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Shazia K. Afridi, BSc, MRCP; Nicola J. Giffin, MD, MRCP; Holger Kaube, MD; Karl J. Friston, MA, MRCPsych; Nick S. Ward, PhD, MRCP; Richard S. J. Frackowiak, MA, MD, DSc, FRCP; Peter J. Goadsby, MD, PhD, DSc, FRCP

Arch Neurol. 2005;62:1270-1275.

Background  Functional brain imaging in acute migraine has proved challenging because of the logistic problems associated with an episodic condition. Since the seminal observation of brainstem activation in migraine, there has been only a single case substantiating this finding.

Objective  To test the hypothesis that brainstem activation could be detected in migraine and to refine the anatomic localization with higher-resolution positron emission tomography than previously used.

Design  Using positron emission tomography with radioactive water (H₂¹⁵O), we studied acute migraine attacks occurring spontaneously. Five patients underwent imaging in ictal and interictal states, and the differences were analyzed by means of statistical parametric mapping.

Setting  Tertiary referral center.

Patients  Six volunteers with episodic migraine were recruited from advertisements in migraine newsletters. One patient was excluded because of use of preventive medication.

Main Outcome Measure  Brainstem activation during migraine state vs interictal state.

Results  Two patients had a typical migrainous aura before the onset of the headache. All of the attacks studied fulfilled standard diagnostic criteria for migraine. Comparing the migraine scans with interictal scans, there was significant activation in the dorsal pons, lateralized to the left (small volume correction, P = .003). Activation was also seen in the right anterior cingulate, posterior cingulate, cerebellum, thalamus, insula, prefrontal cortex, and temporal lobes. There was an area of deactivation in the migraine phase also located in the pons, lateralized to the right.

Conclusions  Our findings provide clear evidence of dorsal pontine activation in migraine and reinforce the view that migraine is a subcortical disorder modulating afferent neural traffic.

Author Affiliations: Headache Group (Drs Afridi, Giffin, Kaube, and Goadsby) and Wellcome Department of Imaging Neuroscience (Drs Friston, Ward, and Frackowiak), Institute of Neurology and The National Hospital for Neurology and Neurosurgery, London, England.

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