title: Functional MRI-BOLD of brainstem structures during visually triggered migraine.
abstract: BACKGROUND
  Previously, hyperoxia and blood volume increase were reported in the red nucleus and substantia nigra during spontaneous migraine with aura.
  
  
  OBJECTIVE
  To further understand the pathophysiologic role of these centers, activation of brainstem structures was investigated in patients with visually triggered migraine.
  
  
  METHODS
  Twenty-six patients with migraine (23 with aura and 3 without aura), and 10 normal control subjects were studied with blood oxygen level-dependent (BOLD) fMRI during repeated checkerboard visual stimulation. Three axial image sections, which covered the occipital cortex and brainstem, were acquired 224 times with a temporal resolution of 3.5 seconds.
  
  
  RESULTS
  Repetitive visual stimulation triggered symptoms in 12 patients; four who had migraine with aura developed both visual symptoms and headaches, and six who had migraine with aura and two who had migraine without aura had headaches only. Four patients who had migraine with aura experienced the onset of their usual aura or onset of their typical headache either during the experiment or immediately after. In the remaining 10 patients with migraine, and all control subjects, visual stimulation failed to trigger symptoms at any time. In 75% of the patients who developed symptoms during stimulation, baseline T2*-weighted MR signal intensities increased in the red nucleus and substantia nigra before occipital cortex signal elevation or the onset of visually triggered symptoms.
  
  
  CONCLUSIONS
  Activation (hyperoxia and blood volume increase) of the red nucleus and substantia nigra in association with visually triggered symptoms of migraine suggest that these brainstem structures are a part of a neuronal network activated during an attack.
authors.affiliation: Department of Neurology, Henry Ford Health Systems, Detroit, MI, USA. yue@radiology.msu.edu
authors.forename: Y
authors.initials: Y
authors.lastname: Cao
authors.forename: S K
authors.initials: SK
authors.lastname: Aurora
authors.forename: V
authors.initials: V
authors.lastname: Nagesh
authors.forename: S C
authors.initials: SC
authors.lastname: Patel
authors.forename: K M A
authors.initials: KM
authors.lastname: Welch
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020325:Migraine with Aura / Q000209:etiology / Q000503:physiopathology*; D020326:Migraine without Aura / Q000209:etiology / Q000503:physiopathology*; D009778:Occipital Lobe / Q000503:physiopathology; D010775:Photic Stimulation / Q000009:adverse effects; D012012:Red Nucleus / Q000503:physiopathology*; D013378:Substantia Nigra / Q000503:physiopathology*