Complex Migraine (vascular related ?)

A forum to discuss Chronic Cerebrospinal Venous Insufficiency and its relationship to Multiple Sclerosis.

Postby Cece » Fri Mar 11, 2011 4:29 pm

Altered Cerebrovenous Drainage in Patients With Migraine as Assessed by Phase-Contrast Magnetic Resonance Imaging

Published Ahead-of-PrintAbstractObjective: We aimed to assess whether migraine is associated with changes in the distribution of the venous drainage through primary and secondary pathways by using phase-contrast magnetic resonance imaging (MRI).

Methods: We examined 26 patients (37.3 +/- 13.9 years) with recurring migraine headaches and 26 age- and gender-matched controls with no neurologic disease (37.3 +/- 13.7 years) on a 3 Tesla MR scanner. A 2D time-of-flight MR-venography of the upper neck region was performed to visualize the venous vasculature. Cine-phase contrast scans with high-velocity encoding were employed to quantify arterial inflow and flow in the primary venous channels (right and left jugular veins), whereas scans with low-velocity encoding were employed to quantify flow in the secondary venous channels (epidural, vertebral, and deep cervical veins).

Results: Patients with migraine showed (i) a higher prevalence of dense secondary extracranial venous networks (15 vs. 2, P = 0.00002) and (ii) a significantly larger percentage of venous outflow through secondary channels (10.5% vs. 5.5%; of total cerebral blood flow, P = 0.02). This mainly included drainage through epidural, vertebral, and deep cervical veins.

Conclusion: Migraine patients showed a significantly larger percentage of venous outflow through secondary channels. The mechanism of this alteration remains to be elucidated. Potential mechanisms include repeated release of vasoactive substances or growth factors.

They imaged the upper neck, but not the lower neck where the valves are located.

http://tinyurl.com/4vemkrm
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Postby bluesky63 » Sat Mar 12, 2011 9:45 am

I need clarification -- sorry! not thinking well! -- so is this saying that people with migraines, in this study, had abnormally slow or fast venous blood flow or is something else entirely? Are they talking about collaterals or what, exactly? Sorry to be dense.

Cece, excellent point. I also remember that many people have what's called "abdominal migraines," which makes you wonder what's happening with blood flow there.
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Postby jimmylegs » Sat Mar 12, 2011 10:35 am

"Migraine patients showed a significantly larger percentage of venous outflow through secondary channels." i don't think they looked at speed blue, just collaterals vs primary channels?
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Postby Cece » Sat Mar 12, 2011 10:38 am

bluesky63 wrote:I need clarification -- sorry! not thinking well! -- so is this saying that people with migraines, in this study, had abnormally slow or fast venous blood flow or is something else entirely? Are they talking about collaterals or what, exactly? Sorry to be dense.

Cece, excellent point. I also remember that many people have what's called "abdominal migraines," which makes you wonder what's happening with blood flow there.

Never heard of an abdominal migraine! Sounds painful.

I haven't seen the full study, but what I understand of the abstract is that patients with migraines depended on secondary venous drainage paths (such as the vertebral plexus and the epidural veins, which are tiny,) instead of what should be the primary drainage path (the internal jugulars).

My own cerebral drainage pattern would have looked like this, since my jugulars were blocked and my verts were taking as much as they could.

They have no explanation for why people with migraines have this altered cerebral drainage pattern and suggest "repeated release of vasoactive substances or growth factors" as potential mechanisms, however if they did not check for blocked jugulars, that is in play as a possibility.

They also listed one of Zamboni's studies in the citations, so this study may have been influenced by his findings.
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Postby bluesky63 » Sat Mar 12, 2011 11:40 am

Thank you :-)
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Postby Cece » Sat Mar 12, 2011 12:39 pm

Also all the study says is that migraines are associated with having the blood take these alternative paths, but if it ends up being that this altered blood flow is in some way causative of the migraines, that would be evidence of the importance of flow going through the jugulars instead of the alternative paths and thus of the value in getting our blockages treated.

I think this is a good study! I hope there are more studies following it up.
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Postby civickiller » Sat Mar 12, 2011 9:31 pm

So alternative pathway because primary pathways were blocked? CCSVI? Any mrv's of migraine patiences to see blockages?
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Postby Cece » Sun Mar 13, 2011 7:36 am

civickiller wrote:So alternative pathway because primary pathways were blocked? CCSVI? Any mrv's of migraine patiences to see blockages?

That's the thing, this study was done using MRV on a 3 Tesla, but it only included the upper neck. Our blockages tend to be in the lower neck in the region of the valves. Whether the migraine patients had such blockages or not, it's another pathology tied in to the altered cerebral drainage that we ourselves experience.
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Postby Brightspot » Fri Apr 15, 2011 10:16 pm

Thanks for another great post Cece.
Lots of us folks with MS also have migraines, or have a family history of migraine.
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Postby civickiller » Sat Apr 16, 2011 12:19 am

upper cervical care can relieve migraine headaches
visit the ccsvi and ccvbp thread and talk with ucc dr, dr flanagan (uprightdoc,) to see how ucc maybe able to help with other MS symptoms, just a personal example of my own, it got rid of my heat intolerance(which every ms'er suffers from), migraines, lower back pain, daily headaches, improved my walking and balance
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Re: Complex Migraine (vascular related ?)

Postby Cece » Sun Mar 31, 2013 1:53 pm

http://www.ncbi.nlm.nih.gov/pubmed/23405151
PLoS One. 2013;8(2):e55447. doi: 10.1371/journal.pone.0055447. Epub 2013 Feb 6.

MRI evidence for altered venous drainage and intracranial compliance in mild traumatic brain injury.

Pomschar A, Koerte I, Lee S, Laubender RP, Straube A, Heinen F, Ertl-Wagner B, Alperin N.
Source
Institute of Clinical Radiology, University of Munich - Grosshadern Campus, Ludwig-Maximilians-University Munich, Munich, Germany.
Abstract
PURPOSE:
To compare venous drainage patterns and associated intracranial hydrodynamics between subjects who experienced mild traumatic brain injury (mTBI) and age- and gender-matched controls.
METHODS:
Thirty adult subjects (15 with mTBI and 15 age- and gender-matched controls) were investigated using a 3T MR scanner. Time since trauma was 0.5 to 29 years (mean 11.4 years). A 2D-time-of-flight MR-venography of the upper neck was performed to visualize the cervical venous vasculature. Cerebral venous drainage through primary and secondary channels, and intracranial compliance index and pressure were derived using cine-phase contrast imaging of the cerebral arterial inflow, venous outflow, and the craniospinal CSF flow. The intracranial compliance index is the defined as the ratio of maximal intracranial volume and pressure changes during the cardiac cycle. MR estimated ICP was then obtained through the inverse relationship between compliance and ICP.
RESULTS:
Compared to the controls, subjects with mTBI demonstrated a significantly smaller percentage of venous outflow through internal jugular veins (60.9±21% vs. controls: 76.8±10%; p = 0.01) compensated by an increased drainage through secondary veins (12.3±10.9% vs. 5.5±3.3%; p<0.03). Mean intracranial compliance index was significantly lower in the mTBI cohort (5.8±1.4 vs. controls 8.4±1.9; p<0.0007). Consequently, MR estimate of intracranial pressure was significantly higher in the mTBI cohort (12.5±2.9 mmHg vs. 8.8±2.0 mmHg; p<0.0007).
CONCLUSIONS:
mTBI is associated with increased venous drainage through secondary pathways. This reflects higher outflow impedance, which may explain the finding of reduced intracranial compliance. These results suggest that hemodynamic and hydrodynamic changes following mTBI persist even in the absence of clinical symptoms and abnormal findings in conventional MR imaging.


Earlier we saw research showing that migraine patients tended to have outflow that look like ours, instead of like normal healthy people's outflow. Their outflow was more likely not to go through the jugular but instead to go through secondary channels. Now there is some Feb 2013 research showing that people with mild traumatic brain injury are like us as well. They have increased venous drainage through secondary channels.
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