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Christensen RH, Ashina H, Al-Khazali HM, Zhang Y, Tolnai D, Poulsen AH, Cagol A, Hadjikhani N, Granziera C, Amin FM, Ashina M. Differences in Cortical Morphology in People With and Without Migraine: A Registry for Migraine (REFORM) MRI Study. Neurology 2024; 102:e209305. [PMID: 38630960 PMCID: PMC11175630 DOI: 10.1212/wnl.0000000000209305] [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: 10/06/2023] [Accepted: 01/31/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Structural imaging can offer insights into the cortical morphometry of migraine, which might reflect adaptations to recurring nociceptive messaging. This study compares cortical morphometry between a large sample of people with migraine and healthy controls, as well as across migraine subtypes. METHODS Adult participants with migraine and age-matched and sex-matched healthy controls attended a single MRI session with magnetization-prepared rapid acquisition gradient echo and fluid-attenuated inversion recovery sequences at 3T. Cortical surface area, thickness, and volume were compared between participants with migraine (including subgroups) and healthy controls across the whole cortex within FreeSurfer and reported according to the Desikan-Killiany atlas. The analysis used cluster-determining thresholds of p < 0.0001 and cluster-wise thresholds of p < 0.05, adjusted for age, sex, and total intracranial volume. RESULTS A total of 296 participants with migraine (mean age 41.6 years ± 12.4 SD, 261 women) and 155 healthy controls (mean age 41.1 years ± 11.7 SD, 133 women) were included. Among the participants with migraine, 180 (63.5%) had chronic migraine, 103 (34.8%) had migraine with aura, and 88 (29.7%) experienced a migraine headache during the scan. The total cohort of participants with migraine had reduced cortical surface area in the left insula, compared with controls (p < 0.0001). Furthermore, participants with chronic migraine (n = 180) exhibited reduced surface area in the left insula (p < 0.0001) and increased surface area in the right caudal anterior cingulate cortex (p < 0.0001), compared with controls. We found no differences specific to participants with aura or ongoing migraine headache. Post hoc tests revealed a positive correlation between monthly headache days and surface area within the identified anterior cingulate cluster (p = 0.014). DISCUSSION The identified cortical changes in migraine were limited to specific pain processing regions, including the insula and caudal anterior cingulate gyrus, and were most notable in participants with chronic migraine. These findings suggest persistent cortical changes associated with migraine. TRIAL REGISTRATION INFORMATION The REFORM study (clinicaltrials.gov identifier: NCT04674020).
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Affiliation(s)
- Rune H Christensen
- From the Department of Neurology (R.H.C., H.A., H.M.A.-K., A.H.P., F.M.A., M.A.), Danish Headache Center, Copenhagen University Hospital-Rigshospitalet; Department of Clinical Medicine (R.H.C., H.A., H.M.A.-K., F.M.A., M.A.), Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Harvard Medical School (R.H.C., H.A., H.M.A-K.), Boston, MA; Department of Anesthesia, Critical Care and Pain Medicine (R.H.C., H.A., H.M.A-K.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Brain and Spinal Cord Injury (H.A., F.M.A.), Copenhagen University Hospital-Rigshospitalet, Denmark; Department of Neurology (Y.Z.), The First Affiliated Hospital of Chongqing Medical University, China; Department of Radiology (D.T.), Rigshospitalet Glostrup, Denmark; Translational Imaging in Neurology (ThINk) Basel (A.C., C.G.), Department of Biomedical Engineering, University Hospital Basel, University of Basel; Neurologic Clinic and Policlinic (A.C., C.G.), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Switzerland; Gillberg Neuropsychiatry Centre (N.H.), Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden; Athinoula A. Martinos Center for Biomedical Imaging (N.H.), Massachusetts General Hospital, Boston; and Danish Knowledge Center on Headache Disorders (M.A.), Glostrup, Denmark
| | - Håkan Ashina
- From the Department of Neurology (R.H.C., H.A., H.M.A.-K., A.H.P., F.M.A., M.A.), Danish Headache Center, Copenhagen University Hospital-Rigshospitalet; Department of Clinical Medicine (R.H.C., H.A., H.M.A.-K., F.M.A., M.A.), Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Harvard Medical School (R.H.C., H.A., H.M.A-K.), Boston, MA; Department of Anesthesia, Critical Care and Pain Medicine (R.H.C., H.A., H.M.A-K.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Brain and Spinal Cord Injury (H.A., F.M.A.), Copenhagen University Hospital-Rigshospitalet, Denmark; Department of Neurology (Y.Z.), The First Affiliated Hospital of Chongqing Medical University, China; Department of Radiology (D.T.), Rigshospitalet Glostrup, Denmark; Translational Imaging in Neurology (ThINk) Basel (A.C., C.G.), Department of Biomedical Engineering, University Hospital Basel, University of Basel; Neurologic Clinic and Policlinic (A.C., C.G.), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Switzerland; Gillberg Neuropsychiatry Centre (N.H.), Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden; Athinoula A. Martinos Center for Biomedical Imaging (N.H.), Massachusetts General Hospital, Boston; and Danish Knowledge Center on Headache Disorders (M.A.), Glostrup, Denmark
| | - Haidar M Al-Khazali
- From the Department of Neurology (R.H.C., H.A., H.M.A.-K., A.H.P., F.M.A., M.A.), Danish Headache Center, Copenhagen University Hospital-Rigshospitalet; Department of Clinical Medicine (R.H.C., H.A., H.M.A.-K., F.M.A., M.A.), Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Harvard Medical School (R.H.C., H.A., H.M.A-K.), Boston, MA; Department of Anesthesia, Critical Care and Pain Medicine (R.H.C., H.A., H.M.A-K.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Brain and Spinal Cord Injury (H.A., F.M.A.), Copenhagen University Hospital-Rigshospitalet, Denmark; Department of Neurology (Y.Z.), The First Affiliated Hospital of Chongqing Medical University, China; Department of Radiology (D.T.), Rigshospitalet Glostrup, Denmark; Translational Imaging in Neurology (ThINk) Basel (A.C., C.G.), Department of Biomedical Engineering, University Hospital Basel, University of Basel; Neurologic Clinic and Policlinic (A.C., C.G.), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Switzerland; Gillberg Neuropsychiatry Centre (N.H.), Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden; Athinoula A. Martinos Center for Biomedical Imaging (N.H.), Massachusetts General Hospital, Boston; and Danish Knowledge Center on Headache Disorders (M.A.), Glostrup, Denmark
| | - Yixin Zhang
- From the Department of Neurology (R.H.C., H.A., H.M.A.-K., A.H.P., F.M.A., M.A.), Danish Headache Center, Copenhagen University Hospital-Rigshospitalet; Department of Clinical Medicine (R.H.C., H.A., H.M.A.-K., F.M.A., M.A.), Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Harvard Medical School (R.H.C., H.A., H.M.A-K.), Boston, MA; Department of Anesthesia, Critical Care and Pain Medicine (R.H.C., H.A., H.M.A-K.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Brain and Spinal Cord Injury (H.A., F.M.A.), Copenhagen University Hospital-Rigshospitalet, Denmark; Department of Neurology (Y.Z.), The First Affiliated Hospital of Chongqing Medical University, China; Department of Radiology (D.T.), Rigshospitalet Glostrup, Denmark; Translational Imaging in Neurology (ThINk) Basel (A.C., C.G.), Department of Biomedical Engineering, University Hospital Basel, University of Basel; Neurologic Clinic and Policlinic (A.C., C.G.), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Switzerland; Gillberg Neuropsychiatry Centre (N.H.), Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden; Athinoula A. Martinos Center for Biomedical Imaging (N.H.), Massachusetts General Hospital, Boston; and Danish Knowledge Center on Headache Disorders (M.A.), Glostrup, Denmark
| | - Daniel Tolnai
- From the Department of Neurology (R.H.C., H.A., H.M.A.-K., A.H.P., F.M.A., M.A.), Danish Headache Center, Copenhagen University Hospital-Rigshospitalet; Department of Clinical Medicine (R.H.C., H.A., H.M.A.-K., F.M.A., M.A.), Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Harvard Medical School (R.H.C., H.A., H.M.A-K.), Boston, MA; Department of Anesthesia, Critical Care and Pain Medicine (R.H.C., H.A., H.M.A-K.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Brain and Spinal Cord Injury (H.A., F.M.A.), Copenhagen University Hospital-Rigshospitalet, Denmark; Department of Neurology (Y.Z.), The First Affiliated Hospital of Chongqing Medical University, China; Department of Radiology (D.T.), Rigshospitalet Glostrup, Denmark; Translational Imaging in Neurology (ThINk) Basel (A.C., C.G.), Department of Biomedical Engineering, University Hospital Basel, University of Basel; Neurologic Clinic and Policlinic (A.C., C.G.), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Switzerland; Gillberg Neuropsychiatry Centre (N.H.), Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden; Athinoula A. Martinos Center for Biomedical Imaging (N.H.), Massachusetts General Hospital, Boston; and Danish Knowledge Center on Headache Disorders (M.A.), Glostrup, Denmark
| | - Amanda H Poulsen
- From the Department of Neurology (R.H.C., H.A., H.M.A.-K., A.H.P., F.M.A., M.A.), Danish Headache Center, Copenhagen University Hospital-Rigshospitalet; Department of Clinical Medicine (R.H.C., H.A., H.M.A.-K., F.M.A., M.A.), Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Harvard Medical School (R.H.C., H.A., H.M.A-K.), Boston, MA; Department of Anesthesia, Critical Care and Pain Medicine (R.H.C., H.A., H.M.A-K.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Brain and Spinal Cord Injury (H.A., F.M.A.), Copenhagen University Hospital-Rigshospitalet, Denmark; Department of Neurology (Y.Z.), The First Affiliated Hospital of Chongqing Medical University, China; Department of Radiology (D.T.), Rigshospitalet Glostrup, Denmark; Translational Imaging in Neurology (ThINk) Basel (A.C., C.G.), Department of Biomedical Engineering, University Hospital Basel, University of Basel; Neurologic Clinic and Policlinic (A.C., C.G.), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Switzerland; Gillberg Neuropsychiatry Centre (N.H.), Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden; Athinoula A. Martinos Center for Biomedical Imaging (N.H.), Massachusetts General Hospital, Boston; and Danish Knowledge Center on Headache Disorders (M.A.), Glostrup, Denmark
| | - Alessandro Cagol
- From the Department of Neurology (R.H.C., H.A., H.M.A.-K., A.H.P., F.M.A., M.A.), Danish Headache Center, Copenhagen University Hospital-Rigshospitalet; Department of Clinical Medicine (R.H.C., H.A., H.M.A.-K., F.M.A., M.A.), Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Harvard Medical School (R.H.C., H.A., H.M.A-K.), Boston, MA; Department of Anesthesia, Critical Care and Pain Medicine (R.H.C., H.A., H.M.A-K.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Brain and Spinal Cord Injury (H.A., F.M.A.), Copenhagen University Hospital-Rigshospitalet, Denmark; Department of Neurology (Y.Z.), The First Affiliated Hospital of Chongqing Medical University, China; Department of Radiology (D.T.), Rigshospitalet Glostrup, Denmark; Translational Imaging in Neurology (ThINk) Basel (A.C., C.G.), Department of Biomedical Engineering, University Hospital Basel, University of Basel; Neurologic Clinic and Policlinic (A.C., C.G.), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Switzerland; Gillberg Neuropsychiatry Centre (N.H.), Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden; Athinoula A. Martinos Center for Biomedical Imaging (N.H.), Massachusetts General Hospital, Boston; and Danish Knowledge Center on Headache Disorders (M.A.), Glostrup, Denmark
| | - Nouchine Hadjikhani
- From the Department of Neurology (R.H.C., H.A., H.M.A.-K., A.H.P., F.M.A., M.A.), Danish Headache Center, Copenhagen University Hospital-Rigshospitalet; Department of Clinical Medicine (R.H.C., H.A., H.M.A.-K., F.M.A., M.A.), Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Harvard Medical School (R.H.C., H.A., H.M.A-K.), Boston, MA; Department of Anesthesia, Critical Care and Pain Medicine (R.H.C., H.A., H.M.A-K.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Brain and Spinal Cord Injury (H.A., F.M.A.), Copenhagen University Hospital-Rigshospitalet, Denmark; Department of Neurology (Y.Z.), The First Affiliated Hospital of Chongqing Medical University, China; Department of Radiology (D.T.), Rigshospitalet Glostrup, Denmark; Translational Imaging in Neurology (ThINk) Basel (A.C., C.G.), Department of Biomedical Engineering, University Hospital Basel, University of Basel; Neurologic Clinic and Policlinic (A.C., C.G.), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Switzerland; Gillberg Neuropsychiatry Centre (N.H.), Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden; Athinoula A. Martinos Center for Biomedical Imaging (N.H.), Massachusetts General Hospital, Boston; and Danish Knowledge Center on Headache Disorders (M.A.), Glostrup, Denmark
| | - Cristina Granziera
- From the Department of Neurology (R.H.C., H.A., H.M.A.-K., A.H.P., F.M.A., M.A.), Danish Headache Center, Copenhagen University Hospital-Rigshospitalet; Department of Clinical Medicine (R.H.C., H.A., H.M.A.-K., F.M.A., M.A.), Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Harvard Medical School (R.H.C., H.A., H.M.A-K.), Boston, MA; Department of Anesthesia, Critical Care and Pain Medicine (R.H.C., H.A., H.M.A-K.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Brain and Spinal Cord Injury (H.A., F.M.A.), Copenhagen University Hospital-Rigshospitalet, Denmark; Department of Neurology (Y.Z.), The First Affiliated Hospital of Chongqing Medical University, China; Department of Radiology (D.T.), Rigshospitalet Glostrup, Denmark; Translational Imaging in Neurology (ThINk) Basel (A.C., C.G.), Department of Biomedical Engineering, University Hospital Basel, University of Basel; Neurologic Clinic and Policlinic (A.C., C.G.), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Switzerland; Gillberg Neuropsychiatry Centre (N.H.), Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden; Athinoula A. Martinos Center for Biomedical Imaging (N.H.), Massachusetts General Hospital, Boston; and Danish Knowledge Center on Headache Disorders (M.A.), Glostrup, Denmark
| | - Faisal Mohammad Amin
- From the Department of Neurology (R.H.C., H.A., H.M.A.-K., A.H.P., F.M.A., M.A.), Danish Headache Center, Copenhagen University Hospital-Rigshospitalet; Department of Clinical Medicine (R.H.C., H.A., H.M.A.-K., F.M.A., M.A.), Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Harvard Medical School (R.H.C., H.A., H.M.A-K.), Boston, MA; Department of Anesthesia, Critical Care and Pain Medicine (R.H.C., H.A., H.M.A-K.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Brain and Spinal Cord Injury (H.A., F.M.A.), Copenhagen University Hospital-Rigshospitalet, Denmark; Department of Neurology (Y.Z.), The First Affiliated Hospital of Chongqing Medical University, China; Department of Radiology (D.T.), Rigshospitalet Glostrup, Denmark; Translational Imaging in Neurology (ThINk) Basel (A.C., C.G.), Department of Biomedical Engineering, University Hospital Basel, University of Basel; Neurologic Clinic and Policlinic (A.C., C.G.), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Switzerland; Gillberg Neuropsychiatry Centre (N.H.), Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden; Athinoula A. Martinos Center for Biomedical Imaging (N.H.), Massachusetts General Hospital, Boston; and Danish Knowledge Center on Headache Disorders (M.A.), Glostrup, Denmark
| | - Messoud Ashina
- From the Department of Neurology (R.H.C., H.A., H.M.A.-K., A.H.P., F.M.A., M.A.), Danish Headache Center, Copenhagen University Hospital-Rigshospitalet; Department of Clinical Medicine (R.H.C., H.A., H.M.A.-K., F.M.A., M.A.), Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Harvard Medical School (R.H.C., H.A., H.M.A-K.), Boston, MA; Department of Anesthesia, Critical Care and Pain Medicine (R.H.C., H.A., H.M.A-K.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Brain and Spinal Cord Injury (H.A., F.M.A.), Copenhagen University Hospital-Rigshospitalet, Denmark; Department of Neurology (Y.Z.), The First Affiliated Hospital of Chongqing Medical University, China; Department of Radiology (D.T.), Rigshospitalet Glostrup, Denmark; Translational Imaging in Neurology (ThINk) Basel (A.C., C.G.), Department of Biomedical Engineering, University Hospital Basel, University of Basel; Neurologic Clinic and Policlinic (A.C., C.G.), MS Center and Research Center for Clinical Neuroimmunology and Neuroscience Basel (RC2NB), University Hospital Basel, University of Basel, Switzerland; Gillberg Neuropsychiatry Centre (N.H.), Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden; Athinoula A. Martinos Center for Biomedical Imaging (N.H.), Massachusetts General Hospital, Boston; and Danish Knowledge Center on Headache Disorders (M.A.), Glostrup, Denmark
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Fila M, Przyslo L, Derwich M, Pawlowska E, Blasiak J. Potential of focal cortical dysplasia in migraine pathogenesis. Cereb Cortex 2024; 34:bhae158. [PMID: 38615241 DOI: 10.1093/cercor/bhae158] [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: 02/14/2024] [Revised: 03/21/2024] [Accepted: 03/23/2024] [Indexed: 04/15/2024] Open
Abstract
Focal cortical dysplasias are abnormalities of the cerebral cortex associated with an elevated risk of neurological disturbances. Cortical spreading depolarization/depression is a correlate of migraine aura/headache and a trigger of migraine pain mechanisms. However, cortical spreading depolarization/depression is associated with cortical structural changes, which can be classified as transient focal cortical dysplasias. Migraine is reported to be associated with changes in various brain structures, including malformations and lesions in the cortex. Such malformations may be related to focal cortical dysplasias, which may play a role in migraine pathogenesis. Results obtained so far suggest that focal cortical dysplasias may belong to the causes and consequences of migraine. Certain focal cortical dysplasias may lower the threshold of cortical excitability and facilitate the action of migraine triggers. Migraine prevalence in epileptic patients is higher than in the general population, and focal cortical dysplasias are an established element of epilepsy pathogenesis. In this narrative/hypothesis review, we present mainly information on cortical structural changes in migraine, but studies on structural alterations in deep white matter and other brain regions are also presented. We develop the hypothesis that focal cortical dysplasias may be causally associated with migraine and link pathogeneses of migraine and epilepsy.
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Affiliation(s)
- Michal Fila
- Department of Developmental Neurology and Epileptology, Polish Mother's Memorial Hospital Research Institute, Rzgowska 281/289, 93-338 Lodz, Łódzkie, Poland
| | - Lukasz Przyslo
- Department of Developmental Neurology and Epileptology, Polish Mother's Memorial Hospital Research Institute, Rzgowska 281/289, 93-338 Lodz, Łódzkie, Poland
| | - Marcin Derwich
- Department of Developmental Dentistry, Medical University of Lodz, Pomorska 251, 90-647 Lodz, Łódzkie, Poland
| | - Ezbieta Pawlowska
- Department of Developmental Dentistry, Medical University of Lodz, Pomorska 251, 90-647 Lodz, Łódzkie, Poland
| | - Janusz Blasiak
- Faculty of Medicine, Collegium Medicum, Mazovian Academy in Plock, Plac Generała Dabrowskiego 2, 09-420 Plock, Mazowieckie, Poland
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Park S, Jung H, Han SW, Lee SH, Sohn JH. Differences in Neuropathology between Nitroglycerin-Induced Mouse Models of Episodic and Chronic Migraine. Int J Mol Sci 2024; 25:3706. [PMID: 38612517 PMCID: PMC11011425 DOI: 10.3390/ijms25073706] [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: 02/16/2024] [Revised: 03/17/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Multiple animal models of migraine have been used to develop new therapies. Understanding the transition from episodic (EM) to chronic migraine (CM) is crucial. We established models mimicking EM and CM pain and assessed neuropathological differences. EM and CM models were induced with single NTG or multiple injections over 9 days. Mechanical hypersensitivity was assessed. Immunofluorescence utilized c-Fos, NeuN, and Iba1. Proinflammatory and anti-inflammatory markers were analyzed. Neuropeptides (CGRP, VIP, PACAP, and substance P) were assessed. Mechanical thresholds were similar. Notable neuropathological distinctions were observed in Sp5C and ACC. ACC showed increased c-Fos and NeuN expression in CM (p < 0.001) and unchanged in EM. Sp5C had higher c-Fos and NeuN expression in EM (p < 0.001). Iba1 was upregulated in Sp5C of EM and ACC of CM (p < 0.001). Proinflammatory markers were strongly expressed in Sp5C of EM and ACC of CM. CGRP expression was elevated in both regions and was higher in CM. VIP exhibited higher levels in the Sp5C of EM and ACC of CM, whereas PACAP and substance P were expressed in the Sp5C in both models. Despite similar thresholds, distinctive neuropathological differences in Sp5C and ACC between EM and CM models suggest a role in the EM to CM transformation.
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Affiliation(s)
- Songyi Park
- Institute of New Frontier Research Team, College of Medicine, Hallym University, Chuncheon 24252, Republic of Korea; (S.P.); (H.J.); (S.-W.H.); (S.-H.L.)
| | - Harry Jung
- Institute of New Frontier Research Team, College of Medicine, Hallym University, Chuncheon 24252, Republic of Korea; (S.P.); (H.J.); (S.-W.H.); (S.-H.L.)
| | - Sang-Won Han
- Institute of New Frontier Research Team, College of Medicine, Hallym University, Chuncheon 24252, Republic of Korea; (S.P.); (H.J.); (S.-W.H.); (S.-H.L.)
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24252, Republic of Korea
| | - Sang-Hwa Lee
- Institute of New Frontier Research Team, College of Medicine, Hallym University, Chuncheon 24252, Republic of Korea; (S.P.); (H.J.); (S.-W.H.); (S.-H.L.)
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24252, Republic of Korea
| | - Jong-Hee Sohn
- Institute of New Frontier Research Team, College of Medicine, Hallym University, Chuncheon 24252, Republic of Korea; (S.P.); (H.J.); (S.-W.H.); (S.-H.L.)
- Department of Neurology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24252, Republic of Korea
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Bhatt RR, Haddad E, Zhu AH, Thompson PM, Gupta A, Mayer EA, Jahanshad N. Mapping Brain Structure Variability in Chronic Pain: The Role of Widespreadness and Pain Type and Its Mediating Relationship With Suicide Attempt. Biol Psychiatry 2024; 95:473-481. [PMID: 37543299 PMCID: PMC10838358 DOI: 10.1016/j.biopsych.2023.07.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 07/14/2023] [Accepted: 07/15/2023] [Indexed: 08/07/2023]
Abstract
BACKGROUND Chronic pain affects nearly 20% of the U.S. POPULATION It is a leading cause of disability globally and is associated with a heightened risk for suicide. The role of the central nervous system in the perception and maintenance of chronic pain has recently been accepted, but specific brain circuitries involved have yet to be mapped across pain types in a large-scale study. METHODS We used data from the UK Biobank (N = 21,968) to investigate brain structural alterations in individuals reporting chronic pain compared with pain-free control participants and their mediating effect on history of suicide attempt. RESULTS Chronic pain and, more notably, chronic multisite pain was associated with, on average, lower surface area throughout the cortex after adjusting for demographic, clinical, and neuropsychiatric confounds. Only participants with abdominal pain showed lower subcortical volumes, including the amygdala and brainstem, and lower cerebellum volumes. Participants with chronic headaches showed a widespread thicker cortex compared with control participants. Mediation analyses revealed that precuneus thickness mediated the relationship of chronic multisite pain and history of suicide attempt. Mediating effects were also identified specific to localized pain, with the strongest effect being amygdala volume in individuals with chronic abdominal pain. CONCLUSIONS Results support a widespread effect of chronic pain on brain structure and distinct brain structures underlying chronic musculoskeletal pain, visceral pain, and headaches. Mediation effects of regions in the extended ventromedial prefrontal cortex subsystem suggest that exacerbated negative internal states, negative self-referencing, and impairments in future planning may underlie suicidal behaviors in individuals with chronic pain.
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Affiliation(s)
- Ravi R Bhatt
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine at USC, University of Southern California, Los Angeles, California.
| | - Elizabeth Haddad
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine at USC, University of Southern California, Los Angeles, California
| | - Alyssa H Zhu
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine at USC, University of Southern California, Los Angeles, California
| | - Paul M Thompson
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine at USC, University of Southern California, Los Angeles, California
| | - Arpana Gupta
- Goodman-Luskin Microbiome Center, G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Emeran A Mayer
- Goodman-Luskin Microbiome Center, G. Oppenheimer Center for Neurobiology of Stress and Resilience, Vatche and Tamar Manoukian Division of Digestive Diseases, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California
| | - Neda Jahanshad
- Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine at USC, University of Southern California, Los Angeles, California.
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Ruiz-Tagle A, Figueiredo P, Pinto J, Vilela P, Martins IP, Gil-Gouveia R. Working memory during spontaneous migraine attacks: an fMRI study. Neurol Sci 2024; 45:1201-1208. [PMID: 37847419 PMCID: PMC10858146 DOI: 10.1007/s10072-023-07120-0] [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: 03/21/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVE To investigate the neural correlates of working memory during a spontaneous migraine attack compared to the interictal phase, using functional magnetic resonance imaging (fMRI). BACKGROUND Cognitive disturbances are commonly observed during migraine attacks, particularly in the headache phase. However, the neural basis of these changes remains unknown. METHODS In a fMRI within-subject test-retest design study, eleven women (32 years of age, average) with episodic migraine were evaluated twice, first during a spontaneous migraine attack, and again in a pain-free period. Each session consisted in a cognitive assessment and fMRI while performing a working memory task (N-back). RESULTS Cognitive test scores were lower during the ictal session than in the pain-free session. Regions typically associated with working memory were activated during the N-back task in both sessions. A voxel wise between session comparison showed significantly greater activation in the left frontal pole and orbitofrontal cortex during the attack relative to the interictal phase. CONCLUSION Migraine patients exhibited greater activation of the left frontal pole and orbitofrontal cortex while executing a verbal working memory task during a spontaneous migraine attack when compared to the interictal state. Given the association of these regions with pain processing and inhibitory control, these findings suggest that patients recruit inhibitory areas to accomplish the cognitive task during migraine attacks, a neural signature of their cognitive difficulties.
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Affiliation(s)
- Amparo Ruiz-Tagle
- Instituto Superior Técnico, Universidade de Lisboa, ISR-Lisboa/LARSyS and Department of Bioengineering, Lisbon, Portugal.
- Centro de Estudos Egas Moniz, Faculty of Medicine, Universidade de Lisboa, and Hospital de Santa Maria, CHULN, Lisbon, Portugal.
| | - Patrícia Figueiredo
- Instituto Superior Técnico, Universidade de Lisboa, ISR-Lisboa/LARSyS and Department of Bioengineering, Lisbon, Portugal
| | - Joana Pinto
- Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK
| | - Pedro Vilela
- Serviço de Neurradiologia, Hospital da Luz, Lisbon, Portugal
| | - Isabel Pavão Martins
- Centro de Estudos Egas Moniz, Faculty of Medicine, Universidade de Lisboa, and Hospital de Santa Maria, CHULN, Lisbon, Portugal
| | - Raquel Gil-Gouveia
- Headache Center, Serviço de Neurologia, Hospital da Luz, Lisbon, Portugal
- Center for Interdisciplinary Research in Health, Universidade Católica Portuguesa, Lisboa, Portugal
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6
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Shibata Y, Ishiyama S. Neurite Damage in Patients with Migraine. Neurol Int 2024; 16:299-311. [PMID: 38525701 PMCID: PMC10961799 DOI: 10.3390/neurolint16020021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 02/20/2024] [Accepted: 02/26/2024] [Indexed: 03/26/2024] Open
Abstract
We examined neurite orientation dispersion and density imaging in patients with migraine. We found that patients with medication overuse headache exhibited lower orientation dispersion than those without. Moreover, orientation dispersion in the body of the corpus callosum was statistically negatively correlated with migraine attack frequencies. These findings indicate that neurite dispersion is damaged in patients with chronic migraine. Our study results indicate the orientation preference of neurite damage in migraine.
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Affiliation(s)
- Yasushi Shibata
- Department of Neurosurgery, Headache Clinic, Mito Medical Center, University of Tsukuba, Mito Kyodo General Hospital, Mito 3100015, Japan
| | - Sumire Ishiyama
- Center for Medical Sciences, Ibaraki Prefectural University of Health Sciences, Ami 3000394, Japan
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Liu S, Hou X, Shi M, Shen Y, Li Z, Hu Z, Yang D. Cortical Sulcal Abnormalities Revealed by Sulcal Morphometry in Patients with Chronic and Episodic Migraine. J Pain Res 2024; 17:477-488. [PMID: 38318330 PMCID: PMC10843978 DOI: 10.2147/jpr.s447148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/21/2024] [Indexed: 02/07/2024] Open
Abstract
Purpose Previous studies have reported mixed results regarding the importance of cortical abnormalities in patients with migraines. However, cortical sulci, as a component of the cerebral cortex, have not been specifically investigated in migraine patients. Therefore, we aim to evaluate alterations in cortical sulcal morphology among patients with chronic migraine (CM), episodic migraine (EM), and healthy controls (HCs). Patients and Methods In this cross-sectional study, structural magnetic resonance images were acquired from 35 patients with CM, 35 with EM, and 35 HCs. Cortical sulci were identified and reconstructed using the BrainVisa 5.0.4 software. We focused on regions involved in pain processing in which abnormal cortical structure were identified in previous neuroimaging studies. Morphometric analysis was performed to calculate sulcal parameters including mean depth, cortical thickness, and opening width. Partial correlation analyses of clinical characteristics and sulcal parameters were performed for CM, EM and the combined migraine (CM + EM) groups. Results In comparison with HCs, both CM and EM groups showed increased opening width in bilateral insula. In comparison with HC and EM groups, CM patients showed increased cortical thickness in bilateral superior postcentral sulcus, bilateral median frontal sulcus and left superior parietal sulcus, as well as increased mean depth in the left anterior callosomarginal fissure and decreased mean depth in bilateral superior frontal sulcus and left median frontal sulcus. Migraine frequency and disease duration were both correlated with cortical thickness in bilateral superior postcentral sulcus. Conclusion Abnormal sulcal morphometry primarily affected areas associated with pain processing in patients with migraine, with CM exhibiting more extensive abnormalities in areas related to sensory and affective processing. These changes may contribute to understanding the pathology of EM and CM.
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Affiliation(s)
- Shanyu Liu
- Department of Neurology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China
| | - Xiaolin Hou
- Department of Neurosurgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, People’s Republic of China
| | - Min Shi
- Department of Neurology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China
| | - Yuling Shen
- Department of Neurology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China
| | - Zhaoying Li
- Department of Neurology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China
| | - Zhenzhu Hu
- Department of Neurology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China
- School of Clinical Medicine, Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China
| | - Dongdong Yang
- Department of Neurology, Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu, People’s Republic of China
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Yang YC, Wei XY, Zhang YY, Xu CY, Cheng JM, Gong ZG, Chen H, Huang YW, Yuan J, Xu HH, Wang H, Zhan SH, Tan WL. Modulation of temporal and occipital cortex by acupuncture in non-menstrual MWoA patients: a rest BOLD fMRI study. BMC Complement Med Ther 2024; 24:43. [PMID: 38245739 PMCID: PMC10799457 DOI: 10.1186/s12906-024-04349-w] [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: 05/22/2023] [Accepted: 01/12/2024] [Indexed: 01/22/2024] Open
Abstract
OBJECTIVE To investigate the changes in amplitude of low-frequency fluctuation (ALFF) and degree centrality (DC) values before and after acupuncture in young women with non-menstrual migraine without aura (MWoA) through rest blood-oxygen-level-dependent functional magnetic resonance imaging (BOLD fMRI). METHODS Patients with non-menstrual MWoA (Group 1, n = 50) and healthy controls (Group 2, n = 50) were recruited. fMRI was performed in Group 1 at 2 time points: before acupuncture (time point 1, TP1); and after the end of all acupuncture sessions (time point 2, TP2), and performed in Group 2 as a one-time scan. Patients in Group 1 were assessed with the Migraine Disability Assessment Questionnaire (MIDAS) and the Short-Form McGill Pain Questionnaire (SF-MPQ) at TP1 and TP2 after fMRI was performed. The ALFF and DC values were compared within Group 1 at two time points and between Group 1 and Group2. The correlation between ALFF and DC values with the statistical differences and the clinical scales scores were analyzed. RESULTS Brain activities increased in the left fusiform gyrus and right angular gyrus, left middle occipital gyrus, and bilateral prefrontal cortex and decreased in left inferior parietal lobule in Group 1, which had different ALFF values compared with Group 2 at TP1. The bilateral fusiform gyrus, bilateral inferior temporal gyrus and right middle temporal gyrus increased and right angular gyrus, right superior marginal gyrus, right inferior parietal lobule, right middle occipital gyrus, right superior frontal gyrus, right middle frontal gyrus, right anterior central gyrus, and right supplementary motor area decreased in activity in Group 1 had different DC values compared with Group 2 at TP1. ALFF and DC values of right inferior temporal gyrus, right fusiform gyrus and right middle temporal gyrus were decreased in Group1 at TP1 compared with TP2. ALFF values in the left middle occipital area were positively correlated with the pain degree at TP1 in Group1 (correlation coefficient r, r = 0.827, r = 0.343; P < 0.01, P = 0.015). The DC values of the right inferior temporal area were positively correlated with the pain degree at TP1 in Group 1 (r = 0.371; P = 0.008). CONCLUSION Spontaneous brain activity and network changes in young women with non-menstrual MwoA were altered by acupuncture. The right temporal area may be an important target for acupuncture modulated brain function in young women with non-menstrual MwoA.
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Affiliation(s)
- Yu-Chan Yang
- Department of Radiology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Xiang-Yu Wei
- Institute of Acupuncture and Anesthesia, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Ying-Ying Zhang
- Department of Radiology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Chun-Yang Xu
- Department of Radiology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Jian-Ming Cheng
- Department of Radiology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Zhi-Gang Gong
- Department of Radiology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Hui Chen
- Department of Radiology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Yan-Wen Huang
- Department of Radiology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Jie Yuan
- Department of Radiology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Hui-Hui Xu
- Department of Radiology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Hui Wang
- Department of Radiology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China
| | - Song-Hua Zhan
- Department of Radiology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
| | - Wen-Li Tan
- Department of Radiology, Shuguang Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203, China.
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Liu H, Zheng R, Zhang Y, Zhang B, Hou H, Cheng J, Han S. Two distinct neuroanatomical subtypes of migraine without aura revealed by heterogeneity through discriminative analysis. Brain Imaging Behav 2023; 17:715-724. [PMID: 37776418 DOI: 10.1007/s11682-023-00802-5] [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] [Accepted: 09/07/2023] [Indexed: 10/02/2023]
Abstract
The neurobiological heterogeneity in migraine is poorly studied, resulting in conflicting neuroimaging findings. This study used a newly proposed method based on gray matter volumes (GMVs) to investigate objective neuroanatomical subtypes of migraine. Structural MRI and clinical measures of 31 migraine patients without aura and 33 matched healthy controls (HCs) were explored. Firstly, we investigated whether migraine patients exhibited higher interindividual variability than HCs in terms of GMVs. Then, heterogeneity through discriminative analysis (HYDRA) was applied to categorize migraine patients into distinct subtypes by regional volumetric measures of GMVs. Voxel-wise volume and clinical characteristics among different subtypes were also explored. Migraine patients without aura exhibited higher interindividual GMVs variability. Two distinct and reproducible neuroanatomical subtypes of migraine were revealed. These two subtypes exhibited opposite neuroanatomical aberrances compared to HCs. Subtype 1 showed widespread decreased GMVs, while Subtype 2 showed increased GMVs in limited regions. The total intracranial volume was significantly positively correlated with cognitive function in Subtype 2. Subtype 1 showed significantly longer illness duration and less cognitive scores compared to Subtype 2. The present study shows that migraine patients without aura have high structural heterogeneity and uncovers two distinct and robust neuroanatomical subtypes, which provide a possible explanation for conflicting neuroimaging findings.
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Affiliation(s)
- Hao Liu
- Department of Magnetic Resonance Imaging, the First Affiliated Hospital of Zhengzhou University, 1 Jianshe Dong Rd, Zhengzhou, 450000, Henan, China
| | - Ruiping Zheng
- Department of Magnetic Resonance Imaging, the First Affiliated Hospital of Zhengzhou University, 1 Jianshe Dong Rd, Zhengzhou, 450000, Henan, China
| | - Yong Zhang
- Department of Magnetic Resonance Imaging, the First Affiliated Hospital of Zhengzhou University, 1 Jianshe Dong Rd, Zhengzhou, 450000, Henan, China
| | - Beibei Zhang
- Department of Magnetic Resonance Imaging, the First Affiliated Hospital of Zhengzhou University, 1 Jianshe Dong Rd, Zhengzhou, 450000, Henan, China
| | - Haiman Hou
- Department of Neurology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jingliang Cheng
- Department of Magnetic Resonance Imaging, the First Affiliated Hospital of Zhengzhou University, 1 Jianshe Dong Rd, Zhengzhou, 450000, Henan, China
| | - Shaoqiang Han
- Department of Magnetic Resonance Imaging, the First Affiliated Hospital of Zhengzhou University, 1 Jianshe Dong Rd, Zhengzhou, 450000, Henan, China.
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10
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Di Antonio S, Arendt-Nielsen L, Ponzano M, Bovis F, Torelli P, Finocchi C, Castaldo M. Trigeminocervical pain sensitivity during the migraine cycle depends on headache frequency. Neurol Sci 2023; 44:4021-4032. [PMID: 37308781 PMCID: PMC10260380 DOI: 10.1007/s10072-023-06858-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 05/13/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE This experimental study aimed to assess pain sensitivity in low-frequency episodic migraine (LFEM), high-frequency episodic migraine (HFEM), and chronic migraine (CM) patients across the different phases of the migraine cycle. METHOD In this observational, experimental study, clinical characteristics (diary and time from the last/next headache attack), and quantitative sensory testing (QST) (wind-up pain ratio (WUR) and pressure pain threshold (PPT) from the trigeminal area and PPT from the cervical spine) was performed. LFEM, HFEM, and CM were assessed in each of the 4 migraine phases (HFEM and LFEM: interictal, preictal, ictal, and postictal; CM: interictal and ictal) and compared vs. each other's (matched for the phase) and controls. RESULTS A total of 56 controls, 105 LFEM, 74 HFEM, and 32 CM were included. No differences in QST parameters were observed between LFEM, HFEM, and CM in any of the phases. During the interictal phase and when comparing with controls the following were found: 1) LFEM had lower trigeminal PPT (p = 0.001) and 2) lower cervical PPT (p = 0.001). No differences were observed between HFEM or CM and healthy controls. During the ictal phase and when comparing with controls the following were found: HFEM and CM had 1) lower trigeminal PPTs (HFEM p = 0.001; CM = p < 0.001), 2) lower cervical PPT s (HFEM p = 0.007; CM p < 0.001), and 3) higher trigeminal WUR (HFEM p = 0.001, CM p = 0.006). No differences were observed between LFEM and healthy controls. During the preictal phase and when comparing with controls the following were found: 1) LFEM had lower cervical PPT (p = 0.007), 2) HFEM had lower trigeminal (p = 0.013) and 3) HFEM had lower cervical (p = .006) PPTs. During the postictal phase and when comparing with controls the following were found: 1) LFEM had lower cervical PPT (p = 0.003), 2) HFEM had lower trigeminal PPT (p = 0.005), and 3) and HFEM had lower cervical (p = 0.007) PPTs. CONCLUSION This study suggested that HFEM patients have a sensory profile matching CM better than LFEM. When assessing pain sensitivity in migraine populations, the phase with respects to headache attacks is of utmost importance and can explain the inconsistency in pain sensitivity data reported in the literature.
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Affiliation(s)
- Stefano Di Antonio
- Department of Health Science and Technology, Center for Pain and Neuroplasticity (CNAP), SMI, School of Medicine, Aalborg University, Aalborg, Denmark
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal Child Health, Genoa, Italy
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology, Center for Pain and Neuroplasticity (CNAP), SMI, School of Medicine, Aalborg University, Aalborg, Denmark
- Department of Medical Gastroenterology, Mech-Sense, Aalborg University Hospital, Aalborg, Denmark
- Steno Diabetes Center North Denmark, Clinical Institute, Aalborg University Hospital, 9000, Aalborg, DK, Denmark
| | - Marta Ponzano
- Department of Health Sciences (DISSAL), Section of Biostatistics, University of Genoa, Genoa, Italy
| | - Francesca Bovis
- Department of Health Sciences (DISSAL), Section of Biostatistics, University of Genoa, Genoa, Italy
| | - Paola Torelli
- Headache Centre, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Matteo Castaldo
- Department of Health Science and Technology, Center for Pain and Neuroplasticity (CNAP), SMI, School of Medicine, Aalborg University, Aalborg, Denmark.
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Kotikalapudi R, Kincses B, Zunhammer M, Schlitt F, Asan L, Schmidt-Wilcke T, Kincses ZT, Bingel U, Spisak T. Brain morphology predicts individual sensitivity to pain: a multicenter machine learning approach. Pain 2023; 164:2516-2527. [PMID: 37318027 PMCID: PMC10578427 DOI: 10.1097/j.pain.0000000000002958] [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: 08/19/2022] [Revised: 02/18/2023] [Accepted: 03/23/2023] [Indexed: 06/16/2023]
Abstract
ABSTRACT Sensitivity to pain shows a remarkable interindividual variance that has been reported to both forecast and accompany various clinical pain conditions. Although pain thresholds have been reported to be associated to brain morphology, it is still unclear how well these findings replicate in independent data and whether they are powerful enough to provide reliable pain sensitivity predictions on the individual level. In this study, we constructed a predictive model of pain sensitivity (as measured with pain thresholds) using structural magnetic resonance imaging-based cortical thickness data from a multicentre data set (3 centres and 131 healthy participants). Cross-validated estimates revealed a statistically significant and clinically relevant predictive performance (Pearson r = 0.36, P < 0.0002, R2 = 0.13). The predictions were found to be specific to physical pain thresholds and not biased towards potential confounding effects (eg, anxiety, stress, depression, centre effects, and pain self-evaluation). Analysis of model coefficients suggests that the most robust cortical thickness predictors of pain sensitivity are the right rostral anterior cingulate gyrus, left parahippocampal gyrus, and left temporal pole. Cortical thickness in these regions was negatively correlated to pain sensitivity. Our results can be considered as a proof-of-concept for the capacity of brain morphology to predict pain sensitivity, paving the way towards future multimodal brain-based biomarkers of pain.
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Affiliation(s)
- Raviteja Kotikalapudi
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Medicine Essen, Essen, Germany
| | - Balint Kincses
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Medicine Essen, Essen, Germany
- Department of Neurology, Center for Translational Neuro- and Behavioural Sciences, University Medicine Essen, Essen, Germany
| | - Matthias Zunhammer
- Department of Neurology, Center for Translational Neuro- and Behavioural Sciences, University Medicine Essen, Essen, Germany
| | - Frederik Schlitt
- Department of Neurology, Center for Translational Neuro- and Behavioural Sciences, University Medicine Essen, Essen, Germany
| | - Livia Asan
- Department of Neurology, Center for Translational Neuro- and Behavioural Sciences, University Medicine Essen, Essen, Germany
| | - Tobias Schmidt-Wilcke
- Institute for Clinical Neuroscience and Medical Psychology, Heinrich Heine University, Düsseldorf, Germany
- Neurocenter, District Hospital Mainkofen, Deggendorf, Germany
| | - Zsigmond T. Kincses
- Departments of Neurology and
- Radiology, University of Szeged, Szeged, Hungary
| | - Ulrike Bingel
- Department of Neurology, Center for Translational Neuro- and Behavioural Sciences, University Medicine Essen, Essen, Germany
| | - Tamas Spisak
- Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Medicine Essen, Essen, Germany
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Szabo E, Ashina S, Melo-Carrillo A, Bolo NR, Borsook D, Burstein R. Peripherally acting anti-CGRP monoclonal antibodies alter cortical gray matter thickness in migraine patients: A prospective cohort study. Neuroimage Clin 2023; 40:103531. [PMID: 37866119 PMCID: PMC10623369 DOI: 10.1016/j.nicl.2023.103531] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/13/2023] [Accepted: 10/13/2023] [Indexed: 10/24/2023]
Abstract
Migraine is underpinned by central nervous system neuroplastic alterations thought to be caused by the repetitive peripheral afferent barrage the brain receives during the headache phase (cortical hyperexcitability). Calcitonin gene-related peptide monoclonal antibodies (anti-CGRP-mAbs) are highly effective migraine preventative treatments. Their ability to alter brain morphometry in treatment-responders vs. non-responders is not well understood. Our aim was to determine the effects of the anti-CGRP-mAb galcanezumab on cortical thickness after 3-month treatment of patients with high-frequency episodic or chronic migraine. High-resolution magnetic resonance imaging was performed pre- and post-treatment in 36 migraine patients. In this group, 19 patients were classified responders (≥50 % reduction in monthly migraine days) and 17 were considered non-responders (<50 % reduction in monthly migraine days). Following cross-sectional processing to analyze the baseline differences in cortical thickness, two-stage longitudinal processing and symmetrized percent change were conducted to investigate treatment-related brain changes. At baseline, no significant differences were found between the responders and non-responders. After 3-month treatment, decreased cortical thickness (compared to baseline) was observed in the responders in regions of the somatosensory cortex, anterior cingulate cortex, medial frontal cortex, superior frontal gyrus, and supramarginal gyrus. Non-responders demonstrated decreased cortical thickness in the left dorsomedial cortex and superior frontal gyrus. We interpret the cortical thinning seen in the responder group as suggesting that reduction in head pain could lead to changes in neural swelling and dendritic complexity and that such changes reflect the recovery process from maladaptive neural activity. This conclusion is further supported by our recent study showing that 3 months after treatment initiation, the incidence of premonitory symptoms and prodromes that are followed by headache decreases but not the incidence of the premonitory symptoms or prodromes themselves (that is, cortical thinning relates to reductions in the nociceptive signals in the responders). We speculate that a much longer recovery period is required to allow the brain to return to a more 'normal' functioning state whereby prodromes and premonitory symptoms no longer occur.
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Affiliation(s)
- Edina Szabo
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Department of Anaesthesiology, Harvard Medical School, Boston, MA 02215, USA
| | - Sait Ashina
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Department of Anaesthesiology, Harvard Medical School, Boston, MA 02215, USA; Comprehensive Headache Center, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA
| | - Agustin Melo-Carrillo
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Department of Anaesthesiology, Harvard Medical School, Boston, MA 02215, USA
| | - Nicolas R Bolo
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | - David Borsook
- Department of Anaesthesiology, Harvard Medical School, Boston, MA 02215, USA; Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02215, USA; Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02215, USA
| | - Rami Burstein
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA; Department of Anaesthesiology, Harvard Medical School, Boston, MA 02215, USA; Comprehensive Headache Center, Beth Israel Deaconess Medical Center, Boston, MA 02215, USA.
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Yoon H, Schwedt TJ, Chong CD, Olatunde O, Wu T. Harmonizing Healthy Cohorts to Support Multicenter Studies on Migraine Classification using Brain MRI Data. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.06.26.23291909. [PMID: 37425905 PMCID: PMC10327280 DOI: 10.1101/2023.06.26.23291909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Abstract
Multicenter and multi-scanner imaging studies might be needed to provide sample sizes large enough for developing accurate predictive models. However, multicenter studies, which likely include confounding factors due to subtle differences in research participant characteristics, MRI scanners, and imaging acquisition protocols, might not yield generalizable machine learning models, that is, models developed using one dataset may not be applicable to a different dataset. The generalizability of classification models is key for multi-scanner and multicenter studies, and for providing reproducible results. This study developed a data harmonization strategy to identify healthy controls with similar (homogenous) characteristics from multicenter studies to validate the generalization of machine-learning techniques for classifying individual migraine patients and healthy controls using brain MRI data. The Maximum Mean Discrepancy (MMD) was used to compare the two datasets represented in Geodesic Flow Kernel (GFK) space, capturing the data variabilities for identifying a "healthy core". A set of homogeneous healthy controls can assist in overcoming some of the unwanted heterogeneity and allow for the development of classification models that have high accuracy when applied to new datasets. Extensive experimental results show the utilization of a healthy core. One dataset consists of 120 individuals (66 with migraine and 54 healthy controls) and another dataset consists of 76 (34 with migraine and 42 healthy controls) individuals. A homogeneous dataset derived from a cohort of healthy controls improves the performance of classification models by about 25% accuracy improvements for both episodic and chronic migraineurs.
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Affiliation(s)
- Hyunsoo Yoon
- Yonsei University; Department of Industrial Engineering
| | - Todd J. Schwedt
- Mayo Clinic; Department of Neurology
- ASU-Mayo Center for Innovative Imaging
| | - Catherine D. Chong
- Mayo Clinic; Department of Neurology
- ASU-Mayo Center for Innovative Imaging
| | - Oyekanmi Olatunde
- Binghamton University; Department of Systems Science and Industrial Engineering
| | - Teresa Wu
- ASU-Mayo Center for Innovative Imaging
- Arizona State University; School of Computing and Augmented Intelligence
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14
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Marino S, Jassar H, Kim DJ, Lim M, Nascimento TD, Dinov ID, Koeppe RA, DaSilva AF. Classifying migraine using PET compressive big data analytics of brain's μ-opioid and D2/D3 dopamine neurotransmission. Front Pharmacol 2023; 14:1173596. [PMID: 37383727 PMCID: PMC10294712 DOI: 10.3389/fphar.2023.1173596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/26/2023] [Indexed: 06/30/2023] Open
Abstract
Introduction: Migraine is a common and debilitating pain disorder associated with dysfunction of the central nervous system. Advanced magnetic resonance imaging (MRI) studies have reported relevant pathophysiologic states in migraine. However, its molecular mechanistic processes are still poorly understood in vivo. This study examined migraine patients with a novel machine learning (ML) method based on their central μ-opioid and dopamine D2/D3 profiles, the most critical neurotransmitters in the brain for pain perception and its cognitive-motivational interface. Methods: We employed compressive Big Data Analytics (CBDA) to identify migraineurs and healthy controls (HC) in a large positron emission tomography (PET) dataset. 198 PET volumes were obtained from 38 migraineurs and 23 HC during rest and thermal pain challenge. 61 subjects were scanned with the selective μ-opioid receptor (μOR) radiotracer [11C]Carfentanil, and 22 with the selective dopamine D2/D3 receptor (DOR) radiotracer [11C]Raclopride. PET scans were recast into a 1D array of 510,340 voxels with spatial and intensity filtering of non-displaceable binding potential (BPND), representing the receptor availability level. We then performed data reduction and CBDA to power rank the predictive brain voxels. Results: CBDA classified migraineurs from HC with accuracy, sensitivity, and specificity above 90% for whole-brain and region-of-interest (ROI) analyses. The most predictive ROIs for μOR were the insula (anterior), thalamus (pulvinar, medial-dorsal, and ventral lateral/posterior nuclei), and the putamen. The latter, putamen (anterior), was also the most predictive for migraine regarding DOR D2/D3 BPND levels. Discussion: CBDA of endogenous μ-opioid and D2/D3 dopamine dysfunctions in the brain can accurately identify a migraine patient based on their receptor availability across key sensory, motor, and motivational processing regions. Our ML-based findings in the migraineur's brain neurotransmission partly explain the severe impact of migraine suffering and associated neuropsychiatric comorbidities.
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Affiliation(s)
- Simeone Marino
- Statistics Online Computational Resource, Department of Health Behavior and Biological Sciences, University of Michigan, Ann Arbor, MI, United States
- Department of Microbiology and Immunology, University of Michigan, Ann Arbor, MI, United States
| | - Hassan Jassar
- The Michigan Neuroscience Institute (MNI), University of Michigan, Ann Arbor, MI, United States
- Headache and Orofacial Pain Effort (H.O.P.E.) Laboratory, Department of Biologic and Materials Sciences and Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, MI, United States
| | - Dajung J. Kim
- The Michigan Neuroscience Institute (MNI), University of Michigan, Ann Arbor, MI, United States
- Headache and Orofacial Pain Effort (H.O.P.E.) Laboratory, Department of Biologic and Materials Sciences and Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, MI, United States
| | - Manyoel Lim
- The Michigan Neuroscience Institute (MNI), University of Michigan, Ann Arbor, MI, United States
- Headache and Orofacial Pain Effort (H.O.P.E.) Laboratory, Department of Biologic and Materials Sciences and Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, MI, United States
| | - Thiago D. Nascimento
- The Michigan Neuroscience Institute (MNI), University of Michigan, Ann Arbor, MI, United States
- Headache and Orofacial Pain Effort (H.O.P.E.) Laboratory, Department of Biologic and Materials Sciences and Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, MI, United States
| | - Ivo D. Dinov
- Statistics Online Computational Resource, Department of Health Behavior and Biological Sciences, University of Michigan, Ann Arbor, MI, United States
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor, MI, United States
- Michigan Institute for Data Science, University of Michigan, Ann Arbor, MI, United States
| | - Robert A. Koeppe
- Department of Radiology, Division of Nuclear Medicine, University of Michigan Medical School, Ann Arbor, MI, United States
| | - Alexandre F. DaSilva
- The Michigan Neuroscience Institute (MNI), University of Michigan, Ann Arbor, MI, United States
- Headache and Orofacial Pain Effort (H.O.P.E.) Laboratory, Department of Biologic and Materials Sciences and Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, MI, United States
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15
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Puledda F, Silva EM, Suwanlaong K, Goadsby PJ. Migraine: from pathophysiology to treatment. J Neurol 2023:10.1007/s00415-023-11706-1. [PMID: 37029836 DOI: 10.1007/s00415-023-11706-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 04/03/2023] [Indexed: 04/09/2023]
Abstract
Migraine is an extremely disabling, common neurological disorder characterized by a complex neurobiology, involving a series of central and peripheral nervous system areas and networks. A growing increase in the understanding of migraine pathophysiology in recent years has facilitated translation of that knowledge into novel treatments, which are currently becoming available to patients in many parts of the world and are substantially changing the clinical approach to the disease. In the first part of this review, we will provide an up to date overview of migraine pathophysiology by analyzing the anatomy and function of the main regions involved in the disease, focusing on how these give rise to the plethora of symptoms characterizing the attacks and overall disease. The second part of the paper will discuss the novel therapeutic agents that have emerged for the treatment of migraine, including molecules targeting calcitonin gene-related peptide (gepants and monoclonal antibodies), serotonin 5-HT1F receptor agonists (ditans) and non-invasive neuromodulation, as well as providing a brief overview of new evidence for classic migraine treatments.
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Affiliation(s)
- Francesca Puledda
- Headache Group, Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and National Institute for Health Research (NIHR) SLaM Clinical Research Facility at King's, Wellcome Foundation Building, King's College Hospital, London, SE5 9PJ, UK
| | | | - Kanokrat Suwanlaong
- Division of Neurology, Department of Medicine, Songkhla Medical Education Center, Songkhla, Thailand
| | - Peter J Goadsby
- Headache Group, Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience, King's College London, and National Institute for Health Research (NIHR) SLaM Clinical Research Facility at King's, Wellcome Foundation Building, King's College Hospital, London, SE5 9PJ, UK.
- Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA.
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16
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Ashina S, Melo-Carrillo A, Toluwanimi A, Bolo N, Szabo E, Borsook D, Burstein R. Galcanezumab effects on incidence of headache after occurrence of triggers, premonitory symptoms, and aura in responders, non-responders, super-responders, and super non-responders. J Headache Pain 2023; 24:26. [PMID: 36927366 PMCID: PMC10018924 DOI: 10.1186/s10194-023-01560-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 03/03/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND The goal of this observational, open-label, cohort study was to determine whether prophylactic migraine treatment with galcanezumab, a peripherally acting drug, alters the incidence of premonitory symptoms, and/or occurrence of headache after exposure to triggers or aura episodes in treatment-responders (≥ 50% reduction in monthly migraine days [MMD]), super-responders (≥ 70%), non-responders (< 50%) and super non-responders (< 30%). METHODS Participants were administered electronic daily headache diaries to document migraine days and associated symptoms one month before and during the three months of treatment. Questionnaires were used to identify conscious prodromal and trigger events that were followed by headache prior to vs. after 3 months of treatment. RESULTS After 3 months of galcanezumab treatment, (a) the incidence of premonitory symptoms that were followed by headache decreased by 48% in the 27 responders vs. 28% in the 19 non-responders, and by 50% in the 11 super-responders vs. 12% in the 8 super non-responders; (b) the incidence of visual and sensory aura that were followed by headache was reduced in responders, non-responders, and super-responders, but not in super non-responders; (c) the number of triggers followed by headache decreased by 38% in responders vs. 13% in non-responders, and by 31% in super-responders vs. 4% in super non-responders; and (d) some premonitory symptoms (e.g., cognitive impairment, irritability, fatigue) and triggers (e.g., stress, sleeping too little, bright light, aura) were followed by headache only in super non-responders. CONCLUSIONS Mechanistically, these findings suggest that even a mild decrease in migraine frequency is sufficient to partially reverse the excitability and responsivity of neurons involved in the generation of certain triggers and potentially premonitory symptoms of migraine. TRIAL REGISTRATION ClinicalTrials.gov: NCT04271202. Registration date: February 10, 2020.
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Affiliation(s)
- Sait Ashina
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Anesthesia, Harvard Medical School, Boston, MA, USA.,Comprehensive Headache Center, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Agustin Melo-Carrillo
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Anesthesia, Harvard Medical School, Boston, MA, USA
| | - Ajayi Toluwanimi
- Clinical Research Center, Beth Israel Deaconess Medical Boston, Boston, MA, USA
| | - Nicolas Bolo
- Departments of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Edina Szabo
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Anesthesia, Harvard Medical School, Boston, MA, USA
| | - David Borsook
- Departments of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Departments of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Rami Burstein
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA. .,Department of Anesthesia, Harvard Medical School, Boston, MA, USA. .,Center for Life Science, Room 649, 3 Blackfan Circle, Boston, MA, 02215, USA.
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17
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Haehner A, Gossrau G, Bock F, Hummel T, Iannilli E. Migraine Type-Dependent Patterns of Brain Activation After Facial and Intranasal Trigeminal Stimulation. Brain Topogr 2023; 36:52-71. [PMID: 36370239 PMCID: PMC9834371 DOI: 10.1007/s10548-022-00924-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/24/2022] [Indexed: 11/15/2022]
Abstract
In migraine, the trigeminal nerve is intimately involved in the pathophysiology of the disease. We hypothesized that alterations in the sensory trigeminal activation in migraine would be reflected by EEG-derived event-related potentials (ERP). We aimed to investigate differences in the temporal and spatial processing of trigeminal stimuli between interictal migraine patients and healthy subjects. ERP to trigeminal stimuli were recorded at 128-channels to allow localization of their cortical sources with high temporal resolution. Seventeen patients with episodic migraine without aura, 17 subjects with episodic migraine with aura, and 17 healthy subjects participated in the study. The first branch of the trigeminal nerve was stimulated using intranasal chemical (CO2), cutaneous electrical, and cutaneous mechanical (air puff) stimuli. Analyses were performed with regard to micro-state segmentation, ERP source localization, and correlation with the patients' clinical characteristics. Topographical assessments of EEG configurations were associated with the pathological condition. The source analysis revealed altered trigeminal-sensory response patterns in the precuneus, temporal pole, and cerebellum for both migraine groups during the interictal phase. The estimated current source density was positively correlated with migraine disease duration, indicating brain functional and structural changes as a consequence of the disease. Hyperactivity of the cerebellar posterior lobe was observed as a specific trigeminal response of migraine patients with aura. In conclusion, our results suggest the presence of brain changes accompanying the advancement of migraine as an expression of dysfunctional central pain processing. Hence, we identified EEG patterns in response to mechano-/chemosensory stimuli that can serve as biomarkers of migraine.
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Affiliation(s)
- Antje Haehner
- Smell & Taste Center, Deptartment of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - Gudrun Gossrau
- Headache Outpatient Clinic, University Pain Center, University Hospital, TU Dresden, Dresden, Germany
| | - Franziska Bock
- Smell & Taste Center, Deptartment of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - Thomas Hummel
- Smell & Taste Center, Deptartment of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - Emilia Iannilli
- Smell & Taste Center, Deptartment of Otorhinolaryngology, TU Dresden, Dresden, Germany. .,Deptartment of Biomed Sci, State Univ of New York at Albany, Albany, NY, USA. .,Deptartment of Psychology, K-F University of Graz, Graz, Austria.
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18
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Vincent M, Viktrup L, Nicholson RA, Ossipov MH, Vargas BB. The not so hidden impact of interictal burden in migraine: A narrative review. Front Neurol 2022; 13:1032103. [PMID: 36408525 PMCID: PMC9669578 DOI: 10.3389/fneur.2022.1032103] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/20/2022] [Indexed: 08/26/2023] Open
Abstract
Migraine is a highly prevalent neurological disease of varying attack frequency. Headache attacks that are accompanied by a combination of impact on daily activities, photophobia and/or nausea are most commonly migraine. The headache phase of a migraine attack has attracted more research, assessment tools and treatment goals than any other feature, characteristic, or phase of migraine. However, the migraine attack may encompass up to 4 phases: the prodrome, aura, headache phase and postdrome. There is growing recognition that the burden of migraine, including symptoms associated with the headache phase of the attack, may persist between migraine attacks, sometimes referred to as the "interictal phase." These include allodynia, hypersensitivity, photophobia, phonophobia, osmophobia, visual/vestibular disturbances and motion sickness. Subtle interictal clinical manifestations and a patient's trepidation to make plans or commitments due to the unpredictability of migraine attacks may contribute to poorer quality of life. However, there are only a few tools available to assess the interictal burden. Herein, we examine the recent advances in the recognition, description, and assessment of the interictal burden of migraine. We also highlight the value in patients feeling comfortable discussing the symptoms and overall burden of migraine when discussing migraine treatment needs with their provider.
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Affiliation(s)
| | - Lars Viktrup
- Eli Lilly and Company, Indianapolis, IN, United States
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19
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Chen Y, Liu Y, Song Y, Zhao S, Li B, Sun J, Liu L. Therapeutic applications and potential mechanisms of acupuncture in migraine: A literature review and perspectives. Front Neurosci 2022; 16:1022455. [PMID: 36340786 PMCID: PMC9630645 DOI: 10.3389/fnins.2022.1022455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022] Open
Abstract
Acupuncture is commonly used as a treatment for migraines. Animal studies have suggested that acupuncture can decrease neuropeptides, immune cells, and proinflammatory and excitatory neurotransmitters, which are associated with the pathogenesis of neuroinflammation. In addition, acupuncture participates in the development of peripheral and central sensitization through modulation of the release of neuronal-sensitization-related mediators (brain-derived neurotrophic factor, glutamate), endocannabinoid system, and serotonin system activation. Clinical studies have demonstrated that acupuncture may be a beneficial migraine treatment, particularly in decreasing pain intensity, duration, emotional comorbidity, and days of acute medication intake. However, specific clinical effectiveness has not been substantiated, and the mechanisms underlying its efficacy remain obscure. With the development of biomedical and neuroimaging techniques, the neural mechanism of acupuncture in migraine has gained increasing attention. Neuroimaging studies have indicated that acupuncture may alter the abnormal functional activity and connectivity of the descending pain modulatory system, default mode network, thalamus, frontal-parietal network, occipital-temporal network, and cerebellum. Acupuncture may reduce neuroinflammation, regulate peripheral and central sensitization, and normalize abnormal brain activity, thereby preventing pain signal transmission. To summarize the effects and neural mechanisms of acupuncture in migraine, we performed a systematic review of literature about migraine and acupuncture. We summarized the characteristics of current clinical studies, including the types of participants, study designs, and clinical outcomes. The published findings from basic neuroimaging studies support the hypothesis that acupuncture alters abnormal neuroplasticity and brain activity. The benefits of acupuncture require further investigation through basic and clinical studies.
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20
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Gollion C, Lerebours F, Nemmi F, Arribarat G, Bonneville F, Larrue V, Péran P. Insular functional connectivity in migraine with aura. J Headache Pain 2022; 23:106. [PMID: 35982396 PMCID: PMC9389744 DOI: 10.1186/s10194-022-01473-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/09/2022] [Indexed: 11/15/2022] Open
Abstract
Introduction Insula plays an integrating role in sensory, affective, emotional, cognitive and autonomic functions in migraine, especially in migraine with aura (MA). Insula is functionally divided into 3 subregions, the dorsoanterior, the ventroanterior and the posterior insula respectively related to cognition, emotion, and somatosensory functions. This study aimed at investigating functional connectivity of insula subregions in MA. Methods Twenty-one interictal patients with MA were compared to 18 healthy controls (HC) and 12 interictal patients with migraine without aura (MO) and were scanned with functional MRI during the resting state. Functional coupling of the insula was comprehensively tested with 12 seeds located in the right and left, dorsal, middle, ventral, anterior and posterior insula, by using a seed-to-voxel analysis. Results Seed-to-voxel analysis revealed, in MA, a strong functional coupling of the right and left antero-dorsal insula with clusters located in the upper cerebellum. The overlap of these cerebellar clusters corresponded to the vermis VI. These functional couplings were not correlated to duration of MA, frequency of MA attacks nor time since last MA attack, and were not found in MO. Discussion The anterior insula and superior cerebellum, including vermis VI, are components of the central Autonomic Nervous System (ANS) network. As these regions are involved in the control of cardiovascular parasympathetic tone, we hypothesize that this connectivity may reflect the cardiovascular features of MA. Conclusion The anterior dorsal insula is connected with vermis VI in MA patients in the resting state. This connectivity may reflect the cardiovascular features of MA. Trial registration NCT02708797.
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Affiliation(s)
- Cédric Gollion
- Department of Neurology, University Hospital of Toulouse, 31059 cedex 9, Toulouse, France. .,Toulouse NeuroImaging Center, ToNIC, University of Toulouse III, Inserm, Toulouse, France.
| | - Fleur Lerebours
- Department of Neurology, University Hospital of Toulouse, 31059 cedex 9, Toulouse, France
| | - Federico Nemmi
- Toulouse NeuroImaging Center, ToNIC, University of Toulouse III, Inserm, Toulouse, France
| | - Germain Arribarat
- Toulouse NeuroImaging Center, ToNIC, University of Toulouse III, Inserm, Toulouse, France
| | - Fabrice Bonneville
- Toulouse NeuroImaging Center, ToNIC, University of Toulouse III, Inserm, Toulouse, France.,Department of Neuroradiology, University Hospital of Toulouse, Toulouse, France
| | - Vincent Larrue
- Department of Neurology, University Hospital of Toulouse, 31059 cedex 9, Toulouse, France
| | - Patrice Péran
- Toulouse NeuroImaging Center, ToNIC, University of Toulouse III, Inserm, Toulouse, France
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21
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Krimmel SR, DeSouza DD, Keaser ML, Sanjanwala BM, Cowan RP, Lindquist MA, Haythornthwaite JA, Seminowicz DA. Three Dimensions of Association Link Migraine Symptoms and Functional Connectivity. J Neurosci 2022; 42:6156-6166. [PMID: 35768210 PMCID: PMC9351635 DOI: 10.1523/jneurosci.1796-21.2022] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 04/27/2022] [Accepted: 06/18/2022] [Indexed: 02/05/2023] Open
Abstract
Migraine is a heterogeneous disorder with variable symptoms and responsiveness to therapy. Because of previous analytic shortcomings, variance in migraine symptoms has been inconsistently related to brain function. In the current analysis, we used data from two sites (n = 143, male and female humans), and performed canonical correlation analysis, relating resting-state functional connectivity (RSFC) with a broad range of migraine symptoms, ranging from headache characteristics to sleep abnormalities. This identified three dimensions of covariance between symptoms and RSFC. The first dimension related to headache intensity, headache frequency, pain catastrophizing, affect, sleep disturbances, and somatic abnormalities, and was associated with frontoparietal and dorsal attention network connectivity, both of which are major cognitive networks. Additionally, RSFC scores from this dimension, both the baseline value and the change from baseline to postintervention, were associated with responsiveness to mind-body therapy. The second dimension was related to an inverse association between pain and anxiety, and to default mode network connectivity. The final dimension was related to pain catastrophizing, and salience, sensorimotor, and default mode network connectivity. In addition to performing canonical correlation analysis, we evaluated the current clustering of migraine patients into episodic and chronic subtypes, and found no evidence to support this clustering. However, when using RSFC scores from the three significant dimensions, we identified a novel clustering of migraine patients into four biotypes with unique functional connectivity patterns. These findings provide new insight into individual variability in migraine, and could serve as the foundation for novel therapies that take advantage of migraine heterogeneity.SIGNIFICANCE STATEMENT Using a large multisite dataset of migraine patients, we identified three dimensions of multivariate association between symptoms and functional connectivity. This analysis revealed neural networks that relate to all measured symptoms, but also to specific symptom ensembles, such as patient propensity to catastrophize painful events. Using these three dimensions, we found four biotypes of migraine informed by clinical and neural variation together. Such findings pave the way for precision medicine therapy for migraine.
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Affiliation(s)
- Samuel R Krimmel
- Department of Neural and Pain Sciences, School of Dentistry, and Center to Advance Chronic Pain Research, University of Maryland, Baltimore, Maryland 21201
- Program in Neuroscience, University of Maryland School of Medicine, Baltimore, Maryland 21201
| | - Danielle D DeSouza
- Department of Neurology and Neurological Sciences, Headache and Facial Pain Program, Stanford University, California 94305
| | - Michael L Keaser
- Department of Neural and Pain Sciences, School of Dentistry, and Center to Advance Chronic Pain Research, University of Maryland, Baltimore, Maryland 21201
| | - Bharati M Sanjanwala
- Department of Neurology and Neurological Sciences, Headache and Facial Pain Program, Stanford University, California 94305
| | - Robert P Cowan
- Department of Neurology and Neurological Sciences, Headache and Facial Pain Program, Stanford University, California 94305
| | - Martin A Lindquist
- Department Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205
| | - Jennifer A Haythornthwaite
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland 21224
| | - David A Seminowicz
- Department of Neural and Pain Sciences, School of Dentistry, and Center to Advance Chronic Pain Research, University of Maryland, Baltimore, Maryland 21201
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22
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Mahammedi A, Wang LL, Vagal AS. Imaging Appearance of Migraine and Tension Type Headache. Neurol Clin 2022; 40:491-505. [PMID: 35871781 DOI: 10.1016/j.ncl.2022.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Abdelkader Mahammedi
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street, Cincinnati, OH 45219, USA.
| | - Lily L Wang
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street, Cincinnati, OH 45219, USA
| | - Achala S Vagal
- Department of Radiology, University of Cincinnati Medical Center, 234 Goodman Street, Cincinnati, OH 45219, USA
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23
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Bassez I, Van de Steen F, Hackl S, Jahn P, Mayr A, Marinazzo D, Schulz E. Investigation on how dynamic effective connectivity patterns encode the fluctuating pain intensity in chronic migraine. NEUROBIOLOGY OF PAIN 2022; 12:100100. [PMID: 36051490 PMCID: PMC9424568 DOI: 10.1016/j.ynpai.2022.100100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 07/20/2022] [Accepted: 07/28/2022] [Indexed: 11/10/2022]
Abstract
Chronic migraine is characterised by persistent headaches for >15 days per month; the intensity of the pain is fluctuating over time. Here, we explored the dynamic interplay of connectivity patterns between regions known to be related to pain processing and their relation to the ongoing dynamic pain experience. We recorded EEG from 80 sessions (20 chronic migraine patients in 4 separate sessions of 25 min). The patients were asked to continuously rate the intensity of their endogenous headache. On different time-windows, a dynamic causal model (DCM) of cross spectral responses was inverted to estimate connectivity strengths. For each patient and session, the evolving dynamics of effective connectivity were related to pain intensities and to pain intensity changes by using a Bayesian linear model. Hierarchical Bayesian modelling was further used to examine which connectivity-pain relations are consistent across sessions and across patients. The results reflect the multi-facetted clinical picture of the disease. Across all sessions, each patient with chronic migraine exhibited a distinct pattern of pain intensity-related cortical connectivity. The diversity of the individual findings are accompanied by inconsistent relations between the connectivity parameters and pain intensity or pain intensity changes at group level. This suggests a rejection of the idea of a common neuronal core problem for chronic migraine.
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24
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Chu C, Zhong R, Cai M, Li N, Lin W. Elevated Blood S100B Levels in Patients With Migraine: A Systematic Review and Meta-Analysis. Front Neurol 2022; 13:914051. [PMID: 35911929 PMCID: PMC9329586 DOI: 10.3389/fneur.2022.914051] [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: 04/20/2022] [Accepted: 06/20/2022] [Indexed: 11/13/2022] Open
Abstract
Background: In recent years, a growing number of researches indicate that S100B may act in migraine, but the relationship between S100B and migraine remains controversial. Therefore, the current study aimed to perform a meta-analysis to quantitatively summarize S100B levels in migraine patients. Methods We used Stata 12.0 software to summarize eligible studies from PubMed, EMBASE, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), and Wanfang databases. We applied standardized mean differences (SMDs) with 95% confidence intervals (95%CIs) to appraise the association between S100B and migraine. Results The combined results of nine case-control studies indicated that compared with healthy controls, overall migraine patients had significantly increased S100B levels in peripheral blood (SMD = 0.688, 95%CI: 0.341–1.036, P < 0.001). The S100B levels in migraineurs during ictal periods (SMD =1.123, 95%CI: 0.409–1.836, P = 0.002) and interictal periods (SMD = 0.487, 95%CI: 0313–0.661, P < 0.001), aura (SMD = 0.999, 95%CI: 0.598–1.400, P < 0.001) and without aura (SMD = 0.534, 95%CI: 0.286–0.783, P < 0.001) were significantly higher than those in the controls. The subgroup analyses by age, country, migraine assessment, and assay method of S100B also illustrated a statistically obvious association between S100B levels and migraine, indicating that age may be the most important source of heterogeneity. Sensitivity analysis showed that no individual study has a significant influence on the overall association between S100B and migraine. Conclusion This meta-analysis demonstrates that the level of S100B in peripheral blood of patients with migraine was significantly increased. Migraine may be associated with pathological reactions involving S100B, which is instrumental for the clinical diagnosis of migraine and therapy that considers S100B as a potential target.
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Liu H, Hou H, Li F, Zheng R, Zhang Y, Cheng J, Han S. Structural and Functional Brain Changes in Patients With Classic Trigeminal Neuralgia: A Combination of Voxel-Based Morphometry and Resting-State Functional MRI Study. Front Neurosci 2022; 16:930765. [PMID: 35844235 PMCID: PMC9277055 DOI: 10.3389/fnins.2022.930765] [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: 04/28/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
Objectives Brain structural and functional abnormalities have been separately reported in patients with classic trigeminal neuralgia (CTN). However, whether and how the functional deficits are related to the structural alterations remains unclear. This study aims to investigate the anatomical and functional deficits in patients with CTN and explore their association. Methods A total of 34 patients with CTN and 29 healthy controls (HCs) with age- and gender-matched were recruited. All subjects underwent structural and resting-state functional magnetic resonance imaging (fMRI) scanning and neuropsychological assessments. Voxel-based morphometry (VBM) was applied to characterize the alterations of gray matter volume (GMV). The amplitude of low-frequency fluctuation (ALFF) method was used to evaluate regional intrinsic spontaneous neural activity. Further correlation analyses were performed between the structural and functional changes and neuropsychological assessments. Results Compared to the HCs, significantly reduced GMV was revealed in the right hippocampus, right fusiform gyrus (FFG), and temporal-parietal regions (the left superior/middle temporal gyrus, left operculo-insular gyrus, left inferior parietal lobule, and right inferior temporal gyrus) in patients with CTN. Increased functional activity measured by zALFF was observed mainly in the limbic system (the bilateral hippocampus and bilateral parahippocampal gyrus), bilateral FFG, basal ganglia system (the bilateral putamen, bilateral caudate, and right pallidum), left thalamus, left cerebellum, midbrain, and pons. Moreover, the right hippocampus and FFG were the overlapped regions with both functional and anatomical deficits. Furthermore, GMV in the right hippocampus was negatively correlated with pain intensity, anxiety, and depression. GMV in the right FFG was negatively correlated with illness duration. The zALFF value in the right FFG was positively correlated with anxiety. Conclusion Our results revealed concurrent structural and functional changes in patients with CTN, indicating that the CTN is a brain disorder with structural and functional abnormalities. Moreover, the overlapping structural and functional changes in the right hippocampus and FFG suggested that anatomical and functional changes might alter dependently in patients with CTN. These findings highlight the vital role of hippocampus and FFG in the pathophysiology of CTN.
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Affiliation(s)
- Hao Liu
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China
- Key Laboratory of Imaging Intelligence Research medicine of Henan Province, Zhengzhou, China
- Henan Engineering Research Center of Brain Function Development and Application, Zhengzhou, China
| | - Haiman Hou
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fangfang Li
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Ruiping Zheng
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China
- Key Laboratory of Imaging Intelligence Research medicine of Henan Province, Zhengzhou, China
- Henan Engineering Research Center of Brain Function Development and Application, Zhengzhou, China
| | - Yong Zhang
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China
- Key Laboratory of Imaging Intelligence Research medicine of Henan Province, Zhengzhou, China
- Henan Engineering Research Center of Brain Function Development and Application, Zhengzhou, China
- *Correspondence: Yong Zhang,
| | - Jingliang Cheng
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China
- Key Laboratory of Imaging Intelligence Research medicine of Henan Province, Zhengzhou, China
- Henan Engineering Research Center of Brain Function Development and Application, Zhengzhou, China
- Jingliang Cheng,
| | - Shaoqiang Han
- Department of Magnetic Resonance Imaging, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Key Laboratory for Functional Magnetic Resonance Imaging and Molecular Imaging of Henan Province, Zhengzhou, China
- Engineering Technology Research Center for Detection and Application of Brain Function of Henan Province, Zhengzhou, China
- Engineering Research Center of Medical Imaging Intelligent Diagnosis and Treatment of Henan Province, Zhengzhou, China
- Key Laboratory of Magnetic Resonance and Brain Function of Henan Province, Zhengzhou, China
- Key Laboratory of Brain Function and Cognitive Magnetic Resonance Imaging of Zhengzhou, Zhengzhou, China
- Key Laboratory of Imaging Intelligence Research medicine of Henan Province, Zhengzhou, China
- Henan Engineering Research Center of Brain Function Development and Application, Zhengzhou, China
- Shaoqiang Han,
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Evaluating Plasma and Brain TRPV1 Channels in the Animal Model of Episodic and Chronic Migraine: The Possible Role of Somatosensory Cortex TRPV1 in Migraine Transformation. ARCHIVES OF NEUROSCIENCE 2022. [DOI: 10.5812/ans.115709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Despite extensive research, the exact molecular mechanisms underlying migraine development and especially its progression and transformation from episodic into chronic is still unknown. Objectives: This study aimed to assess the role of somatosensory cortex and hippocampal transient receptor potential vanilloid 1 (TRPV1) in migraine in a rat model. Methods: This study was an intervention study. Adult male Wistar rats were divided into three groups, including sham, episodic migraine (EM), and chronic migraine (CM). The sham group received normal intraperitoneal (IP) saline injections every two days for 11 days, and the EM group received a single dose of trinitroglycerin (TNG) injection (IP; 10 mg/kg). For the CM group, TNG was administrated every two days (on days 3, 5, 7, 9, and 11; IP; 10 mg/kg). TRPV1 levels in plasma, somatosensory cortex, and hippocampus were detected with an enzyme-linked immunosorbent assay (ELISA) kit. Results: The findings showed that in both CM and EM groups the TRPV1 levels in plasma (P < 0.001 in both groups), somatosensory cortex (P < 0.05 and P < 0.001, respectively), and hippocampus (P < 0.01 in both groups) increased after migraine induction. Interestingly, in the somatosensory cortex, this TRPV1 elevation in the CM group was much greater than the EM group, and a significant difference was observed between the two groups (P < 0.05). Conclusions: Our results suggested that headache severity and frequency may enhance concomitant with the upregulation of somatosensory cortex TRPV1. This new achievement can help to develop new drug approaches to prevent CM.
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Inter-individual differences in pain anticipation and pain perception in migraine: Neural correlates of migraine frequency and cortisol-to-dehydroepiandrosterone sulfate (DHEA-S) ratio. PLoS One 2021; 16:e0261570. [PMID: 34929017 PMCID: PMC8687546 DOI: 10.1371/journal.pone.0261570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 12/05/2021] [Indexed: 01/03/2023] Open
Abstract
Previous studies targeting inter-individual differences in pain processing in migraine mainly focused on the perception of pain. Our main aim was to disentangle pain anticipation and perception using a classical fear conditioning task, and investigate how migraine frequency and pre-scan cortisol-to-dehydroepiandrosterone sulfate (DHEA-S) ratio as an index of neurobiological stress response would relate to neural activation in these two phases. Functional Magnetic Resonance Imaging (fMRI) data of 23 participants (18 females; mean age: 27.61± 5.36) with episodic migraine without aura were analysed. We found that migraine frequency was significantly associated with pain anticipation in brain regions comprising the midcingulate and caudate, whereas pre-scan cortisol-to DHEA-S ratio was related to pain perception in the pre-supplementary motor area (pre-SMA). Both results suggest exaggerated preparatory responses to pain or more general to stressors, which may contribute to the allostatic load caused by stressors and migraine attacks on the brain.
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Dai W, Liu RH, Qiu E, Liu Y, Chen Z, Chen X, Ao R, Zhuo M, Yu S. Cortical mechanisms in migraine. Mol Pain 2021; 17:17448069211050246. [PMID: 34806494 PMCID: PMC8606910 DOI: 10.1177/17448069211050246] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Migraine is the second most prevalent disorder in the world; yet, its underlying mechanisms are still poorly understood. Cumulative studies have revealed pivotal roles of cerebral cortex in the initiation, propagation, and termination of migraine attacks as well as the interictal phase. Investigation of basic mechanisms of the cortex in migraine not only brings insight into the underlying pathophysiology but also provides the basis for designing novel treatments. We aim to summarize the current research literatures and give a brief overview of the cortex and its role in migraine, including the basic structure and function; structural, functional, and biochemical neuroimaging; migraine-related genes; and theories related to cortex in migraine pathophysiology. We propose that long-term plasticity of synaptic transmission in the cortex encodes migraine.
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Affiliation(s)
- Wei Dai
- Department of Neurology, Chinese PLA General Hospital, Beijing, China.,Chinese PLA Medical School, Beijing, China
| | - Ren-Hao Liu
- Center for Neuron and Disease, Frontier Institutes of Science and Technology, 12480Xi'an Jiaotong University, Xi'an, China
| | - Enchao Qiu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Yinglu Liu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Zhiye Chen
- Department of Neurology, Chinese PLA General Hospital, Beijing, China.,Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Xiaoyan Chen
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Ran Ao
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Min Zhuo
- Center for Neuron and Disease, Frontier Institutes of Science and Technology, 12480Xi'an Jiaotong University, Xi'an, China.,International Institute for Brain Research, Qingdao International Academician Park, Qingdao, China.,Department of Physiology, 1 King's College Circle, University of Toronto, Toronto, ON, Canada
| | - Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
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Quantifying changes over 1 year in motor and cognitive skill after transient ischemic attack (TIA) using robotics. Sci Rep 2021; 11:17011. [PMID: 34426586 PMCID: PMC8382836 DOI: 10.1038/s41598-021-96177-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/29/2021] [Indexed: 12/01/2022] Open
Abstract
Recent work has highlighted that people who have had TIA may have abnormal motor and cognitive function. We aimed to quantify deficits in a cohort of individuals who had TIA and measured changes in their abilities to perform behavioural tasks over 1 year of follow-up using the Kinarm Exoskeleton robot. We additionally considered performance and change over time in an active control cohort of migraineurs. Individuals who had TIA or migraine completed 8 behavioural tasks that assessed cognition as well as motor and sensory functionality in the arm. Participants in the TIA cohort were assessed at 2, 6, 12, and 52 weeks after symptom resolution. Migraineurs were assessed at 2 and 52 weeks after symptom resolution. We measured overall performance on each task using an aggregate metric called Task Score and quantified any significant change in performance including the potential influence of learning. We recruited 48 individuals to the TIA cohort and 28 individuals to the migraine cohort. Individuals in both groups displayed impairments on robotic tasks within 2 weeks of symptom cessation and also at approximately 1 year after symptom cessation, most commonly in tests of cognitive-motor integration. Up to 51.3% of people in the TIA cohort demonstrated an impairment on a given task within 2-weeks of symptom resolution, and up to 27.3% had an impairment after 1 year. In the migraine group, these numbers were 37.5% and 31.6%, respectively. We identified that up to 18% of participants in the TIA group, and up to 10% in the migraine group, displayed impairments that persisted for up to 1 year after symptom resolution. Finally, we determined that a subset of both cohorts (25-30%) experienced statistically significant deteriorations in performance after 1 year. People who have experienced transient neurological symptoms, such as those that arise from TIA or migraine, may continue to experience lasting neurological impairments. Most individuals had relatively stable task performance over time, with some impairments persisting for up to 1 year. However, some individuals demonstrated substantial changes in performance, which highlights the heterogeneity of these neurological disorders. These findings demonstrate the need to consider factors that contribute to lasting neurological impairment, approaches that could be developed to alleviate the lasting effects of TIA or migraine, and the need to consider individual neurological status, even following transient neurological symptoms.
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Amin FM, De Icco R, Al-Karagholi MAM, Raghava JM, Wolfram F, Larsson HBW, Ashina M. Investigation of cortical thickness and volume during spontaneous attacks of migraine without aura: a 3-Tesla MRI study. J Headache Pain 2021; 22:98. [PMID: 34418951 PMCID: PMC8380396 DOI: 10.1186/s10194-021-01312-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 08/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Structural imaging has revealed changes in cortical thickness in migraine patients compared to healthy controls is reported, but presence of dynamic cortical and subcortical changes during migraine attack versus inter-ictal phase is unknown. The aim of the present study was to investigate possible changes in cortical thickness during spontaneous migraine attacks. We hypothesized that pain-related cortical area would be affected during the attack compared to an inter-ictal phase. METHODS Twenty-five patients with migraine without aura underwent three-dimensional T1-weighted imaging on a 3-Tesla MRI scanner during spontaneous and untreated migraine attacks. Subsequently, 20 patients were scanned in the inter-ictal phase, while 5 patients did not show up for the inter-ictal scan. Four patients were excluded from the analysis because of bilateral migraine pain and another one patient was excluded due to technical error in the imaging. Longitudinal image processing was done using FreeSurfer. Repeated measures ANOVA was used for statistical analysis and to control for multiple comparison the level of significance was set at p = 0.025. RESULTS In a total of 15 patients, we found reduced cortical thickness of the precentral (p = 0.023), pericalcarine (p = 0.024), and temporal pole (p = 0.017) cortices during the attack compared to the inter-ictal phase. Cortical volume was reduced in prefrontal (p = 0.018) and pericalcarine (p = 0.017) cortices. Hippocampus volume was increased during attack (p = 0.007). We found no correlations between the pain side or any other clinical parameters and the reduced cortical size. CONCLUSION Spontaneous migraine attacks are accompanied by transient reduced cortical thickness and volume in pain-related areas. The findings constitute a fingerprint of acute pain in migraine patients, which can be used as a possible biomarker to predict antimigraine treatment effect in future studies. TRIAL REGISTRATION The study was registered at ClinicalTrials.gov ( NCT02202486 ).
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Affiliation(s)
- Faisal Mohammad Amin
- Danish Headache Center, Department of Neurology, Faculty of Health and Medical Sciences, Rigshospitalet Glostrup, University of Copenhagen, Valdemar Hansens Vej 5, 2600, Glostrup, Denmark.
| | - Roberto De Icco
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Mohammad Al-Mahdi Al-Karagholi
- Danish Headache Center, Department of Neurology, Faculty of Health and Medical Sciences, Rigshospitalet Glostrup, University of Copenhagen, Valdemar Hansens Vej 5, 2600, Glostrup, Denmark
| | - Jayachandra M Raghava
- Functional Imaging Unit, Department of Clinical Physiology, Nuclear Medicine and PET,Faculty of Health and Medical Sciences, Rigshospitalet, University of Copenhagen, Glostrup, Denmark.,Centre for Neuropsychiatric Schizophrenia Research, CNSR and Centre for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS, Mental Health Centre Glostrup, University of Copenhagen, 2600, Glostrup, Denmark
| | - Frauke Wolfram
- Department of Radiology, Herlev-Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Henrik B W Larsson
- Functional Imaging Unit, Department of Clinical Physiology, Nuclear Medicine and PET,Faculty of Health and Medical Sciences, Rigshospitalet, University of Copenhagen, Glostrup, Denmark
| | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Faculty of Health and Medical Sciences, Rigshospitalet Glostrup, University of Copenhagen, Valdemar Hansens Vej 5, 2600, Glostrup, Denmark
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Kim SK, Nikolova S, Schwedt TJ. Structural aberrations of the brain associated with migraine: A narrative review. Headache 2021; 61:1159-1179. [PMID: 34407215 DOI: 10.1111/head.14189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/01/2021] [Accepted: 06/07/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To summarize major results from imaging studies investigating brain structure in migraine. BACKGROUND Neuroimaging studies, using several different imaging and analysis techniques, have demonstrated aberrations in brain structure associated with migraine. This narrative review summarizes key imaging findings and relates imaging findings with clinical features of migraine. METHODS We searched PubMed for English language articles using the key words "neuroimaging" AND/OR "MRI" combined with "migraine" through August 20, 2020. The titles and abstracts of resulting articles were reviewed for their possible inclusion in this manuscript, followed by examination of the full texts and reference lists of relevant articles. RESULTS Migraine is associated with structural brain aberrations within regions that participate in pain processing, the processing of other sensory stimuli, multisensory integration, and in white matter fiber tracts. Furthermore, migraine is associated with magnetic resonance imaging T2/fluid-attenuated inversion recovery white matter hyperintensities. Some structural aberrations are correlated with the severity and clinical features of migraine, whereas others are not. These findings suggest that some structural abnormalities are associated with or amplified by recurrent migraine attacks, whereas others are intrinsic to the migraine brain. CONCLUSIONS Migraine is associated with aberrant brain structure. Structural neuroimaging studies contribute to understanding migraine pathophysiology and identification of brain regions associated with migraine and its individual symptoms. Additional work is needed to determine the extent to which structural aberrations are a result of recurrent migraine attacks, and perhaps reversible with effective treatment or migraine resolution, versus being intrinsic traits of the migraine brain.
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Affiliation(s)
- Soo-Kyoung Kim
- Department of Neurology and Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, South Korea
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OnabotulinumtoxinA in Migraine: A Review of the Literature and Factors Associated with Efficacy. J Clin Med 2021; 10:jcm10132898. [PMID: 34209849 PMCID: PMC8269087 DOI: 10.3390/jcm10132898] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 06/12/2021] [Accepted: 06/16/2021] [Indexed: 11/17/2022] Open
Abstract
The efficacy of onabotulinumtoxinA (OnaB-A) as a preventative treatment for chronic migraine, emerging fortuitously from clinical observation is now supported by class one evidence and over two decades of real-world clinical data. There is still limited ability to predict a clinically meaningful response to OnaB-A for individual patients, however. This review summarises briefly the proposed mechanism of OnaB-A in chronic migraine, the literature of predictors of clinical response, and recent developments in the field.
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Evidence of Potential Mechanisms of Acupuncture from Functional MRI Data for Migraine Prophylaxis. Curr Pain Headache Rep 2021; 25:49. [PMID: 34036477 DOI: 10.1007/s11916-021-00961-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW To summarize the clinical neuroimaging evidence pertaining to the potential mechanisms of acupuncture for migraine prophylaxis. RECENT FINDINGS From a descriptive perspective, converging evidence from recent neuroimaging studies, mainly from functional MRI (fMRI) studies, has demonstrated that when compared with sham acupuncture, verum acupuncture could normalize the decrease of the functional connectivity of the rostral ventromedial medulla-trigeminocervical complex (RVM/TCC) network, frontal-parietal network, cingulo-opercular networks, and default mode network and could normalize sensorimotor network connectivity with sensory-, affective-, and cognitive-related brain areas. These areas overlap with those of the pain matrix. Verum acupuncture works in a more targeted and unique manner compared with sham acupuncture in patients with migraine. These findings from neuroimaging studies may provide new perspectives on the validation of acupoints specificity and confirm the central modulating effects of acupuncture as a migraine prevention treatment. However, the exact mechanism by which acupuncture works for migraine prophylaxis remains unclear and warrants investigation. Future studies with larger sample sizes are still needed to confirm the current results and to further evaluate the complex and specific effects of acupuncture by analyzing different stimulus conditions, such as verum vs. sham acupuncture, deqi vs. no deqi, different acupuncture points or meridians, and different manipulation methods. Moreover, instead of focusing on the changes in a single area of the brain, researchers should focus more on the relationships among the functional connectivity network of brain areas such as the RVM/TCC, thalamus, anterior cingulate cortex (ACC), superior temporal gyrus (STG), and supplementary motor area (SMA) to explore the underlying mechanism of the effects of acupuncture.
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Planchuelo-Gómez Á, García-Azorín D, Guerrero ÁL, Rodríguez M, Aja-Fernández S, de Luis-García R. Gray Matter Structural Alterations in Chronic and Episodic Migraine: A Morphometric Magnetic Resonance Imaging Study. PAIN MEDICINE 2021; 21:2997-3011. [PMID: 33040149 DOI: 10.1093/pm/pnaa271] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE This study evaluates different parameters describing the gray matter structure to analyze differences between healthy controls, patients with episodic migraine, and patients with chronic migraine. DESIGN Cohort study. SETTING Spanish community. SUBJECTS Fifty-two healthy controls, 57 episodic migraine patients, and 57 chronic migraine patients were included in the study and underwent T1-weighted magnetic resonance imaging acquisition. METHODS Eighty-four cortical and subcortical gray matter regions were extracted, and gray matter volume, cortical curvature, thickness, and surface area values were computed (where applicable). Correlation analysis between clinical features and structural parameters was performed. RESULTS Statistically significant differences were found between all three groups, generally consisting of increases in cortical curvature and decreases in gray matter volume, cortical thickness, and surface area in migraineurs with respect to healthy controls. Furthermore, differences were also found between chronic and episodic migraine. Significant correlations were found between duration of migraine history and several structural parameters. CONCLUSIONS Migraine is associated with structural alterations in widespread gray matter regions of the brain. Moreover, the results suggest that the pattern of differences between healthy controls and episodic migraine patients is qualitatively different from that occurring between episodic and chronic migraine patients.
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Affiliation(s)
| | - David García-Azorín
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Ángel L Guerrero
- Headache Unit, Department of Neurology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain.,Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
| | - Margarita Rodríguez
- Department of Radiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
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Headache frequency associates with brain microstructure changes in patients with migraine without aura. Brain Imaging Behav 2021; 15:60-67. [PMID: 31898090 DOI: 10.1007/s11682-019-00232-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Neuroimaging studies have implicated abnormal brain microstructure in episodic migraine (EM), but whether the pattern is altered during migraine chronification is not well known. Fifty-six patients with migraine without aura, including 39 EM patients and 17 chronic migraine (CM) patients, and 35 healthy controls (HCs) were enrolled. Voxel-based morphometry analysis was performed to assess gray matter (GM) volume differences among groups and their association with clinical feature was examined. Compared with the HC group, both migraine groups showed increased GM volume in the periaqueductal grey matter (PAG) and decreased GM volume in the anterior cingulate cortex (ACC). The left hippocampus/parahippocampal gyrus (PHG) volume of the HC group was smaller than that of the EM group, but was larger than that of the CM group. For the dorsolateral prefrontal cortex (dlPFC), the EM group showed the smallest GM volume while the CM group had the largest volume. Higher headache frequency was associated with greater GM volume in the PAG and dlPFC, but was associated with smaller GM volume in the ACC and hippocampus/PHG across all patients. GM volume changes in regions involved in pain generation and control are potential neural mechanism underlying migraine, and are associated with migraine types and headache frequency.
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Abstract
Aberrant functional connectivity of brain networks has been demonstrated in migraine sufferers. Functional magnetic resonance imaging (fMRI) may illustrate altered connectivity in patients suffering from migraine without aura (MwoA). Here, we applied a seed-based approach based on limbic regions to investigate disrupted functional connectivity between spontaneous migraine attacks. Resting-state fMRI data were obtained from 28 migraine patients without aura and 23 well-matched healthy controls (HC). The functional connectivity of the limbic system was characterized using a seed-based whole-brain correlation method. The resulting functional connectivity measurements were assessed for correlations with other clinical features. Neuropsychological data revealed significantly increased connectivity between the limbic system (bilateral amygdala and right hippocampus) and left middle occipital gyrus (MOG), and a positive correlation was revealed between disease duration and connective intensity of the left amygdala and the ipsilateral MOG. There was decreased functional connectivity between the right amygdala and contralateral orbitofrontal cortex (OFC). In addition, resting-state fMRI showed that, compared to HC, patients without aura had significant functional connectivity consolidation between the bilateral hippocampus and cerebellum, and a negative correlation was detected between scores on the headache impact test (HIT) and connectivity intensity of the right hippocampus and bilateral cerebellum. There was decreased functional connectivity between the left hippocampus and three brain areas, encompassing the bilateral inferior parietal gyri (IPG) and contralateral supplementary motor area (SMA). There were no structural differences between the two groups. Our data suggest that migraine patients have disrupted limbic functional connectivity to pain-related regions of the modulatory and encoding cortices, which are associated with specific clinical characteristics. Disturbances of resting-state functional connectivity may play a key role in neuropathological features, perception and affection of migraine. The current study provides further insights into the complex scenario of migraine mechanisms. .
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Protracted hypomobility in the absence of trigeminal sensitization after cortical spreading depolarization: Relevance to migraine postdrome. Neurosci Res 2021; 172:80-86. [PMID: 33819562 DOI: 10.1016/j.neures.2021.03.010] [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: 01/20/2021] [Revised: 03/05/2021] [Accepted: 03/28/2021] [Indexed: 11/21/2022]
Abstract
Migraine sufferers often exhibit photophobia and physical hypoactivity in the postdrome and interictal periods, for which no effective therapy currently exists. Cortical spreading depolarization (CSD) is a neural phenomenon underlying migraine aura. We previously reported that CSD induced trigeminal sensitization, photophobia, and hypomobility at 24 h in mice. Here, we examined the effects of CSD induction on light sensitivity and physical activity in mice at 48 h and 72 h. Trigeminal sensitization was absent at both time points. CSD-subjected mice exhibited significantly less ambulatory time in both light (P = 0.0074, the Bonferroni test) and dark (P = 0.0354, the Bonferroni test) zones than sham-operated mice at 72 h. CSD-subjected mice also exhibited a significantly shorter ambulatory distance in the light zone at 72 h than sham-operated mice (P = 0.0151, the Bonferroni test). Neurotropin® is used for the management of chronic pain disorders, mainly in Asian countries. The CSD-induced reductions in ambulatory time and distance in the light zone at 72 h were reversed by Neurotropin® at 0.27 NU/kg. Our experimental model seems to recapitulate migraine-associated clinical features observed in the postdrome and interictal periods. Moreover, Neurotropin® may be effective in ameliorating postdromal/interictal hypoactivity, especially in a light environment.
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Liu TH, Wang Z, Xie F, Liu YQ, Lin Q. Contributions of aversive environmental stress to migraine chronification: Research update of migraine pathophysiology. World J Clin Cases 2021; 9:2136-2145. [PMID: 33850932 PMCID: PMC8017499 DOI: 10.12998/wjcc.v9.i9.2136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 02/03/2021] [Accepted: 03/16/2021] [Indexed: 02/06/2023] Open
Abstract
Clinical studies have suggested that internal and/or external aversive cues may produce a negative affective-motivational component whereby maladaptive responses (plasticity) of dural afferent neurons are initiated contributing to migraine chronification. However, pathophysiological processes and neural circuitry involved in aversion (unpleasantness)-producing migraine chronification are still evolving. An interdisciplinary team conducted this narrative review aimed at reviewing neuronal plasticity for developing migraine chronicity and its relevant neurocircuits and providing the most cutting-edge information on neuronal mechanisms involved in the processing of affective aspects of pain and the role of unpleasantness evoked by internal and/or external cues in facilitating the chronification process of migraine headache. Thus, information presented in this review promotes the understanding of the pathophysiology of chronic migraine and contribution of unpleasantness (aversion) to migraine chronification. We hope that it will bring clinicians’ attention to how the maladaptive neuroplasticity of the emotion brain in the aversive environment produces a significant impact on the chronification of migraine headache, which will in turn lead to new therapeutic strategies for this type of pain.
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Affiliation(s)
- Tang-Hua Liu
- Department of Algology, The Third People's Hospital of Yibin, Yibin 644000, Sichuan Province, China
| | - Zhen Wang
- Department of Psychology, University of Texas at Arlington, Arlington, TX 76019, United States
| | - Fang Xie
- Department of Algology, The Third People's Hospital of Yibin, Yibin 644000, Sichuan Province, China
| | - Yan-Qing Liu
- Department of Algology, Beijing Tiantan Hospital, Capital Medical University, Beijing 100070, China
| | - Qing Lin
- Department of Psychology, University of Texas at Arlington, Arlington, TX 76019, United States
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Michels L, Koirala N, Groppa S, Luechinger R, Gantenbein AR, Sandor PS, Kollias S, Riederer F, Muthuraman M. Structural brain network characteristics in patients with episodic and chronic migraine. J Headache Pain 2021; 22:8. [PMID: 33657996 PMCID: PMC7927231 DOI: 10.1186/s10194-021-01216-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/28/2021] [Indexed: 12/28/2022] Open
Abstract
Background Migraine is a primary headache disorder that can be classified into an episodic (EM) and a chronic form (CM). Network analysis within the graph-theoretical framework based on connectivity patterns provides an approach to observe large-scale structural integrity. We test the hypothesis that migraineurs are characterized by a segregated network. Methods 19 healthy controls (HC), 17 EM patients and 12 CM patients were included. Cortical thickness and subcortical volumes were computed, and topology was analyzed using a graph theory analytical framework and network-based statistics. We further used support vector machines regression (SVR) to identify whether these network measures were able to predict clinical parameters. Results Network based statistics revealed significantly lower interregional connectivity strength between anatomical compartments including the fronto-temporal, parietal and visual areas in EM and CM when compared to HC. Higher assortativity was seen in both patients’ group, with higher modularity for CM and higher transitivity for EM compared to HC. For subcortical networks, higher assortativity and transitivity were observed for both patients’ group with higher modularity for CM. SVR revealed that network measures could robustly predict clinical parameters for migraineurs. Conclusion We found global network disruption for EM and CM indicated by highly segregated network in migraine patients compared to HC. Higher modularity but lower clustering coefficient in CM is suggestive of more segregation in this group compared to EM. The presence of a segregated network could be a sign of maladaptive reorganization of headache related brain circuits, leading to migraine attacks or secondary alterations to pain. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-021-01216-8.
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Affiliation(s)
- Lars Michels
- Department of Neuroradiology, University Hospital Zurich, Sternwartstr. 6, CH-8091, Zurich, Switzerland.
| | - Nabin Koirala
- Haskins Laboratories, New Haven, Connecticut, USA.,Section of Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing unit, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Sergiu Groppa
- Section of Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing unit, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Roger Luechinger
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - Andreas R Gantenbein
- Department of Neurology and Neurorehabilitation, RehaClinic, Bad Zurzach, CH-5330, Switzerland.,Department of Neurology, University Hospital Zurich, CH-8091, Zurich, Switzerland
| | - Peter S Sandor
- Department of Neurology and Neurorehabilitation, RehaClinic, Bad Zurzach, CH-5330, Switzerland.,Department of Neurology, University Hospital Zurich, CH-8091, Zurich, Switzerland
| | - Spyros Kollias
- Department of Neuroradiology, University Hospital Zurich, Sternwartstr. 6, CH-8091, Zurich, Switzerland
| | - Franz Riederer
- Department of Neurology, Clinic Hietzing and Karl Landsteiner Institute for Clinical Epilepsy Research and Cognitive Neurology, Wolkerssbergenstrasse 1, AT-1130, Vienna, Austria.,University of Zurich, Faculty of Medicine, Rämistrasse 100, CH-8091, Zurich, Switzerland
| | - Muthuraman Muthuraman
- Section of Movement Disorders and Neurostimulation, Biomedical Statistics and Multimodal Signal Processing unit, Department of Neurology, Focus Program Translational Neuroscience (FTN), University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
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Lim M, Jassar H, Kim DJ, Nascimento TD, DaSilva AF. Differential alteration of fMRI signal variability in the ascending trigeminal somatosensory and pain modulatory pathways in migraine. J Headache Pain 2021; 22:4. [PMID: 33413090 PMCID: PMC7791681 DOI: 10.1186/s10194-020-01210-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/10/2020] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The moment-to-moment variability of resting-state brain activity has been suggested to play an active role in chronic pain. Here, we investigated the regional blood-oxygen-level-dependent signal variability (BOLDSV) and inter-regional dynamic functional connectivity (dFC) in the interictal phase of migraine and its relationship with the attack severity. METHODS We acquired resting-state functional magnetic resonance imaging from 20 migraine patients and 26 healthy controls (HC). We calculated the standard deviation (SD) of the BOLD time-series at each voxel as a measure of the BOLD signal variability (BOLDSV) and performed a whole-brain voxel-wise group comparison. The brain regions showing significant group differences in BOLDSV were used to define the regions of interest (ROIs). The SD and mean of the dynamic conditional correlation between those ROIs were calculated to measure the variability and strength of the dFC. Furthermore, patients' experimental pain thresholds and headache pain area/intensity levels during the migraine ictal-phase were assessed for clinical correlations. RESULTS We found that migraineurs, compared to HCs, displayed greater BOLDSV in the ascending trigeminal spinal-thalamo-cortical pathways, including the spinal trigeminal nucleus, pulvinar/ventral posteromedial (VPM) nuclei of the thalamus, primary somatosensory cortex (S1), and posterior insula. Conversely, migraine patients exhibited lower BOLDSV in the top-down modulatory pathways, including the dorsolateral prefrontal (dlPFC) and inferior parietal (IPC) cortices compared to HCs. Importantly, abnormal interictal BOLDSV in the ascending trigeminal spinal-thalamo-cortical and frontoparietal pathways were associated with the patient's headache severity and thermal pain sensitivity during the migraine attack. Migraineurs also had significantly lower variability and greater strength of dFC within the thalamo-cortical pathway (VPM-S1) than HCs. In contrast, migraine patients showed greater variability and lower strength of dFC within the frontoparietal pathway (dlPFC-IPC). CONCLUSIONS Migraine is associated with alterations in temporal signal variability in the ascending trigeminal somatosensory and top-down modulatory pathways, which may explain migraine-related pain and allodynia. Contrasting patterns of time-varying connectivity within the thalamo-cortical and frontoparietal pathways could be linked to abnormal network integrity and instability for pain transmission and modulation.
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Affiliation(s)
- Manyoel Lim
- Headache and Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences & Prosthodontics, University of Michigan School of Dentistry, 1011 N. University Ave, Room 1014A, Ann Arbor, MI 48109-1078 USA
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor, MI 48109 USA
| | - Hassan Jassar
- Headache and Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences & Prosthodontics, University of Michigan School of Dentistry, 1011 N. University Ave, Room 1014A, Ann Arbor, MI 48109-1078 USA
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor, MI 48109 USA
| | - Dajung J. Kim
- Headache and Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences & Prosthodontics, University of Michigan School of Dentistry, 1011 N. University Ave, Room 1014A, Ann Arbor, MI 48109-1078 USA
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor, MI 48109 USA
| | - Thiago D. Nascimento
- Headache and Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences & Prosthodontics, University of Michigan School of Dentistry, 1011 N. University Ave, Room 1014A, Ann Arbor, MI 48109-1078 USA
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor, MI 48109 USA
| | - Alexandre F. DaSilva
- Headache and Orofacial Pain Effort (H.O.P.E.), Department of Biologic and Materials Sciences & Prosthodontics, University of Michigan School of Dentistry, 1011 N. University Ave, Room 1014A, Ann Arbor, MI 48109-1078 USA
- Michigan Neuroscience Institute, University of Michigan, Ann Arbor, MI 48109 USA
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Ictal and interictal brain activation in episodic migraine: Neural basis for extent of allodynia. PLoS One 2021; 16:e0244320. [PMID: 33395413 PMCID: PMC7781392 DOI: 10.1371/journal.pone.0244320] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 12/07/2020] [Indexed: 12/14/2022] Open
Abstract
In some patients, migraine attacks are associated with symptoms of allodynia which can be localized (cephalic) or generalized (extracephalic). Using functional neuroimaging and cutaneous thermal stimulation, we aimed to investigate the differences in brain activation of patients with episodic migraine (n = 19) based on their allodynic status defined by changes between ictal and interictal pain tolerance threshold for each subject at the time of imaging. In this prospective imaging study, differences were found in brain activity between the ictal and interictal visits in the brainstem/pons, thalamus, insula, cerebellum and cingulate cortex. Significant differences were also observed in the pattern of activation along the trigeminal pathway to noxious heat stimuli in no allodynia vs. generalized allodynia in the thalamus and the trigeminal nucleus but there were no activation differences in the trigeminal ganglion. The functional magnetic resonance imaging (fMRI) findings provide direct evidence for the view that in migraine patients who are allodynic during the ictal phase of their attacks, the spinal trigeminal nucleus and posterior thalamus become hyper-responsive (sensitized)–to the extent that they mediate cephalic and extracephalic allodynia, respectively. In addition, descending analgesic systems seem as “switched off” in generalized allodynia.
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Li Z, Zhou J, Lan L, Cheng S, Sun R, Gong Q, Wintermark M, Zeng F, Liang F. Concurrent brain structural and functional alterations in patients with migraine without aura: an fMRI study. J Headache Pain 2020; 21:141. [PMID: 33287704 PMCID: PMC7720576 DOI: 10.1186/s10194-020-01203-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 11/18/2020] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVES To explore the possible concurrent brain functional and structural alterations in patients with migraine without aura (MwoA) patients compared to healthy subjects (HS). METHODS Seventy-two MwoA patients and forty-six HS were recruited. 3D-T1 and resting state fMRI data were collected during the interictal period for MwoA and HS. Voxel-based morphometry (VBM) for structure analysis and regional homogeneity (Reho) for fMRI analysis were applied. The VBM and Reho maps were overlapped to determine a possible brain region with concurrent functional and structural alteration in MwoA patients. Further analysis of resting state functional connectivity (FC) alteration was applied with this brain region as the seed. RESULTS Compared with HS, MwoA patients showed decreased volume in the bilateral superior and inferior colliculus, periaqueductal gray matter (PAG), locus ceruleus, median raphe nuclei (MRN) and dorsal pons medulla junction. MwoA patients showed decreased Reho values in the middle occipital gyrus and inferior occipital gyrus, and increased Reho values in the MRN. Only a region in the MRN showed both structural and functional alteration in MwoA patients. Pearson correlation analysis showed that there was no association between volume or Reho values of the MRN and headache frequency, headache intensity, disease duration, self-rating anxiety scale or self-rating depression scale in MwoA patients. Resting state functional connectivity (FC) with the MRN as the seed showed that MwoA patients had increased FC between the MRN and PAG. CONCLUSIONS MRN are involved in the pathophysiology of migraine during the interictal period. This study may help to better understand the migraine symptoms. TRIAL REGISTRATION NCT01152632 . Registered 27 June 2010.
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Affiliation(s)
- Zhengjie Li
- Acupuncture & Tuina School / The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, 610036, Sichuan, China
- Radiology Department, Stanford University, Stanford, California, 94305, USA
| | - Jun Zhou
- Acupuncture & Tuina School / The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, 610036, Sichuan, China
| | - Lei Lan
- Acupuncture & Tuina School / The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, 610036, Sichuan, China
| | - Shirui Cheng
- Acupuncture & Tuina School / The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, 610036, Sichuan, China
| | - Ruirui Sun
- Acupuncture & Tuina School / The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, 610036, Sichuan, China
| | - Qiyong Gong
- Huaxi MR Research Center, West China Hospital of Sichuan University, Chengdu, 610041, Sichuan, China
| | - Max Wintermark
- Radiology Department, Stanford University, Stanford, California, 94305, USA
| | - Fang Zeng
- Acupuncture & Tuina School / The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, 610036, Sichuan, China.
| | - Fanrong Liang
- Acupuncture & Tuina School / The 3rd Teaching Hospital, Chengdu University of Traditional Chinese Medicine, Chengdu, 610036, Sichuan, China.
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Abstract
PURPOSE OF REVIEW The purpose of this paper is to review and synthesize current literature in which neurochemical and structural brain imaging were used to investigate chronic migraine (CM) pathophysiology and to further discuss the clinical implications. RECENT FINDINGS Spectroscopic and structural MRI studies have shown the presence of both impaired metabolism and structural alterations in the brain of CM patients. Metabolic changes in key brain regions support the notion of altered energetics and homeostasis as part of CM pathophysiology. Furthermore, CM, like other chronic pain disorders, may undergo structural reorganization in pain-related brain regions following near persistent endogenous painful input. Finally, both imaging techniques may provide potential biomarkers of disease state and progression and may help guide novel therapeutic interventions or strategies. Spectroscopic and structural MRI have revealed novel aspects of CM pathophysiology. Findings from the former support the metabolic theory of migraine pathogenesis.
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Affiliation(s)
- Kuan-Lin Lai
- Department of Neurology, The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - David M Niddam
- Brain Research Center, National Yang-Ming University, Taipei, Taiwan.
- Institute of Brain Science, School of Medicine, National Yang-Ming University, No. 155, Section 2, Linong Street, Taipei, 112, Taiwan.
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M H B, R J, A HM. New MRI Finding in Migraineurs: Mesial Temporal Sclerosis. J Biomed Phys Eng 2020; 10:459-466. [PMID: 32802794 PMCID: PMC7416088 DOI: 10.31661/jbpe.v0i0.887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 03/14/2018] [Indexed: 01/03/2023]
Abstract
Background: Based on our experience, a noticeable number of migraineurs without history of epilepsy disclose mesial temporal sclerosis (MTS) on their brain MRI. Objective: This prospective study was conducted to assess the frequency of MTS in migraineurs and also determine the ratio of unilateral and bilateral cases. Material and Methods: In this cross sectional study, the frequency of MTS in MRI of 84 migraine patients, who had symptoms for at least 2 years,
assessed. Brain MRI was done with T1 and T2 weighted protocols. Two radiologists separately interpreted findings, defining MTS
as presence of any of hippocampal atrophy, increased T2 signal of hippocampus, decreased T1 signal of hippocampus or loss
of internal architecture. Patients who radiologists had not agreement on their diagnoses excluded. Stat analysis done using ‘N - 1’ chi squared test. Results: Eleven patients were excluded due to non-accordant interpretation of MRI findings by the two examining radiologists.
MTS was detected in 14 out of 73 patients (19%). Bilateral involvement of mesial temporal lobe was seen in 6 (8%) patients
(M 67%, F 33%). Five cases (7%) had unilateral left MTS (M 67%, F 33%) while 3 (4%) were affected with right-sided MTS (M 33%, F 67%).
These findings highly suggest association of MTS and Migraine (P-value <0.0001). Conclusion: While MTS is a prevalent finding in migraineurs, incidental finding of MTS in MRI should suspect physicians of migraine as well as temporal lobe epilepsy. MTS can be proposed as an etiology of migraine but most likely, consequence of it.
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Affiliation(s)
- Bagheri M H
- MD, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- MD, Department of Radiology and Imaging Sciences (A.P., R.S., D.S.R., M.B., T.E.C., D.A.B.), National Institutes of Health Clinical Center, Bethesda, Maryland
| | - Jalli R
- MD, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Hoseyni Moghadam A
- MD, Medical Imaging Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Burke MJ, Joutsa J, Cohen AL, Soussand L, Cooke D, Burstein R, Fox MD. Mapping migraine to a common brain network. Brain 2020; 143:541-553. [PMID: 31919494 DOI: 10.1093/brain/awz405] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 10/15/2019] [Accepted: 11/11/2019] [Indexed: 11/14/2022] Open
Abstract
Inconsistent findings from migraine neuroimaging studies have limited attempts to localize migraine symptomatology. Novel brain network mapping techniques offer a new approach for linking neuroimaging findings to a common neuroanatomical substrate and localizing therapeutic targets. In this study, we attempted to determine whether neuroanatomically heterogeneous neuroimaging findings of migraine localize to a common brain network. We used meta-analytic coordinates of decreased grey matter volume in migraineurs as seed regions to generate resting state functional connectivity network maps from a normative connectome (n = 1000). Network maps were overlapped to identify common regions of connectivity across all coordinates. Specificity of our findings was evaluated using a whole-brain Bayesian spatial generalized linear mixed model and a region of interest analysis with comparison groups of chronic pain and a neurologic control (Alzheimer's disease). We found that all migraine coordinates (11/11, 100%) were negatively connected (t ≥ ±7, P < 10-6 family-wise error corrected for multiple comparisons) to a single location in left extrastriate visual cortex overlying dorsal V3 and V3A subregions. More than 90% of coordinates (10/11) were also positively connected with bilateral insula and negatively connected with the hypothalamus. Bayesian spatial generalized linear mixed model whole-brain analysis identified left V3/V3A as the area with the most specific connectivity to migraine coordinates compared to control coordinates (voxel-wise probability of ≥90%). Post hoc region of interest analyses further supported the specificity of this finding (ANOVA P = 0.02; pairwise t-tests P = 0.03 and P = 0.003, respectively). In conclusion, using coordinate-based network mapping, we show that regions of grey matter volume loss in migraineurs localize to a common brain network defined by connectivity to visual cortex V3/V3A, a region previously implicated in mechanisms of cortical spreading depression in migraine. Our findings help unify migraine neuroimaging literature and offer a migraine-specific target for neuromodulatory treatment.
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Affiliation(s)
- Matthew J Burke
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Harquail Centre for Neuromodulation and Hurvitz Brain Sciences Program, Sunnybrook Research Institute, Toronto, ON, Canada.,Neuropsychiatry Program, Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada
| | - Juho Joutsa
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Turku Brain and Mind Center, Department of Neurology, University of Turku, Turku, Finland.,Division of Clinical Neurosciences and Turku PET Center, Turku University Hospital, Turku, Finland
| | - Alexander L Cohen
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Louis Soussand
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Danielle Cooke
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Rami Burstein
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Michael D Fox
- Berenson-Allen Center for Noninvasive Brain Stimulation, Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.,Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Athinoula A. Martinos Centre for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
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Abstract
Migraine is the leading cause of years lost due to disability in individuals aged 15 to 49 years. Much has changed over the last three decades about our understanding of this complex neurological disorder. Various phases of migraine have been characterized and are the focus of this review. The premonitory phase involves bothersome symptoms experienced hours to days before migraine pain. Behavioral changes and functional neuroimaging studies point toward hypothalamic involvement during the premonitory and other migraine phases. Migraine aura is a disruptive, reversible neurological phenomenon that affects up to one-third of all migraineurs, and can overlap with the headache phase. The mechanism responsible for this phase is thought to be cortical spreading depolarization through the cortex. This process leads to temporary disruptions in ion homeostasis and the ensuing neuronal dysfunction. The headache phase involves activation of the trigeminocervical complex. Neuropeptides are implicated in trigeminal activation, and calcitonin gene-related peptide in particular has become a promising target of therapeutic intervention for migraine. The final phase of migraine is the postdrome, the period of time from the resolution of headache symptoms until return to baseline following a migraine. People often report neuropsychiatric, sensory, gastrointestinal, and general symptoms during this time, which can limit activity. Elucidating the neuroanatomical, chemical, and neuroimaging correlates of these migraine phases allows for an improved comprehension of the underlying changes associated with migraine symptomatology and can assist with evaluation of arising therapeutics for migraine management.
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Affiliation(s)
- William Qubty
- Pediatric Headache Center, Department of Neurology, Dell Medical School at the University of Texas at Austin, Austin, Texas.
| | - Irene Patniyot
- Department of Pediatric Neurology and Developmental Neuroscience, Baylor College of Medicine, Houston, Texas
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Cerebral cortical dimensions in headache sufferers aged 50 to 66 years: a population-based imaging study in the Nord-Trøndelag Health Study (HUNT-MRI). Pain 2020; 160:1634-1643. [PMID: 30839431 DOI: 10.1097/j.pain.0000000000001550] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Based on previous clinic-based magnetic resonance imaging studies showing regional differences in the cerebral cortex between those with and without headache, we hypothesized that headache sufferers have a decrease in volume, thickness, or surface area in the anterior cingulate cortex, prefrontal cortex, and insula. In addition, exploratory analyses on volume, thickness, and surface area across the cerebral cortical mantle were performed. A total of 1006 participants (aged 50-66 years) from the general population were selected to an imaging study of the head at 1.5 T (HUNT-MRI). Two hundred eighty-three individuals suffered from headache, 80 with migraine, and 87 with tension-type headache, whereas 309 individuals did not suffer from headache and were used as controls. T1-weighted 3D scans of the brain were analysed with voxel-based morphometry and FreeSurfer. The association between cortical volume, thickness, and surface area and questionnaire-based headache diagnoses was evaluated, taking into consideration evolution of headache and frequency of attacks. There were no significant differences in cortical volume, thickness, or surface area between headache sufferers and nonsufferers in the anterior cingulate cortex, prefrontal cortex, or insula. Similarly, the exploratory analyses across the cortical mantle demonstrated no significant differences in volume, thickness, or surface area between any of the headache groups and the nonsufferers. Maps of effect sizes showed small differences in the cortical measures between headache sufferers and nonsufferers. Hence, there are probably no or only very small differences in volume, thickness, or surface area of the cerebral cortex between those with and without headache in the general population.
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von Deneen KM, Zhao L, Liu J. Individual differences of maladaptive brain changes in migraine and their relationship with differential effectiveness of treatments. BRAIN SCIENCE ADVANCES 2020. [DOI: 10.26599/bsa.2019.9050021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Migraine is a difficult disorder to identify with regard to its pathophysiological mechanisms, and its treatment has been primarily difficult owing to interindividual differences. Substantial rates of nonresponsiveness to medications are common, making migraine treatment complicated. In this review, we systematically analyzed recent studies concerning neuroimaging findings regarding the neurophysiology of migraine. We linked the current imaging research with anecdotal evidence from interindividual factors such as duration and pain intensity of migraine, age, gender, hormonal interplay, and genetics. These factors suggested the use of nonpharmacological therapies such as transcranial magnetic stimulation, transcranial direct current stimulation, and placebo therapy for the treatment of migraine. Finally, we discussed how interindividual differences are related to such nondrug treatments.
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Affiliation(s)
- Karen M. von Deneen
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi’an 710126, Shaanxi, China
- Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi’an 710126, Shaanxi, China
| | - Ling Zhao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, Sichuan, China
| | - Jixin Liu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi’an 710126, Shaanxi, China
- Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi’an 710126, Shaanxi, China
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Sheng L, Zhao P, Ma H, Yuan C, Zhong J, Dai Z, Pan P. A lack of consistent brain grey matter alterations in migraine. Brain 2020; 143:e45. [PMID: 32363400 DOI: 10.1093/brain/awaa123] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Affiliation(s)
- LiQin Sheng
- Department of Neurology, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, China
| | - PanWen Zhao
- Department of Central Laboratory, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, China
| | - HaiRong Ma
- Department of Neurology, Kunshan Hospital of Traditional Chinese Medicine, Kunshan, China
| | - CongHu Yuan
- Department of Anesthesia and Pain Management, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, China
| | - JianGuo Zhong
- Department of Neurology, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, China
| | - ZhenYu Dai
- Department of Radiology, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, China
| | - PingLei Pan
- Department of Central Laboratory, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, China
- Department of Neurology, Affiliated Yancheng Hospital, School of Medicine, Southeast University, Yancheng, China
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50
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Torres-Ferrús M, Ursitti F, Alpuente-Ruiz A, Brunello F, Chiappino D, de Vries T, Di Marco S, Ferlisi S, Guerritore L, Gonzalez-Garcia N, Gonzalez-Martinez A, Khutorov D, Kritsilis M, Kyrou A, Makeeva T, Minguez-Olaondo A, Pilati L, Serrien A, Tsurkalenko O, Van den Abbeele D, van Hoogstraten WS, Lampl C. From transformation to chronification of migraine: pathophysiological and clinical aspects. J Headache Pain 2020; 21:42. [PMID: 32349653 PMCID: PMC7189559 DOI: 10.1186/s10194-020-01111-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/15/2020] [Indexed: 02/06/2023] Open
Abstract
Chronic migraine is a neurological disorder characterized by 15 or more headache days per month of which at least 8 days show typical migraine features. The process that describes the development from episodic migraine into chronic migraine is commonly referred to as migraine transformation or chronification. Ample studies have attempted to identify factors associated with migraine transformation from different perspectives. Understanding CM as a pathological brain state with trigeminovascular participation where biological changes occur, we have completed a comprehensive review on the clinical, epidemiological, genetic, molecular, structural, functional, physiological and preclinical evidence available.
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Affiliation(s)
- M. Torres-Ferrús
- Headache and Craniofacial Pain Unit, Neurology Department, Hospital Universitari Vall d’Hebron, Headache and Neurological Pain Research Group, Vall d’Hebron Research Institute (VHIR), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - F. Ursitti
- Headache Center, Child Neurology Unit, Bambino Gesu’ Children’s Hospital, Rome, Italy
| | - A. Alpuente-Ruiz
- Headache and Craniofacial Pain Unit, Neurology Department, Hospital Universitari Vall d’Hebron, Headache and Neurological Pain Research Group, Vall d’Hebron Research Institute (VHIR), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - F. Brunello
- Juvenile Headache Centre, Department of Woman’s and Child’s Health, University Hospital of Padua, Padua, Italy
| | - D. Chiappino
- Department of Internal medicine, Sant’Andrea Hospital, University of Rome, Sapienza, Italy
| | - T. de Vries
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - S. Di Marco
- Department of Biomedicine Neuroscience and Advanced Diagnostics, Policlinico Paolo Giaccone Hospital, University of Palermo, Palermo, Italy
| | - S. Ferlisi
- Department of Biomedicine Neuroscience and Advanced Diagnostics, Policlinico Paolo Giaccone Hospital, University of Palermo, Palermo, Italy
| | - L. Guerritore
- Department of Internal medicine, Sant’Andrea Hospital, University of Rome, Sapienza, Italy
| | - N. Gonzalez-Garcia
- Headache and Craniofacial Pain Unit, Neurology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - A. Gonzalez-Martinez
- Neurology Department, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - D. Khutorov
- Department of Clinical Neurology and Sleep Medicine, The Nikiforov Russian Center of Emergency and Radiation Medicine of EMERCOM of Russia, Saint-Petersburg, Russia
| | | | - A. Kyrou
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland University Hospital of Psychiatry, Bern, Switzerland
| | - T. Makeeva
- Headache Unit, Department of Neurology, Medical center “New Medical Technologies”, Voronezh, Russia
| | - A. Minguez-Olaondo
- Department of Neurology, Universitary Hospital of Donostia, San Sebastian, Spain
- Department of Neurology, Clínica Universidad de Navarra, Pamplona, Spain
- Department of Neurology, Hospital Quironsalud Donostia, San Sebastian, Spain
| | - L. Pilati
- Department of Biomedicine Neuroscience and Advanced Diagnostics, Policlinico Paolo Giaccone Hospital, University of Palermo, Palermo, Italy
| | - A. Serrien
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - O. Tsurkalenko
- Department of Neurology and Neurosurgery, State Institution “Dnipropetrovsk medical akademy MOH Ukraine”, Dnipro, Ukraine
| | | | - W. S. van Hoogstraten
- Department of Neuroscience, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - C. Lampl
- Headache Medical Center Linz, Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria
| | - On behalf of School of Advanced Studies of European Headache Federation (EHF-SAS)
- Headache and Craniofacial Pain Unit, Neurology Department, Hospital Universitari Vall d’Hebron, Headache and Neurological Pain Research Group, Vall d’Hebron Research Institute (VHIR), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
- Headache Center, Child Neurology Unit, Bambino Gesu’ Children’s Hospital, Rome, Italy
- Juvenile Headache Centre, Department of Woman’s and Child’s Health, University Hospital of Padua, Padua, Italy
- Department of Internal medicine, Sant’Andrea Hospital, University of Rome, Sapienza, Italy
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Biomedicine Neuroscience and Advanced Diagnostics, Policlinico Paolo Giaccone Hospital, University of Palermo, Palermo, Italy
- Headache and Craniofacial Pain Unit, Neurology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
- Neurology Department, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Department of Clinical Neurology and Sleep Medicine, The Nikiforov Russian Center of Emergency and Radiation Medicine of EMERCOM of Russia, Saint-Petersburg, Russia
- Grevena General Hospital, Grevena, Greece
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland University Hospital of Psychiatry, Bern, Switzerland
- Headache Unit, Department of Neurology, Medical center “New Medical Technologies”, Voronezh, Russia
- Department of Neurology, Universitary Hospital of Donostia, San Sebastian, Spain
- Department of Neurology, Clínica Universidad de Navarra, Pamplona, Spain
- Department of Neurology, Hospital Quironsalud Donostia, San Sebastian, Spain
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
- Department of Neurology and Neurosurgery, State Institution “Dnipropetrovsk medical akademy MOH Ukraine”, Dnipro, Ukraine
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
- Department of Neuroscience, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Headache Medical Center Linz, Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria
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