This Article  • Full text  • PDF  • Reply to article  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (131)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Headache  • Migraine  • Radiologic Imaging  • Magnetic Resonance Imaging  • Alert me on articles by topic  Social Bookmarking   What's this?

Yue Cao, PhD; K. M. A. Welch, MD; Sheena Aurora, MD; Eric M. Vikingstad, BS

Arch Neurol. 1999;56:548-554.

Background  Spreading depression of Leao has been hypothesized as the basis for the visual aura of the migraine attack, supported by cerebral blood flow measurements of spreading hypoperfusion. The early depolarizing or activation phase of experimental spreading depression, however, is associated with a transient but pronounced cerebral blood flow increase that precedes spreading hypoperfusion.

Objective  To study this early phase of the migraine attack, we investigated visually triggered attacks of headache and visual symptoms using a red-green checkerboard stimulus in patients with migraine.

Interventions  We studied occipital cortex activation during visual stimulation by measuring occipital cortex perfusion with functional magnetic resonance imaging–blood oxygenation level-dependent contrast in 10 patients with migraine with aura and 2 patients with migraine without aura and 6 healthy subjects.

Results  In 6 patients with migraine with aura and 2 patients with migraine without aura, their typical headache with (n=2) or without visual change was visually triggered at 7.3 minutes (mean time) after visual stimulation began. In 5 of these patients, the onset of headache or visual change, or both, was preceded by suppression of initial activation (mean onset time, 4.3 minutes; P<.001) The suppression slowly propagated into contiguous occipital cortex at a rate ranging from 3 to 6 mm/min. This neuronal suppression was accompanied by baseline contrast intensity increases that indicated vasodilatation and tissue hyperoxygenation.

Conclusions  We conclude that visually triggered headache and visual change in patients with migraine is accompanied by spreading suppression of initial neuronal activation and increased occipital cortex oxygenation. We postulate that this spreading suppression may be associated with initial activation of a migraine attack, independent of whether there are associated aura symptoms. We further postulate that there may be an association between vasodilation accompanying the initial stage of suppression and the induction of headache.

From the Headache Research Center and NMR Research Center, Department of Neurology, Henry Ford Health Sciences Center, Case Western Reserve University, Detroit, Mich.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

RELATED ARTICLE

Archives of Neurology Reader's Choice: Continuing Medical Education
Arch Neurol. 1999;56(5):634-636.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Migraine Associated Cerebral Hyperperfusion with Arterial Spin-Labeled MR Imaging
Pollock et al.
Am. J. Neuroradiol. 2008;29:1494-1497.
ABSTRACT | FULL TEXT  

Vernier Acuity Is Normal in Migraine, whereas Global Form and Global Motion Perception Are Not.
McKendrick et al.
IOVS 2006;47:3213-3219.
ABSTRACT | FULL TEXT  

Occipital activation in glyceryl trinitrate induced migraine with visual aura
Afridi et al.
J. Neurol. Neurosurg. Psychiatry 2005;76:1158-1160.
ABSTRACT | FULL TEXT  

A Positron Emission Tomographic Study in Spontaneous Migraine
Afridi et al.
Arch Neurol 2005;62:1270-1275.
ABSTRACT | FULL TEXT  

Targeting therapy for migraine: What to treat?
Ramadan
Neurology 2005;64:S4-S8.
FULL TEXT  

Migraine, headache, and the risk of stroke in women: A prospective study
Kurth et al.
Neurology 2005;64:1020-1026.
ABSTRACT | FULL TEXT  

Contemporary concepts of migraine pathogenesis
Welch
Neurology 2003;61:S2-8.
ABSTRACT | FULL TEXT  

Therapeutic implications of central and peripheral neurologic mechanisms in migraine
Waeber and Moskowitz
Neurology 2003;61:S9-20.
FULL TEXT  

Headache: lessons learned from functional imaging
May
Br Med Bull 2003;65:223-234.
ABSTRACT | FULL TEXT  

Cortical spreading depression in the feline brain following sustained and transient stimuli studied using diffusion-weighted imaging
Bradley et al.
J. Physiol. 2002;544:39-56.
ABSTRACT | FULL TEXT  

Functional MRI-BOLD of brainstem structures during visually triggered migraine
Cao et al.
Neurology 2002;59:72-78.
ABSTRACT | FULL TEXT  

Transcranial magnetic stimulation of visual area V5 in migraine
Battelli et al.
Neurology 2002;58:1066-1069.
ABSTRACT | FULL TEXT  

Effects of repetitive transcranial magnetic stimulation on visual evoked potentials in migraine
Bohotin et al.
Brain 2002;125:912-922.
ABSTRACT | FULL TEXT  

Migraine -- Current Understanding and Treatment
Goadsby et al.
NEJM 2002;346:257-270.
FULL TEXT  

Asymmetric Propagation of Spreading Depression Along the Anteroposterior Axis of the Cerebral Cortex in Mice
Godukhin and Obrenovitch
J. Neurophysiol. 2001;86:2109-2111.
ABSTRACT | FULL TEXT  

Mechanisms of Spreading Depression and Hypoxic Spreading Depression-Like Depolarization
Somjen
Physiol. Rev. 2001;81:1065-1096.
ABSTRACT | FULL TEXT  

Aura in some patients with familial hemiplegic migraine can be stopped by intranasal ketamine
Kaube et al.
Neurology 2000;55:139-141.
ABSTRACT | FULL TEXT  

Mechanisms of migraine aura revealed by functional MRI in human visual cortex
Hadjikhani et al.
Proc. Natl. Acad. Sci. USA 2001;98:4687-4692.
ABSTRACT | FULL TEXT