Cortical and subcortical changes following sphenopalatine ganglion blocks in chronic migraine with medication overuse headache: a preliminary longitudinal study

Abstract

Objective: The purpose of this pilot study was to investigate potential changes in brain morphology (cortical thickness and cortical/subcortical volume) accompanying a series of sphenopalatine ganglion (SPG) blockade treatments in chronic migraine with medication overuse headaches (CM w/MOH). Background: Local anesthetization of the SPG via intranasal application is used for the treatment for multiple types of headache disorders, including CM. Our previous longitudinal fMRI study revealed improved network connectivity after such treatment. However, the impact of SPG blocks on cortical, subcortical gray matter volume and cortical thickness has yet to be assessed. Methods: Using magnetic resonance imaging (MRI), cortical/subcortical volume were measured in 12 chronic migraine patients before and after a series of 12 SPG blocks administered over a 6-week period (2 per week). The average time between MRI assessments was 6 weeks. Targeted, within-subjects t-tests comparing pre-treatment and post-treatment values in specific apriori brain regions of interest, including the hippocampus, amygdala, basal ganglia, somatosensory cortex, temporal cortex and occipital cortex, were used to estimate the impact of repetitive SPG blocks treatment on brain morphology in CM w/MOH. Results: Compared to baseline values, the number of moderate/severe headache days per month, HIT-6, PHQ-9 scores and allodynia scores were all significantly improved at the end of treatment. Analysis of MRI data revealed that the volume of the right hippocampus and the right palladium significantly decreased following SPG block treatment, while the volume of the left nucleus accumbens significantly increased following treatment. Cortical thickness in the left temporal pole and left lateral occipito-temporal gyrus significantly decreased following SPG block treatment. Conclusion: Our results suggest SPG block treatment is associated with significant symptom improvement as well as significant structural brain changes in regions known to be associated with migraine and chronic pain processing in CM w/MOH .

Tracking tDCS induced grey matter changes in episodic migraine: a randomized controlled trial

“…These studies, however, could show longitudinal dynamic cortical volumetric changes over one respectively four years as well as changes during the migraine cycle, speaking to the potential for plasticity of these structural alterations in migraineurs [ 28 , 29 , 57 ]. Another study tracked the morphometric changes in chronic migraineurs following sphenopalatine ganglion block over six weeks and similarly to our results found a change in cortical and subcortical morphology with improving migraine symptoms [ 30 ].…”

“…The results from several studies indicate that additionally to having altered functionality in terms of cortical excitability, migraineurs undergo structural changes in several cortical and subcortical areas related to perception and pain processing, including the occipital cortex, when comparing them to a healthy population [ 27 ]. Moreover, longitudinal observations suggest that these alterations are dynamic over time and respond to beneficial migraine treatment [ 28 – 30 ].…”

The under-recognized but essential role of the limbic system in the migraine brain: a narrative review

“…Psychiatric disorders Depression, anxiety, panic disorder, bipolar disorder, personality disorders, stress, suicide attempts [16][17][18][19][20][21][22][23][24][25][26][27][28][29] Sleep disorders Insomnia, parasomnias, restless leg syndrome, sleep apnea, poor sleep quality and duration [30][31][32][33][34][35] Chronic pain Fibromyalgia [36][37][38][39][40] Epilepsy Seizures, independent of type [41][42][43][44] Cognitive dysfunction Memory changes [45][46][47] Limbic system in migraine allow for the management of patients to be individualized and adjusted accordingly. Such approaches would be valuable in improving the treatment of migraine and its related problems.…”

Pain in midlife women: a growing problem in need of further research

“…Despite the small sample size, this is an important treatment study, which adds to our growing understanding of treatment-related brain changes associated with headache recovery in women with migraine. The fact that all women in the study had history of migraine for over a decade suggests the possibility of recovery even in long established disease states [ 41 ].…”

“…The potential long-term pathophysiologic consequences of migraine were explored in the original study by Newman-Norlund et al [ 41 ], illustrating the potential relevance of some emerging therapeutic modalities for active treatment of migraine in midlife women. Researchers assessed changes in cortical and subcortical brain volume on MRI in 12 patients with chronic migraine before and after treatment with sphenopalatine nerve blocks; a highly specialized in-office procedure.…”