This is your brain with migraine

On the left, an arrow points to cerebral microbleeds captured in the left temporal lobe in a case of migraine with aura.  On the right, the arrow points to another possible abnormality on the same side as the microbleeds.

On the left, an arrow points to cerebral microbleeds captured in the left temporal lobe in a case of migraine with aura. On the right, the arrow points to another possible abnormality on the same side as the microbleeds.
Image: RSNA and Wilson Xu

new research appears to offer the closest look yet at how migraines might affect the brain. Scientists at the University of Southern California in Los Angeles collected detailed MRI images of patients suffering from migraines. Compared with those without migraine, they found that these patients had a greater number of enlarged perivascular spaces, which may be a sign of damage to small blood vessels in the brain. The findings could one day lead to new treatments for the chronic condition, the researchers say.

Migraines are a type of recurring headache that usually causes moderate to severe pain. Often this pain is preceded or accompanied by other symptoms, such as nausea, fatigue, and a variety of sensory disturbances known as auras, which can include seeing bright points of light, ringing in the ears, or numbness and tingling throughout the body. . These episodes usually last for hours, but can sometimes persist for days or a week.

The exact cause of migraines is unclear, but there appears to be a strong genetic component, as people with a family history of migraines are more likely to develop them. migraines are thought they affect approximately 12% of the population, and women are more likely to report them than men. It is estimated that around 1% to 2% of the population experience chronic migraines, or episodes that occur at least 15 days a month.

Migraines can be managed acutely with pain relievers, and some people have been able to decrease their frequency by avoiding known triggers, such as certain foods. In recent years, the Food and Drug Administration has passed a new class of drugs that may more effectively treat or even prevent migraines. But there’s still a lot we don’t understand about the condition, and there may be other avenues of treatment or prevention yet to be discovered.

With their new research, the USC scientists believe they are the first to look at the brains of migraine sufferers using a relatively novel form of ultra-high-resolution MRI known as 7T MRI. They scanned the brains of 20 people with migraines, 10 of whom had chronic migraines and 10 of whom had episodic migraines without aura. For comparison, they also looked at the brains of five healthy people. age-matched controls.

Arrows on the left point to enlarged perivascular spaces seen in the semioval center of a person with chronic migraine headaches.  The brain scan on the right without enlarged spaces is taken from a control without migraines.

Arrows on the left point to enlarged perivascular spaces seen in the semioval center of a person with chronic migraine headaches. The brain scan on the right without enlarged spaces is taken from a control without migraines.
Image: RSNA and Wilson Xu

In both migraine groups, the team found a greater number of enlarged perivascular spaces, which are fluid-filled sacs located near blood vessels in certain parts of the body, including brain. These spaces were most prominent in the centrum semiovale, the central white matter area of ​​the brain. They also found that the presence of these spaces was related to white matter lesions, although there was no significant difference in the severity of the lesions found in people with or without migraines. The findings will be presented Wednesday at the annual meeting of the Radiological Society of North America (RSNA).

“Perivascular spaces are part of a fluid removal system in the brain,” said Wilson Xu, an MD candidate at USC Keck School of Medicine, in a statement provided by the RNSA. “Studying how they contribute to migraine could help us better understand the complexities of how migraines occur.”

Enlarged perivascular spaces have been bound to other neurological conditions, such as dementia. but the team He says It is the first time that these types of changes have been identified in this particular region of the brain in patients with migraine. At the same time, they caution that the implications of what they found are uncertain.

While some studies in the past have suggested a connection between headaches and these enlarged spaces, for example, others I have not. It is also not known why they might be appearing in patients. The scientists they speculate that it could represent a malfunction in the brain’s glymphatic system, the system that uses perivascular channels to remove waste products from the brain. Even if this hypothesis is true, it is not clear if these enlarged spaces appear as a result of migraines or if they play a role in their cause. Lastly, the findings have not yet been formally peer reviewed, which is an important part of the scientific process.

Still, this type of basic research could provide new clues towards migraine treatments and diagnostic tests, researchers tell.

“The results of our study could help inspire future larger-scale studies to further investigate how changes in the brain’s microscopic vessels and blood supply contribute to different types of migraine,” Xu said. “Eventually, this could help us develop new, personalized ways to diagnose and treat migraine.”

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