Christensen Rune H, Ashina Håkan, Al-Khazali Haidar M, Ocampo-Pineda Mario, Rahmanzadeh Reza, Hadjikhani Nouchine, Granziera Cristina, Amin Faisal Mohammad, Ashina Messoud
Department of Neurology, Danish Headache Center, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
Ann Neurol. 2025 Jun;97(6):1168-1179. doi: 10.1002/ana.27197. Epub 2025 Feb 4.
The involvement of cortical inflammation in migraine, particularly migraine with aura, has been a subject of considerable interest, but has proved challenging to demonstrate. We aimed to detect and characterize signs of cortical inflammation in adults with migraine using a novel, multimodal magnetic resonance imaging (MRI) technique.
We used T2 mapping to measure water content/cellularity, T1 mapping to measure tissue microstructure integrity, and apparent diffusion coefficient (ADC) mapping to measure intra- or extracellular edema. We compared these values between participants with migraine (with and without aura) and healthy controls using general linear models adjusted for age and sex.
Two hundred ninety-six adult participants with migraine and 155 age- and sex-matched healthy controls provided eligible imaging data. Among the participants with migraine, 103 had migraine with aura, 180 chronic migraine, and 88 were ictal during the scan. Participants with migraine had higher quantitative T2 (qT2) in the left occipital cortex than healthy controls (p < 0.0001). In migraine with aura, the higher qT2 was more widespread and located bilaterally in the occipital cortices, compared with controls (left, p < 0.0001; right p = 0.004). Post-hoc analysis revealed overlapping ADC elevations in migraine with aura compared with controls (p = 0.0069).
Quantitative MRI changes compatible with cortical inflammation were detected in participants with migraine, and appeared driven by the subgroup with aura. Higher occipital qT2 in migraine with aura might represent either extracellular edema or accumulation of inflammatory microglia or astrocytes. These results support the importance of cortical inflammation in migraine pathophysiology, particularly in migraine with aura. ANN NEUROL 2025;97:1168-1179.
皮质炎症在偏头痛尤其是伴先兆偏头痛中的作用一直是备受关注的课题，但事实证明难以证实。我们旨在使用一种新型多模态磁共振成像（MRI）技术来检测和表征成年偏头痛患者的皮质炎症迹象。
我们使用T2映射测量含水量/细胞密度，T1映射测量组织微结构完整性，并使用表观扩散系数（ADC）映射测量细胞内或细胞外水肿。我们使用针对年龄和性别进行调整的一般线性模型，比较偏头痛患者（有和无先兆）与健康对照者之间的这些值。
296名成年偏头痛患者和155名年龄及性别匹配的健康对照者提供了符合条件的影像数据。在偏头痛患者中，103例有先兆偏头痛，180例为慢性偏头痛，88例在扫描期间处于发作期。偏头痛患者左侧枕叶皮质的定量T2（qT2）高于健康对照者（p < 0.0001）。与对照者相比，有先兆偏头痛患者中较高的qT2分布更广泛且双侧位于枕叶皮质（左侧，p < 0.0001；右侧，p = 0.004）。事后分析显示，与对照者相比，有先兆偏头痛患者的ADC升高存在重叠（p = 0.0069）。
在偏头痛患者中检测到了与皮质炎症相符的定量MRI变化，且似乎由有先兆亚组驱动。有先兆偏头痛患者枕叶较高的qT2可能代表细胞外水肿或炎性小胶质细胞或星形胶质细胞的积聚。这些结果支持皮质炎症在偏头痛病理生理学中的重要性，尤其是在有先兆偏头痛中。《神经病学年鉴》2025年；97：1168 - 1179。
