Migraine Headache Is Not Associated With Cerebral Or Meningeal Vasodilatation - A 3T Magnetic Resonance Angiography Study

G. G. Schoonman; J. van der Grond; C. Kortmann; R. J. van der Geest; G. M. Terwindt; M. D. Ferrari

Disclosures

Brain. 2008;131(8):2192-2200. 

In This Article

Results

Clinical Effects of Infusion of NTG or Placebo

In total 32 migraine patients were randomly infused with either NTG (N = 27) or placebo (N = 5). Demographic characteristics of the study population are summarized in Table 1 . No attack occurred after placebo (0/5). In contrast, infusion of NTG provoked a migraine attack (all without aura) in 20/27 (74%) migraine patients after a median time of 3.75 h (range: 1.5-5.5 h). In 18/20 attacks the headache was unilateral (left: n = 9; right n = 9). The clinical characteristics of the patients who developed a migraine attack in response to NTG and the clinical features of the provoked attacks are summarized in Supplementary Table s1.

Side-to-side Differences for Blood Vessel Diameters

There were no (P > 0.05) right-to-left differences for the diameters of the four bilateral blood vessels (MMA, ICA, ECA, MCA, PCA) in any of the three conditions (data not shown), except for the MCA during session three (P = 0.024). This difference was considered not significant after correction for multiple testing. Similarly, in the 18 patients with a unilateral headache, there were no significant (P > 0.05) differences between the diameters on the headache and the non-headache side (Supplementary Table s4). Therefore, the mean diameters of the right and left blood vessels are presented throughout the article.

Diameter and Blood Flow Changes During Infusion of NTG or Placebo

During NTG infusion there was a significant vasodilatation of all blood vessels compared with baseline (Figure 3A-F and Supplementary Table s2; P < 0.01 for all blood vessels). The diameter increase was greatest in the extra-cerebral blood vessels (MMA and ECA), ranging from 16.4% to 30.3%, as compared with 6.7-20.7% diameter increase in the intra-cranial blood vessels (ICA, MCA, BA and PCA). During infusion of placebo, there were no changes in diameter for any of the blood vessels. There were no changes in ICA or BA blood flow during infusion of NTG or placebo (Figure 4A, B and Supplementary Table s3).

Figure 3.

(A-F) Mean blood vessel diameter changes (mean of left and right in bilateral vessels) in six selected intracranial blood vessels at baseline, during infusion of NTG or placebo, and during an NTG-provoked migraine or, if no attack had occurred, at 6 h after infusion. [filled circle = migraine patients (NTG) with a provoked attack, filled triangle = migraine patients (NTG) without an attack, cross = migraine patients (placebo) without an attack].

Figure 4.

(A and B) Mean blood flow in ICA (mean of left and right) and BA at baseline, during infusion of NTG or placebo, and during an NTG-provoked migraine or, if no attack had occurred, at 6 h after infusion. [filled circle = migraine patients (NTG) with a provoked attack, filled triangle = migraine patients (NTG) without an attack, cross = migraine patients (placebo) without an attack].

Diameter and Blood Flow Changes During Migraine Attacks

Compared with baseline, there were no significant (P > 0.05) diameter changes during attacks for any of the blood vessels ( Table 2 and Figure 3A-F). This was also true when controlling for the headache side in the 18 patients with an unilateral headache; the changes on the headache side were no different compared with those on the non-headache side (Supplementary Table s4). Similarly, there were no significant (P > 0.05) differences when comparing the mean diameter changes (baseline versus attack) in the 20 patients who developed a migraine attack after NTG with the changes (baseline versus 6 h post-infusion) in the seven patients who did not develop an attack and were measured 6 h after infusion. The attack versus no-attack change-differences were for the MMA = 0.06 mm (95% CI: -0.8 to 0.21), for the ECA = 0.05 mm (95% CI: -0.14 to 0.24), for the ICA = 0.06 mm (95% CI: -0.19 to 0.31), for the MCA = -0.13 (95% CI: -0.41 to 0.14), for the BA = -0.24 (95% CI: -0.59 to 0.11) and for the PCA = -0.02 (95% CI: -0.22 to 0.18). There were also no significant (P > 0.05) changes in total-, BA- or ICA-blood flow during a migraine attack when compared with baseline, nor were there significant (P > 0.05) differences in the changes observed during attacks when compared with the changes in the patients who did not develop an attack and were measured 6 h after infusion ( Table 3 ) (Supplementary Table s4).

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