MRI scans of migraine sufferers have revealed that the intense, throbbing headaches they suffer are related to brain abnormalities, some of which are present at birth and others that develop over time, according to a study published online March 26 in Radiology.

“Overall, our results support the notion that patients with migraine experience cortical abnormalities that do not seem to be a mere consequence of repeated attacks but are rather the result of a balance between an intrinsic predisposition (as suggested by cortical surface area abnormalities) and disease-related processes (as indicated by cortical thickness abnormalities),” wrote authors Massimo Fillippi, MD, of University Ospedale San Raffaele in Milan, and colleagues.

The researchers based their findings on surface-based MRI measures of cortical thickness, rather than voxel-based morphometry, which has been the focus of most previous research.

Sixty-three migraine sufferers and 18 matched healthy controls underwent T2-weighted and 3D T1-weighted MRIs of the brain. Cortical thickness and cortical surface area were estimated.

Migraine patients showed reduced cortical thickness and surface area in regions related to pain processing compared to controls, according to the results. There was only minimal anatomical overlap of cortical thickness and cortical surface area abnormalities, with cortical surface area abnormalities being more pronounced and distributed than cortical thickness abnormalities. The presence of aura and white matter hyperintensities on the MRI scans was related to the regional distribution of cortical thickness and surface area abnormalities, but not to disease duration and attack frequency.

“Accurate measurements of cortical gray matter abnormalities might be useful in better characterizing patients with migraine and in understanding the pathophysiologic processes underlying this condition,” wrote the authors.

Cortical surface area increases dramatically during late fetal development and cortical thickness changes dynamically over time due to development and disease, according to the authors.

"Whether the abnormalities are a consequence of the repetition of migraine attacks or represent an anatomical signature that predisposes to the development of the disease is still debated," Fillippi said in a press release. "In my opinion, they might contribute to make migraine patients more susceptible to pain and to an abnormal processing of painful conditions and stimuli."

Additional research is needed to fully understand the meaning of cortical abnormalities in the pain processing areas of migraine patients, he noted. The researchers are conducting a longitudinal study of the patient group to see if their cortical abnormalities are stable or tend to worsen over the course of the disease. They also are studying the effects of treatments on the observed modifications of cortical folding and looking at pediatric patients with migraine to assess whether the abnormalities represent a biomarker of the disease.