Abstract
It remains unknown whether migraine headache has a progressive component in its pathophysiology. Quantitative MRI may provide valuable insight into abnormal changes in the migraine interictum and assist in identifying disrupted brain networks. We carried out a data-driven study of structural integrity and functional connectivity of the resting brain in migraine without aura. MRI scanning was performed in 36 patients suffering from episodic migraine without aura and 33 age-matched healthy subjects. Voxel-wise analysis of regional brain volume was performed by registration of the T1-weighted MRI scans into a common study brain template using the tensor-based morphometry (TBM) method. Changes in functional synchronicity of the brain networks were assessed using probabilistic independent component analysis (ICA). TBM revealed that migraine is associated with reduced volume of the medial prefrontal cortex (mPFC). Among 375 functional brain networks, resting-state connectivity was decreased between two components spanning the visual cortex, posterior insula, and parietal somatosensory cortex. Our study reveals structural and functional alterations of the brain in the migraine interictum that may stem from underlying disease risk factors and the “silent” aura phenomenon. Longitudinal studies will be needed to investigate whether interictal brain changes are progressive and associated with clinical disease trajectories.
Highlights
The current state of clinical practice in migraine is focused on reducing disease morbidity and frequency of headache attacks
There is ongoing debate regarding the potential long-term impacts of migraine on brain integrity and various domains of cognitive function, raising the critical question of whether migraine is accompanied by some progressive neuropathology with irreversible outcomes [1, 2]
There are a number of rare migraine-resembling disorders caused by disruption of single genes, such as CADASIL, MELAS, and subtypes of familial hemiplegic migraine; in these disorders, recurrent headache is accompanied by serious complications including arteriopathy, subcortical infarcts, and brain atrophy [4]
Summary
The current state of clinical practice in migraine is focused on reducing disease morbidity and frequency of headache attacks. There are a number of rare migraine-resembling disorders caused by disruption of single genes, such as CADASIL, MELAS, and subtypes of familial hemiplegic migraine; in these disorders, recurrent headache is accompanied by serious complications including arteriopathy, subcortical infarcts, and brain atrophy [4]. This line of evidence may indicate that chronic headache and progressive neuropathology sometimes share some close genetic and biological underpinnings. Association of migraine without aura, the most prevalent subtype of migraine, with subclinical brain pathology remains elusive
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