Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Brain stem activation in spontaneous human migraine attacks

Abstract

Evidence from animal experiments shows that the brain stem is involved in the pathophysiology of migraine. To investigate human migraine, we used positron emission tomography to examine the changes in regional cerebral blood flow as an index of neuronal activity in the human brain during spontaneous migraine attacks. During the attacks, increased blood flow was found in the cerebral hemispheres in cingulate, auditory and visual association cortices and in the brain stem. However, only the brain stem activation persisted after the injection of sumatriptan had induced complete relief from headache and phono- and photophobia. These findings support the idea that the pathogenesis of migraine is related to an imbalance in activity between brain stem nuclei regulating antinociception and vascular control.

This is a preview of subscription content, access via your institution

Access options

Rent or buy this article

Prices vary by article type

from$1.95

to$39.95

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Moskowitz, M.A. The neurobiology of vascular head pain. Ann. Neurol. 16, 157–168 (1984).

    Article  CAS  Google Scholar 

  2. Lance, J.W. A concept of migraine and the search for the ideal headache drug. Headache 30, 17–23 (1990).

    Article  CAS  Google Scholar 

  3. Goadsby, P.J. & Lance, J.W. Brain stem effects on intra- and extracerebral circulations, in Basic Mechanisms of Headache (eds Olesen, J. & Edvinsson, L.) 413–426 (Elsevier Science Publishers, Amsterdam, 1988).

    Google Scholar 

  4. Goadsby, P.J. & Gundlach, A.L. Localisation of 3H-dihydroergotamine-binding sites in the cat central nervous system: Relevance to migraine. Ann. Neurol. 29, 91–94 (1991).

    Article  CAS  Google Scholar 

  5. Raskin, N.H., Hosobuchi, Y. & Lamb, S. Headache may arise from perturbation of brain. Headache 27, 416–420 (1987).

    Article  CAS  Google Scholar 

  6. Olesen, J. Migraine and Other Headaches: The Vascular Mechanisms. (Raven Press, New York, 1991).

    Google Scholar 

  7. Friberg, L. et al. Interictal “patchy” regional cerebral blood flow patterns in migraine patients. A single photon emission computerized tomography study. Eur. J. Neurol. 1, 35–43 (1994).

    Article  CAS  Google Scholar 

  8. Olesen, J., Larsen, B. & Lauritzen, M. Focal hyperemia followed by spreading oligemia and impaired activation of rCBF in classic migraine. Ann. Neurol. 9, 344–352 (1981).

    Article  CAS  Google Scholar 

  9. Olesen, J., Tfelt-Hansen, P., Henriksen, L. & Larsen, B. The common migraine attack may not be initiated by cerebral ischaemia. Lancet ii, 438–440 (1981).

    Article  Google Scholar 

  10. Ferrari, M.D. et al. Cerebral blood flow during migraine attacks without aura and effect of sumatriptan. Arch. Neurol. 52, 135–139 (1995).

    Article  CAS  Google Scholar 

  11. Herold, S. et al. Oxygen metabolism in migraine. J. Cereb. Blood Flow Metab. 5 (suppl.), S445–S446 (1985).

    Google Scholar 

  12. Woods, R.P., Iacoboni, M. & Mazziotta, J.C. Bilateral spreading cerebral hypoperfusion during spontaneous migraine headache. New Engl. J. Med. 331, 1689–1692 (1994).

    Article  CAS  Google Scholar 

  13. Fox, P.T. & Mintun, M.A. Noninvasive functional brain mapping by change-distribution analysis of averaged PET images of H2 15O tissue activity. J nucl. Med. 30, 141–149 (1989).

    CAS  PubMed  Google Scholar 

  14. Frackowiak, R.S.J. & Friston, K.J. Functional neuroanatomy of the human brain: Positron emission tomography—a new neuroanatomical technique. J. Anat 184, 211–225 (1994).

    PubMed  PubMed Central  Google Scholar 

  15. Jones, A.K.P., Friston, K. & Frackowiak, R.S.J. Localization of responses to pain in human cerebral cortex. Science 255, 215 (1992).

    Article  CAS  Google Scholar 

  16. Casey, K.L. et al. Positron emission tomographic analysis of cerebral structures activated specifically by repetitive noxious heat stimuli. J. Neurophysiol. 71, 802–807 (1994).

    Article  CAS  Google Scholar 

  17. Rosen, S.D. et al. Central nervous pathways mediating angina pectoris. Lancet 344, 147–150 (1994).

    Article  CAS  Google Scholar 

  18. Behbehani, M.M. & Fields, H.L. Evidence that an excitatory connection between the periaqueductal gray and nucleus raphe magnus mediates stimulation produced analgesia. Brain Res. 170, 85–93 (1979).

    Article  CAS  Google Scholar 

  19. Jensen, T.S. & Jaksh, T.L. Comparison of the antinociceptive effect of morphine and glutamate at coincidental sites in the periaqueductal gray and medial medulla in rat. Brain Res. 476, 1–9 (1989).

    Article  CAS  Google Scholar 

  20. Kaube, H., Hoskin, K.L. & Goadsby, P.J. Inhibition by sumatriptan of central trigeminal neurones only after blood-brain barrier disruption. Br. J. Pharmacol. 109, 788–792 (1993).

    Article  CAS  Google Scholar 

  21. Fowler, P.A. et al. The clinical pharmacology, pharmacokinetics and metabolism of sumatriptan. Eur. Neurol. 31, 291–294 (1991).

    Article  CAS  Google Scholar 

  22. Committee of the International Headache Society. Classification and diagnostic criteria for headache disorders, cranial neuralgias and facial pain. Cephalalgia 8 (suppl. 7), 1–96 (1988).

  23. Lammertsma, A.A. et al. Combination of dynamic and integral methods for generating reproducible functional CBF images. J. Cereb. Blood Flow Metab. 9, 461–470 (1989).

    Article  CAS  Google Scholar 

  24. Woods, R.P., Cherry, S.R. & Mazziotta, J.C. Rapid automated algorithm for aligning and reslicing PET images. J CAT 16, 620–633 (1992).

    CAS  Google Scholar 

  25. Talairach, J. & Tournoux, P. Coplanar Stereotaxic Atlas of the Human Brain (Thieme, New York, 1988).

    Google Scholar 

  26. Friston, K.J., Frith, C.D., Liddle, P.F. & Frackowiak, R.S.J. Plastic transformation of PET images. J. comput assist. Tomogr. 15, 634–639 (1991).

    Article  CAS  Google Scholar 

  27. Friston, K.J. et al. The relationship between global and local changes in PET scans. J. Cereb. Blood Flow Metab. 10, 458–466 (1990).

    Article  CAS  Google Scholar 

  28. Friston, K.J., Frith, C.D., Liddle, P.F. & Frackowiak, R.S.J. Comparing functional (PET) images: The assessment of significant change. J. Cereb. Blood Flow Metab. 11, 690–699 (1991).

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Weiller, C., May, A., Limmroth, V. et al. Brain stem activation in spontaneous human migraine attacks. Nat Med 1, 658–660 (1995). https://doi.org/10.1038/nm0795-658

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1038/nm0795-658

This article is cited by

Search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing