PET and fMRI insights into experimentally-induced premonitory symptoms in migraine: A systematic review
Abstract
BackgroundMigraine attacks are believed to unfold through discrete but interrelated phases, among which the premonitory phase has garnered increasing attention. This early phase, occurring hours to days before pain onset, might reflect neurobiological processes that promote subsequent headache generation. Neuroimaging of experimentally induced attacks enables controlled investigation of the brain mechanisms underlying these early symptoms. This systematic review synthesizes and critically appraises current neuroimaging evidence on the experimentally induced premonitory phase in individuals with migraine.MethodsA systematic literature search of MEDLINE and Embase was performed from database inception through June 1, 2025, using predefined terms related to migraine and premonitory symptoms. Studies were eligible if they reported original neuroimaging findings on experimentally induced migraine attacks and specifically addressed the premonitory phase. Two independent reviewers screened all titles, abstracts, and full-text articles and extracted relevant data. Due to methodological heterogeneity in study design, a narrative synthesis was applied to summarize findings and assess the consistency of reported brain activity patterns across included studies.ResultsSeven studies met the inclusion criteria, all of which used glyceryl trinitrate to induce migraine attacks and applied either positron emission tomography or magnetic resonance imaging to assess brain changes. Across…
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