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Updated: Dec 29, 2025
3D-Neuronavigation In Vivo Through a Patient's Brain During a Spontaneous Migraine Headache
Published on: June 2, 2014
Longitudinal Neuroimaging over 30 Days: Temporal Characteristics of Migraine
Laura H Schulte1, Jan Mehnert1, Arne May1
1Department of Systems Neuroscience, University Medical Center Eppendorf Hamburg, Hamburg, Germany.
Objective:
Although migraine is defined by the headache and headache-associated symptoms, the true beginning of a migraine attack lies in the premonitory phase. To understand the generation of attacks, one needs to investigate the phase before headache starts. The premonitory phase of migraine is characterized by a well-described complex of symptoms. Its duration, however, is not clearly defined, and there are no biomarkers to help define when this phase starts.
Methods:
Here, we used functional magnetic resonance imaging (MRI) to elucidate the duration of the premonitory phase in spontaneous human migraine attacks. Because migraine attacks are hardly predictable and thereby the premonitory phase is difficult to catch, we scanned 9 patients daily over a minimum period of 30 days using a well-established paradigm for functional MRI of trigeminal nociception.
Results:
Seven patients were included in the analysis, thus providing cumulative data of 27 spontaneous human migraine attacks including scans before, during, and after migraine pain as well as interictal scans. As a response to painful trigeminal stimulation, activation of the hypothalamus was present within the last 48 hours before headache onset but not earlier.
Interpretation:
Using hypothalamic activation as a potential marker for the premonitory phase of migraine in this unique dataset, our data corroborated a duration of 48 hours for the premonitory phase of migraine. We suggest applying this time criterion in future studies when focusing on this phase of the migraine cycle. ANN NEUROL 2020;87:646-651.
Insights
The premonitory phase of migraine attacks can now be identified up to 48 hours before headache onset. Hypothalamic activation observed via functional MRI serves as a potential biomarker for this early migraine phase.
Area of Science:
- Neuroscience
- Medical Imaging
Background:
- Migraine attacks are preceded by a premonitory phase, crucial for understanding attack generation.
- The exact duration of the premonitory phase and reliable biomarkers remain undefined.
Purpose of the Study:
- To elucidate the duration of the premonitory phase in spontaneous human migraine attacks.
- To identify potential biomarkers for the premonitory phase using functional MRI.
Main Methods:
- Functional magnetic resonance imaging (fMRI) was employed to scan 9 patients daily for at least 30 days.
- A paradigm for fMRI of trigeminal nociception was used to capture premonitory and ictal phases.
Main Results:
- Data from 7 patients, encompassing 27 migraine attacks, were analyzed.
- Hypothalamic activation was detected within 48 hours preceding headache onset, but not earlier.
Conclusions:
- Hypothalamic activation can serve as a biomarker for the migraine premonitory phase.
- The premonitory phase of migraine attacks has a duration of approximately 48 hours.
