title: Hypoechogenicity of brainstem raphe nuclei is associated with increased attack frequency in episodic migraine.
abstract: BACKGROUND
  Reduced echogenicity of the brainstem raphe nuclei (BRN) was demonstrated in major depression, possibly indicating serotonergic dysfunction. Postulating that migraine may constitute a "chronic low serotonin syndrome," we aimed to evaluate the echogenicity of midbrain structures, including serotonergic BRN in episodic migraine.
  
  
  METHODS
  Transcranial sonography was performed in 39 patients with episodic migraine (median age 35, interquartile range (IQR): 27-47 years; 27 women) and 35 controls (median age 31, IQR: 29-47 years; 19 women). Individuals with concomitant depression were excluded. Echogenicity of BRN, substantia nigra (SN) and third ventricle width was evaluated according to an internationally established examination protocol.
  
  
  RESULTS
  Hypoechogenicity of BRN was depicted in 23.1% of migraine patients and 20% of controls, showing no significant difference. Migraine patients with hypoechogenic BRN had significantly higher attack frequency (median 3, IQR 2-5 vs. 1.5, IQR 1-2 days/month; p = 0.029) and a trend toward earlier disease manifestation. The rate of hyperechogenic SN and width of the third ventricle were similar between both groups. We did not observe any differences between migraine patients with and without aura.
  
  
  CONCLUSIONS
  Sonographic findings did not differ between migraine patients and controls. Hypoechogenic BRN correlated to a higher migraine attack frequency, probably indicating more severe disease activity.
authors.affiliation: Department of Neurology, St. Josef-Hospital, Medical Faculty, Ruhr-University Bochum, Germany.
authors.forename: Ilya
authors.initials: I
authors.lastname: Ayzenberg
authors.affiliation: Department of Neurology, St. Josef-Hospital, Medical Faculty, Ruhr-University Bochum, Germany Neurological practice, Bochum, Germany.
authors.forename: Ilias
authors.initials: I
authors.lastname: Nastos
authors.affiliation: Department of Neurology, St. Josef-Hospital, Medical Faculty, Ruhr-University Bochum, Germany.
authors.forename: Katrin
authors.initials: K
authors.lastname: Strassburger-Krogias
authors.affiliation: Center for Neurology, Asklepios Hospitals Schildautal, Germany.
authors.forename: Mark
authors.initials: M
authors.lastname: Obermann
authors.affiliation: Department of Neurology, St. Josef-Hospital, Medical Faculty, Ruhr-University Bochum, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Gold
authors.affiliation: Department of Neurology, St. Josef-Hospital, Medical Faculty, Ruhr-University Bochum, Germany christos.krogias@ruhr-uni-bochum.de.
authors.forename: Christos
authors.initials: C
authors.lastname: Krogias
mesh_terms: D000328:Adult; D001933:Brain Stem / Q000000981:diagnostic imaging* / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000000981:diagnostic imaging* / Q000473:pathology*; D011903:Raphe Nuclei / Q000000981:diagnostic imaging* / Q000473:pathology*; D017585:Ultrasonography, Doppler, Transcranial
keywords: Brainstem raphe nuclei; depression; migraine; nociceptive mechanisms; serotonin; transcranial sonography