Susceptibility Weighted Imaging in Migraines with and Without Aura: A Case-Control Study

Area of Science:

• Neuroimaging
• Neurology
• Radiology

Background:

• Cortical vein asymmetry in susceptibility weighted imaging (SWI) may serve as a biomarker for migraine auras and cortical spreading depression (CSD).
• Investigating SWI asymmetry in patients experiencing migraine attacks without aura is crucial for understanding migraine pathophysiology.

Purpose of the Study:

• To determine if SWI asymmetry is present in patients with migraine attacks without aura.
• To compare SWI findings between migraines with aura, migraines without aura, and control groups.

Main Methods:

• A cohort of 100 patients per group was recruited from an emergency room setting.
• Inclusion criteria included acute neurological deficit or headache, specific discharge diagnoses (migraine with aura, migraine without aura, or controls), and acute brain MRI with SWI.
• Patients were categorized into three groups: migraine with aura, migraine without aura, and controls (without stroke or epilepsy).

Main Results:

• SWI asymmetry was detected in 26% of patients with migraines with auras.
• In contrast, only 3% of patients with migraines without auras and 7% of controls exhibited SWI asymmetry (p < 0.001).
• No significant difference in SWI asymmetry was observed between patients with migraines without auras and the control group (p = 0.19).

Conclusions:

• Distinct SWI changes differentiate migraines with and without auras.
• These findings suggest that cortical spreading depression (CSD) may not play a significant role in the pathophysiology of migraines without auras.
• SWI asymmetry could be a valuable imaging biomarker for distinguishing migraine subtypes.