| Objective:This study aimed to comprehensively assess the effects of acupuncture on pain symptoms,quality of life,mental health status,and sleep quality of patients with migraine by conducting a clinical study of acupuncture for migraine.At the same time,the Resting-state Functional Magnetic Reasoning Imaging(rs-fMRI)technique was utilized to observe the changes of brain functional activity in patients with migraine after single and multiple acupuncture treatments,and to explore the relevant mechanism of acupuncture treatment for migraine.Methods:A randomized controlled trial of acupuncture for migraine was conducted.Migraine patients who met the inclusion and exclusion criteria were recruited and randomly divided into acupuncture group,sham acupuncture group and control group.The acupuncture group was treated with acupuncture once a day,and the needles were kept for 30 minutes.One course of treatment lasted for 5 days,for a total of 2 courses.The sham acupuncture group received non-acupoint and non-acupoint superficial acupuncture intervention,once a day,and left the needle for 30 minutes after puncturing the skin.The control group did not interfere with any,and observed 2 course.Visual analogue scale(VAS),headache frequency,generalized anxiety disorder(GAD-7),and migraine specific quality-of-Life Questionnaire(MSQ)and Pittsburgh Sleep Quality Index(PSQI).At the same time,10 healthy volunteers were recruited,and differences of brain functional connectivity(FC)between migraine patients and healthy volunteers were observed by rs-fMRI,and the changes of brain FC of migraine patients under different intervention conditions were observed.Among them,the first MRI scan was performed before treatment for both the acupuncture group and the sham acupuncture group,while the second and third MRI scans were performed after the initial treatment and at the end of the treatment course,respectively.Two MRI scans were underwent before and after treatment for the control group.The healthy control group underwent only 1 MRI scan.MRI scans were performed with conventional magnetic resonance T1 Weighted Image(T1WI)and T2 Weighted Image(T2WI).Rs-fMRI imaging scans were performed on those with no abnormal signals on the head.After scanning,the image was reprocessed using the AFNI software package,and bilateral island leaves were selected as the seed area.The average value of the time series of the bilateral seed area was extracted and correlated with other pixels in the whole brain area to obtain the relevant r value.Using Fisher’sr-to-z conversion,the correlation coefficient is converted into z-values,so as to obtain the functional connection diagram of the two-sided island leaves.The AFNI software was used for statistical analysis of the images.Independent sample t test was used,and age and gender were used as covariates to compare the differences in island leaf functional connection maps between groups.A paired sample t test was used to compare differences in island leaf FC maps before and after treatment.Results:1.A total of 45 patients with migraine were included in this study,10 of them dropt out during the trial,and 35 of them were completed.Acupuncture group has 14 participants.Sham acupuncture group havs 10 patients while control group has 10.2.Among the patients included in the analysis,14 were males and 21 were females.The age distribution varied from 25 to 55 years,and the course of disease ranged from 1 to 30 years.3.Changes in VAS scores are related to treatment methods and time factors.There is an interactive effect between treatment methods and time.With the development of treatment,the reduction of VAS scores in different treatment methods is different,and the difference is statistically significant(P<0.05).After treatment,the VAS score of the acupuncture group was significantly reduced compared with the previous one,and the difference was statistically significant(P<0.001).The VAS score of the sham acupuncture group was decreased,and the difference was also statistically significant(P<0.05).At the end of the treatment period,the VAS score also in control group also decreased compared with the previous one,and the difference was statistically significant(P<0.05).4.After treatment,the frequency of migraine attacks in the acupuncture group decreased compared with the previous one,and the difference was statistically significant(P<0.05).The frequency of headache attacks in the sham acupuncture group before and after treatment was not statistically significant(P>0.05).There were no significant differences in the frequency of headache attacks before and after treatment in the control group(P>0.05).5.There were no significant differences in GAD-7 score before and after treatment among the acupuncture group,the sham acupuncture group,and the control group(P>0.05).6.Changes of PSQI index are related to the treatment method and the time factor.As time goes on,the PSQI index rises,and the change is statistically significant(P<0.05).In the course of treatment,the decrease in PSQI index was different under different treatment methods,and the difference was statistically significant(P<0.05).Before treatment,the PSQI index in the acupuncture group was higher than that in the sham acupuncture group,and the difference was statistically significant(P<0.05).While the PSQI index in the acupuncture group was a little bit higher than that in the control group,but the difference was not statistically significant(P>0.05).The PSQI index in the sham acupuncture group before treatment was lower than that in the control group,and the difference was statistically significant(P<0.05).After treatment,the PSQI index in the acupuncture group was significantly different from that in the sham acupuncture group(P<0.05).There were no significant differences between the acupuncture group and control group.Through the index in the acupuncture group seems less than that in the control group(P>0.05).The PSQI index in the sham acupuncture group was lower than that in the control group,and the difference was statistically significant(P<0.05).Comparing the changes of PSQI index in each group before and after treatment,it was found that the PSQI index in the acupuncture group after treatment was significantly lower than that before the treatment,and the difference was statistically significant(P<0.001).It was statistically significant that the index in the sham acupuncture group after treatment was lower than before(P<0.05).And the PSQI index at the end of the course in the control group was slightly increased compared with the previous one,but the difference was not statistically significant(P>0.05).7.After treatment,the total MSQ score in the acupuncture group decreased compared with the previous one.The differences were statistically significant(P<0.05).There was no significant differences in the total MSQ score of the sham acupuncture group before and after treatment(P>0.05).There was no significant differences in total MSQ scores before and after treatment in the control group(P>0.05).Among them,the MSQ-function limitation score in the acupuncture group decreased compared with the previous one,and the difference was statistically significant(P<0.001).The difference of the MSQ-function limitation score before and after treatment in the sham-acupuncture group was not statistically significant(P>0.05).There was no significant differences in MSQ-function limitation score before and after treatment in the control group(P>0.05).After treatment,the MSQ-dysfunction score in the acupuncture group was decreased compared with the previous one,and the difference was statistically significant(P<0.05).The difference before and after treatment in the sham acupuncture group was not statistically significant(P>0.05).The control The difference before and after treatment in the group was not statistically significant(P>0.05).Besides,the MSQ-affective disorder score in the acupuncture group decreased after treatment,and the difference was statistically significant(P<0.05).There was no significant differences in the MSQ-affective disorder score in the sham acupuncture group before and after treatment(P>0.05).There was no significant differences in MSQ-affective disorder score in the control group before and after treatment(P>0.05).8.Before treatment,compared with the healthy control group,the bilateral island leaves in the acupuncture group had stronger functional connection with the left thalamus,and the connection with the left superior parietal lobe,right superior temporal gyrus,and right cerebellum was weakened.The functional connection between bilateral islets and the left central posterior gyrus was weakened in the sham acupuncture group.In the control group,FC between bilateral insular lobe and right thalamus,left putamen,left lateral transverse gyrus,left anterior cingulum gyrus,and left medial frontal gyrus were reduced.The functional connection between bilateral insular lobe and the right occipital gyrus,right cerebellum,and left wedge lobe was weakened.9.Before treatment,the FC between the bilateral island leaf and the left anterior wedge in the acupuncture group was enhanced compared with the sham acupuncture group;while the,and FC between the bilateral island leaf and the left superior temporal gyrus,the left hippocampal gyrus and the right superior frontal gyrus were weakened.Compared with the control group,the FC between bilateral island lobes and the left caudate nucleus,the right cingulate gyrus and the right cerebellum in acupuncture group before treatment was enhanced;while the FC between bilateral island lobes and the left medial frontal gyrus,bilateral superior temporal gyrus,bilateral central anterior gyrus,and right hippocampal gyrus,left lateral transverse gyrus,and right lower corpus callosum were weakened.10.After the first treatment,the functional connection between the bilateral island lobe and bilateral cerebellum,the right parietal inferior lobule,the left middle frontal gyrus,and the left lower frontal gyrus in the acupuncture group was weakened compared to before.After the treatment period,the functional connection between the bilateral island leaves and the left caudate nucleus in the acupuncture group was stronger than that before treatment,and the functional connection with the left anterior wedge was weaker than that before treatment.The results showed that the FC of the bilateral islets and the right cerebellum and the right cingulate gyrus at the end of the treatment course in acupuncture group were enhanced compared with that after first treatment;while the FC between bilateral islets and the right precuneus is weakened.11.After the first treatment,the FC between the bilateral island leaflets and the right occipital gyrus in the sham acupuncture group was enhanced than before;while the FC between the bilateral island leaflets and left inferior parietal lobe,the left medial frontal gyrus,and the left precuneus was weakened than before.There was no significant change in the FC of bilateral island leaves before and after treatment in the sham acupuncture,and the difference was not statistically significant.Compared with the first treatment,there was no significant change in the FC of the bilateral island leaves at the end of the treatment in the sham acupuncture.12.After the course of treatment,the FC of the bilateral island leaves and bilateral central anterior gyrus,left anterior cingulate gyrus,right cingulate gyrus,left medial frontal gyrus,left paracentral lobule,left brainstem,right gyri temporales transversi,and right cuneus in the control group was weakened than before.13.Compared with the sham acupuncture group,the FC between the bilateral island leaves and the hippocampus in the acupuncture group was weakened after the first treatment.The functional connection between the bilateral island leaves in the acupuncture group was weakened than that in sham acupuncture group after the treatment,especially with the left lateral island lobe;while the FC between the bilateral island leaves and the left superior temporal gyrus and right superior frontal gyrus were weakened.14.Compared with the control group,the FC between the bilateral island leaves and the right precuneus and the right superior frontal gyrus in the acupuncture group was weakened after the treatment.Conclusion:1.Acupuncture has a significant clinical effect on migraine,which can effectively reduce the degree of pain and the frequency of attacks,enhance the quality of sleep and improve the daily life;while there is no significant effect of acupuncture on reducing the GAD-7 score.In general,acupuncture has better clinical efficacy on migraine than the sham acupuncture group and the control group,which is worth further research and clinical practice.2.It was found that the attack of migraine might be related to the changes of FC in the bilateral island leaf by selecting the bilateral island leaf as the seed region for FC analysis.The relevant brain regions mainly contain the thalamus,the superior temporal gyrus,gyri temporales transversi,cerebellum,cingulate gyrus,lobus frontal and cuneus.3.Acupuncture therapy may be able to regulate the FC between the island lobe and cingulate gyrus,lobus frontalis,cuneus and cerebellumto treat migraine.At the same time,the FC between the island lobe and the cerebellum may play a significant role on regulating sleep and improve the sleep disorders associated with migraine. |
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