Brain structural and functional changes during menstrual migraine: Relationships with pain

Abstract

ObjectivesMenstrual migraine (MM) is a special type of migraine associated with the ovarian cycle, which imposes a marked burden on female patients. However, the pathogenesis of MM is not completely understood. We investigated gray matter volume (GMV) and functional connectivity (FC) alterations in patients with MM to explore whether there are changes in resting-state FC (rsFC) in brain regions with structural GMV abnormalities and investigated their relevance to pain and concomitant symptoms.MethodsSeventy-five patients with MM and 54 female healthy controls underwent functional magnetic resonance imaging and examination. The patients completed a patient’s headache diary, which included the frequency of migraine attacks, a visual analog scale for pain, a self-rating anxiety scale, and a self-rating depression scale. We used voxel-based morphometry (VBM) to examine the GMV differences between the MM and healthy control groups. The identified brain areas were selected as seeds to assess functional changes in the MM group. Correlation analysis between the altered VBM/rsFC and clinical outcomes was performed.ResultsCompared with healthy controls, patients with MM showed decreased GMV in the right anterior cingulum cortex (ACC) and increased GMV in the right superior parietal cortex. Pearson’s correlation analysis illustrated that only GMV in the right ACC was associated with visual analogue scale pain scores in the MM group. RsFC with the ACC as the seed showed that patients with MM exhibited increased FC between the ACC and the left inferior temporal gyrus, bilateral angular gyrus, and right precuneus. Correlation analysis showed that the change in FC between the right ACC and the right precuneus was positively correlated with headache frequency, and the change in FC between the right ACC and the right angular gyrus was positively correlated with the depression score.ConclusionOur results suggested that the ACC may be an important biomarker in MM, and its structural and functional impairments are significantly associated with the severity of pain and pain-related impairment of emotion in patients with MM. These findings demonstrated that headache-associated structural and functional abnormalities in the ACC may can provide integrative evidence on the physiological mechanisms of MM.

Revealing the mechanism of central pain hypersensitivity in primary dysmenorrhea: evidence from neuroimaging

“…It may be involved in analgesic effects, and its stimulation may lead to impaired judgment of pain intensity and reduce perceived pain intensity ( 47 ). The altered function and structure of the superior parietal gyrus has also been found in other pain disorders ( 48 - 50 ). Therefore, the hypoconnectivity between the PAG and the superior parietal gyrus in this study may suggest the disorder of the descending pain modulation system.…”

Impaired Inter-Hemispheric Functional Connectivity during Resting State in Female Patients with Migraine

“…Recent brain fMRI studies supported the existence of functional differences between women and men, between migraine patients and HCs, and between female migraine patients with different hormone levels [ 6 , 29 ]. One study suggested that the FC impairments of the ACC were significantly correlated with pain severity, and pain-associated emotional disorders in menstrual migraine patients and, therefore, the ACC might be an important biomarker to differentiate migraines from HCs [ 30 ]. Additional research explored the difference in amplitude of low-frequency fluctuations and regional homogeneity between pure menstrual migraine and menstrually related migraine in the dorsolateral prefrontal cortex and medial prefrontal cortex [ 31 ].…”

Migraine: from pathophysiology to treatment

“…Occipital cortex involvement in particular can explain the plethora of visual symptoms associated with migraine, from light sensitivity to visual aura and visual snow [ 97 ]. Menstrual migraine has recently been linked to structural and functional connectivity changes in the right anterior cingulum [ 98 ] an area involved in the cognitive processing of pain and previously associated with migraine biology [ 99 ]. However, evidence from neuroimaging studies has been inconclusive at times [ 100 ], with meta-regression analyses failing to pinpoint alterations that are specific to migraine [ 101 ], showing that further research on the topic is needed.…”