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3D-Neuronavigation In Vivo Through a Patient's Brain During a Spontaneous Migraine Headache
10:39

3D-Neuronavigation In Vivo Through a Patient's Brain During a Spontaneous Migraine Headache

Published on: June 2, 2014

Periaqueductal gray matter dysfunction in migraine: cause or the burden of illness?

K M Welch1, V Nagesh, S K Aurora

  • 1Department of Neurology, University of Kansas Medical Center, Kansas City, KS 66160-7300, USA.

Headache
|September 14, 2001
PubMed
Abstract

Insights

Iron homeostasis in the periaqueductal gray matter (PAG) is impaired in episodic migraine (EM) and chronic daily headache (CDH) patients, suggesting the PAG may generate migraine attacks. This dysfunction may stem from repeated headache episodes impacting iron regulation.

Area of Science:

  • Neuroscience
  • Neurology
  • Medical Imaging

Background:

  • The periaqueductal gray matter (PAG) is crucial for descending pain inhibition.
  • Investigating iron homeostasis in the PAG may reveal insights into migraine pathophysiology.
  • Episodic migraine (EM) and chronic daily headache (CDH) represent distinct headache disorders.

Purpose of the Study:

  • To assess iron homeostasis in the PAG of patients with EM and CDH using advanced MRI techniques.
  • To correlate iron levels with headache duration and disease status.
  • To explore the PAG's role in migraine generation.

Main Methods:

  • High-resolution MRI was used to measure transverse relaxation rates (R2, R2*, R2') in the PAG, red nucleus (RN), and substantia nigra (SN).
  • R2' quantifies non-heme iron, serving as an indicator of iron homeostasis.
  • Seventeen EM patients, 17 CDH patients, and 17 healthy controls were included.

Main Results:

  • Significantly increased R2' and R2* values were observed in the PAG of both EM and CDH groups compared to controls.
  • No significant differences in PAG R2' or R2* were found between EM and CDH groups, or within the EM group based on aura presence.
  • Correlations between illness duration and R2' were noted in EM and CDH patients. Decreased R2' and R2* in RN and SN of CDH patients suggest pain-related flow activation.

Conclusions:

  • Iron homeostasis in the PAG is persistently impaired in EM and CDH, potentially due to recurrent migraine attacks.
  • These findings highlight the PAG's potential role as a migraine generator.
  • Dysfunctional PAG control over the trigeminovascular system may underlie migraine pathophysiology.

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