Hypothalamic activation in spontaneous migraine attacks.
BACKGROUND
Migraine sufferers experience premonitory symptoms which suggest that primary hypothalamic dysfunction is a likely trigger of the attacks. Neuroendocrine and laboratory data also support this hypothesis. To date, positron emission tomography (PET) scans of migraine sufferers have demonstrated activation of brainstem nuclei, but not of the hypothalamus.


OBJECTIVE
To record cerebral activations withH2 15OPET during spontaneous migraine without aura attacks.


METHODS
We scanned 7 patients with migraine without aura (6 females and 1 male) in each of 3 situations: within 4 hours of headache onset, after headache relief by sumatriptan injection (between the fourth and the sixth hour after headache onset), and during an attack-free period.


RESULTS
During the headache we found not only significant activations in the midbrain and pons, but also in the hypothalamus, all persisting after headache relief by sumatriptan.


CONCLUSIONS
Hypothalamic activity, long suspected by clinical and experimental arguments as a possible trigger for migraine, is demonstrated for the first time during spontaneous attacks.
Neurology Service, Rangueil Hospital, Toulouse Cedex 9, France.
Marie
M
Denuelle
Nelly
N
Fabre
Pierre
P
Payoux
Francois
F
Chollet
Gilles
G
Geraud
D000328:Adult; D001931:Brain Mapping; D001933:Brain Stem / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology; D005260:Female; D006801:Humans; D007031:Hypothalamus / Q000000981:diagnostic imaging / Q000187:drug effects / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000188:drug therapy / Q000473:pathology*; D049268:Positron-Emission Tomography / Q000379:methods; D018170:Sumatriptan / Q000627:therapeutic use; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
D014662:Vasoconstrictor Agents; D018170:Sumatriptan