Patients with Migraines Have Higher Sodium Levels in Cerebrospinal Fluid

Sodium MR images have shown higher cerebral 23Na concentrations in the cerebral spinal fluid (CSF) of migraine patients compared with the CSF in healthy controls, according to a study presented at RSNA.

Researchers from Germany performed a prospective study including 24 subjects to evaluate 23Na concentrations in patients with clinically manifested migraine compared with healthy controls.

Twelve subjects were female, mean age 34, who had been clinically evaluated for migraine and had filled out a questionnaire regarding onset of disease, length, intensity (scale 1-10) and frequency of attacks, and accompanying aura. Twelve healthy controls, all female, also mean age 34, also participated. Both groups underwent a cerebral 23Na-MRI examination.

For each scan a non-contrast enhanced T1w MP-RAGE sequence for anatomical referencing and a 3D-density-adapted, radial gradient echo (GRE-) sequence for 23Na-imaging were acquired using a double-tuned (1H/23Na), dedicated head-coil. 23Na-sequences were reconstructed according to the MP-RAGE, allowing direct cross-referencing of regions-of-interest (ROI). Circular ROIs were placed in predetermined anatomic regions: anterior and posterior CSF, gray and white matter (GM/WM), brain stem and cerebellum. External 23Na reference phantoms were used to calculate the 23Na tissue concentrations. 23Na concentrations of migraine patients and healthy controls were compared and statistically analyzed by Wilcoxon rank sum test.

The results showed no statistical differences between the two groups for sodium concentrations in the gray and white matter, brain stem, and cerebellum, but overall 23Na concentrations in the anterior CSF region of patients with manifest migraine were significantly higher with 79 mmol ±7 compared with 69 mmol ±4 in healthy controls. Similar findings were found for the posterior CSF region with 23Na concentrations of 85 mmol ±6 in migraine patients compared with 63 mmol ±8 in healthy controls.

“These findings might facilitate the challenging diagnosis of a migraine,” study author Melissa Meyer, MD, a radiology resident at the Institute of Clinical Radiology and Nuclear Medicine, University Hospital Mannheim and Heidelberg University in Heidelberg, said in a release. “As this was an exploratory study, we plan to examine more patients, preferably during or shortly after a migraine attack, for further validation.”

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