Abstract
It is believed than hypothalamus (HTH) might be involved in generation of migraine, and evidence from high resolution fMRI reported that the more anterior part of HTH seemed to play an important role in migraine chronification. The current study was aimed to identify the alteration of morphology and resting-state functional connectivity (FC) of the hypothalamus (HTH) in interictal episodic migraine (EM) and chronic migraine (CM). High-resolution structural and resting-state functional magnetic resonance images were acquired in 18 EM patients, 16 CM patients, and 21 normal controls (NC). The volume of HTH was calculated and voxel-based morphometry (VBM) was performed over the whole HTH. Receiver operating characteristics (ROC) curve analysis was applied to evaluate the diagnostic efficacy of HTH volume. Correlation analyses with clinical variables were performed and FC maps were generated for positive HTH regions according to VBM comparison. The volume of the HTH significantly decreased in both EM and CM patients compared with NC. The cut-off volume of HTH as 1.429 ml had a good diagnostic accuracy for CM with sensitivity of 81.25% and specificity of 100%. VBM analyses identified volume reduction of posterior HTH in EM vs. NC which was negatively correlated with headache frequency. The posterior HTH presented decreased FC with the left inferior temporal gyrus (Brodmann area 20) in EM. Decreased volume of anterior HTH was identified in CM vs. NC and CM vs. EM which was positively correlated with headache frequency in CM. The anterior HTH presented increased FC with the right anterior orbital gyrus (AOrG) (Brodmann area 11) in CM compared with NC and increased FC with the right medial orbital gyrus (MOrG) (Brodmann area 11) in CM compared with EM. Our study provided evidence of structural plasticity and FC changes of HTH in the pathogensis of migraine generation and chronification, supporting potential therapeutic target toward the HTH and its peptide.
Highlights
Migraine is a common disabling primary headache disorder characterized by multiphase attacks of headache and a number of accompanying symptoms
All the patients should fulfill the International Classification of Headache Disorders, 3rd Edition (ICHD-III) criteria of episodic or chronic migraine without aura [1], and the inclusion criteria was as follows: [1]The diagnosis of migraine refers to 1.1 Migraine without aura; [2] episodic migraine (EM) is defined as migraine attack days being
Visual Analog Scale (VAS) showed no significance between EM and CM (P = 0.37)
Summary
Migraine is a common disabling primary headache disorder characterized by multiphase attacks of headache and a number of accompanying symptoms. CM affects approximately 2% of the adult population in western countries, Altered Hypothalamus Volume in Chronic Migraine imposing substantial burdens on individual sufferers, their families and society. This disorder is highly disabling and prevalent, it remains largely underdiagnosed and undertreated [2]. The chronification occurs in about 2.5% or more of episodic cases annually [3, 4]. The underlying pathophysiologic mechanisms leading to migraine chronification are still unknown
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