Imaging techniques continue to evolve and improve, and recent developments in advanced MRI techniques are allowing the clinical community to better understand the underlying pathophysiology of migraines, which remains less well characterized than the clinical phenotype. Early research with novel structural imaging techniques such as voxel based morphometry and surface based morphometry suggest consistent variations in gray matter volume in regions of the brain responsible for pain processing and modulation in patients with migraine and other chronic Headache pain. White matter hyperintensities have been the most common minor intracranial abnormality in patients with migraine. Recent studies have investigated the correlation of white matter volume changes (eg, corpus callosum) and microstructural alterations on diffusion tensor imaging to symptoms in patients with migraine with and without aura, especially those with a depressive/anxious comorbidity. Functional neuroimaging studies have also been used to investigate the brain activation changes during and between migraine attacks. In addition to functional imaging, research using arterial spin labeling imaging to measure perfusion without necessitating IV contrast is providing useful insignts into the transient perfusion changes during the acute phase of an aura and following an attack. Arterial spin labeling has also proved in separating mirgraine with aura from cerebral ischemia, which can have a direct impact on clinical decision making. This ongoing research may help us understand attack ignition/propagation and provide targets for future therapy [27,28]. MRV Head With IV Contrast There is no relevant literature to support the use of MRV head with IV contrast in the initial imaging evaluation of primary migraine or TTH with a normal neurologic examination.
Headache PCAs. Imaging techniques continue to evolve and improve, and recent developments in advanced MRI techniques are allowing the clinical community to better understand the underlying pathophysiology of migraines, which remains less well characterized than the clinical phenotype. Early research with novel structural imaging techniques such as voxel based morphometry and surface based morphometry suggest consistent variations in gray matter volume in regions of the brain responsible for pain processing and modulation in patients with migraine and other chronic Headache pain. White matter hyperintensities have been the most common minor intracranial abnormality in patients with migraine. Recent studies have investigated the correlation of white matter volume changes (eg, corpus callosum) and microstructural alterations on diffusion tensor imaging to symptoms in patients with migraine with and without aura, especially those with a depressive/anxious comorbidity. Functional neuroimaging studies have also been used to investigate the brain activation changes during and between migraine attacks. In addition to functional imaging, research using arterial spin labeling imaging to measure perfusion without necessitating IV contrast is providing useful insignts into the transient perfusion changes during the acute phase of an aura and following an attack. Arterial spin labeling has also proved in separating mirgraine with aura from cerebral ischemia, which can have a direct impact on clinical decision making. This ongoing research may help us understand attack ignition/propagation and provide targets for future therapy [27,28]. MRV Head With IV Contrast There is no relevant literature to support the use of MRV head with IV contrast in the initial imaging evaluation of primary migraine or TTH with a normal neurologic examination.