Cerebrovascular reactivity in migraine: a breath-hold BOLD fMRI study

Prior studies assessing cerebrovascular reactivity (CVR) in participants with migraine primarily utilized Doppler ultrasonography and focused on large vascular territories due to limitations of available technology. Newer functional MRI techniques detect alterations in CVR at much higher spatial resolution and, when coupled with an anatomical scan, allow correlation with specific brain regions. The goal of this study was to measure and compare CVR in participants with migraine during (ictal) versus between (interictal) spontaneous attacks using functional magnetic resonance imaging.

This is an observational cohort study in which CVR was measured using breath-hold BOLD functional MRI during spontaneous migraine attacks involving lateralized headache. All participants returned for a repeat scan when free of all migraine symptoms. CVR was assessed by comparing BOLD activity during the ictal versus interictal scans in the entire group as well as by headache laterality.

Eighteen participants completed the study [77.8% female; mean (SD) age 38.4 (13.6) years]. Comparing the ictal to the interictal scan in the full cohort, no voxel clusters met significance criteria. When stratified by headache laterality, two significant clusters were identified (one decreased/one increased CVR) in 6 participants with right-sided headache. The cluster demonstrating decreased CVR was in the left planum temporale/left Heschl's gyrus. The cluster demonstrating increased CVR was in the right crus I of the cerebellum. No clusters met significance criteria in 12 participants with left-sided headache.

Cerebrovascular reactivity was not observed to differ significantly during the ictal compared to the interictal state in the full cohort but did differ in the subgroup of participants with right-sided headache.