Perfusion patterns in migraine with aura

Cephalalgia. 2014 Oct;34(11):870-6. doi: 10.1177/0333102414523339. Epub 2014 Feb 19.


Objectives: Migraine with aura is a common neurological disorder, and differentiation from transient ischemic attack or stroke based on clinical symptoms may be difficult.

Methods: From an MRI report database we identified 33 patients with migraine with aura and compared these to 33 age-matched ischemic stroke patients regarding perfusion patterns on perfusion-weighted imaging (PWI)-derived maps: time to peak (TTP), mean transit time (MTT), and cerebral blood flow and volume (CBF, CBV).

Results: In 18/33 (54.5%) patients with migraine with aura, TTP showed areas of hypoperfusion, most of these not limited to the territory of a specific artery but affecting two or more vascular territories. In patients with migraine with aura, TTP (1.09 ± 0.05 vs. 1.47 ± 0.40, p < 0.001) and MTT ratios (1.01 ± 0.10 vs. 1.19 ± 0.21, p = 0.003) were significantly lower compared to patients with ischemic stroke. In contrast to this, CBF and CBV ratios did not differ significantly between both groups.

Conclusions: Migraine aura is usually associated with a perfusion deficit not limited to a specific vascular territory, and only a moderate increase of TTP. Thus, hypoperfusion restricted to a single vascular territory in combination with a marked increase of TTP or MTT may be regarded as atypical for migraine aura and suggestive of acute ischemic stroke.

Keywords: DWI; MRA; Migraine; PWI; aura; perfusion.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Brain / blood supply*
  • Cerebrovascular Circulation*
  • Diagnosis, Differential
  • Diffusion Magnetic Resonance Imaging
  • Female
  • Humans
  • Image Interpretation, Computer-Assisted / methods*
  • Male
  • Middle Aged
  • Migraine with Aura / diagnosis*
  • Stroke / diagnosis*
  • Young Adult