Advances in migraine neuroimaging and clinical utility: from the MRI to the bedside

ABSTRACT

Introduction: In current migraine clinical practice, no specific diagnostic investigations are available and therefore the diagnosis is an eminently clinical process where instrumental examinations may have a part to exclude possible causes of secondary headaches. While migraine clinical phenotype has been widely characterized, migraine pathophysiology has still a gap that might be partly bridged by structural and functional neuroimaging investigations.

Areas covered: This article aims to review the recent advances in functional neuroimaging, the consequent progress in the knowledge of migraine pathophysiology and their putative application and impact in the clinical setting. A comprehensive review was conducted of PubMed citations by entering the key word ‘MRI’ combined with ‘migraine’ AND/OR ‘headache.’ Other key words included ‘gray matter’ OR ‘white matter,’ ‘structural’ OR ‘functional.’ The only restriction was English-language publication. The abstracts of all articles meeting these criteria were reviewed, and full texts were examined for relevant references.

Expert commentary: Advanced magnetic resonance imaging (MRI) techniques are tremendously improving our knowledge about brain abnormalities in migraine patients. However, advanced MRI could nowadays overcome the limits linked to the clinicians’ judgment through the identification of objectively measurable neuroimaging findings (quantitative biomarkers) concerning the diagnosis, the prognosis and ‘tailored’ therapeutic-care pathways.

KEYWORDS:

• Migraine
• advanced neuroimaging
• clinical practice
• fMRI
• resting-state
• structural
• microstructural
• grey matter
• white matter
• biomarkers

Declaration of interest

G Tedeschi has received speaker honoraria from Sanofi-Aventis, Merck Serono, Bayer Schering Pharma, Novartis, Biogen-Dompe; travel grants from Bayer Schering Pharma, Biogen Dompe, Merck Serono, Novartis, and Sanofi Aventis; and serves as an associate editor for another journal. A Russo has received speaker honoraria from Allergan and serves as an Associate Editor for Frontiers in Neurology. A Tessitore has received speaker honoraria from Novartis, Schwartz Pharma/UCB, Lundbeck, Abbvie, and GlaxoSmithKlein. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.