| Background: Migraine is an episodic disease which may transform to a chronicform. The most common cause of migraine chronicity is medication overuse. Chronicmigraine plus medication-overuse headache (CM-MOH) and CM without MOH(CMwoMOH) are quite different in pathophysiology and treatment choice. The use ofadvanced neuroimaging techniques has revealed functional and structural changes incertain pain processing networks of migraine patients which may reflectpathophysiological changes of migraine in some way.Objective: We aimed to detect the differences of clinical features and brain graymatter volume in patients with episodic migraine (EM) and chronic headache with orwithout medication overuse in order to investigate possible biomarkers of migrainechronification.Methods:110subjects were included comprising44patients with CM-MOH,16patients with CMwoMOH,18patients with EM and32healthy controls (HCs).General headache information, migraine disability, quality of life, anxiety, depressionand cognitive function were collected. Voxel-based morphometry (VBM) of MRI wasemployed to analyze the different volume of brain gray matter between groups.Results: The participants of each group were age and sex matched. The scores ofMigraine Disability Assessment score (MIDAS) were significantly higher in patientswith CM-MOH and CMwoMOH than with EM. The scores of Hamilton AnxietyScale(HAMA) and Hamilton Depression Scale (HAMD) were significantly higher inpatients of the three headache groups than HCs. Compared to patients with EM, thosewith CM-MOH were more depressive and those with CMwoMOH were moreanxious(p<0.05). Cognitive function did not differ among groups evaluated byMini-Mental State Examination (MMSE) but declined in patients with CM-MOH and CMwoMOH when evaluated by Montreal Cognitive Assessment (MoCA).The globalgray matter volume (GMV) did not differ significantly among groups but waspositively related to body mass index (BMI) and male gender, negatively related to age,years of chronicity and HAMD. Compared with HCs, local GMV of middle temporalpole decreased in all the three patient groups. GMV of right superior and middleorbitofrontal gyrus, right inferior temporal gyrus and cerebellum crus1decreased inCM-MOH and CMwoMOH groups whereas that of right inferior temporal gyrus andcerebellum crus1of EM patients increased. Besides, GMV of left gyrus rectus, middlecingulate gyrus, bilateral insula, right Rolandic Operum, left inferior occipital gyrus,bilateral precuneus gyrus, right calcarine decreased in CM-MOH group. GMV of rightmiddle frontal gyrus, Rolandic Operum, right precentral gyrus, left postcentral gyrus,left superior occipital lobe increased in patients with EM and CMwoMOH.Furthermore, CMwoMOH patients had significantly increased GMV in bilateralcaudate. nucleus. GMV of temporal pole, inferior temporal gyrus, anterior cingulategyrus, and orbitofrontal cortex was negatively correlated with years of chronicheadache and/or headache frequency.Conclusion: Patients of chronic migraine with or without medication overusehave more serious emotional disorder, cognitive dysfunction and migraine disability.GMV of several brain regions decreased or increased in migraine patients. During thechronification of migraine, the medial affective pain pathways were predominantlyinvolved which included GMV reduction in orbitofrontal cortex, middle and anteriorcingulate gyrus, insula and emotional and cognitive related area including inferiortemporal gyrus, temporal pole and cerebellum crus1. GMV increased in bilateralcaudate nucleus in CMwoMOH patients, which may be a biomarker to differentiateCMwoMOH from CM-MOH. Furthermore, GMV of Rolandic Operum decreased inCM-MOH patients but increased in EM and CMwoMOH patients, which may play arole in the pathophysiology of CM-MOH. |
PDF Full Text Request