Phase Contrast MRI Suggests an Internal Carotid Vascular Tone Alteration in Migraines

Abstract

Introduction Migraine is the most common neurological disorder and the third most common disease worldwide. However, the underlying mechanisms contributing to its development are not completely understood. Symptoms may arise from a combination of dilation-independent vascular events and neurogenic mechanisms interacting throughout the brain and within the trigeminovascular system in the meninges

Materials and method We report here a case of a patient with a suspected familial hemiplegic migraine who presented an increased recurrence of events from one per month to one every other day. Three magnetic resonance imaging (MRI) acquisitions were performed after the appearance of a strong crisis which included a paresthesia and aphasia along with headaches. Two MRIs were performed close to the crisis, while the last one was done 1 month later.

Results During the crisis, cerebral perfusion exhibits incoherent results. Blood velocity measurements highlight a strong phase lag between left internal carotid artery (ICA) and basilar artery and more importantly right ICA. After a month, parameters came back to standard values.

Conclusion The transitory nature of the observed modifications suggests a reversible alteration of the vascular tone of the ICA in patients with migraine. This alteration seems to follow recovery pattern of the patient.

Keywords

migraine - MRI - adolescence - perfusion - vascular tone

Compliance with Ethical Standards

Procedures were compliant with the declaration of Helsinki. Informed consent was obtained from subject and its family. Authors report no potential conflicts of interest.

• References

• 1 Shevel E. The extracranial vascular theory of migraine--a great story confirmed by the facts. Headache 2011; 51 (03) 409-417
• 2 Goadsby PJ. The vascular theory of migraine--a great story wrecked by the facts. Brain 2009; 132 (Pt 1): 6-7
• 3 Tietjen GE, Khubchandani J. Vascular biomarkers in migraine. Cephalalgia 2015; 35 (02) 95-117
• 4 Levy D. Migraine pain and nociceptor activation--where do we stand?. Headache 2010; 50 (05) 909-916
• 5 Frederiksen SD, Haanes KA, Warfvinge K, Edvinsson L. Perivascular neurotransmitters: regulation of cerebral blood flow and role in primary headaches. J Cereb Blood Flow Metab 2017 Doi: 10.1177/0271678 × 17747188
• 6 Ayata C, Shin HK, Salomone S. , et al. Pronounced hypoperfusion during spreading depression in mouse cortex. J Cereb Blood Flow Metab 2004; 24 (10) 1172-1182
• 7 Jacobs B, Dussor G. Neurovascular contributions to migraine: moving beyond vasodilation. Neuroscience 2016; 338: 130-144
• 8 Bartolini M, Baruffaldi R, Paolino I, Silvestrini M. Cerebral blood flow changes in the different phases of migraine. Funct Neurol 2005; 20 (04) 209-211
• 9 Loehrer E, Vernooij MW, van der Lugt A, Hofman A, Ikram MA. Migraine and cerebral blood flow in the general population. Cephalalgia 2015; 35 (02) 190-198
• 10 Zarrinkoob L, Ambarki K, Wåhlin A, Birgander R, Eklund A, Malm J. Blood flow distribution in cerebral arteries. J Cereb Blood Flow Metab 2015; 35 (04) 648-654
• 11 Shayestagul NA, Christensen CE, Amin FM, Ashina S, Ashina M. Measurement of blood flow velocity in the middle cerebral artery during spontaneous migraine attacks: a systematic review. Headache 2017; 57 (06) 852-861
• 12 Verbree J, van Osch MJP. Influence of the cardiac cycle on pCASL: cardiac triggering of the end-of-labeling. Magma N Y N March 2017 Doi: 10.1007/s10334-017-0611-6
• 13 Kröner ESJ, Lamb HJ, Siebelink H-MJ. , et al. Pulse wave velocity and flow in the carotid artery versus the aortic arch: effects of aging. J Magn Reson Imaging 2014; 40 (02) 287-293
• 14 Boysen NC, Dragon DN, Talman WT. Parasympathetic tonic dilatory influences on cerebral vessels. Auton Neurosci 2009; 147 (1-2): 101-104