Brain activations in the premonitory phase of nitroglycerin-triggered migraine attacks

Farooq Husain Maniyar, Till Sprenger, Teshamae Monteith, Christoph Schankin, Peter James Goadsby

Research output: Contribution to journalArticlepeer-review

364 Scopus citations


Our aim was identify brain areas involved in the premonitory phase of migraine using functional neuroimaging. To this end, we performed positron emission tomography scans with H215O to measure cerebral blood flow as a marker of neuronal activity. We conducted positron emission tomography scans at baseline, in the premonitory phase without pain and during migraine headache in eight patients. We used glyceryl trinitrate (nitroglycerin) to trigger premonitory symptoms and migraine headache in patients with episodic migraine without aura who habitually experienced premonitory symptoms during spontaneous attacks. The main outcome was comparing the first premonitory scans in all patients to baseline scans in all patients. We found activations in the posterolateral hypothalamus, midbrain tegmental area, periaqueductal grey, dorsal pons and various cortical areas including occipital, temporal and prefrontal cortex. Brain activations, in particular of the hypothalamus, seen in the premonitory phase of glyceryl trinitrate-triggered migraine attacks can explain many of the premonitory symptoms and may provide some insight into why migraine is commonly activated by a change in homeostasis.

Original languageEnglish
Pages (from-to)232-241
Number of pages10
Issue number1
StatePublished - Jan 2014
Externally publishedYes


  • PET
  • hypothalamus
  • migraine
  • periaqueductal grey
  • premonitory


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