Neuronal Dysexcitability May Be a Biomarker of Migraine: A Visual Evoked Potential Study

Abstract

We report neuronal sensitization and impaired habituation in migraine using pattern reversal visual evoked potential (PRVEP) and correlate these with clinical characteristics of migraine. Sixty-five migraineurs and 30 healthy controls were included. A detailed clinical examination was done and migraine characteristics, including migraine trigger, photophobia, phonophobia, and allodynia were noted. Consecutive 5 blocks of PRVEP were recorded averaging 100 epochs at 3 Hz stimuli. The amplitude of N75 and P100 were measured. Amplitude of first block was considered for sensitization, and impaired habituation was considered if any subsequent block was not suppressed. Migraineurs had sensitization of P100 (14.01 ± 6.02 vs 11.60 ± 5.17 µV; P = .049), but not of N75 (42.22 ± 4.79 vs 11.08 ± 4.56 µV; P = .27) compared with the controls. Impaired habituation of N75 was more marked and persisted up to fourth block of VEP recoding. Impaired habituation of P100 was significant only in the third block. Baseline N75 and P100 amplitudes were higher in females, and N75 was also higher in those with longer duration of illness. These phenomena did not correlate with visual triggers. Sensitization and impaired habituation were marked during headache. Based on the PRVEP findings, it may be concluded that migraineurs have sensitization of P100 and impaired habituation of N75 especially during headache. These phenomena may be useful for therapeutic monitoring.

Phonophobia and brainstem excitability in migraine

“…Another study using VEP has reported decreased habituation during the preictal phase, which became normal during headache with a trend toward elevation during the postictal phase (Judit et al., 2000). Other studies, however, have found no difference across migraine phases, rather there was sensitization along with impaired habituation during headache (Kalita et al., 2018).…”

“…Another study using VEP has reported decreased habituation during the preictal phase, which became normal during headache with a trend toward elevation during the postictal phase (Judit et al, 2000). Other studies, however, have found no difference across migraine phases, rather there was sensitization along with impaired habituation during headache (Kalita et al, 2018). F I G U R E 4 Regression curve and box overlaid with scattered plot diagrams show the correlation of brainstem auditory evoked potential at 60dBSL with clinical parameters and hearing threshold.…”

“…The excitability of central auditory pathway may be evaluated using BAEP. Impaired habituation has been reported as a biomarker of migraine based on visual evoked potential (VEP), somatosensory evoked potential (SEP), brainstem auditory evoked potential (BAEP), and P300 studies (Afra et al, 1998;Kalita et al, 2018;Montagna et al, 1985;Schoenen et al, 1985Schoenen et al, , 1995. Normally, the amplitude of evoked potential decreases on repeated stimulation (habituation); whereas this phenomenon is impaired in migraineurs.…”

“…During this period, they were advised to take paracetamol 650 mg and or ibuprofen 400 mg if needed. Patients were enquired about migraine triggers and allodynia using a questionnaire (Tables S1 and S2) (Kalita et al, 2018;Misra et al, 2013). Chronic migraine was considered if the patients had more than 15 headache attacks per month for previous 3 months, of which at least eight attacks had features of migraine (IHS, 2013).…”

A Randomized Controlled Trial of High Rate rTMS Versus rTMS and Amitriptyline in Chronic Migraine

“…Migraine is a multifactorial disease having genetic predisposition and environmental influences. Various studies have reported the basis of neurovascular theory, impaired habituation, and sensitization of cortical, thalamic, and brainstem neurons (7)(8)(9)(10)(11)(12)(13)(14)(15). Chronic migraine (CM) is more disabling compared to episodic migraine (EM) in terms of household productivities, missing family activities, work loss, and direct cost of treatment.…”