Regional cerebral perfusion during the premonitory phase of triggered migraine: A double‐blind randomized placebo‐controlled functional imaging study using pseudo‐continuous arterial spin labeling
Objective To identify changes in regional cerebral blood flow (CBF) associated with premonitory symptoms (PS) of nitroglycerin (NTG)‐triggered migraine attacks. Background PS could provide insights into attack initiation and alterations in neuronal function prior to headache onset. Methods We undert...
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| Veröffentlicht in: | Headache 2023-06, Vol.63 (6), p.771-787 |
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| creator | Karsan, Nazia Bose, Ray Pyari O'Daly, Owen Zelaya, Fernando Goadsby, Peter J. |
| description | Objective
To identify changes in regional cerebral blood flow (CBF) associated with premonitory symptoms (PS) of nitroglycerin (NTG)‐triggered migraine attacks.
Background
PS could provide insights into attack initiation and alterations in neuronal function prior to headache onset.
Methods
We undertook a functional imaging study using a double‐blind placebo‐controlled randomized approach in patients with migraine who spontaneously experienced PS, and in whom PS and migraine‐like headache could be induced by administration of NTG. All study visits took place in a dedicated clinical research facility housing a monitoring area with clinical beds next to a 3Tesla magnetic resonance imaging scanner. Fifty‐three patients with migraine were enrolled; imaging on at least one triggered visit was obtained from 25 patients, with 21 patients completing the entire imaging protocol including a placebo visit. Whole brain CBF maps were acquired using 3D pseudo‐continuous arterial spin labeling (3D pCASL).
Results
The primary outcome was that patients with migraine not taking preventive treatment (n = 12) displayed significant increases in CBF in anterior cingulate cortex, caudate, midbrain, lentiform, amygdala and hippocampus (p |
| doi_str_mv | 10.1111/head.14538 |
| format | Article |
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To identify changes in regional cerebral blood flow (CBF) associated with premonitory symptoms (PS) of nitroglycerin (NTG)‐triggered migraine attacks.
Background
PS could provide insights into attack initiation and alterations in neuronal function prior to headache onset.
Methods
We undertook a functional imaging study using a double‐blind placebo‐controlled randomized approach in patients with migraine who spontaneously experienced PS, and in whom PS and migraine‐like headache could be induced by administration of NTG. All study visits took place in a dedicated clinical research facility housing a monitoring area with clinical beds next to a 3Tesla magnetic resonance imaging scanner. Fifty‐three patients with migraine were enrolled; imaging on at least one triggered visit was obtained from 25 patients, with 21 patients completing the entire imaging protocol including a placebo visit. Whole brain CBF maps were acquired using 3D pseudo‐continuous arterial spin labeling (3D pCASL).
Results
The primary outcome was that patients with migraine not taking preventive treatment (n = 12) displayed significant increases in CBF in anterior cingulate cortex, caudate, midbrain, lentiform, amygdala and hippocampus (p < 0.05 family‐wise error‐corrected) during NTG‐induced PS. A separate region of interest analysis revealed significant CBF increases in the region of the hypothalamus (p = 0.006, effect size 0.77). Post hoc analyses revealed significant reductions in CBF over the occipital cortices in participants with a history of migraine with underlying aura (n = 14).
Conclusions
We identified significant regional CBF changes associated with NTG‐induced PS, consistent with other investigations and with novel findings, withstanding statistical comparison against placebo. These findings were not present in patients who continually took preventive medication. Additional findings were identified only in participants who experience migraine with aura. Understanding this biological and treatment‐related heterogeneity is vital to evaluating functional imaging outcomes in migraine research.</description><identifier>ISSN: 0017-8748</identifier><identifier>EISSN: 1526-4610</identifier><identifier>DOI: 10.1111/head.14538</identifier><identifier>PMID: 37337681</identifier><language>eng</language><publisher>United States: Wiley Subscription Services, Inc</publisher><subject>Amygdala ; Blood flow ; Brain - blood supply ; Brain - diagnostic imaging ; Brain mapping ; Cerebral blood flow ; Cerebrovascular Circulation - physiology ; Cortex (cingulate) ; Double-blind studies ; Error correction ; functional magnetic resonance imaging ; Headache ; Heterogeneity ; Humans ; Hypothalamus ; Image processing ; Labeling ; Magnetic resonance imaging ; Magnetic Resonance Imaging - methods ; Medical imaging ; Mesencephalon ; Migraine ; Migraine Disorders - diagnostic imaging ; Neuroimaging ; Nitroglycerin ; Nitroglycerin - adverse effects ; Occipital lobe ; Patients ; Placebos ; premonitory ; prodrome ; pseudo‐continuous arterial spin labeling ; regional cerebral blood flow ; Research facilities ; Spin labeling ; Spin Labels</subject><ispartof>Headache, 2023-06, Vol.63 (6), p.771-787</ispartof><rights>2023 The Authors. published by Wiley Periodicals LLC on behalf of American Headache Society.</rights><rights>2023 The Authors. Headache: The Journal of Head and Face Pain published by Wiley Periodicals LLC on behalf of American Headache Society.</rights><rights>2023. This article is published under http://creativecommons.org/licenses/by-nc-nd/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3938-3d9bf33fedf86d11c1bf282e660755c5fd0d2bd9af795778021e4b1f4e60ce3</citedby><cites>FETCH-LOGICAL-c3938-3d9bf33fedf86d11c1bf282e660755c5fd0d2bd9af795778021e4b1f4e60ce3</cites><orcidid>0000-0003-3260-5904 ; 0000-0002-9525-1560 ; 0000-0002-6946-5637 ; 0000-0001-5690-1252 ; 0000-0002-2755-2978</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://onlinelibrary.wiley.com/doi/pdf/10.1111%2Fhead.14538$$EPDF$$P50$$Gwiley$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://onlinelibrary.wiley.com/doi/full/10.1111%2Fhead.14538$$EHTML$$P50$$Gwiley$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,1411,27901,27902,45550,45551</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37337681$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Karsan, Nazia</creatorcontrib><creatorcontrib>Bose, Ray Pyari</creatorcontrib><creatorcontrib>O'Daly, Owen</creatorcontrib><creatorcontrib>Zelaya, Fernando</creatorcontrib><creatorcontrib>Goadsby, Peter J.</creatorcontrib><title>Regional cerebral perfusion during the premonitory phase of triggered migraine: A double‐blind randomized placebo‐controlled functional imaging study using pseudo‐continuous arterial spin labeling</title><title>Headache</title><addtitle>Headache</addtitle><description>Objective
To identify changes in regional cerebral blood flow (CBF) associated with premonitory symptoms (PS) of nitroglycerin (NTG)‐triggered migraine attacks.
Background
PS could provide insights into attack initiation and alterations in neuronal function prior to headache onset.
Methods
We undertook a functional imaging study using a double‐blind placebo‐controlled randomized approach in patients with migraine who spontaneously experienced PS, and in whom PS and migraine‐like headache could be induced by administration of NTG. All study visits took place in a dedicated clinical research facility housing a monitoring area with clinical beds next to a 3Tesla magnetic resonance imaging scanner. Fifty‐three patients with migraine were enrolled; imaging on at least one triggered visit was obtained from 25 patients, with 21 patients completing the entire imaging protocol including a placebo visit. Whole brain CBF maps were acquired using 3D pseudo‐continuous arterial spin labeling (3D pCASL).
Results
The primary outcome was that patients with migraine not taking preventive treatment (n = 12) displayed significant increases in CBF in anterior cingulate cortex, caudate, midbrain, lentiform, amygdala and hippocampus (p < 0.05 family‐wise error‐corrected) during NTG‐induced PS. A separate region of interest analysis revealed significant CBF increases in the region of the hypothalamus (p = 0.006, effect size 0.77). Post hoc analyses revealed significant reductions in CBF over the occipital cortices in participants with a history of migraine with underlying aura (n = 14).
Conclusions
We identified significant regional CBF changes associated with NTG‐induced PS, consistent with other investigations and with novel findings, withstanding statistical comparison against placebo. These findings were not present in patients who continually took preventive medication. Additional findings were identified only in participants who experience migraine with aura. Understanding this biological and treatment‐related heterogeneity is vital to evaluating functional imaging outcomes in migraine research.</description><subject>Amygdala</subject><subject>Blood flow</subject><subject>Brain - blood supply</subject><subject>Brain - diagnostic imaging</subject><subject>Brain mapping</subject><subject>Cerebral blood flow</subject><subject>Cerebrovascular Circulation - physiology</subject><subject>Cortex (cingulate)</subject><subject>Double-blind studies</subject><subject>Error correction</subject><subject>functional magnetic resonance imaging</subject><subject>Headache</subject><subject>Heterogeneity</subject><subject>Humans</subject><subject>Hypothalamus</subject><subject>Image processing</subject><subject>Labeling</subject><subject>Magnetic resonance imaging</subject><subject>Magnetic Resonance Imaging - methods</subject><subject>Medical imaging</subject><subject>Mesencephalon</subject><subject>Migraine</subject><subject>Migraine Disorders - diagnostic imaging</subject><subject>Neuroimaging</subject><subject>Nitroglycerin</subject><subject>Nitroglycerin - adverse effects</subject><subject>Occipital lobe</subject><subject>Patients</subject><subject>Placebos</subject><subject>premonitory</subject><subject>prodrome</subject><subject>pseudo‐continuous arterial spin labeling</subject><subject>regional cerebral blood flow</subject><subject>Research facilities</subject><subject>Spin labeling</subject><subject>Spin Labels</subject><issn>0017-8748</issn><issn>1526-4610</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>24P</sourceid><sourceid>EIF</sourceid><recordid>eNp9kc9u1DAQxi0EokvhwgMgS1wQ0hY7TuKE26otFKkSEnCP_GecdeXYwY6FlhOP0OfiMXgSvKTlwAFfPBr_5psZfwg9p-SMlvNmD0Kf0bph3QO0oU3VbuuWkodoQwjl247X3Ql6ktINIaRu-_YxOmGcMd52dIN-foLRBi8cVhBBxhLMEE1OJYl1jtaPeNkDniNMwdslxAOe9yIBDgYv0Y5jKdN4smMU1sNbvMM6ZOng149b6azXOAqvw2S_F2p2QoEM5UkFv8TgXEma7NWyjmAnMR4bpiXrAy4zlHhOkPV9ifU55IRFXCDaUpBm67ETEkqn8Sl6ZIRL8OzuPkWf311-Ob_aXn98_-F8d71VrGfdluleGsYMaNO1mlJFpam6CtqW8KZRjdFEV1L3wvC-4bwjFYVaUlNDSxSwU_RqVZ1j-JohLcNkkwLnhIcy21CkeF_RivCCvvwHvQk5lkVXqqaFIoV6vVIqhpQimGGO5SPiYaBkOPo7HP0d_vhb4Bd3kllOoP-i94YWgK7AN-vg8B-p4epyd7GK_gZIaLlj</recordid><startdate>202306</startdate><enddate>202306</enddate><creator>Karsan, Nazia</creator><creator>Bose, Ray Pyari</creator><creator>O'Daly, Owen</creator><creator>Zelaya, Fernando</creator><creator>Goadsby, Peter J.</creator><general>Wiley Subscription Services, Inc</general><scope>24P</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7TK</scope><scope>7U7</scope><scope>C1K</scope><scope>K9.</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-3260-5904</orcidid><orcidid>https://orcid.org/0000-0002-9525-1560</orcidid><orcidid>https://orcid.org/0000-0002-6946-5637</orcidid><orcidid>https://orcid.org/0000-0001-5690-1252</orcidid><orcidid>https://orcid.org/0000-0002-2755-2978</orcidid></search><sort><creationdate>202306</creationdate><title>Regional cerebral perfusion during the premonitory phase of triggered migraine: A double‐blind randomized placebo‐controlled functional imaging study using pseudo‐continuous arterial spin labeling</title><author>Karsan, Nazia ; Bose, Ray Pyari ; O'Daly, Owen ; Zelaya, Fernando ; Goadsby, Peter J.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3938-3d9bf33fedf86d11c1bf282e660755c5fd0d2bd9af795778021e4b1f4e60ce3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Amygdala</topic><topic>Blood flow</topic><topic>Brain - blood supply</topic><topic>Brain - diagnostic imaging</topic><topic>Brain mapping</topic><topic>Cerebral blood flow</topic><topic>Cerebrovascular Circulation - physiology</topic><topic>Cortex (cingulate)</topic><topic>Double-blind studies</topic><topic>Error correction</topic><topic>functional magnetic resonance imaging</topic><topic>Headache</topic><topic>Heterogeneity</topic><topic>Humans</topic><topic>Hypothalamus</topic><topic>Image processing</topic><topic>Labeling</topic><topic>Magnetic resonance imaging</topic><topic>Magnetic Resonance Imaging - methods</topic><topic>Medical imaging</topic><topic>Mesencephalon</topic><topic>Migraine</topic><topic>Migraine Disorders - diagnostic imaging</topic><topic>Neuroimaging</topic><topic>Nitroglycerin</topic><topic>Nitroglycerin - adverse effects</topic><topic>Occipital lobe</topic><topic>Patients</topic><topic>Placebos</topic><topic>premonitory</topic><topic>prodrome</topic><topic>pseudo‐continuous arterial spin labeling</topic><topic>regional cerebral blood flow</topic><topic>Research facilities</topic><topic>Spin labeling</topic><topic>Spin Labels</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Karsan, Nazia</creatorcontrib><creatorcontrib>Bose, Ray Pyari</creatorcontrib><creatorcontrib>O'Daly, Owen</creatorcontrib><creatorcontrib>Zelaya, Fernando</creatorcontrib><creatorcontrib>Goadsby, Peter J.</creatorcontrib><collection>Wiley Online Library Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Neurosciences Abstracts</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>MEDLINE - Academic</collection><jtitle>Headache</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Karsan, Nazia</au><au>Bose, Ray Pyari</au><au>O'Daly, Owen</au><au>Zelaya, Fernando</au><au>Goadsby, Peter J.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Regional cerebral perfusion during the premonitory phase of triggered migraine: A double‐blind randomized placebo‐controlled functional imaging study using pseudo‐continuous arterial spin labeling</atitle><jtitle>Headache</jtitle><addtitle>Headache</addtitle><date>2023-06</date><risdate>2023</risdate><volume>63</volume><issue>6</issue><spage>771</spage><epage>787</epage><pages>771-787</pages><issn>0017-8748</issn><eissn>1526-4610</eissn><abstract>Objective
To identify changes in regional cerebral blood flow (CBF) associated with premonitory symptoms (PS) of nitroglycerin (NTG)‐triggered migraine attacks.
Background
PS could provide insights into attack initiation and alterations in neuronal function prior to headache onset.
Methods
We undertook a functional imaging study using a double‐blind placebo‐controlled randomized approach in patients with migraine who spontaneously experienced PS, and in whom PS and migraine‐like headache could be induced by administration of NTG. All study visits took place in a dedicated clinical research facility housing a monitoring area with clinical beds next to a 3Tesla magnetic resonance imaging scanner. Fifty‐three patients with migraine were enrolled; imaging on at least one triggered visit was obtained from 25 patients, with 21 patients completing the entire imaging protocol including a placebo visit. Whole brain CBF maps were acquired using 3D pseudo‐continuous arterial spin labeling (3D pCASL).
Results
The primary outcome was that patients with migraine not taking preventive treatment (n = 12) displayed significant increases in CBF in anterior cingulate cortex, caudate, midbrain, lentiform, amygdala and hippocampus (p < 0.05 family‐wise error‐corrected) during NTG‐induced PS. A separate region of interest analysis revealed significant CBF increases in the region of the hypothalamus (p = 0.006, effect size 0.77). Post hoc analyses revealed significant reductions in CBF over the occipital cortices in participants with a history of migraine with underlying aura (n = 14).
Conclusions
We identified significant regional CBF changes associated with NTG‐induced PS, consistent with other investigations and with novel findings, withstanding statistical comparison against placebo. These findings were not present in patients who continually took preventive medication. Additional findings were identified only in participants who experience migraine with aura. Understanding this biological and treatment‐related heterogeneity is vital to evaluating functional imaging outcomes in migraine research.</abstract><cop>United States</cop><pub>Wiley Subscription Services, Inc</pub><pmid>37337681</pmid><doi>10.1111/head.14538</doi><tpages>17</tpages><orcidid>https://orcid.org/0000-0003-3260-5904</orcidid><orcidid>https://orcid.org/0000-0002-9525-1560</orcidid><orcidid>https://orcid.org/0000-0002-6946-5637</orcidid><orcidid>https://orcid.org/0000-0001-5690-1252</orcidid><orcidid>https://orcid.org/0000-0002-2755-2978</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Amygdala Blood flow Brain - blood supply Brain - diagnostic imaging Brain mapping Cerebral blood flow Cerebrovascular Circulation - physiology Cortex (cingulate) Double-blind studies Error correction functional magnetic resonance imaging Headache Heterogeneity Humans Hypothalamus Image processing Labeling Magnetic resonance imaging Magnetic Resonance Imaging - methods Medical imaging Mesencephalon Migraine Migraine Disorders - diagnostic imaging Neuroimaging Nitroglycerin Nitroglycerin - adverse effects Occipital lobe Patients Placebos premonitory prodrome pseudo‐continuous arterial spin labeling regional cerebral blood flow Research facilities Spin labeling Spin Labels |
| title | Regional cerebral perfusion during the premonitory phase of triggered migraine: A double‐blind randomized placebo‐controlled functional imaging study using pseudo‐continuous arterial spin labeling |
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