Migraines and the Brain

As anyone with a chronic migraine could tell you, these headaches demand attention.  Not just from the sufferer, who may be unable to work or do practically anything except lay in a dark room waiting for the pain to pass, but also from researchers, who’s investigations into the causes of these headaches do not receive nearly the amount of research dollars as other debilitating neurological disorders.

Part of the problem in researching migraine is that scientists have to rely almost entirely on the report of the sufferer.  There is no other “gold standard” for headache diagnosis.  Currently, migraine is diagnosed and classified by criteria published by the International Classification of Headache Disorders (ICHD).  While useful, and usually sufficient to assist people with headaches, these criteria are limited by a lack of anything more “solid” to point to regarding the headache’s cause or even its type.

At the American Academy of Neurology’s annual meeting of 2015, Dr. Todd Schwedt of the Mayo Clinic in Arizona discussed new research performed with his collaborator Dr. Catherine Chong. The focus was on using neuroimaging techniques such as magnetic resonance imaging to identify those who were likely sufferers of migraine.

This is not the first time someone has used neuroimaging to explore migraine.

  For example, past neuroimaging studies have been able to capture the changes in electrical activity near the back of the brain that occurs when someone suffers migraine with aura, often involving strange visual patterns dancing in the visual field prior to the attack of headache.  Such studies do not, however, necessarily identify differences between the brains of those who do and who do not suffer from migraine.

Earlier studies have suggested that people who suffer from migraine have a lower tolerance to pain then those who do not experience migraine. Based on an early study suggesting a correlation between the thickness of the gray ribbon near the outside of the brain (the neocortex) and pain thresholds in healthy people, Dr. Schwedt and colleagues guessed that the relationship would be different in people who suffer from migraines.

In healthy people, a thicker cortex was associated with increased sensitivity to pain. In people who experience migraine, however, this relationship was reversed in an area of the brain called the left temporoparietal junction. This area of the brain is associated with sensory integration, meaning the way that we put together sights, sounds, smells and more to get us A more complete picture of what someone or something is. This may help explain why people who suffer from migraine often have worse pain when exposed to sensations such as bright light or loud noise.

The researchers then went one step further and looked at differences in cortical thickness in people with verses without migraine.

Among other regions, the tip of the temporal lobe stood out as being significantly different between these two groups of people.  This is another area involved with sensory integration.

The researchers suggested that these techniques might be useful in distinguishing those with migraine from those who suffer from a different type of headache, such as that caused by medication overuse or traumatic brain injury.

It is unlikely that such neuroimaging techniques will become a necessary part of the evaluation for anyone who suffers from headaches, though it may be useful in certain specific cases.  Perhaps more importantly, such studies further develop our understanding of the basics of migraine. Just understanding that the pain they suffer comes from a real, biological source may offer some comfort to those who experience migraine.


Erpelding, N., Moayedi, M., Davis, K.D., 2012. Cortical thickness correlates of pain and temperature sensitivity. Pain 153, 1602-1609.

Headache Classification Committee of the International Headache, S., 2013. The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia 33, 629-808.

Schwedt, T.J., Chong, C.D., 2014. Correlations between brain cortical thickness and cutaneous pain thresholds are atypical in adults with migraine. PLoS One 9, e99791.

Schwedt, T.J., Berisha, V., Chong, C.D., 2015. Temporal lobe cortical thickness correlations differentiate the migraine brain from the healthy brain. PLoS One 10, e0116687.

Schwedt, T.J., Chong, C.D., 2015. Functional imaging and migraine: new connections? Curr Opin Neurol.

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