Structural changes of cerebellum and brainstem in migraine without aura

Zhaoxia Qin,Rong Zhao,Shiyu Ban,Xiao-Lei Shen,Jilei Zhang,Xiaoxia Du,Xin-Wei He,Yan-Hui Shi,Ge-Fei Li,Jianqi Li,Jian-Ren Liu,Shuai Xu,Yi-Sheng Liu,Yue Hu,Jingjing Su,Mei-Ting Zhuang

doi:10.1186/s10194-019-1045-5

Abstract

BackgroundIncreasing evidence has suggested that the cerebellum is associated with pain and migraine. In addition, the descending pain system of the brainstem is the major site of trigeminal pain processing and modulation and has been discussed as a main player in the pathophysiology of migraine. Cerebellar and brainstem structural changes associated with migraineurs remain to be further investigated.MethodsVoxel-based morphometry (VBM) (50 controls, 50 migraineurs without aura (MWoAs)) and diffusion tensor imaging (DTI) (46 controls, 46 MWoAs) were used to assess cerebellum and brainstem anatomical alterations associated with MWoAs. We utilized a spatially unbiased infratentorial template toolbox (SUIT) to perform cerebellum and brainstem optimized VBM and DTI analysis. We extracted the average diffusion values from a probabilistic cerebellar white matter atlas to investigate whether MWoAs exhibited microstructure alterations in the cerebellar peduncle tracts.ResultsMWoAs showed decreased fractional anisotropy (FA) in the vermis VI extending to the bilateral lobules V and VI of the cerebellum. We also found higher axial diffusivity (AD), mean diffusivity (MD), and radial diffusivity (RD) in the right inferior cerebellum peduncle tract in MWoAs. MWoAs exhibited both reduced gray matter volume and increased AD, MD and RD in the spinal trigeminal nucleus (SpV).ConclusionMWoAs exhibited microstructural changes in the cerebellum and the local brainstem. These structural differences might contribute to dysfunction of the transmission and modulation of noxious information, trigeminal nociception, and conduction and integration of multimodal information in MWoAs. These findings further suggest involvement of the cerebellum and the brainstem in the pathology of migraine without aura.

Highlights

Migraine is a common and disabling neurological disorder that manifests as moderate to severe intensity headaches generally combined with nausea, vomiting, and hypersensitivity to visual, auditory, and olfactory stimuli [1, 2]
Changes in diffusion characteristics (DTI) Compared with controls, Migraineurs without aura (MWoAs) had decreased fractional anisotropy (FA) at the vermis VI extending to the bilateral lobule V and the bilateral lobule VI of the cerebellum (Table 2, Fig. 1)
Cerebellar tract analysis revealed that MWoAs had higher axial diffusivity (AD), mean diffusivity (MD) and radial diffusivity (RD) in the right inferior cerebellum peduncle (ICP) (Table 3, Fig. 2)

Summary

Introduction

Migraine is a common and disabling neurological disorder that manifests as moderate to severe intensity headaches generally combined with nausea, vomiting, and hypersensitivity to visual, auditory, and olfactory stimuli [1, 2]. In the past decade, increasing evidence has suggested that the cerebellum is associated with pain and migraine [5,6,7,8,9]. Recent studies demonstrated the involvement of the cerebellum in human nociception [13], and even suggest a modulating role in pain perception [14]. Migraine research found an increased prevalence of ischemic lesions in the cerebellar posterior lobe of migraineurs [17]. Previous study found the volumes of the cerebellum and brainstem were smaller in chronic migraine compared to healthy controls[20]. Cerebellar anatomy alterations associated with migraineurs need further investigated. Increasing evidence has suggested that the cerebellum is associated with pain and migraine. Cerebellar and brainstem structural changes associated with migraineurs remain to be further investigated

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Conclusion