A Bold-fMRI Study Of The Difference Of Central Response Of Acupuncture For Different Subtypes Of Menstrual Migraine Without Aure

Objection: This study used two subtypes of menstrual migraine without aura: Pure Menstrual Migraine(PMM)and Menstrually Related Migraine(MRM)patients,using resting-state functional MRI(ALFFand Re Ho)and Voxel-basedmorphometry techniques,to explore differences in brain structure and functional activities between PMM and MRM patients,and differences in the effects of acupuncture on central response patterns in PMM and MRM patients.To explain the central nervous mechanism for the treatment of two different types of menstrual migraine patients,and provides objective basis for analyzing the difference in the clinical efficacy of acupuncture for menstrual migraine without aura.Methods: A total of 44 subjects who met the inclusion criteria were included in the study,including 15 patients in the PMM group and 29 patients in the MRM group.All patients receive acupuncture treatment including GB20,GB8,PC6,SP6,LR3(On both sides).Total 27±6 sessions of acupuncture treatments were completed in 3 months.We completed the following analysis: 1.We compared the differences of the clinical indicators between PMM and MRM patients before and after the acupuncture treatments.2.Using VBM to analyze the morphological changes of PMM and MRM whole brain.Combining ALFF and Re Ho analysis to evaluate the changes and differences of brain function status in patients with PMM and MRM,and to explore the central response and activity characteristics of different subtypes of menstrual migraine.3.By comparing the difference of central response of acupuncture of PMM and MRM,we analyzed clinical and imaging data aiming to detect the correlation between clinical outcome improvements and fMRI signal changes after acupuncture,explore the regulating mechanism of acupuncture on resting-state functional networks patients with PMM and MRM.Results: 1.The clinical efficacy of acupuncture treatment of PMM and MRM(1)There were no significant differences in the demographic data between the PMM group and the MRM group,the number of menstrual headaches,the menstrual period headache time,the menstrual period headache VAS score,the menstrual period headache intensity,the HIT-6 score,SAS,SDS,and the course of disease.There was a significant difference in non-menstrual headaches,non-menstrual frequency of onset,non-menstrual headache VAS score,non-menstrual headache intensity,suggesting the frequency of onset of headaches in the non-menstrual period before treatment.(2)After three-months intervention,participants from Group PMM improved in menstrual requency of onset,VAS,HIT-6 score was statistically significant(P<0.05),There was no significant difference in SAS and SDS(P>0.05).While in Group MRM,not only had the frequency of menstrual period headache,VAS score,HIT-6 score improved significantly(P<0.05).The frequency of non-menstrual headache,VAS,intensity of headache,SDS also improved significantly(P<0.05).It is indicated that the MRM group is more susceptible to be adjusted and improved after acupuncture than the PMM group.(3)Comparison of clinical efficacy between groups: PMM group and MRM group were equally effective in menstrual requency of onset,VAS score,HIT-6 score.However,In terms of headache intensity the menstrual,and the frequency of non-menstrual headache,VAS score,non-menstrual headache intensity and SDS,the MRM group were better than the PMM group after acupuncture.2.The characters of brain structure differences between PMM and MRM patients VBM results: This study failed to find differences in the gray matter structure of the brain between the PMM group and the MRM group in the resting state.3.The characters of resting-brain activities in PMM and MRM patients(1)ALFF results: Baseline state,the ALFF of MRM patients in the left insula,right thalamus,frontal gyrus,occipital gyrus,lingual gyrus was significantly higher than PMM group;Correlation analysis between fMRI data and clinical disease indicators showed that the ALFF value of the left insula was significantly negatively correlated with the menstrual period of the MRM group(r=-0.417,P=0.025);the ALFF value of the right occipital mid-back There was a significant negative correlation with the HIT-6 score in the MRM group(r=-0.374,P=0.046).(2)Re Ho results:In the baseline state,the Re Ho of the MRM group in the left insula,the left dorsolateral prefrontal cortex,and the left lingual gyrus was significantly higher than that in the PMM group.In the left medial frontal gyrus and superior frontal gyrus,the Re Ho of MRM group was significantly lower than that in PMM group;Correlation analysis between fMRI data and clinical disease indicators showed that the Re Ho value of the left insula was significantly positively correlated with HIT-6(r=0.739,P=0.015)and SDS score(r=0.694,P=0.026)in the PMM group;Re Ho value and PMM in the left frontal gyrus There was a significant positive correlation between the number of headaches in the menstrual period(r=0.693,P=0.026).4.The influence of acupuncture on the resting-brain activities in PMM and MRM patients(1)ALFF results:(1)After treatment,the ALFF value of MRM in the right frontal middle gyrus,left frontal medial gyrus,left anterior wedge anterior lobe,and inferior parietal lobe was significantly increased,and the left front anterior cingulate gyrus and the right iliac crested The ALFF value of the right,inferior and inferior cerebral islands decreased significantly;(2)After treatment,the ALFF value of PMM in the right lingual gyrus was significantly increased after acupuncture treatment.(2)Re Ho results:(1)After treatment,the Re Ho of MRM group in the right left wedge anterior leaf,the frontal middle gyrus and the frontal gyrus was significantly increased,and the Re Ho value of the right iliac crest was significantly decreased;(2)After the treatment,the Re Ho of PMM group in the right cerebellar tonsil,mid-to-middle,and inferior gyrus was significantly reduced.(3).The relevant analysis results show:(1)There was a significant negative correlation between the increase of Re Ho value in the right anterior wedge of the MRM group and the improvement of the number of menstrual headaches(r=-0.416,P<0.05).(2)The increase of the ALFF value of the right lingual gyrus of the PMM group and HIT-6 The improvement in scoring showed a significant negative correlation(r =-0.614,P < 0.05).Conclusions: 1.There was no significant difference in gray matter volume between the PMM group and the MRM group.The frontal-island-occipital lobe is a brain region with significant differences in brain function between MRM and PMM.It is speculated that the difference in functional activities of the above brain regions may be a potential pathological mechanism that causes the clinical manifestations of MRM to be different from PMM.2.Acupuncture can improve the clinical symptoms,quality of life and mood disorders with varying degrees of patients with PMM and MRM.The clinical effect of acupuncture in MRM group is significantly better than that of PMM group.3.The anterior wedge-frontal cortex is the key brain area for acupuncture treatment of MRM.Tongue back is the key brain area for acupuncture treatment of PMM.The reason why PMM and MRM produce different changes in ALFF and Re Ho in different brain regions after acupuncture may be that the different response patterns of the central nervous system are also different.