Imaging the migrainous brain: the present and the future

In the last 20 years, we observed significant improvements in the use of magnetic resonance imaging (MRI) for the evaluation of patients affected by migraine. Before these technological advances, knowledge of the pathogenesis of migraine was particularly based on clinical assessment. Complementary to clinical evaluation, conventional MRI provides both specific information for differential diagnosis (particularly if cortical or subcortical lesions are detected in the migrainous brain) and unsurpassable opportunities in migraine research. However, the correlations between brain structural and functional alterations and both the clinical manifestation of the disease and the individual history of the patient remains uncertain. Both quantitative and functional MR-based techniques have a great potential to better provide insights into human brain structures and possible links between brain areas and complex brain networks that could be involved in the pathophysiology of migraine. Morphometric and functional MRI approaches are contributing to better elucidate the mechanisms that underlie the pain mechanisms and functional adaptation in migraine patients. All these information support the view of migraine as a complex brain disorder involving different cortical and subcortical areas.