Brain activations in the premonitory phase of nitroglycerin-triggered migraine attacks

Brain. 2014 Jan;137(Pt 1):232-41. doi: 10.1093/brain/awt320. Epub 2013 Nov 25.


Our aim was identify brain areas involved in the premonitory phase of migraine using functional neuroimaging. To this end, we performed positron emission tomography scans with H2(15)O to measure cerebral blood flow as a marker of neuronal activity. We conducted positron emission tomography scans at baseline, in the premonitory phase without pain and during migraine headache in eight patients. We used glyceryl trinitrate (nitroglycerin) to trigger premonitory symptoms and migraine headache in patients with episodic migraine without aura who habitually experienced premonitory symptoms during spontaneous attacks. The main outcome was comparing the first premonitory scans in all patients to baseline scans in all patients. We found activations in the posterolateral hypothalamus, midbrain tegmental area, periaqueductal grey, dorsal pons and various cortical areas including occipital, temporal and prefrontal cortex. Brain activations, in particular of the hypothalamus, seen in the premonitory phase of glyceryl trinitrate-triggered migraine attacks can explain many of the premonitory symptoms and may provide some insight into why migraine is commonly activated by a change in homeostasis.

Keywords: PET; hypothalamus; migraine; periaqueductal grey; premonitory.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Brain / diagnostic imaging*
  • Cerebrovascular Circulation / physiology
  • Data Interpretation, Statistical
  • Disease Progression
  • Female
  • Humans
  • Hypothalamus / pathology
  • Image Processing, Computer-Assisted
  • Infusions, Intravenous
  • Male
  • Middle Aged
  • Migraine without Aura / chemically induced*
  • Migraine without Aura / diagnostic imaging*
  • Nitroglycerin*
  • Periaqueductal Gray / diagnostic imaging
  • Positron-Emission Tomography
  • Tomography, X-Ray Computed
  • Vasodilator Agents*
  • Young Adult


  • Vasodilator Agents
  • Nitroglycerin