Bilateral Spreading Cerebral Hypoperfusion during Spontaneous Migraine Headache

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Abstract
Although decreases in regional cerebral blood flow are known to occur in relation to migraine headache, the pattern of the alterations in blood flow has not been precisely delineated. Olesen et al. have described a series of patients who had migraine headaches during serial cerebral blood-flow measurement by the intracarotid xenon-133 technique.1 They observed a pattern of localized decreases in flow that appeared to spread contiguously along the cerebral cortex. These observations were confirmed in subsequent studies,2,3 and with very few exceptions1,4 the pattern of “spreading oligemia” or “spreading hypoperfusion”5 has been apparent only in patients who have migraine headaches with aura (previously known as classic migraine).6 The carotid-artery puncture itself was thought to trigger the migraines in these patients,2 causing concern about the generalizability of these findings to spontaneous migraines7.