New insight into the neural mechanisms of migraine in adolescents: Relationships with sleep

Abstract

Objective: This case-control study examines if measures of subjective and objective (actigraphic) sleep difficulties mediate alterations in amygdalar connectivity in adolescents with migraine compared to healthy adolescents. Background: Adolescents with migraine have different functional connectivity of the amygdala compared to individuals without migraine. Sleep is often disturbed in adolescents with migraine, and could contribute to the alterations in functional connectivity. Methods: Twenty adolescents with migraine and 20 healthy controls were recruited from Cincinnati Children's Hospital. Participants completed surveys about their headaches and overall sleep quality, sleep hygiene, and perceived sleep difficulties (Insomnia Severity Scale [ISI]); completed wrist-worn actigraphy; and underwent a magnetic resonance imaging scan.Results: Adolescents with migraine differed from healthy controls only in perceived difficulty in sleep initiation and maintenance (ISI: 8.5 ± 4.7 and 4.5 ± 3.7[mean ± standard deviation], −4.00 [95% confidence: −6.7 to −1.3], p = 0.005) and had greater functional connectivity between the amygdala and the posterior cingulate cortex, precuneus, dorsolateral prefrontal, sensorimotor, and the occipital cortexes.

Amygdalar functional connectivity during resting and evoked pain in youth with functional abdominal pain disorders

“…Healthy controls were male and female participants aged between 12 and 17 years and without chronic pain syndrome who were recruited as part of a separate investigation. 49 All participants were recruited between 2016 and 2019. Participants (in FAPD and HC groups) were ineligible based on the presence of the following conditions: evidence of pregnancy; a neurological disorder; MRI counterindications (eg, orthodontic braces or other metallic implants that obscure or interfere with the MRI); and claustrophobia, other significant medical conditions (eg, inflammatory bowel disease [IBD], diabetes), or a documented developmental delay.…”

“…Therefore, neuroimaging changes after the WL-SPT were examined for participants with FAPD only, which constituted the primary aim of the study. The exploratory aim used HC data obtained from a separate project 49 to compare resting-state baseline neuroimaging data in youth with FAPD with those of HCs (all scans compared were in the absence of the WL-SPT). The study was approved by the IRB committee of Cincinnati Children's Hospital Medical Center, and written informed consent from a parent/guardian and participant assent were obtained before performing study procedures.…”

“…To identify alterations in amygdalar connectivity in participants with FAPD, we compared the baseline resting-state functional connectivity (before WL-SPT) of the patient group with HC data collected in parallel (2016-2017) for another study. 49 In this analysis, third-level random effects analyses (FMRIB's Local Analysis of Mixed Effects, FLAME 1 + 2) were used to identify differences in resting-state FC between participants with FAPD and HCs. Clusters of connectivity were identified using a threshold of Z > 2.3.…”

Glutamate, GABA and glutathione in adults with persistent post-concussive symptoms

“…In this study, metabolites were quantified in the anterior cingulate cortex (ACC) and right sensorimotor cortex (RSM) as these regions are functionally relevant to mTBI symptoms given their respective roles in executive function/emotional regulation and sensory processing ( Stevens et al, 2011 , Borich et al, 2015 ). Additionally, the ACC and RSM are relevant target regions as they have both been linked to headache ( Obermann et al, 2009 , Qin et al, 2020 , Peek et al, 2021 , Messina et al, 2022 , Nahman‐Averbuch et al, 2022 ), one of the most common sequelae of mTBI ( Ashina et al, 2019 ).…”

Virtual issue: Recent advances in pediatric headache: Bridging the data gap

“…4 In this issue, we begin to identify the ways in which sleep may be related to migraine pathophysiology at the neural level, which could inform novel interventions focused on improving sleep quality in our patients. 5 However, there remains much to uncover about neuromodulatory pathways in headache disorders; this includes the interaction between environmental factors (like sleep) and headache, as well as basic headache pathophysiology in children and adolescents.…”