Imaging the Premonitory Phase of Migraine

Area of Science:

• Neurology
• Neuroscience
• Brain Imaging

Background:

• Migraine is a common, disabling brain disorder with diverse symptoms.
• The premonitory phase, occurring days before head pain, presents unique symptoms like mood changes and sensory sensitivities.
• This early phase offers insights into migraine mechanisms and potential therapeutic targets.

Purpose of the Study:

• To review recent findings on the premonitory phase of migraine.
• To explore the neurobiological underpinnings of early migraine symptoms.
• To propose a mechanism for migraine initiation involving brainstem and diencephalic activation.

Main Methods:

• Review of current clinical and research literature on migraine premonitory phase.
• Analysis of functional neuroimaging studies investigating early migraine symptoms.
• Hypothesizing migraine attack initiation mechanisms.

Main Results:

• The premonitory phase involves diverse symptoms, including cognitive, mood, and sensory changes.
• Functional neuroimaging reveals activation in subcortical and diencephalic brain regions prior to headache onset.
• Hypothesized mechanism involves basal ganglia, hypothalamus, and thalamus activation, influencing brainstem trigeminovascular pathways.

Conclusions:

• The premonitory phase of migraine is a critical period for understanding attack initiation.
• Subcortical and diencephalic activation precedes headache, suggesting a top-down mechanism.
• Further research into this phase may yield novel migraine therapies.