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• W1978816598 abstract "It is a pity when valuable research such as that described by Faisal Mohammad Amin and colleagues1Amin FM Asghar MS Hougaard A et al.Magnetic resonance angiography of intracranial and extracranial arteries in patients with spontaneous migraine without aura: a cross-sectional study.Lancet Neurol. 2013; 12: 454-461Summary Full Text Full Text PDF PubMed Scopus (198) Google Scholar is incorrectly interpreted and used to justify misleading conclusions. The investigators—who aimed to measure extracranial and intracranial arteries during attacks of migraine without aura—stated that migraine pain was not accompanied by extracranial dilatation. At first glance this assumption seems to be accurate, but on closer inspection it is misleading. The authors measured the proximal portion of the superficial temporal artery, in the retromandibular area, even though the retromandibular area is not the site of migraine pain. This part of the superficial temporal artery has not been implicated in migraine, so what purpose is served by showing that it does not dilate? On the contrary, the extracranial arteries that have repeatedly been shown to be affected during migraine are the superficial scalp arteries.2Shevel E The extracranial vascular theory of migraine—a great story confirmed by the facts.Headache. 2011; 51: 409-417Crossref PubMed Scopus (57) Google Scholar One of the authors was previously an investigator in a study by Iversen and colleagues,3Iversen HK Nielsen TH Olesen J Tfelt-Hansen P Arterial responses during migraine headache.Lancet. 1990; 336: 837-839Summary PubMed Scopus (163) Google Scholar who showed changes in the frontal branch of the superficial temporal artery during migraine. In that study the investigators stated the following: “With the ultrasound techniques that we used diameters can be measured accurately and reproducibly. The patients were investigated during unilateral migraine attacks. The luminal diameter of the frontal branch of the superficial temporal artery was significantly larger on the symptomatic than on the non-symptomatic side during but not between attacks”.3Iversen HK Nielsen TH Olesen J Tfelt-Hansen P Arterial responses during migraine headache.Lancet. 1990; 336: 837-839Summary PubMed Scopus (163) Google Scholar Furthermore, in another article,4Guo S Ashina M Olesen J Birk S The effect of sodium nitroprusside on cerebral hemodynamics and headache in healthy subjects.Cephalalgia. 2013; 33: 301-307Crossref PubMed Scopus (14) Google Scholar the authors of which included two investigators from The Lancet Neurology study,1Amin FM Asghar MS Hougaard A et al.Magnetic resonance angiography of intracranial and extracranial arteries in patients with spontaneous migraine without aura: a cross-sectional study.Lancet Neurol. 2013; 12: 454-461Summary Full Text Full Text PDF PubMed Scopus (198) Google Scholar the aim was to show that sodium nitroprusside, a powerful vasodilatory agent, would induce both headache and vasodilatation. When it was important to show a correlation between headache and vasodilatation, they did not measure the proximal portion of the superficial temporal artery, but chose instead to measure the change in diameter of its frontal branch, which indeed dilated substantially (33%) with sodium nitroprusside.4Guo S Ashina M Olesen J Birk S The effect of sodium nitroprusside on cerebral hemodynamics and headache in healthy subjects.Cephalalgia. 2013; 33: 301-307Crossref PubMed Scopus (14) Google Scholar In view of the fact that at least one of the investigators in Amin and colleagues' study1Amin FM Asghar MS Hougaard A et al.Magnetic resonance angiography of intracranial and extracranial arteries in patients with spontaneous migraine without aura: a cross-sectional study.Lancet Neurol. 2013; 12: 454-461Summary Full Text Full Text PDF PubMed Scopus (198) Google Scholar has shown that the frontal branch of the superficial temporal artery does dilate during migraine, why did they not include this vessel in their study? How can they justify their conclusion that the extracranial vessels do not dilate during migraine? It would go a long way towards clarifying the situation if the authors were to publish their measurements of the frontal branch. One of the treatment modalities that I use is surgical cauterisation of the terminal branches of the external carotid artery (including the superficial temporal artery) in patients with migraine. Magnetic resonance angiography of intracranial and extracranial arteries in patients with spontaneous migraine without aura: a cross-sectional studyMigraine pain was not accompanied by extracranial arterial dilatation, and by only slight intracranial dilatation. Future migraine research should focus on the peripheral and central pain pathways rather than simple arterial dilatation. Full-Text PDF Intracranial and extracranial arteries in migraine – Authors' replyWe thank Elliot Shevel and Antoinette MaassenVanDenBrink and colleagues for their interest in our study of spontaneous migraine using magnetic resonance angiography,1 and for their thoughtful comments. Full-Text PDF" @default.
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• W1978816598 date "2013-09-01" @default.
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• W1978816598 title "Intracranial and extracranial arteries in migraine" @default.
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