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Background It is widely accepted that the brainstem plays a role in migraine pathophysiology. The periaqueductal gray matter (PAG) is a substantial component of the descending pain modulatory network. Previous MRI studies by Welch et al demonstrated that PAG iron levels are abnormally high both in episodic and chronic migraine, suggesting the hypothesis that iron accumulation may be a marker of progressive PAG dysfunction. The increase in iron levels can be investigated with transcranial sonography (TCS) because of heavy metal-induced hyperechogenicity.

the journal of headache and pain

P043. Hyperechogenicity of the periaqueductal gray in chronic migraine and episodic migraine as a potential marker of progressive dysfunction: preliminary results with transcranial sonography