Multimodal assessment of optokinetic visual stimulation response in migraine with aura.

OBJECTIVE

This study aimed to assess activation patterns and the hemodynamic response to optokinetic stimulation in migraine with aura patients compared with controls.

BACKGROUND

It has been proposed that altered visual motion processing in striate and extrastriate visual areas is present in migraine patients and might play a role in the pathophysiology of the disease. Besides activating a large visual network, optokinetic stimulation in particular has been shown to provoke symptoms associated with migraine.

METHODS

In this study, we examined the response to visual stimulation in 18 migraine with aura patients compared with 18 healthy controls by using functional magnetic resonance imaging and functional transcranial Doppler, thereby assessing the activation pattern of the visual areas (V1-V5) as well as the vasomotor reactivity of the posterior cerebral artery. For stimulation, we used a vertically rotating optokinetic drum with complex colored figures.

RESULTS

Group analysis of migraineurs with aura vs controls revealed different activation patterns in functional magnetic resonance imaging: attenuation of the physiological right lateralization with a significantly increased activation in the left V5 complex, the left area V3, and the right V5 complex. Analysis of the visually evoked flow response of the cerebral blood flow velocity in the posterior cerebral artery showed a larger side-difference of the offset latency (P < .05) and a reduced steepness of the decreasing slope on the left side (P < .05).

CONCLUSION

Combining examinations with a good structural (functional magnetic resonance imaging) and temporal (functional transcranial Doppler) resolution is a novel approach to migraine pathophysiology. Our findings of an altered pattern of activation by optokinetic visual stimulation with hyperresponsiveness in visual areas activated by motion perception (V5 and V3) further strengthen the concept of an interictal motion-processing deficit in migraine. This is complemented by the slower restitution of the visually evoked flow response after stimulus offset in migraine with aura patients.