Recent Insights in Migraine With Aura: A Narrative Review of Advanced Neuroimaging

Abstract

Introduction Migraine is a complex neurological disorder characterized by severe headaches associated with a plethora of sensory hypersensitivity and neurovegetative symptoms. In about one‐third of the cases, a set of fully reversible focal neurological symptoms, the aura, accompanies the headache. In the last decades, advanced neuroimaging investigations allowed identification of structural, microstructural, and functional abnormalities characterizing the brain of patients with migraine with aura (MwA). However, mechanisms underlying the aura phenomena are still a matter of debate. Aims This article reviews the most significant findings from advanced neuroimaging studies in patients with MwA both to provide a unifying physiopathological model of the aura phenomena and to clarify the potential impact of advanced neuroimaging investigation in the clinical field. Methods A comprehensive review of PubMed citations was conducted by entering the key words “magnetic resonance imaging” combined with “migraine” AND “aura.” Other key words included “grey matter” OR “white matter,” “structural” OR “functional.” The only restriction was to English‐language publications. The abstracts of all articles published between 1997 and 2018 meeting these criteria were reviewed, and the full texts were examined for relevance to the topic. Conclusion Although several advanced neuroimaging studies have been conducted to investigate the neural correlates of aura phenomena, they have failed in identifying underlying pathophysiological mechanisms in their entirety. Nevertheless, functional and structural neuroimaging findings concerning the extrastriate visual cortex are characterized by a high level of reproducibility, so much so that they could be applied, in a not so far future, as diagnostic, prognostic, or therapeutic biomarkers for MwA.

Functional magnetic resonance imaging of headache: Issues, best‐practices, and new directions, a narrative review

“…The authors go on to outline what is known, including the phenomenon of spreading depolarization 1 . For several of the agreed‐upon aspects of headache pathophysiology, including this one, functional magnetic resonance imaging (fMRI) has played a key role 2 …”

“…1 For several of the agreed-upon aspects of headache pathophysiology, including this one, functional magnetic resonance imaging (fMRI) has played a key role. 2 Neuroimaging has made these contributions in part because it is a non-invasive method for bridging our understanding between basic science findings in animal models and the human brain. An example is the role of fMRI (which in essence tracks changes in oxygenated blood flow) in our understanding of spreading cortical depolarization.…”

Migraine with aura: MRI with perfusion aspects in the ictal and interictal phases

“…Usually at the first manifestation or at the change in the aura pattern, neuroimaging is necessary, considering secondary headache, because one of the main differential diagnoses is the stroke. The gradual onset of neurological deficits, the association with headache that is typically migrainous, and the absence of ischemia on neuroimaging exams are suggestive of MwA (2,3) . Perfusion MRI in the ictal phase reveals decreased cerebral blood flow, with no abnormalities in the DWI sequence, that is, at sub-ischemic levels.…”

“…Perfusion MRI in the ictal phase reveals decreased cerebral blood flow, with no abnormalities in the DWI sequence, that is, at sub-ischemic levels. Vascular alteration that is reversed in the interictal period (3) .…”

Análise das lesões de substância branca identificadas por ressonância magnética de mulheres portadoras de migrânea

“…Como mecanismo celular, desta-se a apoptose induzida pelo aumento do cálcio intracelular e alteração mitocondrial intra-axonal. (55,56,71) Além disso, comorbidades, mais prevalentes entre migranosos, contribuir o surgimento das LSBs: hipo e hipertireoidismo subclínicos, elevação da homocisteína, forame oval patente, prolapso de valva mitral. Existem ainda os casos nos quais a migrânea é apenas parte da apresentação clínica de uma doença de base, a exemplo do que ocorre no CADASIL, na esclerose múltiplas e em algumas mitocondriopatias.…”