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Brain. 2016 Mar;139(Pt 3):723-37. doi: 10.1093/brain/awv359. Epub 2015 Dec 16.

Migraine induced by hypoxia: an MRI spectroscopy and angiography study.

Author information

1
1 Danish Headache Centre, Department of Neurology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2600 Glostrup, Denmark.
2
2 Functional Imaging Unit, Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2600 Glostrup, Denmark.
3
3 Division of Image Processing, Department of Radiology, Leiden University Medical Centre, 2300 RC Leiden, The Netherlands.
4
4 Department of Neuroanaesthesiology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2600 Glostrup, Denmark.
5
5 Department of Anaesthesiology, Rigshospitalet Blegdamsvej, Faculty of Health and Medical Sciences, University of Copenhagen, 2100 Copenhagen Ø, Denmark.
6
1 Danish Headache Centre, Department of Neurology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2600 Glostrup, Denmark ashina@dadlnet.dk.

Abstract

Migraine with aura is prevalent in high-altitude populations suggesting an association between migraine aura and hypoxia. We investigated whether experimental hypoxia triggers migraine and aura attacks in patients suffering from migraine with aura. We also investigated the metabolic and vascular response to hypoxia. In a randomized double-blind crossover study design, 15 migraine with aura patients were exposed to 180 min of normobaric hypoxia (capillary oxygen saturation 70-75%) or sham on two separate days and 14 healthy controls were exposed to hypoxia. Glutamate and lactate concentrations in the visual cortex were measured by proton magnetic resonance spectroscopy. The circumference of cranial arteries was measured by 3 T high-resolution magnetic resonance angiography. Hypoxia induced migraine-like attacks in eight patients compared to one patient after sham (P = 0.039), aura in three and possible aura in 4 of 15 patients. Hypoxia did not change glutamate concentration in the visual cortex compared to sham, but increased lactate concentration (P = 0.028) and circumference of the cranial arteries (P < 0.05). We found no difference in the metabolic or vascular responses to hypoxia between migraine patients and controls. In conclusion, hypoxia induced migraine-like attacks with and without aura and dilated the cranial arteries in patients with migraine with aura. Hypoxia-induced attacks were not associated with altered concentration of glutamate or other metabolites. The present study suggests that hypoxia may provoke migraine headache and aura symptoms in some patients. The mechanisms behind the migraine-inducing effect of hypoxia should be further investigated.

KEYWORDS:

angiography; aura; hypoxia; migraine; spectroscopy

PMID:
26674653
DOI:
10.1093/brain/awv359
[Indexed for MEDLINE]

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