Migraine is far more than a bad headache. It’s a neurological condition that affects tens of millions of Americans and many more worldwide. Using an unusually powerful MRI scanner, researchers at the University of Southern California have spotted small structural changes in the brains of people with migraine that had never been reported before.
What is migraine?
Migraine attacks typically bring intense, often throbbing head pain, frequently on one side. Many people also experience nausea, vomiting, and sensitivity to light and sound. Some have an “aura” beforehand, such as flashing lights or zigzag lines in their vision. People with chronic migraine have headaches on 15 or more days a month, while episodic migraine occurs less often.
Migraine is one of the leading causes of disability worldwide and is about three times more common in women than in men. Many people live with it for years without a proper diagnosis or effective treatment.
What the researchers looked at
The team focused on perivascular spaces, which are tiny fluid-filled channels that surround blood vessels in the brain. They form part of the brain’s waste-clearing system. When these spaces become enlarged, it may be a sign of problems in the brain’s small blood vessels.
To see such small structures clearly, the researchers used a 7-Tesla MRI scanner, which produces far sharper images than the scanners used in most hospitals. They presented their findings at the annual meeting of the Radiological Society of North America in 2022.
The study was small. It included 10 people with chronic migraine, 10 with episodic migraine without aura, and 5 people without migraine for comparison, all between 25 and 60 years old.
What they found
- More enlarged perivascular spaces were found in a deep white matter region called the centrum semiovale in people with both chronic and episodic migraine, compared with people without migraine.
- A link to white matter changes. In people with migraine, more enlarged spaces went along with more white matter “hyperintensities,” small spots that show up brightly on MRI.
The researchers didn’t find a meaningful difference in white matter spots between people with and without migraine. But because those spots were linked to the enlarged spaces, they suggest that perivascular changes could come first and contribute to white matter changes over time.
With so few participants, the findings need to be confirmed in much larger studies. The researchers hope this work will help explain how migraine develops and lead to more personalized diagnosis and treatment.
What this means for you
The study is not a reason for alarm. If you live with migraine, these steps can help you manage it:
- Track your attacks. A headache diary can reveal triggers such as poor sleep, skipped meals, stress, dehydration, alcohol or certain foods.
- Keep a steady routine. Regular sleep, meals and hydration help many people reduce how often attacks happen.
- Talk with your doctor about treatment. There are effective options both for stopping attacks and for preventing them.
- Watch your painkiller use. Taking pain relievers too often can lead to “medication overuse” headaches.
- Know the red flags. Get urgent care for a sudden, severe “worst ever” headache, or a headache with weakness, confusion, trouble speaking, vision loss, fever or a stiff neck.
The bottom line
Ultra-high-resolution MRI suggests migraine may be linked to tiny changes in the brain’s fluid-clearing channels. It’s early research, but it could help scientists better understand migraine and develop new ways to treat it.
This article is for general information and isn’t medical advice. Talk with your healthcare provider about your individual needs.
