Hypothalamic Activation in Spontaneous Migraine Attacks

Marie Denuelle, MD; Nelly Fabre, MD; Pierre Payoux, MD; Francois Chollet, MD; Gilles Geraud, MD

Disclosures

Headache. 2007;47(10):1418-1426. 

In This Article

Results

Clinical Data

( Table 1 ) The 7 patients rated their pain as moderate to severe (5 to 9 on a scale from 0 to 10) during the headache phase. Photophobia was present during the attack in all patients, phonophobia in 5, and nausea in 5. The mean time from attack onset to PET scan was 3 h 08 (range 2 h 15 to 3 h 50). We obtained a total headache relief (0 on a scale from 0 to 10) in less than 60 minutes after a single sumatriptan injection in 6 patients.The seventh needed a second injection of sumatriptan and finally an injection of 1 g of aspirin to achieve headache resolution. The postpain relief PET scan was done within 6 hours of headache onset for all patients (from 4 h 20 to 6 hours, mean time 5 h 09).

PET Data

During acute migraine attacks (when compared to the headache free scans: comparison 1), we observed significant activations of the hypothalamus and several brainstem areas: the bilateral ventral midbrain, dorsal midbrain controlateral to the headache and the dorso-medial pons (Fig. 2). Activations during headache were also seen in both cerebellar hemispheres, fronto-inferior cortex ipsilateral to the headache (Brodmann areas [BA] 47, 13), and inferior anterocaudal cingulate cortex controlateral to the headache (BA 25) (P < .001, uncorrected for multiple comparison). All the areas of activation seen during headache persisted after treatment, when posttreatment scans were compared to the headache free condition (comparison 2: P < .001, uncorrected for multiple comparison, [Fig. 3]). After small volume correction, the activations of the hypothalamus and the brainstem observed before and after sumatriptan were significant (P = .001, corrected). The coordinates and Z-scores are listed in Table 2 .

Figure 2.

Hypothalamic activation during spontaneous migraine attacks in 7 patients.

Figure 3.

Brainstem and hypothalamic activations during spontaneous migraine attacks in 7 patients, before and after headache relief by sumatriptan.

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