title: Cerebral perfusion changes in migraineurs: a voxelwise comparison of interictal dynamic susceptibility contrast MRI measurements.
abstract: BACKGROUND
  The increased risk of cerebro- and cardiovascular disease in migraineurs may be the consequence of a systemic condition affecting whole body vasculature. At cerebrovascular level, this may be reflected by interictal global or regional cerebral perfusion abnormalities. Whether focal perfusion changes occur during interictal migraine has not been convincingly demonstrated.
  
  
  METHODS
  We measured brain perfusion with dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) in 29 interictal female migraineurs (12 migraine with aura (MA), 17 migraine without aura (MO)), and 16 female controls. Perfusion maps were compared between these groups with a voxelwise (p < 0.001, uncorrected, minimum cluster size 20 voxels) and a region-of-interest approach.
  
  
  RESULTS
  In whole brain voxelwise analyses interictal hyperperfusion was observed in the left medial frontal gyrus in migraineurs and in the inferior and middle temporal gyrus in MO patients, in comparison with controls. Hypoperfusion was seen in the postcentral gyrus and in the inferior temporal gyrus in MA patients and in the inferior frontal gyrus in MO patients. Additional focal sites of hyperperfusion were noted in subgroups based on attack frequency and disease history. Region-of-interest analyses of the pons, hypothalamus, occipital lobe, and cerebellum did not show interictal perfusion differences between migraineurs and controls.
  
  
  CONCLUSIONS
  We conclude that interictal migraine is characterized by discrete areas of hyper- and hypoperfusion unspecific for migraine pathophysiology and not explaining the increased vulnerability of particular brain regions for cerebrovascular damage.
authors.affiliation: Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands. e.b.arkink@lumc.nl
authors.forename: Enrico B
authors.initials: EB
authors.lastname: Arkink
authors.forename: Egbert J W
authors.initials: EJ
authors.lastname: Bleeker
authors.forename: Nicole
authors.initials: N
authors.lastname: Schmitz
authors.forename: Guus G
authors.initials: GG
authors.lastname: Schoonman
authors.forename: Ona
authors.initials: O
authors.lastname: Wu
authors.forename: Michel D
authors.initials: MD
authors.lastname: Ferrari
authors.forename: Mark A
authors.initials: MA
authors.lastname: van Buchem
authors.forename: Matthias J P
authors.initials: MJ
authors.lastname: van Osch
authors.forename: Mark C
authors.initials: MC
authors.lastname: Kruit
mesh_terms: D000328:Adult; D001921:Brain / Q000098:blood supply* / Q000473:pathology / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D008881:Migraine Disorders / Q000473:pathology / Q000503:physiopathology*