This is your brain having a migraine

On the left, an arrow points to cerebral microbleeds recorded 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 of the microbleeds.

On the left, an arrow points to cerebral microbleeds recorded 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 of the microbleeds.
Image: RSNA and Wilson Xu

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

Migraine is a recurrent type of 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 an aura, including seeing bright spots of light, ringing in the ears, or numbness and tingling down the body. . These episodes usually last for hours, but they can sometimes last for days to 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 to affect about 12% of the population, and women are more likely to report them than men. It is estimated that about 1% to 2% of the population suffers from chronic migraines, or episodes that occur at least 15 days per month.

Migraines can be treated acutely with pain medications, and some people have been able to reduce their frequency by avoiding known triggers, such as certain foods. In recent years, the Food and Drug Administration approved 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 treatment or prevention options to discover.

With their new research, USC scientists believe they are the first to look at the brains of migraine patients using a relatively new 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 ones controls matched in age.

The arrows on the left point to enlarged perivascular spaces seen in the center semioval of someone with chronic migraine.  The brain scan on the right with no enlarged spaces is from a control without migraine.

The arrows on the left point to enlarged perivascular spaces seen in the center semioval of someone with chronic migraine. The brain scan on the right with no enlarged spaces is from a control without migraine.
Image: RSNA and Wilson Xu

In both migraine groups, the team found a greater number of enlarged perivascular spaces, which are fluid-filled cavities near blood vessels in certain parts of the body, including the brain. These spaces were most prominent in the centrum semiovale, the central region of white matter in the brain. They also found that the presence of these spaces was associated with white matter lesions, although there was no significant difference in the severity of lesions 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 clearance system in the brain,” he said Wilson Xu, an MD candidate at USC’s Keck School of Medicine, in a pronunciation provided by the RNSA. “By studying how they contribute to migraines, we can better understand the complexities of how migraines occur.”

Enlarged perivascular spaces have been linked other neurological conditions, such as dementia. But the squad say it is the first time that these kinds of changes have been identified in this specific part of the brain in migraineurs. At the same time, they warn that the implications of what they found are insecure.

While some studies in the past have suggested a link between headaches and these enlarged spaces, for example, others not. It is also not known why they can occur in patients. The scientists speculate that it could be a malfunction of the brain’s glymphatic system, the system that uses perivascular ducts to flush waste products from the brain. Even if this hypothesis is true, it’s not clear if these enlarged spaces appear as a result of migraines or if they play a role in causing them. Finally, the findings still need to be formally peer reviewed, which is an important part of the scientific process.

Nevertheless, this kind of fundamental research may offer a solution new leads to migraine treatments and diagnostic tests, the researchers say.

“The results of our study may 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 migraines,” Xu said. “Ultimately, this could help us develop new, personalized ways to diagnose and treat migraines.”

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