Of note, magnetic suppression of perceptual accuracy profiles using transcranial magnetic stimulation in these patients showed reduced visual suppression correlating with high cortical excitability. A dysfunction in inhibitory pathways is therefore possible. In summary, ictal imaging studies reveal several intriguing changes in the migraineurs’ brain (Table 2). Activations of dorsal pons, substantia nigra, red nucleus, MRF, amygdala, and insula have been reported, while the trigeminal nuclei activity Smad inhibitor decreased after nociceptive stimulation. Blood flow increased in the brainstem, cerebellum, hypothalamus, thalamus, insula,

cingulate cortex, prefrontal cortex, auditory cortex, and visual association cortex. Chronic migraine Talazoparib led to hypometabolism in several cortical areas and to hypermetabolism in the brainstem.

An increasing body of research that employs neuroimaging methods challenges the traditional view of migraine as a nonprogressive, paroxysmal disorder with no CNS abnormalities between attacks. Structural and functional alterations that often correlate with pain duration and frequency have been unveiled in migraineurs during migraine-free states, in part due to imaging advances (see Tables 3 and 4 for lists of structural and functional interictal neuroimaging findings, respectively). Brain Structure and Vasculature.— Numerous conventional MRI studies unequivocally indicate that migraine is associated with an increased risk of stroke and deep white matter lesions in patients of various ages.61 Migraineurs with and without aura have an elevated risk of stroke, and the relative risk is higher in young subjects, smokers, users of oral contraceptive, patients with aura, and those with more frequent attacks.62-64 The Farnesyltransferase increased stroke risk may

be confined to small cerebellar and watershed-zone infarcts.65 Approximately 10% of patients who have migraine with aura and at least one migraine per month have been found to have a posterior circulation stroke.66 Most of these strokes remain asymptomatic, and their clinical significance is unclear. One proposed mechanism underlying this association is endothelial dysfunction. Results from the few known studies that have compared the anterior and posterior cerebral endothelial function are contradictory, mainly due to methodological limitations (eg, CO2-induced vasodilatation vs L-arginine stimulus) and the presence of comorbidities. Most animal studies, however, suggest that the posterior cerebral circulation is subject to more basal vasomotor control to nitric oxide than the anterior cerebral circulation.67 Perko and colleagues68 used transcranial Doppler sonography to determine the posterior cerebral endothelial function in migraine patients.