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What is migraine and what does MRI tell us?

Migraine affects roughly 39,000,000 citizens in the U.S. including men, women and children.1 Worldwide, about 1,000,000,000 people have migraines.1 One of the most prevalent neurological diseases, migraine plagues more women than men and typically begins in childhood, adolescence or early adulthood. Many people with the disease are never diagnosed with migraine.1,2 Those who are, may have to undergo a few different tests, including a magnetic resonance imaging (MRI) scan.

The main symptoms of migraine is a severe throbbing pain or pulsing sensation that usually occurs on one side of the head, though it can be on both sides as well.2 A migraine can last for hours or days and is sometimes disabling. Some patients experience accompanying symptoms, which include nausea, vomiting and extreme sensitivity to light or sound. For some patients, migraine medication may prevent migraine attacks or make them less severe. There are four possible stages to migraine. The cause of migraines is unknown, but there are genetic and environmental risk factors. Many patients with migraine have at least one family member that also has migraine.

Stages of a migraine2

  • Prodrome is the first stage of a migraine and occurs one or two days before the migraine itself begins. Some possible symptoms that may be experienced during the prodrome stage are constipation, mood changes, food cravings, neck stiffness, increased thirst and urination, and frequent yawning.
  • Aura is the second possible stage of migraine, but many people do not have aura. If a patient has aura, symptoms may be before or during the migraine. In many cases, aura is described as visual disturbances, such as flashes of light or altered vision. Other symptoms include a sense of someone touching the patient, movement or speech disturbances and weak muscles.
  • Attack is the main part of the migraine cycle. A migraine attack can last anywhere from 4-72 hours. The pain typically manifests on one side of the head. This pain can be throbbing or pulsing and can be accompanied by sensitivity to light, sounds, smells or touch, nausea and vomiting, blurred vision and light-headedness, which is sometimes followed by fainting.
  • Post-drome is the final stage of migraine and occurs after the migraine attack. Patients may feel drained and washed out or elated. For a time, migraine sufferers may feel confusion, moodiness, dizziness, weakness or sensory sensitivity.

Triggers of migraine2

  • Hormone changes in women, especially changes in serotonin
  • Foods, such as aged cheeses
  • Food additives, like MSG
  • Drinks, especially those with a high concentration of caffeine
  • Stress
  • Sensory stimulation, such as flashing lights
  • Changes in the patient's wake-sleep pattern, both increased and decreased sleep time
  • Physical factors
  • Changes in the environment, including the weather
  • Medications

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Magnetic resonance imaging of migraine

Physicians do not necessarily need a magnetic resonance imaging (MRI) study to diagnose migraine.3 However, doctors may want to see the structure of the brain. This is primarily because there are two different categories that headaches are classified under: primary and secondary. Primary headache disorders refer to those that do not have a structural cause. Secondary headaches are caused by diseases processes. Migraine is classified as a primary headache. Different headache features may help classify the headache without imaging.

According to one physician, some findings may show on a physical examination that may prompt medical imaging. These include swelling of the optic nerve, abnormal reflexes, weakness on one side of the body, unsteady gait, double vision, vision loss, abnormal pupil reflex, confusion.3 In these cases, physicians may want to investigate brain structure, especially any abnormalities.

Research conducted in 2013 indicated that patients who suffer from migraines may have reduced cortical thickness and surface area in pain-processing regions of the brain when compared to those without migraines.4 These abnormalities may appear at birth or develop over time. If the changes appear over time, they could be related to atrophy, which has been shown in the same areas. This area may be damaged due to chronic stimulation. This study obtained T2-weighted and 3D T1-weighted images of 81 volunteers, 63 of which were chronic migraine sufferers.

For the millions of people suffering from migraines across the United States, the cause of the disease may seem extremely important. Magnetic resonance imaging may continue to provide information about the differences in patients with migraines, in addition to those abnormalities already found. The abnormalities detected using different imaging techniques may eventually lead to a known cause for migraines. If the abnormalities are able to be treated, it could lead to at least partial relief for many people around the world.

References

1. Migraine Research Foundation. "About Migraine." migraineresearchfoundation.org. 2019. Web. 21 May 2019. <https://migraineresearchfoundation.org/about-migraine/migraine-facts/>.

2. Mayo Clinic Staff. "Migraine." MayoClinic.org. 31 May 2018. Web. 21 May 2019. <https://www.mayoclinic.org/diseases-conditions/migraine-headache/symptoms-causes/syc-20360201>.

3. Benjamin Frishberg. "Spotlight On: Headache, MRI and Brain Imaging: what to know about your headache before getting a brain scan." AmericanMigraineFoundation.org. Web. 21 May 2019. <https://americanmigrainefoundation.org/resource-library/headache-mri-and-brain-imaging/>.

4. Christian Nordqvist. "Migraine Patients Have Brain Abnormalities, MRI Scans Show." medicalnewstoday.com. 27 March 2013. Web. 21 May 2019.<https://www.medicalnewstoday.com/articles/258252.php>.