Background: In current migraine clinical practice, conventional neuroimaging examinations
are often sought to exclude possible causes of secondary headaches or migraineassociated
disorders. Contrariwise, although advanced Magnetic Resonance Imaging (MRI)
has improved tremendously our understanding of human brain processes in migraine patients,
to the state of the art they have not superseded the conventional neuroimaging techniques in
the migraine clinical setting.
Methods: A comprehensive review was conducted of PubMed citations by entering the
keyword “marker” and/or “biomarker” combined with “migraine” and/or “headache”. Other
keywords included “imaging” or “neuroimaging”, “structural” or “functional”. The only restriction
was English-language publication. The abstracts of all articles meeting these criteria
were reviewed, and the full text was retrieved and examined for relevant references.
Results: Several authors tried to identify imaging biomarkers able to identify different migraine
phenotypes or, even better, to follow-up the same migraine patients during the course
of the disease, to predict the evolution into more severe phenotypes and, finally, the response
to specific treatment.
Conclusion: The identification of diagnostic, prognostic and therapeutic advanced neuroimaging
biomarkers in the migraine clinical setting, in order to approach to patients in a more
and more rational and “tailored” way, is extremely intriguing and futuristic. Unfortunately,
reliable and robust neuroimaging biomarkers are still lacking for migraine, probably due to
both not completely understood pathogenesis and clinical and neuroimaging heterogeneity.
Although further longitudinal advanced neuroimaging studies, aimed to identify effective
neuroimaging biomarkers, are needed, this review aims to collect the main and most recent
works on this topic.