Document Detail

Evidence for a vascular factor in migraine.
MedLine Citation:
PMID:  21416486     Owner:  NLM     Status:  MEDLINE    
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 non headache 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.
Mohammad S Asghar; Adam E Hansen; Faisal M Amin; R J van der Geest; Patrick van der Koning; Henrik B W Larsson; Jes Olesen; Messoud Ashina
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2011-03-17
Journal Detail:
Title:  Annals of neurology     Volume:  69     ISSN:  1531-8249     ISO Abbreviation:  Ann. Neurol.     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-04-26     Completed Date:  2011-06-17     Revised Date:  2012-01-18    
Medline Journal Info:
Nlm Unique ID:  7707449     Medline TA:  Ann Neurol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  635-45     Citation Subset:  IM    
Copyright Information:
Copyright © 2010 American Neurological Association.
Danish Headache Center and Department of Neurology, Glostrup Hospital, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark.
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MeSH Terms
Arteries / physiopathology*
Injections, Subcutaneous
Magnetic Resonance Angiography* / methods
Meninges / blood supply*
Middle Aged
Middle Cerebral Artery / physiopathology
Migraine without Aura / diagnosis*,  drug therapy,  physiopathology*
Sumatriptan / administration & dosage,  pharmacology*
Time Factors
Vasoconstriction / drug effects*
Vasoconstrictor Agents / administration & dosage,  pharmacology*
Vasodilation / drug effects
Reg. No./Substance:
0/Vasoconstrictor Agents; 103628-46-2/Sumatriptan
Comment In:
Ann Neurol. 2011 Apr;69(4):600-1   [PMID:  21520229 ]
J Neurol. 2011 Jul;258(7):1385-8   [PMID:  21698388 ]
Ann Neurol. 2011 Nov;70(5):862; author reply 862-3   [PMID:  22162066 ]

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