Hypoechogenicity of brainstem raphe nuclei is associated with increased attack frequency in episodic migraine.

IntroductionReduced echogenicity of the brainstem raphe nuclei (BRN) was demonstrated in major depression, possibly indicating serotonergic dysfunction. Postulating that migraine may constitute a “chronic low serotonin syndrome,” we aimed to evaluate the echogenicity of midbrain structures, including serotonergic BRN in episodic migraine.MethodsTranscranial sonography was performed in 39 patients with episodic migraine (median age 35, interquartile range (IQR): 27–47 years; 27 women) and 35 controls (median age 31, IQR: 29–47 years; 19 women). Individuals with concomitant depression were excluded. Echogenicity of BRN, substantia nigra (SN) and third ventricle width was evaluated according to an internationally established examination protocol.ResultsHypoechogenicity of BRN was depicted in 23.1% of migraine patients and 20% of controls, showing no significant difference. Migraine patients with hypoechogenic BRN had significantly higher attack frequency (median 3, IQR 2–5 vs. 1.5, IQR 1–2 days/month; p = 0....