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Altered Cerebrovenous Drainage in Patients With Migraine as Assessed by Phase-Contrast Magnetic Resonance Imaging

Koerte, Inga K. MD*; Schankin, Christoph J. MD; Immler, Stefanie MD*; Lee, Sang MS; Laubender, Ruediger P. MA, MPH§; Grosse, Christina MD*; Eftimov, Lara MD*; Milde-Busch, Astrid MD; Reiser, Maximilian MD*; Straube, Andreas MD; Heinen, Florian MD; Alperin, Noam PhD; Ertl-Wagner, Birgit MD*

doi: 10.1097/RLI.0b013e318210ecf5
Original Article
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Objective: We aimed to assess whether migraine is associated with changes in the distribution of the venous drainage through primary and secondary pathways by using phase-contrast magnetic resonance imaging (MRI).

Methods: We examined 26 patients (37.3 ± 13.9 years) with recurring migraine headaches and 26 age- and gender-matched controls with no neurologic disease (37.3 ± 13.7 years) on a 3 Tesla MR scanner. A 2D time-of-flight MR-venography of the upper neck region was performed to visualize the venous vasculature. Cine-phase contrast scans with high-velocity encoding were employed to quantify arterial inflow and flow in the primary venous channels (right and left jugular veins), whereas scans with low-velocity encoding were employed to quantify flow in the secondary venous channels (epidural, vertebral, and deep cervical veins).

Results: Patients with migraine showed (i) a higher prevalence of dense secondary extracranial venous networks (15 vs. 2, P = 0.00002) and (ii) a significantly larger percentage of venous outflow through secondary channels (10.5% vs. 5.5%; of total cerebral blood flow, P = 0.02). This mainly included drainage through epidural, vertebral, and deep cervical veins.

Conclusion: Migraine patients showed a significantly larger percentage of venous outflow through secondary channels. The mechanism of this alteration remains to be elucidated. Potential mechanisms include repeated release of vasoactive substances or growth factors.

From the *Institute of Clinical Radiology, Ludwig-Maximilians-University, Grosshadern Campus, Munich, Germany; †Department of Neurology, Ludwig-Maximilians-University, Munich, Germany; ‡Department of Radiology, Miller School of Medicine, University Miami, Miami, FL; §Institute of Medical Informatics, Biometry and Epidemiology, IBE Ludwig-Maximilians-University, Munich, Germany; ¶Institute of Social Pediatrics and Adolescent Medicine, Ludwig-Maximilians-University, Munich, Germany; ∥Department of Pediatric Neurology and Developmental Medicine, Dr. von Hauner's Children's Hospital, Ludwig-Maximilians-University, Munich, Germany.

Received September 23, 2010, and accepted for publication (after revision) December 31, 2010.

Supported by a grant from the Society for Neuropediatrics/Europe (to I.K.).

Noam Alperin is a stockholder of Alperin Noninvasive Diagnostics, Inc.

Reprints: Inga K. Koerte, MD, Institute of Clinical Radiology, Ludwig-Maximilians-University, Marchioninistr. 15, 81377 Munich, Germany. E-mail: ikoerte@med.lmu.de.

© 2011 Lippincott Williams & Wilkins, Inc.