophysiology remains poorly understood. Based on a Global Burden of Disease research, migraine headaches are one of the commonest factors related to disability-adjusted life. Many studies claim the abnormalities associated with cerebral blood flow (CBF) as the main cause behind the disease. Non-invasive approaches such as arterial spin labelling via imaging could help in the analysis of blood flow to different regions of the brain. A recent study published in The Journal of Headache and Pain discusses the use of the same approach to establish knowledge on pathophysiology related to migraines.
Migraines stages
Migraines affect more than 20% of women and 8% of men globally. The most common symptom is a throbbing headache, usually unilateral, pulsating and pain that gets worsened by movement. This is accompanied by vomiting or fear of light, sound, sensitivity to touch, irritability etc. in most patients. The International Headache Society puts forth the diagnostic criteria as a headache for a time period of 4 hours to 3 days with a minimum of two of the symptoms mentioned above. Migraine can include many phases, one or more of which a patient experiences during an episode as mentioned below:
- The premonitory or the prodome phase can begin even a few days before the actual migraine experience at its peak intensity.
Symptoms: Mood fluctuations, cravings, fatigue, feeling of nausea, difficulty in focusing and constipation and early medication can actually prevent the next stages from happening.
- The next stage is the Aura experienced by nearly 1/3rd of migraineurs.
Symptoms: Can range from blurry visions, vertigo to even olfactory and auditory hallucinations, in some a partial paralysis, which last for less than an hour.
Fig. A spoof of different phases of Migraine (Image modified from an article at migraine.com by Lisa Benson, 2016).
- The third phase is the hemi-cranial headache that sometimes turns bilateral.
Symptoms: The intense pain can extend throughout the body with symptoms of nausea, diarrhoea, anxiety, photo and phonophobia.
- The last phase or the postdrome phase
Symptoms: It is marked by muscle aches, mood changes, stiff neck and dizziness.
Research Strategy
The methodology in the study involved analysis of variation in normalized CBF and the one during migraine phases without aura using the arterial spin labelling technique on 80 people. 40 of those were patients with episodic migraines while the rest were labelled control in the age range of 18-50 years. The strategy was based on the characterization of CBF concurrent changes in different regions of the brain using a correlation coefficient that analyses significant CBF connectivity across different areas. A lot of exclusion criteria such as poor image quality, consumption of alcohol or other substances, any coincidence with another neurological disorder, genetic history, and effect of menstrual hormones on cortical excitation were applied. A two-sample t-test for age was used for comparison in healthy samples and patient samples.
Significance of the study
The results prove a correlation between CBF abnormalities in the frontal gyrus region of the brain with migraine which even corresponded with a monthly attack frequency. CBF defects were reported even at the resting stage and the most affected areas were involved in thinking, emotional and pain processing etc. These conclusions will help in advancing the knowledge on the neuropathology of the condition.
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Source:
1. Zhang, Di, et al. “Assessment of Normalized Cerebral Blood Flow and Its Connectivity with Migraines without Aura during Interictal Periods by Arterial Spin Labeling.” The Journal of Headache and Pain, vol. 22, no. 1, Dec. 2021, p. 72. DOI.org (Crossref), doi:http://10.1186/s10194-021-01282-y.
2. Urits, Ivan, et al. “CGRP Antagonists for the Treatment of Chronic Migraines: A Comprehensive Review.” Current Pain and Headache Reports, vol. 23, no. 5, May 2019, p. 29. DOI.org (Crossref), doi:http://10.1007/s11916-019-0768-y.
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About the author: Kanikah Mehndiratta is an avid researcher in the field of Genetics with a background in Biotechnology. She is a postgraduate from the University of Glasgow in their Medical Genetics and Genomics program. Currently, based in Chandigarh as a scientific writer, she involves herself mainly in projects related to neurological disorders. Outside of academics, she likes to read novels, travel and is involved in volunteer work mostly.
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