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Brain Advance Access published online on February 10, 2005
Brain, doi:10.1093/brain/awh416
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© The Author (2005). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oupjournals.org
Received October 1, 2004
Revised December 9, 2004
Accepted January 5, 2005

Article

A PET study exploring the laterality of brainstem activation in migraine using glyceryl trinitrate

S. K. Afridi 1, M. S. Matharu 1, L. Lee 2, H. Kaube 1, K. J. Friston 2, R. S. J. Frackowiak 2, and P. J. Goadsby 1*

1 Headache Group, Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
2 Wellcome Department of Imaging Neuroscience, Institute of Neurology and The National Hospital for Neurology and Neurosurgery, Queen Square, London, UK

* To whom correspondence should be addressed.
P. J. Goadsby, E-mail: peterg{at}ion.ucl.ac.uk


  Abstract

Summary Migraine is a common disabling condition likely to be associated with dysfunction of brain pathways involved in pain and other sensory modalities. A cardinal, indeed signature, feature of the disorder that led to its name is that the pain may be lateralized. H215O-labelled PET was used to study 24 migraineurs and eight healthy controls. The migraineurs were divided into three groups according to the site of their headache: right, left or bilateral. In each group, a migraine was induced using a glyceryl trinitrate (GTN) infusion. The subjects were scanned at predefined points: pre-infusion, during GTN, during migraine and post-migraine. SPM99 software was used to analyse the data. Significant brainstem activation was seen in the dorsal lateral pons (P < 0.05 after small volume correction) during the migraine state versus the pain-free state when comparing migraineurs with controls. When each group was analysed separately, to investigate laterality, it was found that the dorsal pontine activation was ipsilateral in the right-sided and left-sided groups and bilateral in the bilateral headache group with a left-sided preponderance. Consistent with previous work, the activation persisted after pain was controlled by sumatriptan. These results suggest that lateralization of pain in migraine is due to lateralized brain dysfunction.

Keywords: migraine; brainstem; PET; glyceryl trinitrate; laterality.
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