Cerebrovascular Reactivity According to Migraine Subtypes: with or without Aura

Hong, Ji Man; Shin, Sang Kun; Huh, Kyoon; Joo, In Soo

Abstract

BACKGROUND: In migraine studies, the cerebrovascular reactivity (CVR) using a transcranial Doppler (TCD) has been investigated to elucidate the nature and role of the vascular response. However, past studies have not comprised the posterior circulation including functionally important brainstem structures. The purpose of this study was to compare the simultaneous CVRs between the middle cerebral artery (MCA) and basilar artery (BA) in migraine patients with and without aura, by means of a power motion mode Doppler (PMD) with an anterior-posterior probes fixating device.
METHODS
Thirty-six consecutive patients with migranes [15 migraine patients with aura (MA) and 21 migraine patients without aura (MWA)] were compared with 29 healthy volunteers. CVR [(Vmax-Vbase)x100/Vbase] was evaluated by the re-breathing technique. TCD was performed as two steps. First, the velocities and spectra of the MCAs through both temporal windows were simultaneously monitored. Second, those were simultaneously monitored between MCA and BA. RESULT: There were no significant differences in age, sex, baseline hemodynamic values (blood pressure, heart rate), and those of the baseline mean flow velocity and CVR of TCD between the migraine patients and the controls. However, the CVR of the BA significantly differed between the MA and the MWA (39.4+/-13.7 vs 64.6+/-25.4%; p=0.001), among MA, MWA, and controls (39.4+/-13.7, 64.6+/-25.4, 45.6+/-14.9%; p<0.001).
CONCLUSIONS
CVR of BA was entirely different according to migraine subtypes: with or without aura. Our study suggests that MWA and MWOA seem to be distinct disorders in terms of different vascular responses of the BA during the interictal period.