| BackgroudMigraine is the second most common neurological disability,seriously affecting the life and work of patients.The majority of Migraine sufferers are Migraine without Aura(MwoA).Modern medicine mainly treats migraine with drugs,including preventive drugs in remission stage and analgesic drugs in acute stage.The use of these drugs has certain limitations,accompanied by many adverse reactions.Compared with drugs,acupuncture has significant advantages in the treatment of migraine,which can reduce the days of headache attack,relieve the degree of headache,improve depression and anxiety.At the same time,it has good security.Therefore,acupuncture is widely used in the treatment of migraine.In clinical practice,our team observed that the treatment of acupuncture combined thirteen needles of Du meridian with Shaoyang meridian has a significant efficacy in the treatment of MwoA patients.However,the pathophysiological mechanism of migraine is complex,and the central effect mechanism of treating migraine with the acupuncture needs further study and interpretation.ObjectiveIn this study,the patients with MwoA were taken as research objects.Diffusion tensor imaging and resting state functional magnetic resonance imaging were used to observe the abnormal changes in the activity level of white matter fibers and brain neurons in WMoA patients compared with healthy subjects,so as to explore the central pathogenesis of migraine.At the same time,the effect of acupuncture on headache related symptoms,anxiety and depression and quality of life in MwoA patients was evaluated by acupuncture with the thirteen acupuncture needles and Shaoyang meridian acupoints.On this basis,the regulation effect of the acupuncture method on the white matter fibers and neuronal activities of MwoA patients was observed,and the central effect mechanism of the acupuncture method in the treatment of migraine was discussed.MethodsThis study is divided into two parts.A total of 20 patients with MwoA and 20 healthy subjects matched in age,gender and education level were included in the first clinical study,functional magnetic resonance data were collected after enrollment,four parameters FA,MD,RD,and AD were collected from DTI,and the resting state functional magnetic resonance was processed by ReHo and ALFF,and the data between the two groups were statistically analyzed.A total of 13 patients with MwoA were included in the second clinical study,who received acupuncture twice a week for 6 weeks,and collected clinical data such as headache attack days,visual analogue score(VAS),Beck Depression Scale(BDI),Beck Anxiety Scale(BAI)headache impact test-6 questionnaire(HIT-6),and migraine patient quality of life questionnaire(MSQ)at weeks 0 and 6,and completed 2 functional magnetic resonance scans,and DTI collected four parameters of FA,MD,RD,and AD.Resting state functional magnetic resonance was processed by ReHo and ALFF,and finally the clinical data and functional magnetic resonance data were analyzed before and after and correlation analysis within the group.ResultsThe first clinical study1.The baseline data of MwoA patients and healthy subjects were balanced,and there were no statistical differences in gender,age,years of education and other data(P>0.05),which was comparable.2.No significant difference was found in the RD and AD values of white matter fiber tracts in MwoA patients compared with healthy subjects.The FA value of fornix was significantly increased(P<0.05),and the FA value of right anterior radiation crown was significantly decreased(P<0.05).AD in the right anterior limb of internal capsule,right uncinate bundle,right anterior radiative crown,right superior fronto-occipital bundle and right superior longitudinal bundle were significantly decreased(P<0.05),while the left hippocampus cingulate was significantly increased(P<0.05).3.Compared with healthy subjects,the ReHo values of the left supplementary motor area,the right supplementary motor area,the left ilerectus muscle and the left piniform globus pallidus in MwoA patients were significantly increased,with statistical significance(P<0.05),while the ReHo values of the left caudate nucleus,the left central sulci cap and the right anterior cuneus were significantly decreased.The difference was statistically significant(P<0.05).Compared with healthy subjects,the ALFF values of the left orbitofrontal gyrus,left hippocampus,left tongue gyrus,left inferior occipital gyrus,left middle temporal gyrus,left temporal pole:middle temporal gyrus and right temporal pole:middle temporal gyrus in MwoA patients were significantly increased,with statistical significance(P<0.05).ALFF values of right middle frontal gyrus and right superior marginal gyrus were significantly decreased,the difference was statistically significant(P<0.05).4.Compared with healthy subjects,the ALFF values of the left orbitofrontal gyrus,left hippocampus,left tongue gyrus,left inferior occipital gyrus,left middle temporal gyrus,left temporal pole:middle temporal gyrus and right temporal pole:middle temporal gyrus in MwoA patients were significantly increased,with statistical significance(P<0.05).ALFF values of right middle frontal gyrus and right superior marginal gyrus were significantly decreased,the difference was statistically significant(P<0.05).The second clinical study1.Compared with before acupuncture treatment,days of headache attack,VAS score,BDI score,BAI score and HIT-6 score were significantly decreased after acupuncture treatment,while MSQ score was significantly increased,with statistical significance(P<0.05).2.Compared with before acupuncture treatment,the RD value of the left corticospinal tract、the MD and AD value of the right corticospinal tract was significantly increased after acupuncture treatment(P<0.05),and the MD value of cerebrum foot and uncinate tract was significantly increased(P<0.05).3.In terms of ReHo,compared with before acupuncture treatment,there was no significant change after acupuncture(P>0.05).4.Compared with before acupuncture treatment,ALFF value of the right orbital superior frontal gyrus、the right amygdala and the temporal pole:middle temporal gyrus after acupuncture treatment was significantly increased,and the difference was statistically significant(P<0.05).ConclusionCompared with healthy subjects,MwoA patients had extensive changes in the activity levels of white matter fibers and brain neurons,including:The changes of neuronal activity in the fornix,the right anterior capsular limb,the right uncinate tract,the right anterior radiative crown,the right superior fronto-occipital tract,the right superior longitudinal tract and other fiber tracts included the default network,the limbic network,the frontal lobe,the occipital lobe,the sensorimotor network,the basal ganglia and other brain regions.In the treatment of MwoA patients,thirteen acupuncture needles combined with Shaoyang meridian acupoint acupuncture can not only improve headache symptoms,relieve depression and anxiety,and improve the quality of life of the patients,but also play a regulating role in the activity level of white matter fibers and brain neurons in MwoA patients.The specific regulating brain area may be the right temporal pole:middle temporal gyrus. |
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