Hypothalamic Activation in Spontaneous Migraine Attacks

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


Headache. 2007;47(10):1418-1426. 

In This Article


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.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.