Is ischemia involved in the pathogenesis of migraine?

Regional cerebral blood flow (rCBF) was measured in 254 areas of a hemisphere with the intraarterial 133-xenon method in seven patients before and during classical migraine attacks. During prodromes/accompaniments focal flow was markedly reduced (mean 36 p. cent. range 22-60 p. cents). Initial focal hyperemia was observed in three patients, loss of functional focal activation in six patients and headache during oligemia in four patients. The oligemia was observed in all seven patients. It started at the posterior pole of the brain and gradually spread anteriorly in the course of 15-45 minutes. The findings indicate that a simple vasospastic model of the classical migraine attack is not likely. In six patients with common migraine, attacks were induced with red wine. On eight occasions rCBF was measured before and after provocation, and just before and during induction of migraine attacks. In three patients stationary detection and xenon-inhalation was used. In one patient intra-arterial xenon and in four patients xenon-inhalation and 133-xenon tomography measuring from about 700 regions of the brain. Measurements were taken about 15 minutes apart. In no patient was oligemia observed at any time. The results suggest that the pathogenesis of common migraine is different from that of classical migraine.