title: Migraine and magnetic resonance spectroscopy: a systematic review.
abstract: To present an updated and streamlined overview of the metabolic and biochemical aspect of the migraine pathophysiology based on findings from phosphorous (P) and hydrogen (H) magnetic resonance spectroscopy (MRS) studies.
  
  
  
  Despite of the variation in the methodology and quality of the MRS migraine studies over time, some results were consistent and reproducible. P-MRS studies suggested reduced availability of neuronal energy and implied a mitochondrial dysfunction in the migraine brain. H-MRS studies reported interictal abnormalities in the excitatory and inhibitory neurotransmitters, glutamate and γ-aminobutyric acid (GABA), suggesting persistent altered excitability in migraine patients. N-Acetylaspartate levels were decreased in migraine, probably due to a mitochondrial dysfunction and abnormal energy metabolism. The reported abnormalities may increase the susceptibility of migraine patients to excitatory stimulation, such as migraine attack triggers.
  
  
  
  Several biochemical aspects of the migraine pathophysiology remain to be elucidated using MRS, such as the migraine attack, correlation to disease severity, and medication efficacy. Nevertheless, to identify a biomarker in migraine, MRS may be a valuable noninvasive technique.
authors.affiliation: aDanish Headache Center and Department of Neurology bFunctional Imaging Unit, Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Samaira
authors.initials: S
authors.lastname: Younis
authors.forename: Anders
authors.initials: A
authors.lastname: Hougaard
authors.forename: Mark B
authors.initials: MB
authors.lastname: Vestergaard
authors.forename: Henrik B W
authors.initials: HBW
authors.lastname: Larsson
authors.forename: Messoud
authors.initials: M
authors.lastname: Ashina
mesh_terms: D001224:Aspartic Acid / Q000031:analogs & derivatives; D015415:Biomarkers / Q000032:analysis; D006801:Humans; D009682:Magnetic Resonance Spectroscopy / Q000379:methods*; D008881:Migraine Disorders / Q000378:metabolism* / Q000503:physiopathology; D005680:gamma-Aminobutyric Acid
chemical_list: D015415:Biomarkers; D001224:Aspartic Acid; D005680:gamma-Aminobutyric Acid; C000179:N-acetylaspartate