title: Migraine induced by hypoxia: an MRI spectroscopy and angiography study.
abstract: Migraine with aura is prevalent in high-altitude populations suggesting an association between migraine aura and hypoxia. We investigated whether experimental hypoxia triggers migraine and aura attacks in patients suffering from migraine with aura. We also investigated the metabolic and vascular response to hypoxia. In a randomized double-blind crossover study design, 15 migraine with aura patients were exposed to 180 min of normobaric hypoxia (capillary oxygen saturation 70-75%) or sham on two separate days and 14 healthy controls were exposed to hypoxia. Glutamate and lactate concentrations in the visual cortex were measured by proton magnetic resonance spectroscopy. The circumference of cranial arteries was measured by 3 T high-resolution magnetic resonance angiography. Hypoxia induced migraine-like attacks in eight patients compared to one patient after sham (P = 0.039), aura in three and possible aura in 4 of 15 patients. Hypoxia did not change glutamate concentration in the visual cortex compared to sham, but increased lactate concentration (P = 0.028) and circumference of the cranial arteries (P < 0.05). We found no difference in the metabolic or vascular responses to hypoxia between migraine patients and controls. In conclusion, hypoxia induced migraine-like attacks with and without aura and dilated the cranial arteries in patients with migraine with aura. Hypoxia-induced attacks were not associated with altered concentration of glutamate or other metabolites. The present study suggests that hypoxia may provoke migraine headache and aura symptoms in some patients. The mechanisms behind the migraine-inducing effect of hypoxia should be further investigated.
authors.affiliation: 1 Danish Headache Centre, Department of Neurology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2600 Glostrup, Denmark.
authors.forename: Nanna
authors.initials: N
authors.lastname: Arngrim
authors.affiliation: 1 Danish Headache Centre, Department of Neurology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2600 Glostrup, Denmark.
authors.forename: Henrik Winther
authors.initials: HW
authors.lastname: Schytz
authors.affiliation: 1 Danish Headache Centre, Department of Neurology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2600 Glostrup, Denmark.
authors.forename: Josefine
authors.initials: J
authors.lastname: Britze
authors.affiliation: 1 Danish Headache Centre, Department of Neurology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2600 Glostrup, Denmark.
authors.forename: Faisal Mohammad
authors.initials: FM
authors.lastname: Amin
authors.affiliation: 2 Functional Imaging Unit, Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2600 Glostrup, Denmark.
authors.forename: Mark Bitsch
authors.initials: MB
authors.lastname: Vestergaard
authors.affiliation: 1 Danish Headache Centre, Department of Neurology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2600 Glostrup, Denmark.
authors.forename: Anders
authors.initials: A
authors.lastname: Hougaard
authors.affiliation: 2 Functional Imaging Unit, Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2600 Glostrup, Denmark.
authors.forename: Frauke
authors.initials: F
authors.lastname: Wolfram
authors.affiliation: 3 Division of Image Processing, Department of Radiology, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands.
authors.forename: Patrick J H
authors.initials: PJ
authors.lastname: de Koning
authors.affiliation: 4 Department of Neuroanaesthesiology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2600 Glostrup, Denmark.
authors.forename: Karsten S
authors.initials: KS
authors.lastname: Olsen
authors.affiliation: 5 Department of Anaesthesiology, Rigshospitalet Blegdamsvej, Faculty of Health and Medical Sciences, University of Copenhagen, 2100 Copenhagen Ø, Denmark.
authors.forename: Niels H
authors.initials: NH
authors.lastname: Secher
authors.affiliation: 2 Functional Imaging Unit, Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2600 Glostrup, Denmark.
authors.forename: Henrik Bo Wiberg
authors.initials: HB
authors.lastname: Larsson
authors.affiliation: 1 Danish Headache Centre, Department of Neurology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2600 Glostrup, Denmark.
authors.forename: Jes
authors.initials: J
authors.lastname: Olesen
authors.affiliation: 1 Danish Headache Centre, Department of Neurology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2600 Glostrup, Denmark ashina@dadlnet.dk.
authors.forename: Messoud
authors.initials: M
authors.lastname: Ashina
mesh_terms: D000293:Adolescent; D000328:Adult; D018592:Cross-Over Studies; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000150:complications* / Q000175:diagnosis* / Q000378:metabolism; D018810:Magnetic Resonance Angiography / Q000379:methods; D009682:Magnetic Resonance Spectroscopy / Q000379:methods; D008297:Male; D008875:Middle Aged; D020325:Migraine with Aura / Q000175:diagnosis* / Q000209:etiology* / Q000378:metabolism; D055815:Young Adult
keywords: angiography; aura; hypoxia; migraine; spectroscopy