It's your brain with a migraine

It’s your brain with a migraine

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

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

New search 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 scans from patients with migraines. Compared to those without migraine, they found that these patients had a higher 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 disease, the researchers say.

Migraines are a recurring 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 aura, which may include seeing bright spots of light, ringing in the ears or numbness and tingling along the body. . These episodes usually last for hours, but sometimes they can persist for days to a week.

The exact cause of migraines is unclear, but there appears to be a strong genetic component, since people with a family history of migraines are more likely to develop them. Migraines are thought 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 a month.

Migraines can be managed acutely with painkillers, 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 has approved a new class of drugs that can more effectively treat or even prevent migraines. But there’s still a lot we don’t understand about the disease, and there may still be other avenues of treatment or prevention to be discovered.

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

Arrows on the left point to enlarged perivascular spaces seen in the semi-oval center of a person with chronic migraines.  The right brain scan without enlarged spaces is from a control without migraines.

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

In both groups of migraine sufferers, the team found more enlarged perivascular spaces, which are fluid-filled pockets located near blood vessels in certain parts of the body, including the brain. These spaces were largest in the centrum semiovale, the central white matter area of ​​the brain. They also found that the presence of these spaces was linked to white matter damage, although there was no significant difference in the severity of the damage found in people with and without migraines. The results are expected to be presented Wednesday at the annual meeting of the Radiological Society of North America (RSNA).

“The perivascular spaces are part of a fluid clearance system in the brain,” said Wilson Xu, an MD candidate at USC’s 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 related to other neurological conditions, such as dementia. But the team said this is the first time that these kinds of changes have been identified in this particular region of the brain in migraine sufferers. At the same time, they warn that the implications of what they have found are uncertain.

While some studies in the past have suggested a link between headaches and these enlarged spaces, for example, other do not have. It is also not known why they might appear in people with the condition. The scientists speculate that this could represent a breakdown in the brain’s glymphatic system, the system that uses the perivascular ducts to remove waste from the brain. Even if this assumption is true, it is unclear whether these enlarged spaces arise as a result of migraines or play a role in their cause. Finally, the results have not yet been formally peer reviewed, which is an important part of the scientific process.

Yet this kind of basic research might be able to provide new leads to migraine treatments and diagnostic tests, researchers say.

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

#brain #migraine

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