Clinical Features Contributing to Cortical Thickness Changes in Chronic Migraine – A Pilot Study

Abstract

Objectives.-The objectives of this cross-sectional pilot study were threefold: to identify regions of cortical thickness that differentiate chronic migraine (CM) from controls, to assess group differences in interregional cortical thickness covariance, and to determine group differences in associations between clinical variables and cortical thickness.Background.-Cortical thickness alterations in relation to clinical features have not been adequately explored in CM. Assessment of this relationship can be useful to describe cortical substrates for disease progression in migraine and to identify clinical variables that warrant management emphasis.Methods.-Thirty CM cases (mean age 40 years; male-to-female 1:4) and 30 sex-matched healthy controls (mean age 40 years) were enrolled. Participants completed self-administered and standardized questionnaires assessing headache-related clinical features and common psychological comorbidities. T1-weighted brain images were acquired on a 3T MRI. A whole-brain cortical thickness analysis was performed. Additionally, correlations between all brain regions were assessed to examine interregional cortical thickness covariance. Interactions were analyzed to identify clinical variables that were significantly associated with cortical thickness.Results.-The whole brain cortical thickness analysis revealed no significant differences between CM patients and controls. However, significant associations between clinical features and cortical thickness were observed for the patients only. These associations included the right superior temporal sulcus (R 2 = 0.72, P = .001) and the right insula (R 2 = 0.71, P = .002) with distinct clinical variables ie, longer history of CM, posttraumatic stress disorder (PTSD), sleep quality, pain self-efficacy, and somatic symptoms. Higher interregional cortical covariance was found in CM compared to controls (OR = 3.1, CI 2.10-4.56, P < .0001), such that cortical thickness between regions tended to be more correlated in patients, particularly in the temporal and frontal lobes.Conclusion.-CM patients have significantly greater cortical covariance compared to controls. Cortical thickness in CM patients was predominantly accounted for by CM duration, PTSD, and poor sleep quality, while improved pain self-efficacy buffered cortical thickness. While it is important to address all CM features and comorbidities, it may be useful to emphasize optimizing the management of certain clinical features that contribute to cortical abnormalities including managing PTSD, early management to shorten duration of CM, and improving pain self-efficacy and sleep quality. Abbreviations: CM chronic migraine, CSF cerebrospinal fluid, EM episodic migraine, GAD-7 generalized anxiety disorder-7, GM gray matter, ICHD International Classification of Headache Disorders, IQR interquartile range, MIDAS migraine disability assessment, MOH medication overuse headache, PC-PTSD primary care posttraumatic stress disorder, PCS pain catastrophizing scale, PHQ-9 patient health questionnaire-9, ...

Altered Hypothalamic Region Covariance in Migraine and Cluster Headache: A Structural MRI Study

“…Several studies demonstrated stronger interregional cortical thickness correlations in patients with migraine specifically over temporal regions. Woldeamanuel and colleagues found stronger cortical thickness covariance patterns of frontal and temporal areas in patients with chronic migraine compared to HC . Similarly, results by Schwedt et al found that interregional cortical thickness correlations (specifically temporal pole correlations) distinguished groups of migraine patients from HC .…”

“…Woldeamanuel and colleagues found stronger cortical thickness covariance patterns of frontal and temporal areas in patients with chronic migraine compared to HC. 40 Similarly, results by Schwedt et al found that interregional cortical thickness correlations (specifically temporal pole correlations) distinguished groups of migraine patients from HC. 41 Although these studies focused on corticocortical thickness covariance patterns only, (and did not investigate hypothalamic region to cortical thickness covariance), these results further demonstrate some modification of structural covariance patterns in regions involved in pain-processing and multisensory integration.…”

Cortical Thickness in Migraine: A Coordinate-Based Meta-Analysis

“…Increased CTh in patients with migraine relative to HCs was observed in the left middle frontal sulcus (Messina et al, 2013), left temporo-occipital incisure (Messina et al, 2013), lateral occipital-temporal cortex (Zhang et al, 2017), and left occipital lobe (Gaist et al, 2018). In contrast, patients with migraine compared to HCs showed reduced CTh in the left superior frontal sulcus (Messina et al, 2013), left middle frontal gyrus (Kim et al, 2014;Magon et al, 2019), left precentral sulcus (Messina et al, 2013), bilateral central sulcus (Magon et al, 2019), bilateral postcentral gyri (Kim et al, 2014), right occipitotemporal area (Magon et al, 2019), left primary visual cortex (Magon et al, 2019), left secondary visual cortex (Magon et al, 2019), left anterior midcingulate (Hubbard et al, 2014), and insula (Maleki et al, 2015;Zhang et al, 2017), while several other studies did not detect any CTh differences between patients with migraine and HCs (Datta et al, 2011;Hougaard et al, 2016;Husøy et al, 2019;Woldeamanuel et al, 2019;Masson et al, 2020). These divergent results hinder us to obtain a clear picture of brain morphometry regarding CTh alterations in migraine.…”

“…After deleting the repetitive publications from the electronic database and manual searches, 250 records were screened. Based on the eligibility criteria, a total of 16 studies that reported 17 datasets were finally included in the CBMA (Datta et al, 2011;Maleki et al, 2012Maleki et al, , 2015Messina et al, 2013;Chong et al, 2014;Hubbard et al, 2014;Kim et al, 2014;Hougaard et al, 2016;Zhang et al, 2017;Gaist et al, 2018;Petrusic et al, 2018;Husøy et al, 2019;Magon et al, 2019;Woldeamanuel et al, 2019;Lai et al, 2020;Masson et al, 2020). .…”

Is there a reliable brain morphological signature for migraine?

“…VBM studies have shown that GM alterations are associated with attack frequency [5,30,35,40], disease duration [21,35], disease severity [23], aura [4], migraine cycle (during or between attacks) [20], long-term outcomes [5], the number of tablets taken per month [19], and medication overuse [24]. In addition, age and female gender are potential confounding factors that may affect GM alterations in migraine [9,[45][46][47]. Migraine is associated with higher rates of psychiatric disorders, such as major depression, bipolar disorder, and anxiety disorders [48].…”