title: Altered cerebrovenous drainage in patients with migraine as assessed by phase-contrast magnetic resonance imaging.
abstract: OBJECTIVE
  We aimed to assess whether migraine is associated with changes in the distribution of the venous drainage through primary and secondary pathways by using phase-contrast magnetic resonance imaging (MRI).
  
  
  METHODS
  We examined 26 patients (37.3 ± 13.9 years) with recurring migraine headaches and 26 age- and gender-matched controls with no neurologic disease (37.3 ± 13.7 years) on a 3 Tesla MR scanner. A 2D time-of-flight MR-venography of the upper neck region was performed to visualize the venous vasculature. Cine-phase contrast scans with high-velocity encoding were employed to quantify arterial inflow and flow in the primary venous channels (right and left jugular veins), whereas scans with low-velocity encoding were employed to quantify flow in the secondary venous channels (epidural, vertebral, and deep cervical veins).
  
  
  RESULTS
  Patients with migraine showed (i) a higher prevalence of dense secondary extracranial venous networks (15 vs. 2, P = 0.00002) and (ii) a significantly larger percentage of venous outflow through secondary channels (10.5% vs. 5.5%; of total cerebral blood flow, P = 0.02). This mainly included drainage through epidural, vertebral, and deep cervical veins.
  
  
  CONCLUSIONS
  Migraine patients showed a significantly larger percentage of venous outflow through secondary channels. The mechanism of this alteration remains to be elucidated. Potential mechanisms include repeated release of vasoactive substances or growth factors.
authors.affiliation: Institute of Clinical Radiology, Ludwig-Maximilians-University, Grosshadern Campus, Munich, Germany. ikoerte@med.lmu.de
authors.forename: Inga K
authors.initials: IK
authors.lastname: Koerte
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Schankin
authors.forename: Stefanie
authors.initials: S
authors.lastname: Immler
authors.forename: Sang
authors.initials: S
authors.lastname: Lee
authors.forename: Ruediger P
authors.initials: RP
authors.lastname: Laubender
authors.forename: Christina
authors.initials: C
authors.lastname: Grosse
authors.forename: Lara
authors.initials: L
authors.lastname: Eftimov
authors.forename: Astrid
authors.initials: A
authors.lastname: Milde-Busch
authors.forename: Maximilian
authors.initials: M
authors.lastname: Reiser
authors.forename: Andreas
authors.initials: A
authors.lastname: Straube
authors.forename: Florian
authors.initials: F
authors.lastname: Heinen
authors.forename: Noam
authors.initials: N
authors.lastname: Alperin
authors.forename: Birgit
authors.initials: B
authors.lastname: Ertl-Wagner
mesh_terms: D000293:Adolescent; D000328:Adult; D001921:Brain / Q000098:blood supply*; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000175:diagnosis / Q000473:pathology*; D009333:Neck / Q000098:blood supply*; D012039:Regional Blood Flow; D055815:Young Adult