Structural Brain Changes Are Associated with Pain Sensitivity in New Daily Persistent Headache

Abstract

New daily persistent headache (NDPH) is a rare form of chronic daily headache with poorly understood pathophysiology. The aim of this study was to investigate for the first time the presence of possible brain changes in pediatric NDPH and their associations with pain-related measures. Structural images were acquired for 13 patients with NDPH and 13 pain-free, healthy controls using magnetic resonance imaging (20 females, 12-18 years old, mean age=16.1, SD=1.6). In patients, brain changes were correlated with disease duration, pain intensity ratings, pain sensitivity, and functional disability. Deceased cortical thickness was found in the bilateral superior temporal gyrus, left superior frontal gyrus, and left middle frontal gyrus areas in patients with NDPH compared to controls (cluster-wise threshold of p<0.05, Monte Carlo corrected). In addition, decreased cortical thickness in the left superior frontal gyrus was associated with elevated pain sensitivity in NDPH. Our results might represent abnormal pain modulation in NDPH including increased pain sensitivity through cognitive control processes in the developing brain. The detected brain changes could help understand the underlying mechanisms of NDPH that could guide future investigations and personalized therapeutic interventions. This study was primarily supported by Migraine Research Foundation (NCT03447782).