Increased cerebral blood flow velocity induced by cold pressor test in migraine. A possible basis for pathogenesis.

Noradrenergic nuclei of the locus coeruleus are believed to be involved in migraine pathogenesis. We recently demonstrated a typical intracerebral vasoconstriction after prolonged (5 min) exposure to cold pressor test (CPT), likely related to a central noradrenergic mechanism modulated at the locus coeruleus level and eliminated by pretreatment with clonidine. In the present study, we used transcranial Doppler ultrasonography to monitor blood flow velocity (BFV) changes to CPT in the middle cerebral artery (MCA) of migraine with (MA, n = 12) and without (MO, n = 15) aura subjects. CPT induced a significant increase in BFV and a concomitant decrease in the pulsatility index (PI), a pattern which is the opposite of the results obtained with controls. The results were comparable when controls were pretreated with clonidine. The MO patients produced an intermediate pattern between the MA and control subjects. A possible altered modulatory effect of opioids and/or serotonin on noradrenergic nuclei of the brainstem is the possible cause of the observed inverse response in migraine, suggesting intracerebral vasomotor instability in these patients.