Migraine Attacks as a Result of Hypothalamic Loss of Control

Abstract

To assess the natural trajectory of brain activity over the migraine cycle, we assessed (1) the cerebral perfusion and (2) the hypothalamic connectivity during spontaneous headache attacks with follow-up recordings towards the next migraine attack. Using pseudo-continuous arterial spin labelling and resting-state functional magnetic resonance imaging, 12 migraine patients were examined in 82 sessions. We detected cyclic changes of brain perfusion in the limbic circuit (insula, hippocampus, and nucleus accumbens), with the highest perfusion during headache attacks. In addition, we found an increase of hypothalamic connectivity to the limbic system over the interictal interval, then collapsing during the headache. Our data provide strong evidence for the predominant role of the hypothalamus as a zeitgeber for generating migraine attacks. Our findings suggest that migraine attacks are the result of the hypothalamus losing control over the limbic system.

Multilevel clinical fingerprinting: uncovering longitudinal changes in the functional connectome of the brain along the migraine cycle

“…Moreover, the FC decrease between the SMN and VAN (posterior insula) observed by (Araújo et al, 2023) was not replicated, though other connections involving the SMN or VAN showed decreased FC in our case. Decreased FC within limbic structures and with the hypothalamus has also been observed (Stankewitz et al, 2021;Stankewitz & Schulz, 2022). Furthermore, M-post shows decreased FC bilaterally for connections involving SMN and VN, as well as left DAN and DMN, yet no differences were found in the existing literature.…”

“…In a comprehensive review spanning fMRI studies from 2014 to 2021, only a small fraction (9 out of 114) included data partially collected during the ictal phase, and often the cycle phases were poorly defined (Schramm et al, 2023). Moreover, only 14 FC studies sampled more than one phase, and of these only 9 were longitudinal (Amin et al, 2018;Araújo et al, 2023;Filippi et al, 2022;Marciszewski et al, 2018;Meylakh et al, 2018;Schulte, Menz, et al, 2020;Schulte & May, 2016;Stankewitz et al, 2021;Stankewitz & Schulz, 2022), with some of them relying on the same sample and including 2 case studies. Furthermore, only 3 of the longitudinal studies sampled all migraine cycle phases and they did not compare them with healthy controls.…”