An update on EEG in migraine

ABSTRACT

Introduction: In the past few years, brain functional analysis has provided scientific evidence supporting the neuronal basis of migraine. The role of electroencephalography (EEG) in detecting subtle dysfunctions in sensory temporal processing has been fully re-evaluated, thanks to advances in methods of quantitative analysis. However, the diagnostic value of EEG in migraine is very low, and migraine diagnosis is completely based on clinical criteria, while the utility of EEG in migraine pathophysiology has only been confirmed in more recent applications.

Areas covered: The present review focuses on the few situations in which EEG may provide diagnostic utility, and on the numerous and intriguing applications of novel analysis, based on time-related changes in neuronal network oscillations and functional connectivity.

Expert opinion: Although routine EEG is not particularly useful for the clinical assessment of migraine, novel methods of analysis, mostly based on functional connectivity, could improve knowledge of the migraine brain. The application is worthy of promotion and improvement in support of neuroimaging data to shed light on migraine mechanisms and support the rationale for therapeutic approaches.

KEYWORDS:

• Migraine
• EEG
• differential diagnosis
• pathophysiology
• functional connectivity

Article Highlights

• Clinical indications for EEG in migraine are limited to rare cases with suspected headache or aura symptoms of epileptic origin.

• The absence of evident EEG changes during aura could suggest the complexity of cortical spreading depression (CSD) propagation in migraine.

• Quantitative analysis of spectral power revealed fluctuating behavior, especially in the posterior alpha rhythm, dependent on the timing of the migraine attack.

• EEG frequency changes under repetitive visual stimulation, are different among migraine with and without aura and controls.

• The application of functional connectivity methods to spontaneous and stimulated EEG, emphasize the complexity of migraine as an ‘oscillopathy’.

• The graph theory applied to EEG and magnetoencephalography data, describes peculiar neuronal network functional connections in migraine with aura.

Declaration of interest

The author has received honoraria for seminars and teaching by Allergan, Novartis, Electrocore, and Neopharmed. The author has no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.

Reviewer disclosures

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

Additional information

Funding

The study was funded by Bari Aldo Moro research funds.