Distinctive anatomical and physiological features of migraine aura revealed by 18 years of recording.
TLDR
The results indicate that there can be multiple distinct sites of aura initiation in a given individual and suggest that the spatial pattern of propagation in the occipital cortex is non-concentric with a variable extent of propagation.Abstract:
The mechanisms underlying the initiation and propagation of the migraine aura, and the visual percept that is produces, remain uncertain The objective of this study was to characterize and quantify a large number of visual auras recorded by a single individual over nearly two decades to gain insight into basic aura mechanisms An individual made detailed drawings of his visual percept of migraine aura in real time during more than 1000 attacks of migraine aura without headache over 18 years Drawings were made in a consistent fashion documenting the shape and location of the aura wavefront or scotoma in the visual field at one minute intervals These drawings were digitized and the spatial and temporal features of auras were quantified and analysed Consistent patterns of aura initiation, propagation and termination were observed in both right and left visual fields Most aura attacks originated centrally (within 10° eccentricity), but there were also other distinct sites of initiation in the visual field Auras beginning centrally preferentially propagated first through lower nasal field (69-77% of all auras) before travelling to upper and temporal fields, on both sides Some auras propagated from peripheral to central regions of the visual field-these typically followed the reverse path of those travelling in the opposite direction The mean velocity of the perceived visual phenomenon did not differ between attacks starting peripherally and centrally The estimated speed of the underlying cortical event (2-3 mm/min) was in the same range as has been previously reported by others Some auras had limited propagation and spontaneously 'aborted' after a few minutes, despite being initiated in similar locations to those that spread throughout the entire visual field The visual percept of the aura changed corresponding with the presumed propagation from the V1 to the V2 region of the occipital cortex In some cases the visual percept disappeared for several minutes before reappearing in a distant location, providing direct evidence that the aura can be clinically 'silent' These results indicate that there can be multiple distinct sites of aura initiation in a given individual and suggest that the spatial pattern of propagation in the occipital cortex is non-concentric with a variable extent of propagation The visual percept of migraine aura changes depending on the region of the occipital cortex that is involvedread more
Citations
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Journal ArticleDOI
Pathophysiology of Migraine: A Disorder of Sensory Processing
Peter J. Goadsby,Philip R. Holland,Margarida Martins-Oliveira,Jan Hoffmann,Christoph J. Schankin,Simon Akerman +5 more
TL;DR: Investment in understanding migraine leaves us at a new dawn, able to transform its impact on a global scale, as well as understand fundamental aspects of human biology.
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Migraine: multiple processes, complex pathophysiology.
TL;DR: Attempts to understand the headache pain itself point to activation of the trigeminovascular pathway as a prerequisite for explaining why the pain is restricted to the head, often affecting the periorbital area and the eye, and intensifies when intracranial pressure increases.
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The pathophysiology of migraine: implications for clinical management.
TL;DR: The identification of new migraine-associated genes, the visualisation of brain regions that are activated at the earliest stages of a migraine attack, and the recognition of the crucial role for neuropeptides are among the advances that have led to novel targets for migraine therapy.
Journal ArticleDOI
The Relation Between Migraine, Typical Migraine Aura and “Visual Snow”
Christoph J. Schankin,Christoph J. Schankin,Christoph J. Schankin,Farooq H. Maniyar,Farooq H. Maniyar,Till Sprenger,Denise E. Chou,Michael A. Eller,Peter J. Goadsby,Peter J. Goadsby +9 more
TL;DR: To assess the relationship between the phenotype of the “visual snow” syndrome, comorbid migraine, and typical migraine aura on a clinical basis and usingfunctional brain imaging, functional brain imaging is used.
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A Systems Neuroscience Approach to Migraine.
TL;DR: This work conceptualize migraine as a disorder of sensory network gain and plasticity, and it is proposed that this framing makes it amenable to the tools of current systems neuroscience.
References
More filters
Journal ArticleDOI
The International Classification of Headache Disorders: 2nd edition
Journal ArticleDOI
The Alzheimer's Disease Neuroimaging Initiative (ADNI): MRI methods.
Clifford R. Jack,Matt A. Bernstein,Nick C. Fox,Paul M. Thompson,Gene E. Alexander,Danielle J Harvey,Bret J. Borowski,Paula J. Britson,Jennifer L. Whitwell,Chadwick P. Ward,Anders M. Dale,Joel P. Felmlee,Jeffrey L. Gunter,Derek L. G. Hill,Ronald J. Killiany,Norbert Schuff,Sabrina Fox-Bosetti,Chen Lin,Colin Studholme,Charles DeCarli,Gunnar Krueger,Heidi A. Ward,Gregory J. Metzger,Katherine T. Scott,Richard Philip Mallozzi,Daniel J. Blezek,Joshua Levy,Josef Phillip Debbins,Adam S. Fleisher,Marilyn S. Albert,Robert C. Green,George Bartzokis,Gary H. Glover,John P. Mugler,Michael W. Weiner +34 more
TL;DR: The approach taken in ADNI to standardization across sites and platforms of the MRI protocol, postacquisition corrections, and phantom‐based monitoring of all scanners could be used as a model for other multisite trials.
Journal ArticleDOI
Spreading depression of activity in the cerebral cortex
TL;DR: In this article, an interesting response elicited by electrical stimulation was noticed in the cortex of rabbits, and the distinctive feature of this response was a marked, enduring reduction of the "spontaneous" electrical activity of the cortex.
Journal ArticleDOI
Migraine prevalence, disease burden, and the need for preventive therapy
Richard B. Lipton,Marcelo E. Bigal,Merle L. Diamond,Frederick G. Freitag,Michael L. Reed,Walter F. Stewart +5 more
TL;DR: The epidemiologic profile of migraine has remained stable in the United States during the past 15 years and more than one in four migraineurs are candidates for preventive therapy, and a substantial proportion of those who might benefit from prevention do not receive it.
Journal ArticleDOI
Migraine--current understanding and treatment.
TL;DR: The epidemiology, pathophysiology, and preventive and symptomatic treatment of migraine is described, with special attention to drug therapy with the triptans.
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