Migraine: High-resolution MRI may help pinpoint some causes of these headaches

Migraine is a complex condition that often involves severe headaches.

These headaches can be painful and debilitating. People may have triggers that bring on migraine headaches, such as stress, smoking, or changes in the weather.

Dr. Achillefs Ntranos, a neurologist trained at Johns Hopkins in Baltimore and Mount Sinai in New York, and now practices in Beverly Hills, California, explained to Medical News Today:

“Migraines are a neurological disorder that affects the brain and can cause a range of symptoms in addition to severe headache pain. These symptoms can include nausea, vomiting, and sensitivity to light, sound, and smells. Some people also experience an aura before the headache, which can include visual disturbances such as seeing flashing lights or blind spots. Migraines can vary in frequency and intensity, with some people experiencing them occasionally and others having them multiple times per week.”

Treatment for migraine may involve the use of medications and lifestyle modifications.

However, there is much about migraine causes and brain changes that experts still don’t understand.

Researchers are still working to understand the underlying mechanisms behind migraine, including the changes they can observe in the brain.

Researchers in the current study wanted to look at specific brain differences in people who experience migraine.

Their study included 10 participants who had chronic migraine and 10 who had episodic migraine without aura. They compared these participants to five people who don’t experience migraine.

The researchers utilized a special type of MRI in their research to perform highly-refined scans.

Wilson Xu, a study author who is currently working in the neuroradiology department at the University of Southern California as part of the Sheikh-Bahaei Lab, explained to MNT:

“Our study used ultra-high field 7T MRI to look at the brains of migraine patients, and compared to most clinically available MRIs right now (which are mainly 3T or 1.5T), 7T MRI has much higher resolution and better image quality for better detection of very small changes in brain tissue that would otherwise not be visible with other MRI types.”

Researchers studied three key components when looking at the images. Xu explained each of them to MNT:

• Perivascular spaces (or PVS) are small fluid-filled spaces in the brain found next to blood vessels and are thought to be part of a glymphatic (or fluid and waste clearance) system in the brain.
• White matter hyperintensities (or WMH) are bright spots in the white matter seen on MRI, a common finding in many neurological disorders. Many believe they represent long-standing ischemia (or reduced blood flow) in the brain or changes in small vessels that supply the brain with blood.
• Cerebral microbleeds (or CMB) are small, chronic areas of bleeding in the brain likely caused by abnormal blood vessels and are seen as small dark spots on certain types of MRI.

W​hen researchers looked at each of these components, they found that participants with migraine had enlarged perivascular spaces in a specific area of the brain called the centrum semiovale, the central area of white matter.

These enlarged perivascular spaces were further associated with more severe white matter hyperintensities among participants with migraine.

“The study found a correlation between the quantity of enlarged perivascular spaces in the centrum semiovale and the severity of white matter hyperintensities in the brain,” Ntranos noted. “These findings add to our understanding of the potential structural changes in the brain associated with migraines.”

Xu said he was fascinated by the study’s results because it could bring researchers closer to understanding the underlying mechanisms of migraine:

“These findings are exciting because they suggest some kind of disruption in the waste clearance system of the brain in migraine; previous studies show many neurological disorders are associated with increased PVS. Whether these changes cause migraine to develop OR are a result of migraine is still unclear, as is the exact mechanism behind how migraine works.”

This study only provides a limited amount of data and indicates the need for further research.

For example, looking at the brain differences does not prove that migraine causes these changes or vice versa. The study also only included a limited number of participants, so larger studies will likely be needed to confirm its findings.

Xu noted a few areas for continued research:

“Our goal is to continue using ultra-high field 7T MRI for additional studies, this time with larger populations of patients, longer follow-up periods, and more migraine types to confirm our findings; we hope that with additional studies, we can better understand what exactly the relationship is between these changes and migraine.”

He further explained that further understanding in this area will ideally improve outcomes for those who experience migraine:

“Hopefully, as we learn more about migraine and understand more about the underlying pathophysiology, we might even be able to use these changes as biomarkers to better diagnose migraine and choose medications that will best help treat and prevent migraine in these patients.”