All migraine patients had lower cerebrovascular reactivity to L-arginine in the PCA and similar in the MCA compared with healthy subjects. The lower reactivity to L-arginine in the PCA in migraine patients could underlie migraine and cerebral infarcts that Adriamycin cost are more common in the posterior vascular distribution. Arkink and collaborators69

measured brain perfusion using dynamic susceptibility contrast MRI in interictal female migraineurs (with or without aura) and normal controls, and compared perfusion maps between these groups with a voxelwise and a region-of-interest approach. In whole-brain voxelwise analyses, interictal hyperperfusion appeared in the left medial frontal gyrus in migraineurs with aura and in the inferior and middle temporal (MT) gyri in patients without aura. Hypoperfusion was seen in the postcentral gyrus and in the inferior temporal gyrus in migraneurs with aura, and in the inferior frontal gyrus in migraneurs without aura. Additional focal sites of hyperperfusion were check details observed in subgroups based on attack frequency and disease history. Region-of-interest analyses of the pons, hypothalamus, occipital lobe, and cerebellum did not reveal interictal perfusion differences between migraineurs and controls. The study showed that interictal migraine is characterized by discrete areas of hyperperfusion and hypoperfusion not specific for migraine

pathophysiology and not explaining the increased vulnerability of particular brain regions for cerebrovascular damage. Migraine patients with and without medchemexpress aura

also exhibit a higher risk of deep white matter lesions compared with controls, and more frequent migraines (at least one per month) further elevate this risk.65,70 Retrospective analyses of clinical data pertaining to 186 patients with migraine yielded significant associations between the presence of white matter hyperintensities and longer disease duration and higher headache frequency.71 A population-based, cross-sectional study (Epidemiology of Vascular Ageing Study, France) found that any history of severe headache associates with increased volume of white matter hyperintensities.72 Migraine with aura was the only headache type associated with brain infarcts. No cognitive impairment accompanied any headache type, with or without brain lesions. An increased probability of white matter hyperintensities was noted in normally functioning elderly subjects with a history of migraine.61 Brain white matter hyperintensities may be more prevalent in migraine patients than in the general population, but the pathogenesis and the risk factors of these hyperintensities remain unclear. The white matter changes may represent gliosis and focal myelin loss induced by microvascular damage. Although no neuropathological support exists, hemodynamic ischemic processes and mitochondrial dysfunction have been proposed to underlie these alterations.