Studies that used different stimuli (e.g.; CO2 inhalation, hyperventilation) reported normal(5,6) or reduced(7,8) CR in the interictal period. Other studies using methods such as Xenon blood flow studies, SPECT, PET, and functional magnetic resonance also reported discordant results. The different methods of CR measurement is a major factor that limits comparison between studies.
Migraineurs might have an increased CR during the headache-free period due to alterations in their autonomic tonus. These patients might have a state of vagal hyperactivity during headache free periods leading to an enhanced vasodilatatory response. Furthermore, it has been reported that migraineurs present an enhanced secretion and response to nitric oxid.(15)
Aprevious comparison between tension-type headache (TTH) and migraine using the transcranial Doppler was performed by Rosengarten et al., measuring the evoked flow velocity in the posterior cerebral artery utilizing a visual stimulation paradigm.(16) This study showed that TTH patients had similar flow velocity response during the ictal and interictal periods, which was also comparable to controls. The same evaluation in migraineurs demonstrated that CR was reduced during the ictal phase when compared to the interictal phase, suggesting an impaired vasodilatation reserve during the ictal phase.
Our study has several limitations. Individuals evaluated in the ictal phase were not the same ones tested in the interictal phase. We did not control for the presence of carotid stenosis, which can influence the breath holding index. However, the mean age of the migraineurs and the control group was relatively low to be influenced by this variable.
In addition, due to the wide BHI variability found among migraineurs, it does not seem possible to set a BHI cutoff value to define migraine using the transcranialDoppler. However, it is tempting to consider that a significant CR variation between ictal and interictal phase in a single patient could be an additional information to the diagnosis of migraine. Further research evaluating CR of the same patient during ictal and interictal phases of migraine would be of great value.
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Dr. Ricardo A. Teixeira Instituto do Cérebro de Brasília SHLS 716 Conjunto L Centro Clínico Sul Torre II 2o andar Sala 211 70390-700 Brasília, DF, Brazil
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Headache Medicine, v.2, n.1, p. 10-12, jan./feb./mar. 2011