The Use of Neuroimaging for Predicting Sumatriptan Treatment Response in Patients With Migraine

Abstract

ObjectivesTo identify the neuroimaging predictors for the responsiveness of patients to sumatriptan and use an independent cohort for external validation.MethodsStructuralized headache questionnaire and 3-Tesla brain magnetic resonance imaging were performed in migraine patients. Regional brain volumes were automatically calculated using FreeSurfer version 6.0, including bilateral amygdala, anterior cingulated cortex, caudate, putamen, precuneus, orbitofrontal cortex, superior frontal gyri, middle frontal gyri, hippocampus, and parahippocampus. A sumatriptan-responder was defined as headache relief within 2 h after the intake of sumatriptan in at least two out of three treated attacks. We constructed a prediction model for sumatriptan response using the regional brain volume and validated it with an independent cohort of migraine patients.ResultsA total of 105 migraine patients were recruited, including 73 sumatriptan responders (69.5%) and 32 (30.5%) non-responders. We divided the migraine patients into derivation (n = 73) and validation cohorts (n = 32). In the derivation cohort, left hippocampal volume was larger in sumatriptan responders (responders vs. non-responders: 3,929.5 ± 403.1 vs. 3,611.0 ± 389.9 mm3, p = 0.002), and patients with a larger left hippocampal volume had a higher response rate to sumatriptan (>4,036.2 vs. ≤4,036.2 mm3: 92.0 vs. 56.3%, p = 0.001). Based on the findings, we constructed a prediction model using the cutoff value of 4,036.2 mm3, and we found that patients with a left hippocampal volume >4,032.6 mm3 had a higher response rate to sumatriptan than those with a left hippocampal volume ≤4,032.6 mm3 (84.6 vs. 42.1%, odds ratio [OR] = 7.6 [95% confidence interval = 1.3–44.0], p = 0.013) in the validation cohort.ConclusionOur study showed that left hippocampal volume is helpful to identify sumatriptan non-responders. This proof-of-concept study shows that left hippocampal volume could be used to predict the treatment response to sumatriptan in migraine patients.

Imaging the brain and vascular reactions to headache treatments: a systematic review

“…One study [ 27 ] also explored morphometric brain features associated with a good triptan response, showing a lower volume of the left hippocampus in sumatriptan responders compared to non-responders. Even so, sumatriptan response was defined retrospectively and the between-group comparison was not adjusted for age, gender, or total intracranial volume, which may all influence hippocampal volume.…”

Prevalence of Ponticulus Posticus and Migraine in 220 Orthodontic Patients: A Cross-Sectional Study

“…The exclusion criteria were as follows: Age under 18; Non-Italian nationality; Low-quality images (e.g., due to patient movement); Incomplete region of interest (ROI); Head congenital anomalies or syndromic pathologies; Anamnesis positive for trauma or surgery of the neck; Anamnesis positive for traumatic injury or concussion of the brain; Anamnesis positive for more than 1 type of primary headache; Anamnesis positive for comorbidity with other medical conditions (e.g., epilepsy, diabetes mellitus, underlying hypertension, cerebrovascular diseases or other neurodegenerative disorders); Anamnesis positive for psychiatric conditions (anxiety disorders, schizophrenia bipolar disorders or major depressive disorders) [ 13 ]; Inability to provide a detailed history. …”

“…Anamnesis positive for psychiatric conditions (anxiety disorders, schizophrenia bipolar disorders or major depressive disorders) [ 13 ];…”

Migraine: from pathophysiology to treatment

“…Non-responsiveness to triptans may be categorized into refractory: failure of three triptans, one of which should be subcutaneous sumatriptan; and resistant: failure of at least two triptans [ 125 ]. Non-responsiveness can have a significant impact on health-related quality of life and work productivity [ 126 ] and has been linked by recent neuroimaging data to changes in hippocampal volume [ 127 ]. Importantly, even if clinical practice has not demonstrated strong drug-related cardiovascular risk [ 128 ], triptans are still contraindicated in at-risk patients due to their vasoconstrictive qualities [ 129 ].…”