Danish Headache Center

To synthesize and interpret magnetic resonance angiography (MRA) findings on vascular changes after administration of established molecular migraine triggers in adults with migraine and in healthy individuals, focusing on the middle meningeal artery (MMA) and middle cerebral artery (MCA).

A systematic review of experimental studies using MRA to assess extracerebral and intracerebral arterial responses to established molecular migraine triggers was conducted. Eligible studies included adults with migraine or healthy volunteers, use of MRA, and oral ingestion or intravenous infusion of an established molecular migraine trigger. Studies not meeting these criteria, as well as conference abstracts, preprints, reviews, case reports, and case series, were excluded.

Sixteen eligible MRA studies were identified. The triggers used included calcitonin gene-related peptide, pituitary adenylate cyclase-activating polypeptides (PACAP-27 and PACAP-38), vasoactive intestinal polypeptide, nitroglycerin, cilostazol, sildenafil, and levcromakalim. All triggers induced extracerebral (meningeal) arterial dilation, often accompanied by headache or migraine attacks. Dilation induced by neuropeptides was confined to extracerebral arteries, consistent with limited blood-brain barrier penetration. In contrast, nitroglycerin and levcromakalim also dilated cerebral arteries. Across all studies, sumatriptan consistently reversed extracerebral arterial dilation and alleviated migraine pain.

Established molecular triggers reliably induce extracerebral arterial dilation, an effect reversed by sumatriptan. These findings support the hypothesis that sustained meningeal vasodilation might contribute causally to migraine pathogenesis. Standardized MRA protocols, rigorous methodological designs, and well-controlled studies are needed to further refine our understanding of these vascular mechanisms and to guide the development of more targeted therapies for migraine.

Migraine is common among women, particularly during their reproductive years. There is limited research on the use of antimigraine medication before and during pregnancy. This study was undertaken to describe the use of antimigraine medication 3 months before pregnancy and in the first trimester among women with migraine and to evaluate maternal characteristics associated with continued use in the first trimester.

In this cross-sectional study, we used patient-reported data from the Copenhagen Pregnancy Cohort from October 2013 to May 2019 and included all women with migraine before pregnancy. The use of antimigraine medication before pregnancy and during the first trimester was assessed descriptively.

Among women with migraine (N = 1586), 1241 of 1586 (78.2%) reported use of any antimigraine medication before pregnancy, and 347 of 1586 (21.8%) in the first trimester. Before pregnancy, paracetamol was the most used medication (793/1586, 50.0%), followed by ibuprofen (417/1586, 26.3%) and sumatriptan (191/1586, 12.0%). In the first trimester, paracetamol remained the most common medication (271/1586, 17.1%), followed by sumatriptan (49/1586, 3.1%), whereas the use of ibuprofen declined to 11 of 1586 (0.7%). A total of 278 of 1586 (17.5%) reported frequent use (daily or 1-2 times/week) of antimigraine medication before pregnancy, but only 79 of 1586 (5.0%) in the first trimester. Having a short length of education of 1-2 years, other chronic somatic diseases, or mental illness were, after adjustment for maternal age and parity, associated with frequent use of antimigraine medication in the first trimester compared to women with higher education, without other chronic somatic diseases, or without mental illness, respectively (adjusted odds ratio [aOR] = 3.09, 95% confidence interval [CI] = 1.93-4.95; aOR = 1.92, 95% CI = 1.14-3.23; and aOR = 2.14, 95% CI = 1.05-4.38).

Most women with migraine used antimigraine medication before pregnancy, whereas usage decreased markedly in the first trimester. Only a few women had frequent use in the first trimester. Women with a short length of education of 1-2 years, additional chronic somatic diseases, or mental illness were more likely to report use of antimigraine medication. By offering an overview of patient-reported use of antimigraine medication before and during early pregnancy in a hospital-based setting, this study contributes to existing knowledge in the field and provides valuable insights for clinicians working with pregnant women affected by migraine.