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Migraine mutations increase stroke vulnerability by facilitating ischemic depolarizations.

Katharina Eikermann-Haerter1, Jeong Hyun Lee, Izumi Yuzawa

  • 1Stroke and Neurovascular Regulation Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA.

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Familial hemiplegic migraine (FHM) mutations increase stroke risk by making the brain more vulnerable to ischemic events. This heightened susceptibility to brain depolarization leads to larger strokes and worse outcomes.

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Area of Science:

  • Neuroscience
  • Genetics
  • Stroke Research

Background:

  • Migraine is a known stroke risk factor, but underlying mechanisms remain unclear.
  • Familial hemiplegic migraine (FHM) serves as a valuable model for common migraine due to shared features and mechanisms.
  • FHM is associated with an increased risk of stroke.

Purpose of the Study:

  • To investigate the impact of FHM type 1 (FHM1) mutations on brain vulnerability to ischemic stroke.
  • To elucidate the cellular and physiological mechanisms linking FHM to stroke risk.

Main Methods:

  • Utilized two FHM1 mutant mouse strains and wild-type controls.
  • Assessed brain activity using anoxic depolarization and peri-infarct depolarizations.
  • Quantified infarct size and neurological outcomes using diffusion-weighted MRI and laser speckle flowmetry.
  • Investigated the effect of a glutamate receptor antagonist.

Main Results:

  • FHM1 mutations led to earlier anoxic depolarization and more frequent peri-infarct depolarizations in mutant mice.
  • Mutant mice exhibited rapid infarct core expansion and larger perfusion deficits.
  • Mutant mice required higher cerebral blood flow for survival, leading to infarction with milder ischemia.
  • Mutant mice developed larger infarcts and worse neurological outcomes, which were reduced by glutamate receptor antagonist treatment.

Conclusions:

  • Enhanced susceptibility to ischemic depolarizations, similar to spreading depression, predisposes migraineurs to infarction during mild ischemic events.
  • This mechanism contributes to the increased stroke risk observed in migraineurs.
  • Targeting glutamatergic mechanisms may offer therapeutic potential for stroke prevention in susceptible individuals.