Neuronal Dynamics of Menstrually Related Migraine: A Longitudinal Task-Based fMRI Study

Area of Science:

• Neuroscience
• Medical Imaging
• Neurology

Background:

• Migraine research indicates hypothalamic involvement in headache generation.
• Menstrual migraine (MM) is influenced by hormonal fluctuations, raising questions about distinct neuronal mechanisms.
• Investigating pre-attack brain activity in MM is crucial for understanding its unique pathophysiology.

Purpose of the Study:

• To investigate central nervous system changes preceding menstrual migraine (MM) attacks using longitudinal, task-based functional magnetic resonance imaging (fMRI).
• To determine if MM has different neuronal attack generators compared to non-menstrual migraines.
• To explore the role of the hypothalamus in the preictal phase of MM.

Main Methods:

• Recruited patients with pure or menstrually related migraine and age/sex-matched healthy controls.
• Conducted daily task-based fMRI for 7-11 days, starting 6 days before expected menstruation.
• Used electrical forehead stimulation tailored to individual pain thresholds to activate the trigeminal nociceptive system.

Main Results:

• Ten MM patients and 13 controls completed the study.
• Patients with MM showed significant hypothalamic activation in the preictal phase (0-48 hours before headache onset).
• No hypothalamic activation was observed in MM patients during interictal/ictal phases or in healthy controls during the premenstrual period.

Conclusions:

• Hypothalamic activation is a consistent feature of migraine attacks, regardless of menstrual status.
• Hormonal changes in the late luteal phase may uniquely trigger hypothalamic activation in MM patients.
• Future research should combine neuroimaging with hormone level measurements to elucidate the interplay between hormones and hypothalamic activity in migraine.