Future Research on Neuronal Microstructure Integrity in Migraine Using High-Gradient Diffusion MRI: Katharina Eikermann-Haerter, MD

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"For example, in patients with visual aura, it will be important to look at the occipital lobe, which is where the aura is located, to see if this neuronal loss is more pronounced in that area compared with other brain areas, as well as to better understand if the aura part is the mechanism that leads to the neuronal loss.”

Migraine, a neurovascular disorder involving the trigeminovascular system, is one of the most frequent and disabling neurological diseases, affecting approximately 14% of the general population, with higher rates found in women. Although efforts in understanding migraine pathophysiology have increased, the exact mechanisms underlying this disease still remain unclear. Some data have shown that reduced gray matter (GM) and white matter (WM) volume are present in those with migraine, particularly those with aura.

At the 2024 American Academy of Neurology (AAN) Annual Meeting, held April 13-18, in Denver, Colorado, a study led by Katharina Eikermann-Haerter, MD, looked at the neuronal microstructure and glymphatic system integrity in patients with migraine with aura. The study included 16 patients with migraine with aura and 16 matched healthy controls, with diffusion weighted imaging (DWI) models used to characterize the microstructure of both GM and WM. Glymphatic activity was also evaluated with diffusion-tensor image analysis along the perivascular space.

Results showed that the GM of patients with migraine exhibited neuronal density with increased soma radius of the remaining cells. These microstructural changes were present in both cortex and deep GM structures including the thalamus, putamen, hippocampus, and amygdala. In WM of patients with migraine that appeared normal on conventional MRI, microstructural analysis showed axonal loss and increased axonal diameter, which was even more pronounced in WM lesions.

Overall, the study highlighted the impacts of high-gradient diffusion MRI to observe occult changes in the microstructural integrity of GM and WM in patients with migraine. In an interview with NeurologyLive^®, Eikermann-Haerter, an associate professor in the department of radiology at NYU Langone, discussed the next steps following this research, stressing the need to conduct longitudinal studies to see dynamics of these changes. In addition, she spoke on the need to look at different brain regions to see where the aura is most involved in the brain. Furthermore, she gave thoughts on the feasibility of observing microstructural integrity in patients with migraine on a larger, more consistent basis.

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REFERENCE
1. Li M, Eskandarian L, Huang S, Eikermann-Haerter. Neuronal microstructure and glymphatic system integrity in migraine patients with high-gradient diffusion MRI. Presented at: 2024 AAN Annual Meeting; April 13-18; Denver, CO. ABSTRACT 007113