Increased Cerebral Vasomotor Reactivity in Migraine With Aura: An Autoregulation Disorder? A Transcranial Doppler and Near-Infrared Spectroscopy Study

Abstract

Migraine with aura (MA) is associated with changes in cerebral blood flow (CBF), whereas the role of cerebral autoregulation is uncertain. This study aimed to evaluate basal CBF, cerebral blood volume (CBV) and vasomotor reactivity (VMR) in MA patients. Twenty-one controls and 16 MA patients (eight with side predominance) underwent simultaneous examination of flow velocity in the middle cerebral arteries by transcranial Doppler (TCD) and of near-infrared spectroscopy (NIRS) parameters [oxygen haemoglobin saturation: oxygen%, and total haemoglobin content (THC)] at rest and after hypercapnia. Cerebral VMR, THC and oxygen% increases were significantly greater on the predominant compared with the non-predominant migraine side, with both sides of patients without side predominance and with controls. These findings suggest altered autoregulation in MA patients, possibly secondary to impaired cerebrovascular autonomic control. Simultaneous TCD and NIRS investigation could represent a non-invasive approach to evaluate cerebral haemodynamics at the cortical and subcortical level.

The effects of topiramate therapy on cerebral metabolism in migraine with aura patients

“…Nedeltchev et al reported that migraine patients suffer from an autoregulation disorder, based on flow response behaviour in both MCAs and (31). Dora and Balkan studied patients with migraine and a control group.…”

“…TCD can be used to evaluate the flow characteristics of intracranial arteries, microemboli, and vasomotor reactivity (VMR). The acoustic window is the cranial bone's thinnest region for using TCD and the transtemporal window facilitates insonation of the ipsilateral middle cerebral artery (MCA), anterior cerebral artery (ACA), and posterior cerebral artery (PCA) (13,15,30,31). Neuronal activity is correlated with changes in local cerebral blood flow.…”

Neurovascular coupling in humans: Physiology, methodological advances and clinical implications

“…107 Further, when using other vasoactive stimuli, such as hypercapnia, the NIRSderived percent hyperemic response is markedly less (1À15% increases vs. 20À100% increases) of that demonstrated by NIRS. 108 This discrepancy, likely reflecting different physiological mechanisms, potentially impacts the sensitivity of NIRS to detect significant differences between clinical and control populations. 109 Clearly, more studies are needed to address the congruency of TCD and NIRS signals during NVC.…”

Time-Frequency Characterization of Cerebral Hemodynamics of Migraine Sufferers as Assessed by NIRS Signals

“…Results are not consistent in literature, since the testing procedures may vary from group to group. In previous studies, we documented a limited vasodilation capability in migraine sufferers [12], but Vernieri et al recently found an increase in the vascular response of migraineurs [20], possibly mediated by a dysfunction in the autonomic control. Such experiments, conducted on groups of patients, document the limited reliability of time-derived parameters when used to assess autoregulation.…”

“…It has been proven that aura determines an alteration in the subjects' cerebral hemodynamics. Even if cerebral autoregulation impairment has been observed during MwA attacks, it is still unclear whether MwA sufferers present a normal autoregulation during attack-free periods [20]. The aim of our study was twofold: (i) first, to accurately measure the VLF and LF power changes in the NIRS signals of migraineurs during active stimulations; and (ii) second, to document possible differences in the cerebral hemodynamics of MwA and MwoA sufferers.…”