Mechanisms of Migraine Aura Revealed by Functional MRI in Human Visual Cortex

Cortical spreading depression (CSD) has been suggested to underlie migraine visual aura. However, it has been challenging to test this hypothesis in human cerebral cortex. Using high-field functional MRI with near-continuous recording during visual aura in three subjects, we observed blood oxygenati...

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Published in:	Proceedings of the National Academy of Sciences - PNAS Vol. 98; no. 8; pp. 4687 - 4692
Main Authors:	Hadjikhani, Nouchine, del Rio, Margarita Sanchez, Wu, Ona, Schwartz, Denis, Bakker, Dick, Fischl, Bruce, Kwong, Kenneth K., Cutrer, F. Michael, Rosen, Bruce R., Roger B. H. Tootell, Sorensen, A. Gregory, Moskowitz, Michael A.
Format:	Journal Article
Language:	English
Published:	United States National Academy of Sciences 10-04-2001 National Acad Sciences
Subjects:	Adult Biological Sciences Blood flow Eyes & eyesight Headache Humans Imaging Magnetic Resonance Imaging Male Medical imaging Middle Aged Migraine Migraine with Aura - physiopathology Neurology NMR Nuclear magnetic resonance Perception Scintillation Signal reflection Vision Disorders - physiopathology Visual cortex Visual Cortex - physiopathology Visual fields Visual stimulation
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Abstract	Cortical spreading depression (CSD) has been suggested to underlie migraine visual aura. However, it has been challenging to test this hypothesis in human cerebral cortex. Using high-field functional MRI with near-continuous recording during visual aura in three subjects, we observed blood oxygenation level-dependent (BOLD) signal changes that demonstrated at least eight characteristics of CSD, time-locked to percept/onset of the aura. Initially, a focal increase in BOLD signal (possibly reflecting vasodilation), developed within extrastriate cortex (area V3A). This BOLD change progressed contiguously and slowly (3.5 ± 1.1 mm/min) over occipital cortex, congruent with the retinotopy of the visual percept. Following the same retinotopic progression, the BOLD signal then diminished (possibly reflecting vasoconstriction after the initial vasodilation), as did the BOLD response to visual activation. During periods with no visual stimulation, but while the subject was experiencing scintillations, BOLD signal followed the retino-topic progression of the visual percept. These data strongly suggest that an electrophysiological event such as CSD generates the aura in human visual cortex.
AbstractList	Cortical spreading depression (CSD) has been suggested to underlie migraine visual aura. However, it has been challenging to test this hypothesis in human cerebral cortex. Using high-field functional MRI with near-continuous recording during visual aura in three subjects, we observed blood oxygenation level-dependent (BOLD) signal changes that demonstrated at least eight characteristics of CSD, time-locked to percept/onset of the aura. Initially, a focal increase in BOLD signal (possibly reflecting vasodilation), developed within extrastriate cortex (area V3A). This BOLD change progressed contiguously and slowly (3.5 ± 1.1 mm/min) over occipital cortex, congruent with the retinotopy of the visual percept. Following the same retinotopic progression, the BOLD signal then diminished (possibly reflecting vasoconstriction after the initial vasodilation), as did the BOLD response to visual activation. During periods with no visual stimulation, but while the subject was experiencing scintillations, BOLD signal followed the retinotopic progression of the visual percept. These data strongly suggest that an electrophysiological event such as CSD generates the aura in human visual cortex. Cortical spreading depression (CSD) has been suggested to underlie migraine visual aura. However, it has been challenging to test this hypothesis in human cerebral cortex. Using high-field functional MRI with near-continuous recording during visual aura in three subjects, we observed blood oxygenation level-dependent (BOLD) signal changes that demonstrated at least eight characteristics of CSD, time-locked to percept/onset of the aura. Initially, a focal increase in BOLD signal (possibly reflecting vasodilation), developed within extrastriate cortex (area V3A). This BOLD change progressed contiguously and slowly (3.5 ± 1.1 mm/min) over occipital cortex, congruent with the retinotopy of the visual percept. Following the same retinotopic progression, the BOLD signal then diminished (possibly reflecting vasoconstriction after the initial vasodilation), as did the BOLD response to visual activation. During periods with no visual stimulation, but while the subject was experiencing scintillations, BOLD signal followed the retinotopic progression of the visual percept. These data strongly suggest that an electrophysiological event such as CSD generates the aura in human visual cortex. Cortical spreading depression (CSD) has been suggested to underlie migraine visual aura. However, it has been challenging to test this hypothesis in human cerebral cortex. Using high-field functional MRI with near-continuous recording during visual aura in three subjects, we observed blood oxygenation level-dependent (BOLD) signal changes that demonstrated at least eight characteristics of CSD, time-locked to percept/onset of the aura. Initially, a focal increase in BOLD signal (possibly reflecting vasodilation), developed within extrastriate cortex (area V3A). This BOLD change progressed contiguously and slowly (3.5 +/- 1.1 mm/min) over occipital cortex, congruent with the retinotopy of the visual percept. Following the same retinotopic progression, the BOLD signal then diminished (possibly reflecting vasoconstriction after the initial vasodilation), as did the BOLD response to visual activation. During periods with no visual stimulation, but while the subject was experiencing scintillations, BOLD signal followed the retinotopic progression of the visual percept. These data strongly suggest that an electrophysiological event such as CSD generates the aura in human visual cortex. Cortical spreading depression (CSD) has been suggested to underlie migraine visual aura. However, it has been challenging to test this hypothesis in human cerebral cortex. Using high-field functional MRI with near-continuous recording during visual aura in three subjects, we observed blood oxygenation level-dependent (BOLD) signal changes that demonstrated at least eight characteristics of CSD, time-locked to percept/onset of the aura. Initially, a focal increase in BOLD signal (possibly reflecting vasodilation), developed within extrastriate cortex (area V3A). This BOLD change progressed contiguously and slowly (3.5 plus or minus 1.1 mm/min) over occipital cortex, congruent with the retinotopy of the visual percept. Following the same retinotopic progression, the BOLD signal then diminished (possibly reflecting vasoconstriction after the initial vasodilation), as did the BOLD response to visual activation. During periods with no visual stimulation, but while the subject was experiencing scintillations, BOLD signal followed the retinotopic progression of the visual percept. These data strongly suggest that an electrophysiological event such as CSD generates the aura in human visual cortex. Cortical spreading depression (CSD) has been suggested to underlie migraine visual aura. However, it has been challenging to test this hypothesis in human cerebral cortex. Cortical spreading depression (CSD) has been suggested to underlie migraine visual aura. However, it has been challenging to test this hypothesis in human cerebral cortex. Using high-field functional MRI with near-continuous recording during visual aura in three subjects, we observed blood oxygenation level-dependent (BOLD) signal changes that demonstrated at least eight characteristics of CSD, time-locked to percept/onset of the aura. Initially, a focal increase in BOLD signal (possibly reflecting vasodilation), developed within extrastriate cortex (area V3A). This BOLD change progressed contiguously and slowly (3.5 ± 1.1 mm/min) over occipital cortex, congruent with the retinotopy of the visual percept. Following the same retinotopic progression, the BOLD signal then diminished (possibly reflecting vasoconstriction after the initial vasodilation), as did the BOLD response to visual activation. During periods with no visual stimulation, but while the subject was experiencing scintillations, BOLD signal followed the retino-topic progression of the visual percept. These data strongly suggest that an electrophysiological event such as CSD generates the aura in human visual cortex.
Author	Wu, Ona Schwartz, Denis Kwong, Kenneth K. Roger B. H. Tootell Moskowitz, Michael A. Hadjikhani, Nouchine Fischl, Bruce Bakker, Dick Rosen, Bruce R. Cutrer, F. Michael del Rio, Margarita Sanchez Sorensen, A. Gregory
AuthorAffiliation	Nuclear Magnetic Resonance Center and ‡ Stroke and Neurovascular Laboratory, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129
AuthorAffiliation_xml	– name: Nuclear Magnetic Resonance Center and ‡ Stroke and Neurovascular Laboratory, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129
Author_xml	– sequence: 1 givenname: Nouchine surname: Hadjikhani fullname: Hadjikhani, Nouchine – sequence: 2 givenname: Margarita Sanchez surname: del Rio fullname: del Rio, Margarita Sanchez – sequence: 3 givenname: Ona surname: Wu fullname: Wu, Ona – sequence: 4 givenname: Denis surname: Schwartz fullname: Schwartz, Denis – sequence: 5 givenname: Dick surname: Bakker fullname: Bakker, Dick – sequence: 6 givenname: Bruce surname: Fischl fullname: Fischl, Bruce – sequence: 7 givenname: Kenneth K. surname: Kwong fullname: Kwong, Kenneth K. – sequence: 8 givenname: F. Michael surname: Cutrer fullname: Cutrer, F. Michael – sequence: 9 givenname: Bruce R. surname: Rosen fullname: Rosen, Bruce R. – sequence: 10 fullname: Roger B. H. Tootell – sequence: 11 givenname: A. Gregory surname: Sorensen fullname: Sorensen, A. Gregory – sequence: 12 givenname: Michael A. surname: Moskowitz fullname: Moskowitz, Michael A.
BackLink	https://www.ncbi.nlm.nih.gov/pubmed/11287655$$D View this record in MEDLINE/PubMed
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Notes	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23 ObjectType-Article-1 ObjectType-Feature-2 N.H. and M.S.d.R. contributed equally to this work. Edited by Marcus E. Raichle, Washington University School of Medicine, St. Louis, MO, and approved February 6, 2001 To whom reprint requests should be addressed at: Stroke and Neurovascular Regulation, Departments of Neurology and Neurosurgery, Massachusetts General Hospital, 149 13th Street, Room 6403, Charlestown, MA 02129. E-mail: moskowitz@helix.mgh.harvard.edu.
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Snippet	Cortical spreading depression (CSD) has been suggested to underlie migraine visual aura. However, it has been challenging to test this hypothesis in human... Cortical spreading depression (CSD) has been suggested to underlie migraine visual aura. However, it has been challenging to test this hypothesis in human...
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SubjectTerms	Adult Biological Sciences Blood flow Eyes & eyesight Headache Humans Imaging Magnetic Resonance Imaging Male Medical imaging Middle Aged Migraine Migraine with Aura - physiopathology Neurology NMR Nuclear magnetic resonance Perception Scintillation Signal reflection Vision Disorders - physiopathology Visual cortex Visual Cortex - physiopathology Visual fields Visual stimulation
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Title	Mechanisms of Migraine Aura Revealed by Functional MRI in Human Visual Cortex
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