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Extra‐Axial Inflammatory Signal in Parameninges in Migraine with Visual Aura
Author(s) -
Hadjikhani Nouchine,
Albrecht Daniel S.,
Mainero Caterina,
Ichijo Eri,
Ward Noreen,
Granziera Cristina,
Zürcher Nicole R.,
Akeju Oluwaseun,
Bonnier Guillaume,
Price Julie,
Hooker Jacob M.,
Napadow Vitaly,
Nahrendorf Matthias,
Loggia Marco L.,
Moskowitz Michael A.
Publication year - 2020
Publication title -
annals of neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 4.764
H-Index - 296
eISSN - 1531-8249
pISSN - 0364-5134
DOI - 10.1002/ana.25731
Subject(s) - meninges , migraine , aura , medicine , migraine with aura , cortical spreading depression , positron emission tomography , pathology , visual cortex , occipital lobe , neuroscience , psychology , radiology
Objective Cortical spreading depression (CSD) underlies the neurobiology of migraine with aura (MWA). Animal studies reveal networks of microvessels linking brain–meninges–bone marrow. CSD activates the trigeminovascular system, evoking a meningeal inflammatory response. Accordingly, this study examines the upregulation of an inflammatory marker in extra‐axial tissues in migraine with visual aura. Methods We used simultaneously acquired 11 C‐PBR28 positron emission tomography/magnetic resonance imaging data of 18kDa translocator protein (an inflammatory marker) in MWA patients (n = 11) who experienced headaches and visual aura in the preceding month. We measured mean tracer uptake (standardized uptake value ratio [SUVR]) in 4 regions of interest comprising the meninges plus the adjacent overlying skull bone (parameningeal tissues [PMT]). These data were compared to healthy controls and patients with pain (chronic low back pain). Results MWA had significantly higher mean SUVR in PMT overlying occipital cortex than both other groups, although not in the PMT overlying 3 other cortical areas. A positive correlation was also found between the number of visual auras and tracer uptake in occipital PMT. Interpretation A strong persistent extra‐axial inflammatory signal was found in meninges and calvarial bone overlying the occipital lobe in migraine with visual auras. Our findings are reminiscent of CSD‐induced meningeal inflammation and provide the first imaging evidence implicating inflammation in the pathophysiology of migraine meningeal symptoms. We suspect that this inflammatory focus results from a signal that migrates from underlying brain and if so, may implicate newly discovered bridging vessels that crosstalk between brain and skull marrow, a finding of potential relevance to migraine and other neuroinflammatory brain disorders. ANN NEUROL 2020;87:939–949