Abstract
Migraine is a prevalent neurological disease that leads to severe headaches. Moreover, it is the commonest among the primary headaches that cause medication overuse headache (MOH). The orbitofrontal cortex (OFC) is one of the structures most associated with medication overuse. To determine microstructural changes in the OFC among migraine patients who developed MOH, through the diffusion tensor imaging (DTI) technique. Fifty-eight patients who had been diagnosed with migraine based on the Classification of Headache Disorders (ICHD-III-B) were included in the study. Patients were sub-classified into two groups, with and without MOH, based on the MOH criteria of ICHD-III-B. DTI was applied to each patient. The OFC fractional anisotropy (FA), and apparent diffusion coefficient (ADC) values of the two groups were compared. The mean age of all the patients was 35.98±7.92 years (range: 18-65), and 84.5% (n=49) of them were female. The two groups, with MOH (n=25) and without (n=33), were alike in terms of age, gender, family history, migraine with or without aura and duration of illness. It was found that there was a significant difference in FA values of the left OFC between the two groups (0.32±0.01 versus 0.29±0.01; p=0.04). An association was found between MOH and changes to OFC microstructure. Determination of neuropathology and factors associated with medication overuse among migraine patients is crucial in terms of identifying the at-risk patient population and improving proper treatment strategies specific to these patients.
Highlights
Migraine is the most common primary headache impacting the population of patients who are at a younger and more productive age[1]
It was determined that the mean orbitofrontal cortex (OFC) fractional anisotropy (FA) values of all patients were 0.29±0.05 × 10-3 mm2/s on the right side and 0.30±0.05 × 10-3 mm2/s on the left side; while the mean values of OFC apparent diffusion coefficient (ADC) was 8.27±0.61 × 10-3 mm2/s on the right side and 8.14±0.54 × 10-3 mm2/s on the left side
The patients were divided into two groups: those with medication overuse headache (MOH) and those without MOH
Summary
Migraine is the most common primary headache impacting the population of patients who are at a younger and more productive age[1]. Through hypofunctioning of the OFC, the inhibition mechanism is impaired[8], and this induces an increase in impulsivity and deterioration in reward and decision-making mechanisms[6,9] This is observed among substance abusers and contributes to development of MOH in migraine patients. It has been observed that hypometabolism in the OFC remained despite drug withdrawal, and it has been put forward that this might be associated with relapses among MOH patients[10] Given this information, we established the hypothesis of our research on the premise that MOH could develop as a result of behavioral pathologies induced by structural impairments in the OFC of migraine patients. We aimed to compare the OFC of patients with and without MOH, through the method of region of interest (ROI) based on DTI
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