Cerebral sodium (23Na) magnetic resonance imaging in patients with migraine — a case-control study

  • Melissa M. MeyerEmail author
  • Alexander Schmidt
  • Justus Benrath
  • Simon Konstandin
  • Lothar R. Pilz
  • Michael G. Harrington
  • Johannes Budjan
  • Mathias Meyer
  • Lothar R. Schad
  • Stefan O. Schoenberg
  • Stefan Haneder



Evaluation of MRI-derived cerebral 23Na concentrations in patients with migraine in comparison with healthy controls.

Materials and methods

In this case-control study, 24 female migraine patients (mean age, 34 ± 11 years) were enrolled after evaluation of standardized questionnaires. Half (n = 12) of the cohort suffered from migraine, the other half was impaired by both migraine and tension-type headaches (TTH). The combined patient cohort was matched to 12 healthy female controls (mean age, 34 ± 11 years). All participants underwent a cerebral 23Na-magnetic resonance imaging examination at 3.0 T, which included a T1w MP-RAGE sequence and a 3D density-adapted, radial gradient echo sequence for 23Na imaging. Circular regions of interests were placed in predetermined anatomic regions: cerebrospinal fluid (CSF), gray and white matter, brain stem, and cerebellum. External 23Na reference phantoms were used to calculate the total 23Na tissue concentrations. Pearson’s correlation, Kendall Tau, and Wilcoxon rank sum test were used for statistical analysis.


23Na concentrations of all patients in the CSF were significantly higher than in healthy controls (p < 0.001). The CSF of both the migraine and mixed migraine/TTH group showed significantly increased sodium concentrations compared to the control group (p = 0.007 and p < 0.001). Within the patient cohort, a positive correlation between pain level and TSC in the CSF (r = 0.62) could be observed.


MRI-derived cerebral 23Na concentrations in the CSF of migraine patients were found to be statistically significantly higher than in healthy controls.

Key Points

• Cerebral sodium MRI supports the theory of ionic imbalances and may aid in the challenging pathophysiologic understanding of migraine.

• Case-control study shows significantly higher sodium concentrations in cerebrospinal fluid of migraineurs.

• Cerebral sodium MRI may become a non-invasive imaging tool for drugs to modulate sodium, and hence migraine, on a molecular level, and influence patient management.


Sodium Magnetic resonance imaging Migraine Cerebrospinal fluid 



Cerebrospinal fluid


Diffusion-weighted imaging


Fluid-attenuated inversion recovery


Gray matter


Magnetization-prepared rapid acquisition gradient echo


Magnetic resonance imaging


Standard deviation


Total sodium concentration


Tension-type headaches


White matter



IRB approval: Medical Ethics Committee II Mannheim, Germany; reference number: 2013 566N – MA.


The authors state that this work has not received any funding.

Compliance with ethical standards


The scientific guarantor of this publication is Melissa Meyer, MD.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

One of the authors has significant statistical expertise.

Lothar R. Pilz, co-author.

Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.


• prospective

• case-control study

• performed at one institution


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Copyright information

© European Society of Radiology 2019

Authors and Affiliations

  • Melissa M. Meyer
    • 1
    Email author
  • Alexander Schmidt
    • 1
    • 2
  • Justus Benrath
    • 3
  • Simon Konstandin
    • 4
  • Lothar R. Pilz
    • 5
  • Michael G. Harrington
    • 6
  • Johannes Budjan
    • 1
  • Mathias Meyer
    • 1
  • Lothar R. Schad
    • 7
  • Stefan O. Schoenberg
    • 1
  • Stefan Haneder
    • 8
  1. 1.Institute of Clinical Radiology and Nuclear Medicine, Medical Faculty MannheimUniversity of HeidelbergMannheimGermany
  2. 2.Department of Diagnostic and Interventional RadiologyUniversity of WürzburgWürzburgGermany
  3. 3.Clinic for Anaesthesiology and Operative Intensive CareUniversity of HeidelbergMannheimGermany
  4. 4.MR-Imaging and SpectroscopyFraunhofer MEVISBremenGermany
  5. 5.Medical Faculty MannheimHeidelberg UniversityMannheimGermany
  6. 6.Huntington Medical Research InstitutesPasadenaUSA
  7. 7.Computer Assisted Clinical Medicine, Medical Faculty MannheimHeidelberg UniversityMannheimGermany
  8. 8.Department of RadiologyUniversity Hospital of CologneCologneGermany

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