Advanced MR imaging with cognitive and vestibular stimulation in vestibular migraine

Objective: The aim of the study was to evaluate the changes in cortical activation during 5 different tasks after stimulation of vestibular pathways at patients with vestibular and episodic migraine and to identify metabolic changes possibly be seen in thalamus, that is a key role in vestibular and pain pathways. Method: Fifteen patients with vestibular migraine and 15 patients with episodic migraine that had diagnosed at Çukurova University Neurology Department were included into this prospective study. Functional MRI was applied before and after the caloric test. BOLD fMRI data were registered during conjunctive eye movements, cognitive task, visual stimuli with 3 Tesla MR 32-channel head coil. At the same time, pre-caloric test cases were examined by MR spectroscopy. SPSS v20 and SPM software was used for the statistical analysis. Results: Functional MR imaging demonstrated increased cerebellar and insular activation in patients with vestibular migraine following caloric testing during finger-nose testing. During object naming task to activate linguistic-associated cortical areas increased thalamic activation was determined in vestibular migraine patients after caloric testing. In migraine patients, loss of activation in the occipital lobe was observed during visual stimulation after caloric testing. In cases vestibular migraine with no migraine history, loss of cholin in the left thalamus posterior was detected. The left thalamus posterior NAA/Cholin ratio was found to increase in patients with vestibular migraine with no migraine history. Conclusion: Activation changes in brain regions during vestibular pathway activation and during performing cognitive, different tasks in vestibular and episodic migraine patients provide information about the pathophysiology of disease and functional changes that may occur during an attack in patients. Key words: Functional MRI, migraine, vestibular migrain