Skip to main content


Volume 16 Supplement 1

1st Joint ANIRCEF-SISC Congress

  • Invited speaker presentation
  • Open Access

Controversies about the role of the deficit of habituation of evoked potentials in migraine: a disease biomarker? PROS

The Journal of Headache and Pain201516 (Suppl 1) :A14

  • Published:


  • Migraine
  • Migraine Attack
  • Chronic Migraine
  • Episodic Migraineurs
  • Migraine Pathophysiology

In most studies, episodic migraineurs have an interictal habituation deficit of cortical evoked potentials to repeated monotonous stimuli. It has been found by applying almost every modality of sensory stimulation for evoked potentials (visual - VEP, auditory - AEP, somatosensory - SEP), as well as in visual evoked magnetoencephalographic (MEG) responses[1], thus it is considered as a biomarker of the interictal status, which normalises during the migraine attacks and cannot be found in chronic migraine. A reduced habituation deficit, however, was not confirmed in migraineurs in some studies[1], which was attributed to low reliability and repeatability[2, 3], and to a reduced specificity to migraine pathophysiology.

Nonetheless, some studies that demonstrated an interictal deficit of cortical habituation were conducted blindly, both for VEP[4, 5] and AEP[6]. Moreover, when the same VEP data were analysed independently by two investigators, one of them totally blinded to the diagnosis and the migraine state (ictal vs interictal), blinded and non-blinded analyses were strictly intraindividually correlated and both confirmed the presence of interictal deficit and ictal normalization of VEP habituation. Repeated intraindividual recordings were also strictly correlated, which suggests a good test repeatability[7].

The habituation deficit in VEP has been demonstrated up to now only in pediatric photosensitive epilepsy (which may share some cortical abnormalities with migraine)[8] and in healthy subjects with a high analytic score[9], suggested to be increased in migraineurs[10]. Although the latter may play a role in the habituation deficit found in migraineurs, it cannot explain its variations during the migraine cycle and its absence in chronic migraineurs.

On the other hand it has been demonstrated that at least two different electrophysiological phenotypes may be found in migraineurs[11] and that the deficit of VEP habituation may be slightly different when the same tests are performed in different countries[12].

The discrepant findings in the literature can thus most likely not be explained by the presence or absence of blinding nor by low repeatability. Other methodological issues might be responsible, such as, for instance, online averaging - commonly used in the “negative” studies - that is associated with short interruptions of the visual stimulation, possibly allowing a recovery of habituation. Also, the recruitment of patients, usually performed in headache centers in the “positive” studies, may have contributed to a better selection of patients. Alternatively, phenotypic and/or genotypic differences in cohorts of patients could result in different neurophysiologic patterns.

Authors’ Affiliations

Headache Clinic, IRCCS Neuromed, Pozzilli, IS, Italy


  1. de Tommaso M, Ambrosini A, Brighina F, Coppola G, Perrotta A, Pierelli F, Sandrini G, Valeriani M, Marinazzo D, Stramaglia S, Schoenen J: Altered processing of sensory stimuli in patients with migraine. Nat Rev Neurol. 2014, 10: 144-155. 10.1038/nrneurol.2014.14.View ArticlePubMedGoogle Scholar
  2. Omland PM, Nilsen KB, Uglem M, Gravdahl G, Linde M, Hagen K, Sand T: Visual evoked potentials in interictal migraine: no confirmation of abnormal habituation. Headache. 2013, 53: 1071-1086. 10.1111/head.12006.View ArticlePubMedGoogle Scholar
  3. Omland PM, Uglem M, Hagen K, Linde M, Tronvik E, Sand T: Visual evoked potentials in migraine: Is the “neurophysiological hallmark” concept still valid?. Clin Neurophysiol. 2015, S1388-2457(15)00627-6-doi: 10.1016/j.clinph.2014.12.035. [Epub ahead of print]Google Scholar
  4. Bednář M, Kubová Z, Kremláček J: Lack of visual evoked potentials amplitude decrement during prolonged reversal and motion stimulation in migraineurs. Clin Neurophysiol. 2014, 125: 1223-1230. 10.1016/j.clinph.2013.10.050.View ArticlePubMedGoogle Scholar
  5. Ambrosini A, Iezzi E, Perrotta A, Kisialiou A, Nardella A, Berardelli A, Pierelli F, Schoenen J: Correlation between habituation of visual-evoked potentials and magnetophosphene thresholds in migraine: A case-control study. Cephalalgia. 2015, 0333102415590241-[Epub ahead of print]Google Scholar
  6. Ambrosini A, Rossi P, De Pasqua V, Pierelli F, Schoenen J: Lack of habituation causes high intensity dependence of auditory evoked cortical potentials in migraine. Brain. 2003, 126: 2009-2015. 10.1093/brain/awg206.View ArticlePubMedGoogle Scholar
  7. Ambrosini A, Coppola G, Iezzi E, Pierelli F, Schoenen J: Reliability and repeatability of testing Visual Evoked Potentials in migraine. Abstracts of the 1st European Academy Congress, Berlin (Germany), 20-23 June 2015. Eur J Neurol. 2015, 22 (1): 1120-131.Google Scholar
  8. Brazzo D, Di Lorenzo G, Bill P, Fasce M, Papalia G, Veggiotti P, Seri S: Abnormal visual habituation in pediatric photosensitive epilepsy. Clin Neurophysiol. 2011, 122: 16-20. 10.1016/j.clinph.2010.06.002.View ArticlePubMedGoogle Scholar
  9. Buonfiglio M, Toscano M, Puledda F, Avanzini G, Di Clemente L, Di Sabato F, Di Piero V: Lack of habituation of evoked visual potentials in analytic information processing style: evidence in healthy subjects. Neurol Sci. 2015, 36: 391-395. 10.1007/s10072-014-1962-7.View ArticlePubMedGoogle Scholar
  10. Di Sabato F, Buonfiglio M, Mandillo S: Analytic information processing style in migraineurs. Neurol Sci. 2013, 34: 1145-1150. 10.1007/s10072-012-1193-8.View ArticlePubMedGoogle Scholar
  11. Ambrosini A, Coppola G, Gérardy PY, Pierelli F, Schoenen J: Intensity dependence of auditory evoked potentials during light interference in migraine. Neurosci Lett. 2011, 492: 80-83. 10.1016/j.neulet.2011.01.060.View ArticlePubMedGoogle Scholar
  12. Ambrosini A, Kisialiou A, Finos L, Afra J, Coppola G, Di Clemente L, Iezzi E, Magis D, Sandor PS, Sasso D'Elia T, Viganò A, Fataki M, Pierelli F, Schoenen J: The diagnostic value of Visual and Auditory Evoked Potentials in migraine: a retrospective multicenter study. Abstracts of the 2013 International Headache Congress, Boston, MA (USA), 27-30 June, 2013. Cephalalgia. 2013, 33 (Suppl 8): 213-153.Google Scholar


© Ambrosini 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.


By submitting a comment you agree to abide by our Terms and Community Guidelines. If you find something abusive or that does not comply with our terms or guidelines please flag it as inappropriate. Please note that comments may be removed without notice if they are flagged by another user or do not comply with our community guidelines.