Never-before-seen images show what a migraine looks like in the brain

"This could help us develop new, personalized ways to diagnose and treat migraine."
Mert Erdemir
Punctate deep white matter hyperintensities (WMH) on sagittal T2-weighted MRI, more prominent in the frontal lobes.
Punctate deep white matter hyperintensities (WMH) on sagittal T2-weighted MRI, more prominent in the frontal lobes.

RSNA and Wilson Xu 

A new study spotted enlarged perivascular spaces in migraine sufferers' brains for the first time, according to a press release.

"In people with chronic migraine and episodic migraine without aura, there are significant changes in the perivascular spaces of a brain region called the centrum semiovale," said study co-author Wilson Xu, an M.D. candidate at Keck School of Medicine of the University of Southern California in Los Angeles.

"These changes have never been reported before."

Researchers will present the results of their study at the annual meeting of the Radiological Society of North America (RSNA) next week.

Studying the link between migraine and enlarged perivascular spaces

Migraine is a common neurologic disorder. Associated with an intense headache, it often affects one side of the head and can be extremely painful, throbbing, or pulsating. It frequently comes with high sensitivity to light and sound and nausea and vomiting.

More than 37 million people in the U.S. suffer from migraine, and up to 148 million people around the world are estimated to have chronic migraine, according to the American Migraine Foundation.

The research team used ultra-high-field 7T MRI to study the link between migraine and enlarged perivascular spaces. They also compared the scans to see how different types of migraine lead to structural microvascular changes.

"Perivascular spaces are part of a fluid clearance system in the brain," Xu said. "Studying how they contribute to migraine could help us better understand the complexities of how migraines occur."

Never-before-seen images show what a migraine looks like in the brain
Cerebral microbleeds visualized as round, dark lesions.

"To our knowledge, this is the first study using ultra-high-resolution MRI to study microvascular changes in the brain due to migraine, particularly in perivascular spaces," Xu said. "Because 7T MRI is able to create images of the brain with much higher resolution and better quality than other MRI types, it can be used to demonstrate much smaller changes that happen in brain tissue after a migraine."

Inspiring future studies

All between the ages of 25 and 60, study subjects included ten chronic migraine patients, ten people with episodic migraine without aura, and five age-matched healthy controls. The study did not include any participants with overt cognitive impairment, brain tumors, prior intracranial surgery, MRI contraindications, and claustrophobia.

The results of the analysis revealed that the number of enlarged perivascular spaces in the centrum semiovale, the central area of white matter, was significantly higher in patients with migraine than in healthy controls. Plus, the quantity of enlarged perivascular space in the centrum semiovale was associated with deep white matter hyperintensity severity in migraine patients.

"We studied chronic migraine and episodic migraine without aura and found that, for both types of migraine, perivascular spaces were bigger in the centrum semiovale," said Xu.

"Although we didn't find any significant changes in the severity of white matter lesions in patients with and without migraine, these white matter lesions were significantly linked to the presence of enlarged perivascular spaces. This suggests that changes in perivascular spaces could lead to the future development of more white matter lesions."

Xu and his team hope their study will pave the way for more studies on developing diagnosis and treatment methods for migraine.

"The results of our study could help inspire future, larger-scale studies to continue investigating how changes in the brain's microscopic vessels and blood supply contribute to different migraine types," Xu said.

"Eventually, this could help us develop new, personalized ways to diagnose and treat migraine."

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