In the pons, glutamatergic mechanisms are involved in regulating inhibitory descending pain modulation, serotoninergic neurotransmission as well as modulating the sensory transmission of the trigeminovascular system. Migraine involves altered pontine activation and structural changes, while biochemical, genetic and clinical evidence suggests that altered interictal pontine glutamate levels may be an important pathophysiological feature of migraine abetting to attack initiation.

Migraine without aura patients were scanned outside attacks using a proton magnetic resonance spectroscopy protocol optimized for the pons at 3 Tesla. The measurements were performed on two separate days to increase accuracy and compared to similar repeated measurements in healthy controls. We found that interictal glutamate (i.e. Glx) levels in the pons of migraine patients (n = 33) were not different from healthy controls (n = 16) (p = 0.098), while total creatine levels were markedly increased in patients (9%, p = 0.009). There was no correlation of glutamate or total creatine levels to migraine frequency, days since the last attack, usual pain intensity of attacks or disease duration.

In conclusion, migraine is not associated with altered interictal pontine glutamate levels. However, the novel finding of increased total creatine levels suggests that disequilibrium in the pontine energy metabolism could be an important feature of migraine pathophysiology.

在脑桥中，谷氨酸能机制参与调节抑制性下行疼痛调节、血清素能神经传递以及调节三叉血管系统的感觉传递。偏头痛涉及脑桥激活和结构变化的改变，而生化、遗传和临床证据表明，发作间期脑桥谷氨酸水平的改变可能是偏头痛发作的重要病理生理学特征。

使用针对脑桥在 3 特斯拉优化的质子磁共振波谱方案对无先兆偏头痛患者进行外部扫描。这些测量是在不同的两天进行的，以提高准确性，并与健康对照中类似的重复测量进行比较。我们发现偏头痛患者 (n = 33) 的脑桥发作间期谷氨酸 (即 Glx) 水平与健康对照 (n = 16) 没有差异 (p = 0.098)，而患者的总肌酸水平显着升高 (9%) ，p = 0.009）。谷氨酸或总肌酸水平与偏头痛频率、上次发作后的天数、通常发作的疼痛强度或疾病持续时间没有相关性。

总之，偏头痛与发作间期脑桥谷氨酸水平的改变无关。然而，总肌酸水平增加的新发现表明，脑桥能量代谢的不平衡可能是偏头痛病理生理学的一个重要特征。