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Investigating macrophage-mediated inflammation in migraine using ultrasmall superparamagnetic iron oxide-enhanced 3T
Sabrina Khan1, Faisal Mohammad Amin1, Frederikke Petrine Fliedner2
1Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Copenhagen, Denmark.
Background:
Initiating mechanisms of migraine headache remain poorly understood and a biomarker of migraine does not exist. Inflammation pertaining to the wall of cerebral arteries and brain parenchyma has been suggested to play a role in migraine pathophysiology.
Objective:
We conducted the first experimental human study to investigate macrophage-mediated inflammation as a possible biomarker of migraine.
Methods:
Using ultrasmall superparamagnetic iron oxide (USPIO)-enhanced 3T magnetic resonance imaging (MRI), we investigated the presence of macrophages in cerebral artery walls and in brain parenchyma of patients with migraine without aura. We used the phosphodiesterase-3-inhibitor cilostazol as an experimental migraine trigger, and investigated both patients who received sumatriptan treatment, and patients who did not. To validate our use of USPIO-enhanced MRI, we included a preclinical mouse model with subcutaneous capsaicin injection in the trigeminal V1 area. The study is registered at ClinicalTrials.gov with the identifier NCT02549898.
Results:
A total of 28 female patients with migraine without aura underwent a baseline MRI scan, ingested cilostazol, developed a migraine-like attack, and underwent an USPIO-enhanced MRI scan > 24 hours after intravenous administration of USPIO. Twelve patients treated their attack with 6 mg s.c. sumatriptan, while the remaining 16 patients received no migraine-specific rescue medication. The preclinical model confirmed that USPIO-enhanced MRI detects macrophage-mediated inflammation. In patients, however, migraine attacks were not associated with increased USPIO signal on the pain side of the head compared to the non-pain side.
Conclusion:
Our findings suggest that migraine without aura is not associated with macrophage-mediated inflammation specific to the head pain side.
Insights
This study investigated macrophage-mediated inflammation as a potential migraine biomarker. Researchers found no evidence of such inflammation on the head pain side in patients with migraine without aura.
Area of Science:
- Neuroscience
- Medical Imaging
- Inflammation Research
Background:
- Migraine headache mechanisms are poorly understood, and no reliable biomarker exists.
- Cerebral artery and brain parenchyma inflammation is a suspected factor in migraine pathophysiology.
Purpose of the Study:
- To conduct the first human study investigating macrophage-mediated inflammation as a potential migraine biomarker.
- To explore the role of inflammation in migraine pathophysiology using advanced imaging techniques.
Main Methods:
- Ultrasmall superparamagnetic iron oxide (USPIO)-enhanced 3T MRI was used to detect macrophages in cerebral arteries and brain parenchyma.
- Migraine without aura patients underwent MRI before and after cilostazol-induced migraine attacks.
- A preclinical mouse model was used to validate USPIO-enhanced MRI for detecting macrophage-mediated inflammation.
Main Results:
- USPIO-enhanced MRI confirmed macrophage detection in a preclinical model.
- In human patients, migraine attacks were not linked to increased USPIO signal on the head's pain side.
- No significant difference in USPIO signal was observed between the pain and non-pain sides during migraine attacks.
Conclusions:
- Migraine without aura is not associated with macrophage-mediated inflammation on the head pain side.
- The study did not identify macrophage-mediated inflammation as a biomarker for migraine without aura.
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