Afridi Shazia K, Giffin Nicola J, Kaube Holger, Friston Karl J, Ward Nick S, Frackowiak Richard S J, Goadsby Peter J
Headache Group, Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, England.
Arch Neurol. 2005 Aug;62(8):1270-5. doi: 10.1001/archneur.62.8.1270.
Functional brain imaging in acute migraine has proved challenging because of the logistic problems associated with an episodic condition. Since the seminal observation of brainstem activation in migraine, there has been only a single case substantiating this finding.
To test the hypothesis that brainstem activation could be detected in migraine and to refine the anatomic localization with higher-resolution positron emission tomography than previously used.
Using positron emission tomography with radioactive water (H(2)15O), we studied acute migraine attacks occurring spontaneously. Five patients underwent imaging in ictal and interictal states, and the differences were analyzed by means of statistical parametric mapping.
Tertiary referral center.
Six volunteers with episodic migraine were recruited from advertisements in migraine newsletters. One patient was excluded because of use of preventive medication.
Brainstem activation during migraine state vs interictal state.
Two patients had a typical migrainous aura before the onset of the headache. All of the attacks studied fulfilled standard diagnostic criteria for migraine. Comparing the migraine scans with interictal scans, there was significant activation in the dorsal pons, lateralized to the left (small volume correction, P = .003). Activation was also seen in the right anterior cingulate, posterior cingulate, cerebellum, thalamus, insula, prefrontal cortex, and temporal lobes. There was an area of deactivation in the migraine phase also located in the pons, lateralized to the right.
Our findings provide clear evidence of dorsal pontine activation in migraine and reinforce the view that migraine is a subcortical disorder modulating afferent neural traffic.
由于与发作性疾病相关的后勤问题，急性偏头痛的功能性脑成像已被证明具有挑战性。自从首次观察到偏头痛患者脑干激活以来，仅有一个病例证实了这一发现。
检验偏头痛患者脑干激活可被检测到的假设，并使用比以往更高分辨率的正电子发射断层扫描来完善解剖定位。
我们使用放射性水（H(2)15O）进行正电子发射断层扫描，研究自发发生的急性偏头痛发作。5名患者在发作期和发作间期接受成像，并通过统计参数映射分析差异。
三级转诊中心。
从偏头痛时事通讯中的广告招募了6名发作性偏头痛志愿者。1名患者因使用预防性药物被排除。
偏头痛状态与发作间期状态下的脑干激活情况。
2名患者在头痛发作前有典型的偏头痛先兆。所有研究的发作均符合偏头痛的标准诊断标准。将偏头痛扫描与发作间期扫描进行比较，脑桥背侧有明显激活，定位于左侧（小体积校正，P = 0.003）。右侧前扣带回、后扣带回、小脑、丘脑、岛叶、前额叶皮质和颞叶也可见激活。偏头痛期也有一个失活区域位于脑桥，定位于右侧。
我们的研究结果为偏头痛患者脑桥背侧激活提供了明确证据，并强化了偏头痛是一种调节传入神经流量的皮质下疾病的观点。
