Abstract
Menstrually-related migraine without aura refers to a specific type of migraine that is associated with the female ovarian cycle. Compared with non-menstrual migraine without aura, in menstrually-related migraine without aura, there are additional attacks of migraine outside of the menstrual period. Menstrually-related migraine without aura tends to be less responsive to acute treatment and more prone to relapse than non-menstrual migraine without aura. Currently menstrually-related migraine without aura is treated no differently from any other migraine but, the differences in the central mechanisms underlying menstrually-related migraine without aura and non-menstrual migraine without aura remain poorly understood. Here, using resting-state functional magnetic resonance imaging and graph theory approaches, we aimed to explore the differences in topological properties of functional networks in 51 menstrually-related migraine without aura patients and 47 non-menstrual migraine without aura patients. The major finding of our study was that significant differences in topological properties between the two groups were mainly evident in the nodal centrality of the inferior frontal gyrus and the thalamus. Nodal centrality in inferior frontal gyrus was negatively correlated with Headache Impact Test questionnaire scores in the menstrually-related migraine without aura patients. Partial least squares correlation analysis revealed enhanced correlations of inferior frontal gyrus to pain-related behavior in the non-menstrual migraine without aura group, while within the menstrually-related migraine without aura group these effects were non-significant. These results indicate that the regulatory mechanisms in the central nervous system may differ between the two subtypes of migraine. The results provide novel insights into the pathophysiology of different subtypes of migraine, and could help us to enhance their clinical diagnosis and treatment.
Highlights
Migraine is an idiopathic headache disorder that is characterized as moderate to severe intensity, and is often associated with a combination of symptoms, including nausea, vomiting, tiredness, phonophobia, and photophobia (May 2009)
We found no statistical differences between the Menstrually-related migraine without aura (MRM) and non-menstrual migraine without aura (NMM) groups in terms of their age, height, weight, disease duration, attack frequency, visual analogue scale (VAS) score, or duration of migraine attack, or in any subscales of the Migraine-Specific Quality of Life Questionnaire (MSQ)
We found that the degree centrality (DC) in the inferior frontal gyrus (IFG) of MRM patients was negatively correlated with their HIT-6 scores (p = 0.012, r = −0.349; Fig. 2), but an equivalent correlation was not found in the NMM group
Summary
Migraine is an idiopathic headache disorder that is characterized as moderate to severe intensity, and is often associated with a combination of symptoms, including nausea, vomiting, tiredness, phonophobia, and photophobia (May 2009). A decline in estrogen levels in MRM patients may have a facilitating effect on the development of central sensitization, causing changes in the pain threshold of trigeminal neurons (Martin et al 2007; Welch et al 2006) These changes may be responsible for the stronger migraine attacks in patients with MRM rather than NMM (Güven et al 2017). Ovarian hormones could modulate these pathways to increase the frequency, severity, or duration of MRM (Martin and Behbehani 2006) In light of such differences in MRM and NMM, an investigation of the pathogenic mechanisms in the two different subtypes of migraine may help the development of effective and innovative treatments for clinical application
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