Hemodynamic and Metabolic Coupling in Migraine

描述(申请人提供)：这些研究的长期目标是了解脑血流动力学和氧代谢改变如何导致神经系统疾病，并确定它们在偏头痛的病理生理学中的作用。我们的总体假设是大脑 偏头痛患者血流量(CBF)和氧代谢(CMRO2)异常，影响局部脑组织氧合(PtO2)。此外，偏头痛患者对视觉刺激反应的CBF/CMRO2偶联也是异常的。在最近的研究中，我们观察到了无先兆偏头痛期间的低灌流和低代谢，但代谢的较大下降导致头痛期间局部组织氧合的轻微增加。舒马曲坦治疗后，CBF和CMRO2均恢复正常。在视觉刺激后，我们观察到CBF反应增加，CBF/CMRO2偶联反应增加，这可能与神经元的超兴奋性有关。这两种刺激引起的变化对舒马曲坦都没有反应。我们的第一个具体目标是描述基线期间稳态CBF和CMRO2的变化、先兆症状、头痛症状和舒马曲坦的反应，并确定这如何影响偏头痛不同阶段的组织氧合。我们的第二个目标是表征CBF/CMRO2在高对比度和低对比度视觉刺激下的耦合反应，同样是在偏头痛的不同阶段。第三个目标是解决偏头痛期间静息状态大胆同步的变化，作为偏头痛期间皮质同步性增强的迹象。此外，从静息状态的fMRI数据中检查BOLD信号衰减的非先兆扩散波现象。这些研究将在10名患有月经性偏头痛的女性和10名对照组中进行。这些研究为解决偏头痛病理生理学中的基本机制问题提供了新的途径。这项探索性工作的终点是CBF和CMRO2偶联的特征及其对脑组织氧合的影响，以及BOLD同步性在月经性偏头痛症状演变/治疗中的作用。这将为应用这些新的MRI工具来评估偏头痛疾病的自然病史或更广泛的治疗反应奠定基础。

DESCRIPTION (provided by applicant): The long-term goal of these studies is to understand how altered cerebral hemodynamics and oxygen metabolism contribute to neurological disease, and identify their role in the pathophysiology of migraine. Our overall hypothesis is that cerebral blood flow (CBF) and oxygen metabolism (CMRO2) are abnormal in migraine, and this affects local cerebral tissue oxygenation (PtO2). Further, that the CBF / CMRO2 coupling in response to a visual stimulus is also abnormal in migraine. During recent studies we observed hypoperfusion and hypometabolism during migraine without aura, but a greater decline in metabolism resulted in a small increase in local tissue oxygenation during the headache phase. Following sumatriptan both CBF and CMRO2 were normalized. Following a visual stimulus, we observed an increased CBF response, and increased CBF/CMRO2 coupling response, possibly related to neuronal hyperexcitability. Neither of these stimulus-induced changes responded to sumatriptan. Our first specific aim is to characterize the changes in steady-state CBF and CMRO2 during baseline, prodrome symptoms, headache symptoms and in response to sumatriptan, and determine how this affects tissue oxygenation at different phases of migraine. Our second aim is to characterize the CBF/CMRO2 coupling in response to a high contrast vs. a low contrast visual stimulus, again at different phases of migraine. A third aim is to address changes in resting state BOLD synchrony during migraine, as an indication of increased cortical synchrony during migraine. Also to examine a phenomenon of non-aura spreading waves of BOLD signal attenuation, from resting state fMRI data. These studies will be conducted in 10 women with menstrual migraine, and 10 controls. These studies present a new approach to address basic mechanistic questions in migraine pathophysiology. The endpoint of this exploratory work is the characterization of CBF and CMRO2 coupling and its impacts on cerebral tissue oxygenation, as well as the role of BOLD synchrony, during the evolution / treatment of symptoms in menstrual migraine. This will establish the basis for applying these novel MRI tools to evaluate the natural history or response to therapy more widely in migraine disorders.