Table 1 Acute therapies for migraine
From: Imaging the brain and vascular reactions to headache treatments: a systematic review
Reference | Population | Treatment | Imaging modality and timing of scans | Results | Limitations |
|---|---|---|---|---|---|
Wei et al., 2022 [16] | 70 MO 33 HC | Type: NSAID Duration: 2 attacks treated within 3 months of scan Response definition: 50% or greater reduction in pain intensity from pre-treatment | Modality: RS fMRI Time-point: Pretreatment | Baseline: Responders vs non-responders: ↑ FC between visual and auditory network in responders ↓ FC between sensorimotor and visual network in responders | Type of NSAID not specified FC compared at p < 0.05, uncorrected for multiple comparison Overlap of regions belonging to distinct networks |
Wei et al., 2022 [17] | 73 MO 33 HC | Type: NSAID Duration: 2 attacks treated within 3 months of scan Response definition: 50% or greater reduction in pain intensity between the pre-treatment level and 2 h after taking medication | Modality: RS fMRI and T1w MRI Time-point: Pretreatment | Baseline: Responders vs non-responders: ↑ FC between left amygdala and right superior frontal gyrus, left calcarine sulcus, left superior parietal gyrus and paracentral lobule in responders ↓ FC between left amygdala and ipsilateral caudate nucleus in responders No whole-brain GM volume differences | Type of NSAID not specified |
Ahmed et al., 2022 [18] | 500 Mx (150 MA, 235 CM) | Type: Ibuprofen 200–400 mg Duration: At least 2 months Response definition: Pain freedom within 2 h in ≥ 4 of 5 attacks while insufficient responders achieved pain freedom in ≤ 3 of 5 attacks | Modality: T2w MRI Time-point: Pretreatment | Baseline: Responders vs non-responders: Acute treatment responders less frequently had WMHs, had fewer WMHs, and smaller WMHs | Only T2-w images were used to assess WMHs. FLAIR acquisition would also be recommended The same population was assessed for response to preventive treatments. However, the association between patients’ response to acute and preventive medications have not been examined |
Asghar et al., 2011 [19] | 24 MO (12 received sumatriptan) | Type: Sumatriptan 6 mg s.c Duration: One administration | Modality: MR-angiography Time-point: Pretreatment, at follow-up during CGRP-induced migraine attack and 15 min after treatment | Baseline-to-follow-up: ↑ MMA and MCA circumference during CGRP-induced migraine attack compared to baseline, and specific to the attack side ↓ MMA circumference after sumatriptan compared to pretreatment. For patients with unilateral headache, this was only on the pain side No change in MCA circumference after sumatriptan |  |
Khan et al., 2019 [20] | 26 MO | Type: Sumatriptan 6 mg s.c Duration: One administration | Modality: MR-angiography Time-point: Pretreatment, at follow-up during cilostazol-induced migraine attack and one hour after treatment | Baseline-to-follow-up: ↑ Bilateral circumference of MCA, ICAcerebral, ICAcavernous, and ECA from baseline to early ictal scan. Increase in MMA circumference only on the pain side ↓ Bilateral circumference of MMA, ICAcavernous, ECA and STA after sumatriptan No reduction in MCA, ICAcerebral or basilar artery |  |
Ferrari et al., 1995 [21] | 15 MO | Type: Sumatriptan 6 mg s.c Duration: One administration | Modality: Tc 99 m HM-PAO SPECT Time-point: Pretreatment during migraine attack and 3–45 min after treatment | Baseline-to-follow-up: Sumatriptan did not change rCBF during the attack phase on the headache or non-headache side in frontal, occipital, parietal, temporal, white matter, or cerebellar region of interests |  |
Friberg et al., 1991 [22] | 6 MA, 4 MO 18 HC | Type: Sumatriptan 2Â mg i.v Duration: One administration for both patients and HC | Modality: Xe-133 SPECT w/ MCA TCD Time-point: Pre-treatment during migraine attack and at follow-up 30Â min after treatment HC were studied at the same time-points as patients | Baseline-to-follow-up: Patients and HC Global and regional CBF in ROIs unchanged 30Â min after sumatriptan infusion in both patients and HC Symptom relief 30Â min after sumatriptan infusion in patients | MCA mean blood flow velocity likewise unchanged on TCD. Combined with unchanged CBF, this indicates no dilation of the MCA |
Deen et al., 2019 [23] | 8 MO | Type: Sumatriptan 6 mg s.c Duration: One administration | Modality: [11C]AZ10419369 PET-MRI Time-point: Pre-treatments during cilostazol-induced migraine attack and at follow-up 43 min after treatment | Baseline-to-follow-up: ↓ 5-HT1B binding after sumatriptan treatment of migraine attack in all brain regions examined (dorsofrontal and ventrolateral prefrontal, orbitofrontal, anterior cingulate, sensorimotor, and insular cortices as well as amygdala) | One tailed paired t-test between study days at p < 0.05, uncorrected for seven comparisons |
Khan et al., Cephalalgia 2019 [24] | 28 MO (12 received sumatriptan) 4 HC | Type: Sumatriptan 6 mg s.c Duration: One administration | Modality: MRI with USPIO contrast Time-point: Single scan performed 24 h after treatment and after cilostazol-induced attacks HC underwent the same MRI protocol as patients | Sumatriptan-treated vs untreated attacks: Patients ↓ bilateral USPIO uptake in the ACA for patients who received sumatriptan compared to those who didn’t ↓ reduction of USPIO intake on the pain side compared to the non-pain side in patients treated with sumatriptan Baseline-to-follow-up: HC No significant differences in USPIO intake between the right and left side of the brain | Post-hoc analysis |
Sakai et al., Cephalalgia 2014 [25] | 6 MO (interictal patients) 6 HC | Type: Eletriptan 40 mg Duration: One administration | Modality: α-[11C]MTrp PET-MRI Time-point: Pretreatment interictally and at follow-up one hour after treatment in both patients and HC | Baseline: Migraine vs HC No significant differences Baseline-to-follow-up: Patients and HC ↓ cerebral 5-HT synthesis in whole brain for migraine patients No changes after treatment in healthy controls | Migraine subjects were not ictal at baseline scan |
Schankin et al., 2016 [26] | 6 Mx (4 MO, 2 MA) 6 HC | Type: Dihydro-ergotamine (11C labelled) Duration: One administration | Modality:11C-Dihydro-ergotamine PET MRI Time-point: Pretreatment and at follow-up during GTN-induced attacks concomitant with treatment HC underwent the same protocol as patients | Baseline-to-follow-up: Patients and HC No 11C-DHE binding in central regions of interest at baseline or post-GTN for migraine patients or healthy controls 11C-DHE Binding in regions outside the BBB (choroid plexus, pituitary fossa, venous sinuses, and facial tissue) for both groups at all scans | Â |
Wu et al., 2022 [27] | 105 Mx (73 in testing and 32 in validation cohort) | Type: Sumatriptan (unspecified) Response definition: Decreased in headache severity from moderate or severe to none or mild within 2 h of sumatriptan intake in at least 2 out of 3 attacks | Modality: T1w MRI Time-point: Pretreatment | Baseline: Responders vs non-responders: ↑ Left hippocampus volume in sumatriptan responders in the testing cohort Left hippocampal volume greater than 4,032.6 mm3 differentiated responders from non-responders, in the validation cohort | 20 regions of interest compared on both sides without correction for multiple comparisons Left hippocampal volume not different for responders compared to non-responders in validation cohort |