phosphocreatine and Migraine-Disorders

The authors propose that patients who suffer from migraine with aura have a susceptibility to spontaneous neuronal discharges and subsequent spreading depression. This is based upon a state of central neuronal excitability involving the excitatory neurotransmitter glutamate, in combination with supersensitivity of the N-méthyl-D-aspartate (NMDA) receptor. This hypersusceptibility is supported by increased turnover of high-energy phosphates, low intracellular Mg2+ and large amplitude depolarizing waves on magnetoencephalography (MEG).

Topics: Cortical Spreading Depression; Energy Metabolism; Humans; Hydrogen-Ion Concentration; Ischemic Attack, Transient; Magnesium; Magnetic Resonance Spectroscopy; Magnetoencephalography; Migraine Disorders; Phosphates; Phosphocreatine; Radiography; Reference Values

Previous (31)P-magnetic resonance spectroscopy ((31)P-MRS) studies have shown that cerebral cortical energy metabolism is abnormal in migraine and that cortical energy reserves decrease with increasing severity and duration of aura. Migrainous infarction is a rare complication of migraine with aura, and its pathophysiology is poorly understood. We used (31)P-MRS to determine whether migrainous stroke shows similar interictal abnormalities in cortical energy metabolism as severe, prolonged aura.. We used (31)P-MRS to study patients with a diagnosis of either migrainous infarction or migraine with persistent aura without infarction (aura duration >7 days) according to International Headache Society criteria. We compared clinical presentation and metabolite ratios between patient groups. We also studied healthy controls with no history of migraine.. Patients with persistent aura without infarction had lower phosphocreatine-phosphate (PCr/Pi) ratios (mean+/-SD, 1.61+/-0.10) compared with controls (1.94+/-0.35, P=0.011) and with patients with migrainous stroke (1.96+/-0.16, P<0.0001). These differences were present in cortical tissue only. In migrainous stroke patients, the metabolite ratios did not differ significantly from those of controls without migraine.. The differences in cortical energy reserves between patients with migrainous stroke and in those with migraine with persistent aura suggest that the pathomechanisms of these conditions differ and that migrainous infarction does not simply represent a particularly severe form of migrainous aura. This finding supports the revised International Headache Society criteria, which now distinguish between migrainous infarction and migraine with persistent aura without infarction.

Topics: Biomarkers; Cerebral Cortex; Diagnosis, Differential; Energy Metabolism; Magnetic Resonance Spectroscopy; Migraine Disorders; Migraine with Aura; Phosphates; Phosphocreatine; Phosphorus Radioisotopes; Predictive Value of Tests; Stroke

We investigated 22 patients with migraine without aura, all drug-free and in headache-free periods, by means of 31P-magnetic resonance spectroscopy (MRS) of brain and muscle. Brain 31P-MRS showed significantly low phosphocreatine, increased adenosine diphosphate, and decreased phosphorylation potential. There was a slow rate of phosphocreatine recovery after exercise in the muscle of 12 of 22 patients. Energy metabolism is abnormal in migraine without aura, as previously demonstrated in patients with migraine stroke and migraine with aura.

Topics: Adolescent; Adult; Brain; Female; Humans; Magnetic Resonance Spectroscopy; Male; Middle Aged; Migraine Disorders; Muscles; Phosphocreatine; Phosphorus; Time Factors

The brain and skeletal muscle oxidative metabolism of a patient with prolonged aura was studied by phosphorus magnetic resonance spectroscopy. We found that the phosphocreatine to ATP ratio in brain was reduced, while the inorganic phosphate to phosphocreatine ratio and the calculated ADP concentration were increased. The phosphorylation potential and percentage of maximal rate of ATP synthesis were also altered. Intracellular pH and inorganic phosphate concentration were normal. In muscle we found a low post-exercise recovery of phosphocreatine. These data indicate an impairment of energy oxidative metabolism both in brain and muscle.

Topics: Adenosine Diphosphate; Adenosine Triphosphate; Adolescent; Brain; Energy Metabolism; Exercise Test; Humans; Magnetic Resonance Spectroscopy; Male; Migraine Disorders; Muscles; Phosphates; Phosphocreatine

We studied brain and muscle energy metabolism by phosphorus 31 magnetic resonance spectroscopy (31P-MRS) in 12 patients affected by migraine with aura (classic migraine) in interictal periods. Brain 31P-MRS disclosed a low phosphocreatine content in all patients, accompanied by high adenosine diphosphate concentration, a high percentage of V/Vmax (adenosine triphosphate), and a low phosphorylation potential--features showing an unstable state of metabolism in classic migraine. Abnormal muscle mitochondrial function, in the absence of clinical signs of muscle impairment, was present in nine of the 12 patients examined.

Topics: Adenosine Diphosphate; Adenosine Triphosphate; Brain; Energy Metabolism; Humans; Magnetic Resonance Imaging; Migraine Disorders; Muscles; Nervous System Diseases; Phosphocreatine; Phosphorus; Sensation

We measured brain energy phosphate metabolism and intracellular pH (pHi) in a cross-sectional study of migraine patients by in vivo phosphorus 31 NMR spectroscopy. During a migraine attack the ratio ATP/total phosphate signal (mole % ATP) was preserved, but there was a decrease in mole % phosphocreatine (PCr) and an increase in mole % inorganic phosphate (Pi) resulting in a decrease of the PCr/Pi ratio, an index of brain phosphorylation potential. This was found in classic but not common migraine. Mole % Pi was also increased in combined brain regions between attacks. There was no alteration in brain pHi during or between attacks. Energy phosphate metabolism but not pHi appears disordered during a migraine attack.

Topics: Adenosine Triphosphate; Adult; Brain; Energy Metabolism; Female; Humans; Hydrogen-Ion Concentration; Magnetic Resonance Spectroscopy; Migraine Disorders; Phosphates; Phosphocreatine; Phosphorus; Reference Values