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Ou Y, Ni X, Gao X, Yu Y, Zhang Y, Wang Y, Liu J, Yin Z, Rong J, Sun M, Chen J, Tang Z, Xiao W, Zhao L. Structural and functional changes of anterior cingulate cortex subregions in migraine without aura: relationships with pain sensation and pain emotion. Cereb Cortex 2024; 34:bhae040. [PMID: 38342690 PMCID: PMC10859245 DOI: 10.1093/cercor/bhae040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 01/19/2024] [Accepted: 01/20/2024] [Indexed: 02/13/2024] Open
Abstract
Migraine without aura is a multidimensional neurological disorder characterized by sensory, emotional, and cognitive symptoms linked to structural and functional abnormalities in the anterior cingulate cortex. Anterior cingulate cortex subregions play differential roles in the clinical symptoms of migraine without aura; however, the specific patterns and mechanisms remain unclear. In this study, voxel-based morphometry and seed-based functional connectivity were used to investigate structural and functional alterations in the anterior cingulate cortex subdivisions in 50 patients with migraine without aura and 50 matched healthy controls. Compared with healthy controls, patients exhibited (1) decreased gray matter volume in the subgenual anterior cingulate cortex, (2) increased functional connectivity between the bilateral subgenual anterior cingulate cortex and right middle frontal gyrus, and between the posterior part of anterior cingulate cortex and right middle frontal gyrus, orbital part, and (3) decreased functional connectivity between the anterior cingulate cortex and left anterior cingulate and paracingulate gyri. Notably, left subgenual anterior cingulate cortex was correlated with the duration of each attack, whereas the right subgenual anterior cingulate cortex was associated with migraine-specific quality-of-life questionnaire (emotion) and self-rating anxiety scale scores. Our findings provide new evidence supporting the hypothesis of abnormal anterior cingulate cortex subcircuitry, revealing structural and functional abnormalities in its subregions and emphasizing the potential involvement of the left subgenual anterior cingulate cortex-related pain sensation subcircuit and right subgenual anterior cingulate cortex -related pain emotion subcircuit in migraine.
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Affiliation(s)
- Yangxu Ou
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 1166, Liutai Avenue, Wenjiang District, Chengdu, Sichuan 611137, China
| | - Xixiu Ni
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 1166, Liutai Avenue, Wenjiang District, Chengdu, Sichuan 611137, China
| | - Xiaoyu Gao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 1166, Liutai Avenue, Wenjiang District, Chengdu, Sichuan 611137, China
| | - Yang Yu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 1166, Liutai Avenue, Wenjiang District, Chengdu, Sichuan 611137, China
| | - Yutong Zhang
- Department of Scientific Research and Education and Training Management, the Third People’s Hospital of Chengdu, Chengdu, Sichuan 610000, China
| | - Yanan Wang
- Department of Pain Treatment, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China
| | - Jie Liu
- Department of Neurology, Sichuan Provincial People’s Hospital, Chengdu, Sichuan 610072, China
| | - Zihan Yin
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 1166, Liutai Avenue, Wenjiang District, Chengdu, Sichuan 611137, China
| | - Jing Rong
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 1166, Liutai Avenue, Wenjiang District, Chengdu, Sichuan 611137, China
| | - Mingsheng Sun
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 1166, Liutai Avenue, Wenjiang District, Chengdu, Sichuan 611137, China
- Sichuan Clinical Medical Research Center for Acupuncture and Moxibustion, Chengdu, Sichuan 611137, China
| | - Jiao Chen
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 1166, Liutai Avenue, Wenjiang District, Chengdu, Sichuan 611137, China
- Sichuan Clinical Medical Research Center for Acupuncture and Moxibustion, Chengdu, Sichuan 611137, China
| | - Zili Tang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 1166, Liutai Avenue, Wenjiang District, Chengdu, Sichuan 611137, China
| | - Wang Xiao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 1166, Liutai Avenue, Wenjiang District, Chengdu, Sichuan 611137, China
| | - Ling Zhao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 1166, Liutai Avenue, Wenjiang District, Chengdu, Sichuan 611137, China
- Sichuan Clinical Medical Research Center for Acupuncture and Moxibustion, Chengdu, Sichuan 611137, China
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Dobos D, Kökönyei G, Gyebnár G, Szabó E, Kocsel N, Galambos A, Gecse K, Baksa D, Kozák LR, Juhász G. Microstructural differences in migraine: A diffusion-tensor imaging study. Cephalalgia 2023; 43:3331024231216456. [PMID: 38111172 DOI: 10.1177/03331024231216456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
BACKGROUND Diffusion-tensor imaging can be applied to describe the microstructural integrity of the whole brain. As findings about microstructural alterations in migraine are inconsistent, we aimed to replicate the most frequent results and assess a relationship between migraine parameters and changes in microstructure. METHODS Diffusion-weighted MRI data of 37 migraine patients and 40 controls were collected. Two indices of diffusion of water molecules, fractional anisotropy and mean diffusivity were used in a voxel-wise analysis. Group comparisons were carried out in SPM12 using age and sex as covariates. Statistically significant results survived family-wise error correction (pFWE < 0.05). Migraine intensity, frequency, and duration were self-reported and correlated with mean fractional anisotropy and mean diffusivity values across clusters. RESULTS Migraine patients showed significantly lower fractional anisotropy in occipital regions, and significantly higher fractional anisotropy in thirteen clusters across the brain. Mean diffusivity of migraine patients was significantly decreased in the cerebellum and pons, but it was not increased in any area. Correlation between migraine duration and fractional anisotropy was significantly positive in the frontal cortex and significantly negative in the superior parietal lobule. CONCLUSION We suggest that microstructural integrity of the migraine brain is impaired in visual areas and shows duration-related alterations in regions of the default mode network.
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Affiliation(s)
- Dóra Dobos
- NAP3.0-SE Neuropsychopharmacology Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- SE NAP 2 Genetic Brain Imaging Migraine Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- Department of Pharmacodynamics, Faculty of Pharmaceutical Sciences, Semmelweis University, Budapest, Hungary
| | - Gyöngyi Kökönyei
- NAP3.0-SE Neuropsychopharmacology Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- SE NAP 2 Genetic Brain Imaging Migraine Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- Department of Pharmacodynamics, Faculty of Pharmaceutical Sciences, Semmelweis University, Budapest, Hungary
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Gyula Gyebnár
- Magnetic Resonance Research Centre, Semmelweis University, Budapest, Hungary
| | - Edina Szabó
- SE NAP 2 Genetic Brain Imaging Migraine Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Natália Kocsel
- SE NAP 2 Genetic Brain Imaging Migraine Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Attila Galambos
- SE NAP 2 Genetic Brain Imaging Migraine Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- Institute of Psychology, ELTE Eötvös Loránd University, Budapest, Hungary
| | - Kinga Gecse
- NAP3.0-SE Neuropsychopharmacology Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- SE NAP 2 Genetic Brain Imaging Migraine Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- Department of Pharmacodynamics, Faculty of Pharmaceutical Sciences, Semmelweis University, Budapest, Hungary
| | - Dániel Baksa
- NAP3.0-SE Neuropsychopharmacology Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- SE NAP 2 Genetic Brain Imaging Migraine Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- Department of Pharmacodynamics, Faculty of Pharmaceutical Sciences, Semmelweis University, Budapest, Hungary
- Department of Personality and Clinical Psychology, Institute of Psychology, Faculty of Humanities and Social Sciences, Pazmany Peter Catholic University, Budapest, Hungary
| | - Lajos R Kozák
- Magnetic Resonance Research Centre, Semmelweis University, Budapest, Hungary
| | - Gabriella Juhász
- NAP3.0-SE Neuropsychopharmacology Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- SE NAP 2 Genetic Brain Imaging Migraine Research Group, Hungarian Brain Research Program, Semmelweis University, Budapest, Hungary
- Department of Pharmacodynamics, Faculty of Pharmaceutical Sciences, Semmelweis University, Budapest, Hungary
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Chou BC, Lerner A, Barisano G, Phung D, Xu W, Pinto SN, Sheikh-Bahaei N. Functional MRI and Diffusion Tensor Imaging in Migraine: A Review of Migraine Functional and White Matter Microstructural Changes. J Cent Nerv Syst Dis 2023; 15:11795735231205413. [PMID: 37900908 PMCID: PMC10612465 DOI: 10.1177/11795735231205413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 09/14/2023] [Indexed: 10/31/2023] Open
Abstract
Migraine is a complex and heterogenous disorder whose disease mechanisms remain disputed. This narrative review summarizes functional MRI (fMRI) and diffusion tensor imaging (DTI) findings and interprets their association with migraine symptoms and subtype to support and expand our current understanding of migraine pathophysiology. Our PubMed search evaluated and included fMRI and DTI studies involving comparisons between migraineurs vs healthy controls, migraineurs with vs without aura, and episodic vs chronic migraineurs. Migraineurs demonstrate changes in functional connectivity (FC) and regional activation in numerous pain-related networks depending on migraine phase, presence of aura, and chronicity. Changes to diffusion indices are observed in major cortical white matter tracts extending to the brainstem and cerebellum, more prominent in chronic migraine and associated with FC changes. Reported changes in FC and regional activation likely relate to pain processing and sensory hypersensitivities. Diffuse white matter microstructural changes in dysfunctional cortical pain and sensory pathways complement these functional differences. Interpretations of reported fMRI and DTI measure trends have not achieved a clear consensus due to inconsistencies in the migraine neuroimaging literature. Future fMRI and DTI studies should establish and implement a uniform methodology that reproduces existing results and directly compares migraineurs with different subtypes. Combined fMRI and DTI imaging may provide better pathophysiological explanations for nonspecific FC and white matter microstructural differences.
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Affiliation(s)
- Brendon C. Chou
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Alexander Lerner
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Daniel Phung
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Wilson Xu
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Soniya N. Pinto
- Department of Diagnostic Imaging, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Nasim Sheikh-Bahaei
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Zeng G, Zhou Y, Yang Y, Ruan L, Tan L, Luo H, Ruan J. Neural oscillations after acute large artery atherosclerotic cerebral infarction during resting state and sleep spindles. J Sleep Res 2023; 32:e13889. [PMID: 36944554 DOI: 10.1111/jsr.13889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/01/2023] [Accepted: 03/07/2023] [Indexed: 03/23/2023]
Abstract
Electroencephalogram-microstate analysis was conducted using low-resolution electromagnetic tomography (LORETA)-KEY to evaluate dynamic brain network changes in patients with acute large artery atherosclerotic cerebral infarction (LAACI) during the rest and sleep stages. This study included 35 age- and sex-matched healthy controls and 34 patients with acute LAACI. Each participant performed a 3-h, 19-channel video electroencephalogram test. Subsequently, 20 epochs of 2-s sleep spindles during stage N2 sleep and five epochs of 10-s electroencephalogram data in the resting state for each participant were obtained. In both the resting state and sleep spindles, patients with LAACI displayed altered neural oscillations. The parameters of microstate A (coverage, occurrence, and duration) increased during the resting state in the patients with LAACI compared with healthy controls. The coverage and occurrence of microstate B and D were reduced in the LAACI group compared with the healthy controls (p < 0.05). Moreover, during sleep spindles, the duration of microstate A and the transition probability from microstate A and B to C decreased, but the coverage of microstate B and the transition rate from microstate B to D increased (p < 0.05) in the LAACI group compared with the healthy controls. These results enable better understanding of how neural oscillations are modified in patients with LAACI during the resting state and sleep spindles. Following LAACI, the dynamic brain network undergoes changes during sleep spindles and the resting state. Continued long-term investigations are required to determine how well these changes in brain dynamics reflect the clinical characteristics of patients with LAACI.
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Affiliation(s)
- Guoli Zeng
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Department of Neurology, Luzhou People's Hospital, Luzhou, China
| | - Yan Zhou
- Department of Neurology, Jianyang People's Hospital, Jianyang, China
| | - Yushu Yang
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Laboratory of Neurological Diseases and Brain Function, Luzhou, China
| | - Lili Ruan
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Laboratory of Neurological Diseases and Brain Function, Luzhou, China
| | - Linjie Tan
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Laboratory of Neurological Diseases and Brain Function, Luzhou, China
| | - Hua Luo
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Laboratory of Neurological Diseases and Brain Function, Luzhou, China
| | - Jianghai Ruan
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, China
- Laboratory of Neurological Diseases and Brain Function, Luzhou, China
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Robblee J. Breaking the cycle: unraveling the diagnostic, pathophysiological and treatment challenges of refractory migraine. Front Neurol 2023; 14:1263535. [PMID: 37830088 PMCID: PMC10565861 DOI: 10.3389/fneur.2023.1263535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 09/11/2023] [Indexed: 10/14/2023] Open
Abstract
Background Refractory migraine is a poorly described complication of migraine in which migraine has chronified and become resistant to standard treatments. The true prevalence is unknown, but medication resistance is common in headache clinic patient populations. Given the lack of response to treatment, this patient population is extremely difficult to treat with limited guidance in the literature. Objective To review the diagnostic, pathophysiological, and management challenges in the refractory migraine population. Discussion There are no accepted, or even ICHD-3 appendix, diagnostic criteria for refractory migraine though several proposed criteria exist. Current proposed criteria often have low bars for refractoriness while also not meeting the needs of pediatrics, lower socioeconomic status, and developing nations. Pathophysiology is unknown but can be hypothesized as a persistent "on" state as a progression from chronic migraine with increasing central sensitization, but there may be heterogeneity in the underlying pathophysiology. No guidelines exist for treatment of refractory migraine; once all guideline-based treatments are tried, treatment consists of n-of-1 treatment trials paired with non-pharmacologic management. Conclusion Refractory migraine is poorly described diagnostically, its pathophysiology can only be guessed at by extension of chronic migraine, and treatment is more the art than science of medicine. Navigating care of this refractory population will require multidisciplinary care models and an emphasis on future research to answer these unknowns.
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Affiliation(s)
- Jennifer Robblee
- Department of Neurology, Dignity Health, St Joseph’s Hospital and Medical Center, Lewis Headache Clinic, Barrow Neurological Institute, Phoenix, AZ, United States
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6
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Messina R, Rocca MA, Goadsby PJ, Filippi M. Insights into migraine attacks from neuroimaging. Lancet Neurol 2023; 22:834-846. [PMID: 37478888 DOI: 10.1016/s1474-4422(23)00152-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 03/15/2023] [Accepted: 04/12/2023] [Indexed: 07/23/2023]
Abstract
Migraine is one of the most common neurological diseases and it has a huge social and personal impact. Although head pain is the core symptom, individuals with migraine can have a plethora of non-headache symptoms that precede, accompany, or follow the pain. Neuroimaging studies have shown that the involvement of specific brain areas can explain many of the symptoms reported during the different phases of migraine. Recruitment of the hypothalamus, pons, spinal trigeminal nucleus, thalamus, and visual and pain-processing cortical areas starts during the premonitory phase and persists through the headache phase, contributing to the onset of pain and associated symptoms. Once the pain stops, the involvement of most brain areas ends, although the pons, hypothalamus, and visual cortex remain active after acute treatment intake and resolution of migraine symptoms. A better understanding of the correlations between imaging findings and migraine symptomatology can provide new insight into migraine pathophysiology and the mechanisms of novel migraine-specific treatments.
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Affiliation(s)
- Roberta Messina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Peter J Goadsby
- NIHR King's Clinical Research Facility, King's College, London, UK; Department of Neurology, University of California, Los Angeles, CA, USA
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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Silvestro M, Orologio I, Siciliano M, Trojsi F, Tessitore A, Tedeschi G, Russo A. Emerging drugs for the preventive treatment of migraine: a review of CGRP monoclonal antibodies and gepants trials. Expert Opin Emerg Drugs 2023. [PMID: 37185047 DOI: 10.1080/14728214.2023.2207819] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
INTRODUCTION Migraine is a leading cause of years lived with disability and preventive strategies represent a mainstay to reduce health-related disability and improve quality of life of migraine patients. Until a few years ago, migraine prevention was based on drugs developed for other clinical indications and relocated in the migraine therapeutic armamentarium, characterized by unfavourable tolerability profiles. The advent of monoclonal antibodies against Calcitonin Gene-Related Peptide (CGRP) and gepants, CGRP receptor antagonists, has been a turning point in migraine prevention owing to advantageous efficacy, safety and tolerability profiles.Nevertheless, while in an ideal scenario a drug characterized by significant greater efficacy and tolerability compared to existing therapeutic strategies should be adopted as a first-line treatment, cost-effectiveness analyses available for monoclonal antibodies against CGRP pathway tend to limit their administration to more severe migraine phenotypes. AREAS COVERED The present narrative review aim to provide a critical appraisal of phase II and III CGRP-mAbs and gepants trials to analyse their use in clinical practice. EXPERT OPINION Despite monoclonal antibodies against CGRP pathway and gepants can be undoubtedly considered top-of-the-range treatments, there are still issues deserving to be addressed in the coming years as the risk of off-target effects as well as their economic sustainability based on the considerable migraine burden.
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Affiliation(s)
- Marcello Silvestro
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - Ilaria Orologio
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - Mattia Siciliano
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - Francesca Trojsi
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - Alessandro Tessitore
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - Gioacchino Tedeschi
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Italy
| | - Antonio Russo
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Italy
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Kowalski JL, Morse LR, Troy K, Nguyen N, Battaglino RA, Falci SP, Linnman C. Resting state functional connectivity differentiation of neuropathic and nociceptive pain in individuals with chronic spinal cord injury. Neuroimage Clin 2023; 38:103414. [PMID: 37244076 PMCID: PMC10238876 DOI: 10.1016/j.nicl.2023.103414] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 05/29/2023]
Abstract
Many individuals with spinal cord injury live with debilitating chronic pain that may be neuropathic, nociceptive, or a combination of both in nature. Identification of brain regions demonstrating altered connectivity associated with the type and severity of pain experience may elucidate underlying mechanisms, as well as treatment targets. Resting state and sensorimotor task-based magnetic resonance imaging data were collected in 37 individuals with chronic spinal cord injury. Seed-based correlations were utilized to identify resting state functional connectivity of regions with established roles in pain processing: the primary motor and somatosensory cortices, cingulate, insula, hippocampus, parahippocampal gyri, thalamus, amygdala, caudate, putamen, and periaqueductal gray matter. Resting state functional connectivity alterations and task-based activation associated with individuals' pain type and intensity ratings on the International Spinal Cord Injury Basic Pain Dataset (0-10 scale) were evaluated. We found that intralimbic and limbostriatal resting state connectivity alterations are uniquely associated with neuropathic pain severity, whereas thalamocortical and thalamolimbic connectivity alterations are associated specifically with nociceptive pain severity. The joint effect and contrast of both pain types were associated with altered limbocortical connectivity. No significant differences in task-based activation were identified. These findings suggest that the experience of pain in individuals with spinal cord injury may be associated with unique alterations in resting state functional connectivity dependent upon pain type.
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Affiliation(s)
- Jesse L Kowalski
- Spaulding Neuroimaging Laboratory, Spaulding Rehabilitation Hospital, Harvard Medical School, 79/96 13th St, Charlestown, Boston, MA, United States; Department of Rehabilitation Medicine, University of Minnesota, MMC 297, 420 Delaware St. SE, Minneapolis, MN 55455, United States.
| | - Leslie R Morse
- Department of Rehabilitation Medicine, University of Minnesota, MMC 297, 420 Delaware St. SE, Minneapolis, MN 55455, United States.
| | - Karen Troy
- Department of Biomedical Engineering, Worcester Polytechnic Institute, 100 Institute Road, Worcester, MA 01609, United States.
| | - Nguyen Nguyen
- Department of Rehabilitation Medicine, University of Minnesota, MMC 297, 420 Delaware St. SE, Minneapolis, MN 55455, United States.
| | - Ricardo A Battaglino
- Department of Rehabilitation Medicine, University of Minnesota, MMC 297, 420 Delaware St. SE, Minneapolis, MN 55455, United States.
| | - Scott P Falci
- Department of Rehabilitation Medicine, University of Minnesota, MMC 297, 420 Delaware St. SE, Minneapolis, MN 55455, United States; Department of Neurosurgery, Swedish Medical Center, 501 E Hampden Ave, Englewood, CO 80113, United States.
| | - Clas Linnman
- Spaulding Neuroimaging Laboratory, Spaulding Rehabilitation Hospital, Harvard Medical School, 79/96 13th St, Charlestown, Boston, MA, United States; Department of Rehabilitation Medicine, University of Minnesota, MMC 297, 420 Delaware St. SE, Minneapolis, MN 55455, United States.
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9
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Zhou Y, Gong L, Yang Y, Tan L, Ruan L, Chen X, Luo H, Ruan J. Spatio-temporal dynamics of resting-state brain networks are associated with migraine disability. J Headache Pain 2023; 24:13. [PMID: 36800935 PMCID: PMC9940435 DOI: 10.1186/s10194-023-01551-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 02/13/2023] [Indexed: 02/21/2023] Open
Abstract
OBJECTIVE The changes in resting-state functional networks and their correlations with clinical traits remain to be clarified in migraine. Here we aim to investigate the brain spatio-temporal dynamics of resting-state networks and their possible correlations with the clinical traits in migraine. METHODS Twenty Four migraine patients without aura and 26 healthy controls (HC) were enrolled. Each included subject underwent a resting-state EEG and echo planar imaging examination. The disability of migraine patients was evaluated by Migraine Disability Assessment (MIDAS). After data acquisition, EEG microstates (Ms) combining functional connectivity (FC) analysis based on Schafer 400-seven network atlas were performed. Then, the correlation between obtained parameters and clinical traits was investigated. RESULTS Compared with HC group, the brain temporal dynamics depicted by microstates showed significantly increased activity in functional networks involving MsB and decreased activity in functional networks involving MsD; The spatial dynamics were featured by decreased intra-network FC within the executive control network( ECN) and inter-network FC between dorsal attention network (DAN) and ECN (P < 0.05); Moreover, correlation analysis showed that the MIDAS score was positively correlated with the coverage and duration of MsC, and negatively correlated with the occurrence of MsA; The FC within default mode network (DMN), and the inter-FC of ECN- visual network (VN), ECN- limbic network, VN-limbic network was negatively correlated with MIDAS. However, the FC of DMN-ECN was positively correlated with MIDAS; Furthermore, significant interactions between the temporal and spatial dynamics were also obtained. CONCLUSIONS Our study confirmed the notion that altered spatio-temporal dynamics exist in migraine patients during resting-state. And the temporal dynamics, the spatial changes and the clinical traits such as migraine disability interact with each other. The spatio-temporal dynamics obtained from EEG microstate and fMRI FC analyses may be potential biomarkers for migraine and with a huge potential to change future clinical practice in migraine.
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Affiliation(s)
- Yan Zhou
- Department of Neurology, Jianyang People's Hospital, Jianyang, 641400, China
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
- Laboratory of Neurological Diseases and Brain Function, Luzhou, 646000, China
| | - Liusheng Gong
- Department of Neurology, Jianyang People's Hospital, Jianyang, 641400, China
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
| | - Yushu Yang
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
- Laboratory of Neurological Diseases and Brain Function, Luzhou, 646000, China
| | - Linjie Tan
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
- Laboratory of Neurological Diseases and Brain Function, Luzhou, 646000, China
| | - Lili Ruan
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
- Laboratory of Neurological Diseases and Brain Function, Luzhou, 646000, China
| | - Xiu Chen
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
- Laboratory of Neurological Diseases and Brain Function, Luzhou, 646000, China
| | - Hua Luo
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China
- Laboratory of Neurological Diseases and Brain Function, Luzhou, 646000, China
| | - Jianghai Ruan
- Department of Neurology, The Affiliated Hospital of Southwest Medical University, Luzhou, 646000, China.
- Laboratory of Neurological Diseases and Brain Function, Luzhou, 646000, China.
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Messina R, Filippi M. What imaging has revealed about migraine and chronic migraine. HANDBOOK OF CLINICAL NEUROLOGY 2023; 198:105-116. [PMID: 38043956 DOI: 10.1016/b978-0-12-823356-6.00011-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Although migraine pathophysiology is not yet entirely understood, it is now established that migraine should be viewed as a complex neurological disease, which involves the interplay of different brain networks and the release of signaling molecules, instead of a pure vascular disorder. The field of migraine research has also progressed significantly due to the advancement of brain imaging techniques. Numerous studies have investigated the relation between migraine pathophysiology and cerebral hemodynamic changes, showing that vascular changes are neither necessary nor sufficient to cause the migraine pain. Abnormal function and structure of key cortical, subcortical, and brainstem regions involved in multisensory, including pain, processing have been shown to occur in migraine patients during both an acute attack and the interictal phase. Whether brain imaging alterations represent a predisposing trait or are the consequence of the recurrence of headache attacks is still a matter of debate. It is highly likely that brain functional and structural alterations observed in migraine patients derive from the interaction between predisposing brain traits and experience-dependent responses. Neuroimaging studies have also enriched our knowledge of the mechanisms responsible for migraine chronification and have shed light on the mechanisms of actions of acute and preventive migraine treatments.
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Affiliation(s)
- Roberta Messina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
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11
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Szabo E, Timmers I, Borsook D, Simons LE, Sieberg CB. Altered anterior insula functional connectivity in adolescent and young women with endometriosis-associated pain: Pilot resting-state fMRI study. Eur J Paediatr Neurol 2022; 41:80-90. [PMID: 36375399 PMCID: PMC9722632 DOI: 10.1016/j.ejpn.2022.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 09/12/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Endometriosis is the leading cause of chronic pelvic pain. Alterations in brain functional connectivity have been reported in adult women with endometriosis-associated pain (EAP), however, it is still unknown if similar patterns of changes exist in adolescents. METHODS In this pilot study, resting-state fMRI scans were obtained from 11 adolescent and young women with EAP and 14 healthy female controls. Using a seed-to-voxel approach, we investigated functional connectivity between the anterior insula, medial prefrontal cortex, and the rest of the brain. Furthermore, we explored whether potential functional connectivity differences were correlated with clinical characteristics including disease duration, pain intensity, and different psychosocial factors (pain catastrophizing, fear of pain, functional disability, anxiety, and depression). RESULTS Our findings revealed that patients with EAP demonstrated significantly decreased connectivity between the right anterior insula and two clusters: one in the right cerebellum, and one in the left middle frontal gyrus compared to controls. Additionally, functional connectivity between the right anterior insula and the right cerebellum was positively associated with pain intensity levels. In patients with EAP, brain changes were also correlated with state anxiety and fear of pain. CONCLUSIONS Our results are relevant not only for understanding the brain characteristics underlying EAP at a younger age, but also in enhancing future pain treatment efforts by supporting the involvement of the central nervous system in endometriosis.
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Affiliation(s)
- Edina Szabo
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA; Biobehavioral Pain Innovations Lab, Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, MA, USA; Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Inge Timmers
- Department of Rehabilitation Medicine, Maastricht University, Maastricht, the Netherlands; Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - David Borsook
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA; Department of Radiology, Massachusetts General Hospital, Boston, MA, USA; Department of Anesthesiology, Harvard Medical School, Boston, MA, USA
| | - Laura E Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Christine B Sieberg
- Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA; Biobehavioral Pain Innovations Lab, Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
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12
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Suzuki K, Suzuki S, Shiina T, Kobayashi S, Hirata K. Central Sensitization in Migraine: A Narrative Review. J Pain Res 2022; 15:2673-2682. [PMID: 36101891 PMCID: PMC9464439 DOI: 10.2147/jpr.s329280] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/16/2022] [Indexed: 11/23/2022] Open
Abstract
Central sensitization (CS) is an increase in the responsiveness of nociceptive neurons in the central nervous system to their normal afferent input. As a result, even minor irritation can induce severe pain, leading to the chronicity and severity of various diseases, such as neurological disorders. CS is associated with migraine, which is a major neurological disorder that inflicts a high disability in daily life. Specifically, CS is thought to be involved in the pathogenesis of cutaneous allodynia as well as chronification of migraine. In this article, we reviewed the association between CS and migraine, including pathophysiological aspects and evidence from clinical studies. We suggest that appropriate screening and management of CS in migraine could further improve the quality of life of migraine patients.
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Affiliation(s)
- Keisuke Suzuki
- Department of Neurology, Dokkyo Medical University, Mibu, Japan
| | - Shiho Suzuki
- Department of Neurology, Dokkyo Medical University, Mibu, Japan
| | - Tomohiko Shiina
- Department of Neurology, Dokkyo Medical University, Mibu, Japan
| | - Saro Kobayashi
- Department of Neurology, Dokkyo Medical University, Mibu, Japan
| | - Koichi Hirata
- Department of Neurology, Dokkyo Medical University, Mibu, Japan
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13
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Wang ZW, Yin ZH, Wang X, Zhang YT, Xu T, Du JR, Wen Y, Liao HQ, Zhao Y, Liang FR, Zhao L. Brain structural and functional changes during menstrual migraine: Relationships with pain. Front Mol Neurosci 2022; 15:967103. [PMID: 36187356 PMCID: PMC9515315 DOI: 10.3389/fnmol.2022.967103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 08/25/2022] [Indexed: 12/21/2022] Open
Abstract
Objectives Menstrual migraine (MM) is a special type of migraine associated with the ovarian cycle, which imposes a marked burden on female patients. However, the pathogenesis of MM is not completely understood. We investigated gray matter volume (GMV) and functional connectivity (FC) alterations in patients with MM to explore whether there are changes in resting-state FC (rsFC) in brain regions with structural GMV abnormalities and investigated their relevance to pain and concomitant symptoms. Methods Seventy-five patients with MM and 54 female healthy controls underwent functional magnetic resonance imaging and examination. The patients completed a patient’s headache diary, which included the frequency of migraine attacks, a visual analog scale for pain, a self-rating anxiety scale, and a self-rating depression scale. We used voxel-based morphometry (VBM) to examine the GMV differences between the MM and healthy control groups. The identified brain areas were selected as seeds to assess functional changes in the MM group. Correlation analysis between the altered VBM/rsFC and clinical outcomes was performed. Results Compared with healthy controls, patients with MM showed decreased GMV in the right anterior cingulum cortex (ACC) and increased GMV in the right superior parietal cortex. Pearson’s correlation analysis illustrated that only GMV in the right ACC was associated with visual analogue scale pain scores in the MM group. RsFC with the ACC as the seed showed that patients with MM exhibited increased FC between the ACC and the left inferior temporal gyrus, bilateral angular gyrus, and right precuneus. Correlation analysis showed that the change in FC between the right ACC and the right precuneus was positively correlated with headache frequency, and the change in FC between the right ACC and the right angular gyrus was positively correlated with the depression score. Conclusion Our results suggested that the ACC may be an important biomarker in MM, and its structural and functional impairments are significantly associated with the severity of pain and pain-related impairment of emotion in patients with MM. These findings demonstrated that headache-associated structural and functional abnormalities in the ACC may can provide integrative evidence on the physiological mechanisms of MM.
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Affiliation(s)
- Zi-wen Wang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Sichuan Provincial Acupuncture Clinical Medicine Research Center, Chengdu, China
| | - Zi-han Yin
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Sichuan Provincial Acupuncture Clinical Medicine Research Center, Chengdu, China
| | - Xiao Wang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yu-tong Zhang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Sichuan Provincial Acupuncture Clinical Medicine Research Center, Chengdu, China
| | - Tao Xu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Sichuan Provincial Acupuncture Clinical Medicine Research Center, Chengdu, China
| | - Jia-rong Du
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yi Wen
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Hua-qiang Liao
- Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yu Zhao
- Chengdu Integrated Traditional Chinese Medicine and Western Medicine Hospital, Chengdu, China
| | - Fan-rong Liang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Sichuan Provincial Acupuncture Clinical Medicine Research Center, Chengdu, China
- Fan-rong Liang,
| | - Ling Zhao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
- Sichuan Provincial Acupuncture Clinical Medicine Research Center, Chengdu, China
- *Correspondence: Ling Zhao,
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Zhang YN, Xing XX, Chen L, Dong X, Pan HT, Hua XY, Wang K. Modification of the resting-state network involved at different stages of neuropathic pain. Neurosci Lett 2022; 789:136866. [PMID: 36075318 DOI: 10.1016/j.neulet.2022.136866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 08/20/2022] [Accepted: 09/02/2022] [Indexed: 10/14/2022]
Abstract
Neuropathic pain (NeuP) is shown to be associated with abnormal changes in several specific brain regions. However, the large-scale interactivity of neuronal networks underlying the sensory and emotional abnormalities during NeuP remains unexplored. The present study aimed to explore the alterations in the relevant functional resting-state networks (RSNs) and their intra-networks at the different stages of NeuP based on resting-state functional magnetic resonance imaging (rs-fMRI). A NeuP rat model was established by chronic constriction injury (CCI). Three RSNs were identified to be associated with the NeuP, including the default mode network (DMN), sensorimotor network (SMN), and interoceptive network (IN). The functional connectivity (FC) of the left caudate putamen (CPu) within the DMN and the right piriform cortex within the IN were significantly reduced at the early stage of NeuP, when the maximum allodynia was apparent early, which reflected the suppressed function of the DMN and IN. At 4 weeks post-CCI, when negative emotions were present, the FC of the right insular cortex in the SMN and left visual cortex in the IN were significantly elevated, representing the increased excitability of both SMN and IN. Our study revealed the characteristic functional organization at the network level induced by NeuP and emphasized the role of SMN, DMN, and IN in the pathological mechanisms of NeuP.
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Affiliation(s)
- Ya-Nan Zhang
- Acupuncture Anesthesia Clinical Research Institute, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Xiang-Xin Xing
- Department of Rehabilitation Medicine, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China; Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai 201203, China
| | - Liu Chen
- Acupuncture Anesthesia Clinical Research Institute, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Xin Dong
- Acupuncture Anesthesia Clinical Research Institute, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Hao-Tian Pan
- Acupuncture Anesthesia Clinical Research Institute, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Xu-Yun Hua
- Department of Traumatology and Orthopedics, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China; Engineering Research Center of Traditional Chinese Medicine Intelligent Rehabilitation, Ministry of Education, Shanghai 201203, China.
| | - Ke Wang
- Acupuncture Anesthesia Clinical Research Institute, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China.
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15
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Markin K, Trufanov A, Frunza D, Litvinenko I, Tarumov D, Krasichkov A, Polyakova V, Efimtsev A, Medvedev D. fMRI Findings in Cortical Brain Networks Interactions in Migraine Following Repetitive Transcranial Magnetic Stimulation. Front Neurol 2022; 13:915346. [PMID: 35800086 PMCID: PMC9253380 DOI: 10.3389/fneur.2022.915346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/12/2022] [Indexed: 11/21/2022] Open
Abstract
Background Repetitive transcranial magnetic stimulation (rTMS) is one of the high-potential non-pharmacological methods for migraine treatment. The purpose of this study is to define the neuroimaging markers associated with rTMS therapy in patients with migraine based on data from functional MRI (fMRI). Materials and Methods A total of 19 patients with episodic migraine without aura underwent a 5-day course of rTMS of the fronto-temporo-parietal junction bilaterally, at 10 Hz frequency and 60% of motor threshold response of 900 pulses. Resting-state functional MRI (1.5 T) and a battery of tests were carried out for each patient to clarify their diagnosis, qualitative and quantitative characteristics of pain, and associated affective symptoms. Changes in functional connectivity (FC) in the brain's neural networks before and after the treatment were identified through independent components analysis. Results Over the course of therapy, we observed an increase in FC of the default mode network within it, with pain system components and with structures of the visual network. We also noted a decrease in FC of the salience network with sensorimotor and visual networks, as well as an increase in FC of the visual network. Besides, we identified 5 patients who did not have a positive response to one rTMS course after the first week of treatment according to the clinical scales results, presumably because of an increasing trend of depressive symptoms and neuroimaging criteria for depressive disorder. Conclusions Our results show that a 5-day course of rTMS significantly alters the connectivity of brain networks associated with pain and antinociceptive brain systems in about 70% of cases, which may shed light on the neural mechanisms underlying migraine treatment with rTMS.
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Affiliation(s)
- Kirill Markin
- Psychiatry Department, Kirov Military Medical Academy, Saint Petersburg, Russia
- *Correspondence: Kirill Markin ; orcid.org/0000-0002-6242-1279
| | - Artem Trufanov
- Neurology Department, Kirov Military Medical Academy, Saint Petersburg, Russia
- Department of Software Engineering and Computer Applications, Saint Petersburg Electrotechnical University “LETI”, Saint Petersburg, Russia
| | - Daria Frunza
- Neurology Department, Kirov Military Medical Academy, Saint Petersburg, Russia
| | - Igor Litvinenko
- Neurology Department, Kirov Military Medical Academy, Saint Petersburg, Russia
| | - Dmitriy Tarumov
- Psychiatry Department, Kirov Military Medical Academy, Saint Petersburg, Russia
| | - Alexander Krasichkov
- Radio Engineering Systems Department, Saint Petersburg Electrotechnical University “LETI”, Saint Petersburg, Russia
| | - Victoria Polyakova
- Department of Pathology, Saint-Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | - Alexander Efimtsev
- Department of Software Engineering and Computer Applications, Saint Petersburg Electrotechnical University “LETI”, Saint Petersburg, Russia
- Department of Radiology, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Dmitriy Medvedev
- Federal State Unitary Enterprise, Federal Medical Biological Agency, Saint Petersburg, Russia
- Department of Physical Therapy and Sports Medicine, North-Western State Medical University Named After I.I. Mechnikov, Saint Petersburg, Russia
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16
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Microstructural white matter alterations associated with migraine headaches: a systematic review of diffusion tensor imaging studies. Brain Imaging Behav 2022; 16:2375-2401. [PMID: 35710680 PMCID: PMC9581876 DOI: 10.1007/s11682-022-00690-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/17/2022] [Indexed: 11/04/2022]
Abstract
The pathophysiology of migraine as a headache disorder is still undetermined. Diffusion tensor imaging (DTI) has significantly improved our knowledge about brain microstructure in this disease. Here, we aimed to systematically review DTI studies in migraine and survey the sources of heterogeneity by investigating diffusion parameter changes associated with clinical characteristics and migraine subtypes. Microstructural changes, as revealed by widespread alteration of diffusion metrics in white matter (WM) tracts, subcortical and cortical regions, were reported by several migraine DTI studies. Specifically, we reported changes in the corpus callosum, thalamic radiations, corona radiata, and brain stem. These alterations showed high variability across migraine cycle phases. Additionally, migraine associated with depressive/anxiety symptoms revealed significant changes in the corpus callosum, internal capsule, and superior longitudinal fasciculus. No significant WM microstructural differences were observed between migraine patients with and without aura. Overall, differences between chronic and episodic migraine showed inconsistency across studies. Migraine is associated with microstructural changes in widespread regions including thalamic radiations, corpus callosum, and brain stem. These alterations can highlight neuronal damage and neuronal plasticity mechanisms either following pain stimulations occurring in migraine cycle or as a compensatory response to pain in chronic migraine. Longitudinal studies applying advanced modalities may shed new light on the underlying microstructural changes in migraine subtypes.
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Abstract
PURPOSE OF REVIEW The underlying mechanisms of migraine are complex and heterogenous. Advances in neuroimaging techniques during the past few decades have contributed to our understanding of migraine pathophysiology. Brain function in migraine patients has been widely explored using functional MRI (fMRI). This review will highlight the major fMRI findings that characterize the different phases of migraine. RECENT FINDINGS The migraine attack starts with hypothalamic hyperexcitability and early reorganization of the common ascending pain and central trigeminovascular pathways. Moreover, the visual cortex becomes hyperexcitable during the aura phase. During the headache phase, further disruptions of the pontine, thalamic, sensorimotor and visual networks occur, although the hypothalamic activity and connectivity normalizes. The visual cortex remains hyperexcitable during the postdromal phase. Asymptomatic migraine patients can also experience functional alternations of pain and visual processing brain areas. At present, the heterogeneity of the asymptomatic phase and fMRI findings make it difficult to find common denominator. SUMMARY fMRI studies have captured functional brain changes associated with migraine phases, leading to an improvement of our understanding of migraine pathophysiology. Further MRI studies are needed to disclose whether the migraine attack is triggered by intrinsic brain dysfunction or external factors.
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Xu H, Seminowicz DA, Krimmel SR, Zhang M, Gao L, Wang Y. Altered Structural and Functional Connectivity of Salience Network in Patients with Classic Trigeminal Neuralgia. THE JOURNAL OF PAIN 2022; 23:1389-1399. [PMID: 35381362 DOI: 10.1016/j.jpain.2022.02.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/28/2022] [Accepted: 02/28/2022] [Indexed: 12/27/2022]
Abstract
Classic trigeminal neuralgia (CTN) is a neuropathic pain disorder displaying spontaneously stabbing or electric shock-like paroxysms in the face. Previous research suggests structural and functional abnormalities in brain regions related to sensory and cognitive-affective dimensions of pain contribute to the pathophysiology of CTN. However, few studies to date have investigated how changes in whole-brain functional networks and white matter connectivity are related to CTN. We performed an independent component analysis to examine abnormalities in resting state functional connectivity of large-scale networks in 48 patients with CTN compared to 46 matched healthy participants. Then, diffusion tensor tractography was performed to test whether these alterations of functional connectivity in intrinsic networks were associated with impairment of the white matter tracts connecting them. Distinct patterns of functional connectivity were detected within default mode network, somatosensory network, and salience network (SN) in the CTN group when compared with healthy controls. Furthermore, abnormality of SN was negatively correlated with pain severity. In support of aberrant functional connectivity within SN, structural disintegration was observed in the white matter tract from left anterior insula (aIns) to left anterior cingulate cortex (ACC) in CTN. These results suggest that altered structural and functional connectivity between aIns and ACC may underpin the aberrant SN in patients with CTN and provide an alternative target for clinical interventions. PERSPECTIVE: This article presents distinctive abnormalities of functional and structural connectivity from aIns to ACC in the patients with CTN, which is associated with pain ratings. This measure could potentially provide an alternative target for clinicians to alleviate this type of intermittent and refractory pain.
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Affiliation(s)
- Hui Xu
- Department of Medical Imaging, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - David A Seminowicz
- Department of Neural and Pain Sciences, School of Dentistry, University of Maryland Baltimore, Baltimore, Maryland; Center to Advance Chronic Pain Research, University of Maryland Baltimore, Baltimore, Maryland
| | - Samuel R Krimmel
- Department of Neurology, Washington University School of Medicine, St. Louis, Missouri
| | - Ming Zhang
- Department of Medical Imaging, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Lin Gao
- Department of Mechanical Engineering, Xian Jiaotong University, Xi'an, Shaanxi, China
| | - Yuan Wang
- Department of Medical Imaging, the First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shaanxi, China.
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Silvestro M, Tessitore A, Scotto di Clemente F, Battista G, Tedeschi G, Russo A. Refractory migraine profile in CGRP-monoclonal antibodies scenario. Acta Neurol Scand 2021; 144:325-333. [PMID: 34019304 PMCID: PMC8453754 DOI: 10.1111/ane.13472] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/25/2021] [Accepted: 05/04/2021] [Indexed: 12/23/2022]
Abstract
Objective Refractory migraine (Ref‐M) represents a conundrum that headache experts have to face with. We aim to investigate whether a peculiar profile may characterize patients with Ref‐M according to 2020 European Headache Federation criteria. Furthermore, to substantiate a dysfunctional dopaminergic pathway involvement in these patients, we explored the effectiveness of olanzapine. Materials & Methods Eighty‐four patients (fitting previous Ref‐M criteria of the 2014) were treated with erenumab for six months. Differences between clinical and demographic features of responder (Ref‐M according to 2014 criteria) and not‐responder (Ref‐M according to 2020 criteria) patients to CGRP‐mAbs were investigated and their predictive values assessed. In fifteen patients with Ref‐M not responders to CGRP‐mAbs, olanzapine was administered (5 mg/die) for 3 months and frequency and pain intensity of migraine attacks were estimated. Results Patients with Ref‐M not responsive to CGRP‐mAbs (29/84) when compared with Ref‐M responsive to CGRP‐mAbs showed higher baseline frequency of migraine attacks, medication overuse and pain catastrophizing scale (PCS) scores. Logistic regression analyses showed that frequency of attacks, medication overuse and PCS score represent independent negative predictors of CGRP‐mAbs response. A ≥50% reduction of headache days/month was observed after olanzapine treatment in 67% of patients with Ref‐M not responsive to CGRP‐mAbs. Conclusions We outline that higher frequency of migraine attacks, medication overuse and pain catastrophizing characterize patients with Ref‐M not responsive to CGRP‐mAbs. In this frame, olanzapine effectiveness on frequency and pain intensity of migraine attacks supports the hypothesis that migraine refractoriness may be subtended by a prominent involvement of the dopaminergic pathway.
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Affiliation(s)
- Marcello Silvestro
- Headache Centre Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences University of Campania “Luigi Vanvitelli” Napoli Italy
| | - Alessandro Tessitore
- Headache Centre Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences University of Campania “Luigi Vanvitelli” Napoli Italy
| | - Fabrizio Scotto di Clemente
- Headache Centre Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences University of Campania “Luigi Vanvitelli” Napoli Italy
| | - Giorgia Battista
- Headache Centre Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences University of Campania “Luigi Vanvitelli” Napoli Italy
| | - Gioacchino Tedeschi
- Headache Centre Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences University of Campania “Luigi Vanvitelli” Napoli Italy
| | - Antonio Russo
- Headache Centre Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences University of Campania “Luigi Vanvitelli” Napoli Italy
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Wei HL, Li J, Guo X, Zhou GP, Wang JJ, Chen YC, Yu YS, Yin X, Li J, Zhang H. Functional connectivity of the visual cortex differentiates anxiety comorbidity from episodic migraineurs without aura. J Headache Pain 2021; 22:40. [PMID: 34020591 PMCID: PMC8138918 DOI: 10.1186/s10194-021-01259-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 05/12/2021] [Indexed: 01/04/2023] Open
Abstract
Background Migraine is a common neurological disease that is often accompanied by psychiatric comorbidities. However, the relationship between abnormal brain function and psychiatric comorbidities in migraine patients remains largely unclear. Therefore, the present study sought to explore the correlations between the resting-state functional deficits and psychiatric comorbidities in migraine without aura (MwoA) patients. Methods Resting-state functional magnetic resonance images were obtained. In addition, the amplitude of low-frequency fluctuation (ALFF) and regional homogeneity (ReHo) values were obtained. Thereafter regional abnormalities in MwoA patients with and without anxiety (MwoA-A and MwoA-OA) were chosen as seeds to conduct functional connectivity (FC) analysis. Results Compared to the healthy controls (HCs), the MwoA-A and MwoA-OA patients had abnormal ALFF and ReHo values in the right lingual gyrus (LG). They also had abnormal FC of the right LG with the ipsilateral superior frontal gyrus (SFG) and middle cingulate cortex (MCC). Additionally, the MwoA-A patients showed higher ReHo values in the left posterior intraparietal sulcus (pIPS) and abnormal FC of the right LG with ipsilateral pIPS and primary visual cortex, compared to the MwoA-OA patients. Moreover, the MwoA-OA patients showed an increase in the FC with the right posterior cingulate cortex/precuneus (PCC/PCUN), left middle frontal gyrus (MFG) and left inferior temporal gyrus (ITG) relative to the HCs. Furthermore, the ALFF values of the right LG positively were correlated with anxiety scores in MwoA-A patients. The abnormal LG-related FCs with the PCC/PCUN, MFG and ITG were negatively associated with the frequency of headaches in MwoA-OA patients. Conclusions This study identified abnormal visual FC along with other core networks differentiating anxiety comorbidity from MwoA. This may therefore enhance the understanding of the neuropsychological basis of psychiatric comorbidities and provide novel insights that may help in the discovery of new marks or even treatment targets.
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Affiliation(s)
- Heng-Le Wei
- Department of Radiology, The Affiliated Jiangning Hospital with Nanjing Medical University, No.169, Hushan Road, 211100, Nanjing, Jiangsu, China
| | - Jian Li
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, No.169, Hushan Road, 211100, Nanjing, Jiangsu, China
| | - Xi Guo
- Department of Radiology, The Affiliated Jiangning Hospital with Nanjing Medical University, No.169, Hushan Road, 211100, Nanjing, Jiangsu, China
| | - Gang-Ping Zhou
- Department of Radiology, The Affiliated Jiangning Hospital with Nanjing Medical University, No.169, Hushan Road, 211100, Nanjing, Jiangsu, China
| | - Jin-Jin Wang
- Department of Radiology, The Affiliated Jiangning Hospital with Nanjing Medical University, No.169, Hushan Road, 211100, Nanjing, Jiangsu, China
| | - Yu-Chen Chen
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, 210006, Nanjing, Jiangsu Province, China
| | - Yu-Sheng Yu
- Department of Radiology, The Affiliated Jiangning Hospital with Nanjing Medical University, No.169, Hushan Road, 211100, Nanjing, Jiangsu, China
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, 210006, Nanjing, Jiangsu Province, China
| | - Junrong Li
- Department of Neurology, The Affiliated Jiangning Hospital with Nanjing Medical University, No.169, Hushan Road, 211100, Nanjing, Jiangsu, China.
| | - Hong Zhang
- Department of Radiology, The Affiliated Jiangning Hospital with Nanjing Medical University, No.169, Hushan Road, 211100, Nanjing, Jiangsu, China.
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21
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Liu L, Tian T, Li X, Wang Y, Xu T, Ni X, Li X, He Z, Gao S, Sun M, Liang F, Zhao L. Revealing the Neural Mechanism Underlying the Effects of Acupuncture on Migraine: A Systematic Review. Front Neurosci 2021; 15:674852. [PMID: 34093119 PMCID: PMC8172773 DOI: 10.3389/fnins.2021.674852] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 04/16/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Migraine is a chronic neurological disorder characterized by attacks of moderate or severe headache and various neurological symptoms. Migraine is typically treated by pharmacological or non-pharmacological therapies to relieve pain or prevent migraine attacks. Pharmacological therapies show limited efficacy in relieving headache and are often accompanied by adverse effects, while the benefits of acupuncture, a non-pharmacological therapy, have been well-documented in both the treatment and prevention of acute migraine attacks. However, the underlying mechanism of the effect of acupuncture on relieving migraine remains unclear. Recent advances in neuroimaging technology have offered new opportunities to explore the underlying neural mechanism of acupuncture in treating migraine. To pave the way for future research, this review provides an overview neuroimaging studies on the use of acupuncture for migraine in the last 10 years. Methods: Using search terms about acupuncture, neuroimaging and migraine, we searched PubMed, Embase, Cochrane Central Register of Controlled Trials, and China National Knowledge Infrastructure from January 2009 to June 2020 for neuroimaging studies that examined the effect of acupuncture in migraine. All published randomized and non-randomized controlled neuroimaging studies were included. We summarized the proposed neural mechanism underlying acupuncture analgesia in acute migraine, and the proposed neural mechanism underlying the sustained effect of acupuncture in migraine prophylaxis. Results: A total of 619 articles were retrieved. After removing reviews, meta-analyses, animal studies and etc., 15 articles were eligible and included in this review. The methods used were positron emission computed tomography (PET-CT; n = 2 studies), magnetic resonance spectroscopy (n = 1), and functional magnetic resonance imaging (fMRI; n = 12). The analyses used included the regional homogeneity (ReHo) method (n = 3), amplitude of low frequency (ALFF) method (n = 2), independent component analysis (ICA; n = 3), seed-based analysis (SBA; n = 1), both ICA and SBA (n = 1), Pearson's correlation to calculate functional connectivity (FC) between brain regions (n = 1), and a machine learning method (n = 1). Five studies focused on the instant effect of acupuncture, and the research objects were those with acute migraine (n = 2) and migraine in the interictal phase (n = 3). Ten studies focused on the lasting effect of acupuncture, and all the studies selected migraine patients in the interictal phase. This review included five task-based studies and 10 resting-state studies. None of the studies conducted a correlation analysis between functional brain changes and instant clinical efficacy. For studies that performed a correlation analysis between functional brain changes and sustained clinical efficacy, the prophylactic effect of acupuncture on migraine might be through regulation of the visual network, default mode network (DMN), sensory motor network, frontoparietal network (FPN), limbic system, and/or descending pain modulatory system (DPMS). Conclusion: The neural mechanism underlying the immediate effect of acupuncture analgesia remains unclear, and the neural mechanism of sustained acupuncture treatment for migraine might be related to the regulation of pain-related brain networks. The experimental design of neuroimaging studies that examined the effect of acupuncture in migraine also have some shortcomings, and it is necessary to standardize and optimize the experimental design. Multi-center neuroimaging studies are needed to provide a better insight into the neural mechanism underlying the effect of acupuncture on migraine. Multi-modality neuroimaging studies that integrate multiple data analysis methods are required for cross-validation of the neuroimaging results. In addition, applying machine learning methods in neuroimaging studies can help to predict acupuncture efficacy and screen for migraineurs for whom acupuncture treatment would be suitable.
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Affiliation(s)
- Lu Liu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Tian Tian
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiang Li
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yanan Wang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Tao Xu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xixiu Ni
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xiao Li
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhenxi He
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shan Gao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Mingsheng Sun
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fanrong Liang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Acupuncture & Chronobiology Key Laboratory of Sichuan Province, Chengdu, China
| | - Ling Zhao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu, China.,Acupuncture & Chronobiology Key Laboratory of Sichuan Province, Chengdu, China
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22
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Su M, Wang R, Dong Z, Zhao D, Yu S. Decline in attentional inhibition among migraine patients: an event-related potential study using the Stroop task. J Headache Pain 2021; 22:34. [PMID: 33941081 PMCID: PMC8091750 DOI: 10.1186/s10194-021-01242-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/08/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND As a disorder of brain dysfunction, migraine has been associated with cognitive decline. However, no consistent results with respect to the attention function in migraineurs have been found, and the relationship between attentional inhibition and migraine is also unclear. In this study, the attentional inhibition function was evaluated using event-related potentials (ERPs) while migraine patients and healthy controls were performing the color-word Stroop task. METHODS In this study, 75 migraine patients and 41 age-, gender-, and education-matched healthy controls were enrolled. The Stroop task was performed, and both behavioral and ERP data were analyzed. RESULTS As to the behavioral data, the migraine group had a longer reaction time compared to the control group, but no difference in Stroop effect was observed. With respect to ERP components, the amplitudes of both early and late medial frontal negativity (MFN) were decreased in the migraine group. Additionally, obvious differences in the early MFN and sustained potential (SP) amplitudes were found between patients with and without allodynia. CONCLUSIONS At the behavioral level, migraine patients exhibited decreased executive ability but no obvious decline in inhibition. By contrast, a decline in attentional inhibition during the migraine interictal phase was confirmed by the analysis of ERP components, mainly those associated with changes in the conflict-monitoring stage, independent of confounding factors such as age, education, medication and mood disorders. Migraine patients with allodynia exhibited some significant differences in early MFN and SP compared to those without, supporting the hypothesis that migraine chronification aggravates the decline in attentional inhibition.
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Affiliation(s)
- Min Su
- Department of Neurology, the First Medical Center, Chinese PLA General Hospital, 100853, Beijing, China
| | - Rongfei Wang
- Department of Neurology, the First Medical Center, Chinese PLA General Hospital, 100853, Beijing, China
| | - Zhao Dong
- Department of Neurology, the First Medical Center, Chinese PLA General Hospital, 100853, Beijing, China
| | - Dengfa Zhao
- Department of Neurology, the First Medical Center, Chinese PLA General Hospital, 100853, Beijing, China
| | - Shengyuan Yu
- Department of Neurology, the First Medical Center, Chinese PLA General Hospital, 100853, Beijing, China.
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23
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de Tommaso M, Vecchio E, Quitadamo SG, Coppola G, Di Renzo A, Parisi V, Silvestro M, Russo A, Tedeschi G. Pain-Related Brain Connectivity Changes in Migraine: A Narrative Review and Proof of Concept about Possible Novel Treatments Interference. Brain Sci 2021; 11:brainsci11020234. [PMID: 33668449 PMCID: PMC7917911 DOI: 10.3390/brainsci11020234] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/27/2021] [Accepted: 02/08/2021] [Indexed: 01/07/2023] Open
Abstract
A neuronal dysfunction based on the imbalance between excitatory and inhibitory cortical-subcortical neurotransmission seems at the basis of migraine. Intercritical neuronal abnormal excitability can culminate in the bioelectrical phenomenon of Cortical Spreading Depression (CSD) with secondary involvement of the vascular system and release of inflammatory mediators, modulating in turn neuronal activity. Neuronal dysfunction encompasses the altered connectivity between the brain areas implicated in the genesis, maintenance and chronic evolution of migraine. Advanced neuroimaging techniques allow to identify changes in functional connectivity (FC) between brain areas involved in pain processes. Through a narrative review, we re-searched case-control studies on FC in migraine, between 2015 and 2020, by inserting the words migraine, fMRI, EEG, MEG, connectivity, pain in Pubmed. Studies on FC have shown that cortical processes, in the neurolimbic pain network, are likely to be prevalent for triggering attacks, in response to predisposing factors, and that these lead to a demodulation of the subcortical areas, at the basis of migraine maintenance. The link between brain dysfunction and peripheral interactions through the inhibition of CGRP, the main mediator of sterile migraine inflammation needs to be further investigated. Preliminary evidence could suggest that peripheral nerves inference at somatic and trigeminal levels, appears to change brain FC.
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Affiliation(s)
- Marina de Tommaso
- Applied Neurophysiology and Pain Unit, Bari Aldo Moro University, 70121 Bari, Italy; (E.V.); (S.G.Q.)
- Correspondence: ; Tel.: +39-080-5596739
| | - Eleonora Vecchio
- Applied Neurophysiology and Pain Unit, Bari Aldo Moro University, 70121 Bari, Italy; (E.V.); (S.G.Q.)
| | - Silvia Giovanna Quitadamo
- Applied Neurophysiology and Pain Unit, Bari Aldo Moro University, 70121 Bari, Italy; (E.V.); (S.G.Q.)
| | - Gianluca Coppola
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, 00185 Rome, Italy;
| | | | - Vincenzo Parisi
- IRCCS—Fondazione Bietti, 00198 Rome, Italy; (A.D.R.); (V.P.)
| | - Marcello Silvestro
- Clinica Neurologica e Neurofisiopatologia Università della Campania ‘Luigi Vanvitelli’, 81100 Napoli, Italy; (M.S.); (A.R.); (G.T.)
| | - Antonio Russo
- Clinica Neurologica e Neurofisiopatologia Università della Campania ‘Luigi Vanvitelli’, 81100 Napoli, Italy; (M.S.); (A.R.); (G.T.)
| | - Gioacchino Tedeschi
- Clinica Neurologica e Neurofisiopatologia Università della Campania ‘Luigi Vanvitelli’, 81100 Napoli, Italy; (M.S.); (A.R.); (G.T.)
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24
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Suzuki K, Suzuki S, Haruyama Y, Okamura M, Shiina T, Fujita H, Kobashi G, Sairenchi T, Uchiyama K, Hirata K. Central sensitization in migraine is related to restless legs syndrome. J Neurol 2020; 268:1395-1401. [PMID: 33150529 DOI: 10.1007/s00415-020-10295-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/22/2020] [Accepted: 10/26/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We hypothesized that, in migraine patients, central sensitization (CS) could be associated with comorbid restless legs syndrome (RLS). METHODS We conducted a case-control study including 186 migraine patients and 186 age- and sex-matched healthy controls. Symptoms related to CS syndrome were assessed by the Central Sensitization Inventory (CSI). Individuals with CSI Part A (CSI-A) scores ≥ 40 were defined as having CS. For patients with migraine, the Brief Pain Inventory (BPI) and Patient Health Questionnaire (PHQ)-9 were administered. In the patient group, RLS and migraine were diagnosed through face-to-face interviews. RESULTS Among migraine patients, 26 (14.0%) suffered from chronic migraine. The mean disease duration was 23.7 ± 11.8 years. Migraine patients showed a higher rate of CS (21.0% vs. 8.6%) than healthy controls, with an adjusted odds ratio (AOR) of 3.039 (95% confidence interval (CI) 1.560-5.992; p = 0.001). Migraine patients in the CS group had higher rates of smoking, chronic migraine and RLS and higher BPI and PHQ-9 scores than migraine patients in the non-CS group. The use of acute and preventive treatment for migraine did not significantly differ between the CS and non-CS groups. Multivariable analysis identified the presence of RLS (AOR, 28.471; 95% CI 6.438-125.918; p < 0.001) and the BPI pain interference score (AOR, 1.398; 95% CI 1.061-1.843; p = 0.017) as the significant determinants of CS among migraine patients. CONCLUSION Migraine patients were 3 times more likely to have CS than healthy controls. Our study results showed an association between RLS and CS in migraine patients.
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Affiliation(s)
- Keisuke Suzuki
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Shimotsuga, Mibu, Tochigi, 321-0293, Japan.
| | - Shiho Suzuki
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Shimotsuga, Mibu, Tochigi, 321-0293, Japan
| | - Yasuo Haruyama
- Department of Public Health, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Madoka Okamura
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Shimotsuga, Mibu, Tochigi, 321-0293, Japan
| | - Tomohiko Shiina
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Shimotsuga, Mibu, Tochigi, 321-0293, Japan
| | - Hiroaki Fujita
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Shimotsuga, Mibu, Tochigi, 321-0293, Japan
| | - Gen Kobashi
- Department of Public Health, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Toshimi Sairenchi
- Department of Public Health, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Koji Uchiyama
- Laboratory of International Environmental Health, Center for International Cooperation, Dokkyo Medical University, Tochigi, Japan
| | - Koichi Hirata
- Department of Neurology, Dokkyo Medical University, 880 Kitakobayashi, Shimotsuga, Mibu, Tochigi, 321-0293, Japan
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