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3D-Neuronavigation In Vivo Through a Patient's Brain During a Spontaneous Migraine Headache
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Extra-Axial Inflammatory Signal in Parameninges in Migraine with Visual Aura

Nouchine Hadjikhani1, Daniel S Albrecht1, Caterina Mainero1

  • 1Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA.

Annals of Neurology
|April 3, 2020
PubMed
Abstract

Insights

Migraine with visual aura shows inflammation in the meninges and skull bone overlying the occipital lobe. This inflammatory signal may be linked to cortical spreading depression and bridging vessels.

Area of Science:

  • Neuroscience
  • Medical Imaging
  • Inflammation Research

Background:

  • Cortical spreading depression (CSD) is implicated in the neurobiology of migraine with aura (MWA).
  • CSD activates the trigeminovascular system, leading to meningeal inflammation.
  • Animal studies suggest microvessel networks link the brain, meninges, and bone marrow.

Purpose of the Study:

  • To investigate the upregulation of an inflammatory marker in extra-axial tissues in patients with migraine with visual aura.
  • To examine the association between CSD, meningeal inflammation, and MWA pathophysiology.

Main Methods:

  • Utilized 11C-PBR28 positron emission tomography/magnetic resonance imaging to measure 18kDa translocator protein (an inflammatory marker).
  • Assessed mean tracer uptake (standardized uptake value ratio [SUVR]) in parameningeal tissues (meninges and overlying skull bone) in MWA patients, healthy controls, and chronic low back pain patients.
  • Compared SUVR in four regions of interest across the groups.

Main Results:

  • MWA patients exhibited significantly higher mean SUVR in parameningeal tissues overlying the occipital cortex compared to controls.
  • This elevated inflammatory signal was specific to the occipital region and not observed over other cortical areas.
  • A positive correlation was found between the frequency of visual auras and tracer uptake in the occipital parameningeal tissues.

Conclusions:

  • A persistent extra-axial inflammatory signal is present in the meninges and calvarial bone overlying the occipital lobe in MWA.
  • These findings provide the first imaging evidence linking inflammation in these tissues to MWA pathophysiology, potentially related to CSD.
  • The study suggests a possible role for newly discovered bridging vessels in transmitting inflammatory signals from the brain to the skull marrow, relevant to neuroinflammatory disorders.

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