Regular Practice of Autogenic Training Reduces Migraine Frequency and Is Associated With Brain Activity Changes in Response to Fearful Visual Stimuli.

Dóra Dobos,Gyöngyi Kökönyei,Lajos R Kozák,Dorottya Pap,Dániel Baksa,Gabriella Juhász,Natália Kocsel,Kinga Gecse,Edina Szabó,Terézia Zsombók

doi:10.3389/fnbeh.2021.780081

Abstract

Several factors can contribute to the development and chronification of migraines, including stress, which is undoubtedly a major trigger. Beyond pharmacotherapy, other treatment methods also exist, including behavioral techniques aiming at reducing patients’ stress response. However, the exact brain mechanisms underlying the efficacy of such methods are poorly understood. Our pilot study examined whether the regular practice of autogenic training (AT) induces functional brain changes and if so, how it could be associated with the improvement of migraine parameters. By exploring neural changes through which AT exerts its effect, we can get closer to the pathomechanism of migraine. In particular, we investigated the effect of a headache-specific AT on brain activation using an implicit face emotion processing functional MRI (fMRI) task in female subjects with and without episodic migraine. Our focus was on migraine- and psychological stress-related brain regions. After a 16-week training course, migraineurs showed decreased activation in the migraine-associated dorsal pons to fearful compared with neutral visual stimuli. We also detected decreasing differences in supplementary motor area (SMA) activation to fearful stimuli, and in posterior insula activation to happy stimuli between healthy subjects and migraineurs. Furthermore, migraineurs reported significantly less migraine attacks. These brain activation changes suggest that AT may influence the activity of brain regions responsible for emotion perception, emotional and motor response integration, as well as cognitive control, while also being able to diminish the activation of regions that have an active role in migraine attacks. Improvements induced by the training and the underlying neurophysiological mechanisms are additional arguments in favor of evidence-based personalized behavioral therapies.

Highlights

Being the third most prevalent disorder in the world, migraines affect more than 10% of the population (Bohm et al, 2018)
We used an implicit emotional processing functional magnetic resonance imaging (MRI) task, and we investigated whether the regular practice of autogenic training (AT) has any effect on brain activation patterns
Our pilot study is the first one investigating the effect of AT on brain activation of migraineurs compared with healthy controls

Summary

Introduction

Being the third most prevalent disorder in the world, migraines affect more than 10% of the population (Bohm et al, 2018). The pharmacotherapy of migraines consists of an acute treatment aimed at relieving pain and preventive therapy (prophylaxis) that intends to reduce the frequency and intensity of attacks. A series of promising new antimigraine targets has appeared (e.g., calcitonin gene-related peptide (CGRP) receptor antagonists, anti-CGRP monoclonal antibodies, anti-PACAP antibodies; Do et al, 2019), and some of them can be used in prophylaxis. Despite these developments, only a negligible proportion of patients receives appropriate preventive therapy at the moment (Katsarava et al, 2018). Evidence-based behavioral therapies could be viable alternatives or supplements to drug therapies (Holroyd et al, 2010)

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