Focal hyperemia followed by spreading oligemia and impaired activation of rcbf in classic migraine

This study examined regional cerebral blood flow (rCBF) in migraine patients. Researchers measured rCBF in 254 brain areas using a special injection method. Six classic migraine cases were followed from normal states to the prodromal phase. Three of these cases were tracked into the headache phase. One common migraine patient was also studied during a classic attack. In three patients, attacks began with focal hyperemia. During prodromes, all patients showed occipitoparietal rCBF reduction, known as oligemia. Only one patient had critical values of this reduction. Oligemia spread anteriorly over 15 to 45 minutes. Four patients exhibited global oligemia. Severe headache coincided with oligemia in four patients, showing no hyperemia. Additionally, six patients experienced impaired rCBF increase during activities like hand movement or speech. Therefore, the study suggests that the vasospastic model of migraine is overly simplistic. Clinical relevance: This research indicates that understanding rCBF changes may improve migraine treatment strategies.