To study regional cerebral blood flow (rCBF) during migraine attacks without aura and after treatment with sumatriptan.
We performed three technetium Tc99m hexemethyl-propyleneamineoxime single photon emission computed tomography scanning procedures in patients with migraine who participated in a double-blind, placebo-controlled, randomized clinical trial (1) outside an attack, (2) during an attack, and (3) after treatment of the attack with 6 mg of subcutaneous sumatriptan.
We studied 20 patients with migraine without aura, 15 of whom were evaluated under all three conditions and five of whom were evaluated under only two conditions.
The single photon emission computed tomographic images were evaluated semiquantitatively with regard to (1) the degree of asymmetry of the rCBF between the headache side and the nonheadache side and (2) the ratio of the rCBF in regions of interest to the rCBF in two reference areas (cerebellum or frontal cortex).
We found no significant rCBF asymmetries outside or during the attack or after treatment with sumatriptan, and there were no significant changes of the rCBF ratios during the attack (compared with outside the attack) or after treatment of the attack (compared with during the attack).
Migraine attacks without aura and treatment of the attacks with 6 mg of subcutaneous sumatriptan are not associated with detectable focal changes of the rCBF.
[Show abstract][Hide abstract] ABSTRACT: Evidence from animal experiments shows that the brain stem is involved in the pathophysiology of migraine. To investigate human migraine, we used positron emission tomography to examine the changes in regional cerebral blood flow as an index of neuronal activity in the human brain during spontaneous migraine attacks. During the attacks, increased blood flow was found in the cerebral hemispheres in cingulate, auditory and visual association cortices and in the brain stem. However, only the brain stem activation persisted after the injection of sumatriptan had induced complete relief from headache and phono- and photophobia. These findings support the idea that the pathogenesis of migraine is related to an imbalance in activity between brain stem nuclei regulating antinociception and vascular control.
Nature Medicine 08/1995; 1(7):658-60. DOI:10.1038/nm0795-658 · 27.36 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Bei der Migräne handelt es sich um eine komplexe Funktionstörung neuronaler und vaskulärer Elemente des ZNS. Die ursprüngliche
Theorie einer primär vaskulären Erkrankung im Sinne intra- und extrakranieller arterieller Kaliberschwankungen ist überholt.
Aufgrund umfangreicher dopplersonographischer Untersuchungen und Blutflußuntersuchungen mit Hilfe bildgebender Verfahren (SPECT
und PET) muß man von einer zentral gesteuerten Imbalance trigeminal nozizeptiver, endogen antinozizeptiver und den vaskulären
Tonus regelnder Hirnstammkerne ausgehen. Wenn arterielle Kaliberschwankungen während der akuten Migräneattacke oder der medikamentösen
Therapie mit z. B. Sumatriptan oder Ergotaminen auftreten, so sind dies Lokalphänomene ohne Einfluß auf den kortikalen Butfluß.
Der eigentliche Kopfschmerz entsteht in der Peripherie im Bereich der großen zerebralen Blutleiter, am ehesten im Gefolge
einer aseptischen perivaskulären Entzündung dieser Gefäße.
Whether the primary mechanisms of migraine are vascular or neurogenic is, as yet unresolved. Early studies using Doppler sonography
prompted heterogeneous results, mainly due to methodological differences. However, blood flow measurements using single photon
emission tomography (SPECT) or positron emission tomography (PET) have not revealed any differences in cerebral blood flow
in migraine without aura. Moreover, specific migraine compounds do not alter cortical blood flow. During attacks, increased
blood flow is found in the cerebral hemispheres in cingulate, auditory and visual association cortices and the brain stem.
Alltogether, these findings suggest that the pathogenesis of migraine is related to an imbalance in activity between brain
stem nuclei regulating antinociception and vascular control, rather than in primary vessel diameter changes.
Der Schmerz 04/1996; 10(3):140-145. DOI:10.1007/s004820050034 · 1.02 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Whether the primary mechanisms of migraine are vascular or neurogenic is, as yet, unresolved. In humans it is still unclear whether sumatriptan acts via constriction of dilated arteries or through other mechanisms. Doppler sonography is a non-invasive method for measuring blood flow velocities (BFV), an indirect marker of vessel diameter. This double-blind crossover placebo-controlled trial investigated changes in BFV in extra- and intracranial arteries in 132 migraine attacks (66 patients) before and after treatment with either 6 mg sumatriptan s.c. or placebo. Significant increases in BFV were observed only in the middle cerebral artery (MCA) and the basilar artery (BA) after administration of sumatriptan. However, the majority of the patients showed no change in BFV following sumatriptan. No difference in BFV could be detected between headache and non-headache side or between migraine and headache free periods. Despite a slight increase in BFV in intracerebral arteries, this study does not support the concept that vasoconstriction is sumatriptan's principal mechanism in pain relief.
Journal of the Neurological Sciences 07/1996; 138(1-2):60-5. DOI:10.1016/0022-510X(95)00344-2 · 2.47 Impact Factor
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