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EHC 2022 | The link between interictal migraine brain and acute migraine symptoms

Roberta Messina, MD, Vita-Salute San Raffaele University, Milan, Italy, outlines the current understanding of the link between the interictal migraine brain and acute migraine symptoms. Much evidence shows that during the interictal phase, migraine patients can experience widespread functional imaging alterations involving different cortical and subcortical areas involved in pain and visual processing. The alterations observed in the brain of migraine patients during the interictal phase could influence the symptoms experienced during the acute phase of a migraine attack and affect disease progression and severity. Those findings could help understand better the pathophysiology of migraine and develop new treatments. This interview took place at the 16th European Headache Congress (EHC) in Vienna, Austria.

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Transcript (edited for clarity)

There are many evidence showing that also when patients are symptomatic, so also during their interictal phase, they can experience widespread functional imaging alterations involving different cortical and subcortical areas involved in the pain processing and also visual processing.

Many studies have shown that what we observed in migraine patients during the interictal phase could influence the symptoms experienced by patients during the acute phase of the migraine attack...

There are many evidence showing that also when patients are symptomatic, so also during their interictal phase, they can experience widespread functional imaging alterations involving different cortical and subcortical areas involved in the pain processing and also visual processing.

Many studies have shown that what we observed in migraine patients during the interictal phase could influence the symptoms experienced by patients during the acute phase of the migraine attack. There are, for example, some evidence that different activation of frontal areas involved in a pain modulation or of the periaqueductal grey, which is a brainstem region involved in the inhibitory pathway of pain processing. And could actually influence and indeed alter the activation were significantly associated with the pain perceived by patients during the acute phase of migraine and also with the presence of cutaneous allodynia during the acute phase.

This evidence suggests that imaging alteration that we observed in migraine patients during the ictal phase could influence the severity of pain experienced by patients during acute migraine attack and also the presence of ictal cutaneous allodynia.

This evidence could help us to understand better the pathophysiology of a migraine. And also it has also been shown that interictal brain alterations found using imaging techniques could also affect the disease progression and disease severity. This is very important because if we understand better what happened in the migraine brain and also during the interictal phase and the link with the acute phases, we could also try to develop a new treatment that could help our patients.

In the future, we hope to have more studies and actually more evidence are now becoming available in the literature that actually investigate the possible, the central mechanism of action of acute and preventive treatments used for migraine patients and how so these treatments could affect and influence the interictal migraine brain. For sure, I think in the future we will see more and more studying investigating this aspect.

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