Abstract
BackgroundNausea is a common and disabling symptom of migraine. The origin of nausea is not well understood although functional connections between trigeminal neurons and the nucleus tractus solitarius may explain occurrence of nausea with pain. However, nausea occurs as a premonitory symptom in about a quarter of patients, suggesting that a primary brain alteration unrelated to the experience of pain may be the reason for nausea.MethodsWe performed positron emission tomography scans with H215O PET in premonitory phase of nitroglycerin-induced migraine and compared patients with and without nausea.ResultsThe results showed activation in rostral dorsal medulla and periaqueductal grey (PAG) in the nausea group, which was absent in the no nausea group. The rostral dorsal medullary area included the nucleus tractus solitarius, dorsal motor nucleus of the vagus nerve and the nucleus ambiguus, all of which are thought to be involved in brain circuits mediating nausea.ConclusionsThe results demonstrate that nausea can occur as a premonitory symptom in migraine, independent of pain and trigeminal activation. This is associated with activation of brain structures known to be involved in nausea. We conclude that nausea is a centrally driven symptom in migraine.
Highlights
Nausea is a common and disabling symptom of migraine
Using the brainstem as the region of interest (ROI), we looked for differences in the two groups: nausea and no nausea in the premonitory phase, in areas known to be involved in nausea like the rostral dorsal medulla containing the nucleus tractus solitarius (NTS), dorsal motor nucleus of the vagus nerve, nucleus ambiguus and area postrema [8,9,10]
Comparing the premonitory scans > baseline scans in the nausea group with an uncorrected p value threshold of p < 0.05, we found brainstem activations in the rostral dorsal medulla and the periaqueductal grey (PAG)
Summary
Nausea is a common and disabling symptom of migraine. The origin of nausea is not well understood functional connections between trigeminal neurons and the nucleus tractus solitarius may explain occurrence of nausea with pain. Nausea occurs as a premonitory symptom in about a quarter of patients, suggesting that a primary brain alteration unrelated to the experience of pain may be the reason for nausea. Nausea is often associated with the pain in migraine and in this regard, connections between trigeminal neurons and nucleus tractus solitarius (NTS) are thought to explain the occurrence of nausea with headache [2]. Nausea in the premonitory phase correctly predicted headache in a quarter of migraineurs [3].
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