Susceptibility Weighted Imaging in Migraine with and Without Aura: A Case–Control Study

TL;DR

This study found that MRI scans of migraine patients show different vein patterns depending on whether they experience aura, suggesting different biological processes.

Contribution

The study is the first to show that SWI asymmetry is specific to migraine with aura, indicating no role for cortical spreading depression in migraine without aura.

Findings

Migraine with aura showed 26% SWI asymmetry compared to 3% in migraine without aura.

SWI asymmetry was significantly higher in migraine with aura than in controls.

Migraine without aura showed no significant difference from controls in SWI asymmetry.

Abstract

Background: The asymmetry of cortical veins in susceptibility weighted imaging (SWI) in MRI might be a biomarker for migraine aura and cortical spreading depression (CSD). The aim of this study was to assess in humans if SWI asymmetry can be found in patients who have migraine attacks without aura. Methods: We included patients (n = 100 per group) from the emergency room setting when they (i) presented with an acute neurological deficit or headache; (ii) had a discharge diagnosis of a migraine aura, a migraine without an aura, or neither (controls without stroke or epilepsy); and (iii) had a brain MRI with SWI in the acute setting. Results: In the migraine with aura group, SWI asymmetry was found in 26% (95% CI 18–35) compared to patients with migraine without aura (3%, [95% CI 1–8], p < 0.001) and controls 7% [95% CI 3–14], p < 0.001). There was no difference between patients with migraine without aura and controls (p = 0.19). Conclusions: The distinct SWI changes in migraine with and without aura suggest that CSD might not be involved in the pathophysiology of migraine without aura.

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