Arterial spin-labeled MRI study of migraine attacks treated with rizatriptan

Spin-tag perfusion imaging is an MRI method that quantitatively measures cerebral blood flow. Compared with conventional perfusion techniques, advantages of this arterial spin-labeling (ASL) include repeatability and the avoidance of intravenous contrast administration. In the present study, we performed an analysis of 3T high-field MRI examinations utilizing ASL perfusion during migraine attacks. A 32-year-old male patient was studied in three situations: during migraine attack within 1 h post-onset, 30 min after oral administration of rizatriptan 10 mg, and attack-free period. Normalized ASL images acquired during migraine attack showed significant relative hypoperfusion in the bilateral median thalamic areas including hypothalamus and significant relative hyperperfusion in the frontal cortex compared to images acquired during the migraine-free state. When normalized ASL images acquired 30 min after treatment were compared with those acquired during the attack, relative improvement of perfusion in the bilateral median thalamic areas including hypothalamus was observed. Hypothalamus and its surrounding areas may participate in the pathogenesis in migraine attack.