Early Onset Diffusion Abnormalities in Refractory Headache Disorders

Author:

Santoro Jonathan D.,Moon Peter K.,Han Michelle,McKenna Emily S.,Tong Elizabeth,MacEachern Sarah J.,Forkert Nils D.,Yeom Kristen W.

Abstract

ObjectiveThis study sought to determine if individuals with medically refractory migraine headache have volume or diffusion abnormalities on neuroimaging compared to neurotypical individuals.BackgroundNeuroimaging biomarkers in headache medicine continue to be limited. Early prediction of medically refractory headache and migraine disorders could result in earlier administration of high efficacy therapeutics.MethodsA single-center, retrospective, case control study was performed. All patients were evaluated clinically between 2014 and 2018. Individuals with medically refractory migraine headache (defined by ICDH-3 criteria) without any other chronic medical diseases were enrolled. Patients had to have failed more than two therapeutics and aura was not exclusionary. The initial MRI study for each patient was reviewed. Multiple brain regions were analyzed for volume and apparent diffusion coefficient values. These were compared to 81 neurotypical control patients.ResultsA total of 79 patients with medically refractory migraine headache were included and compared to 74 neurotypical controls without headache disorders. Time between clinical diagnosis and neuroimaging was a median of 24 months (IQR: 12.0–37.0). Comparison of individuals with medically refractory migraine headache to controls revealed statistically significant differences in median apparent diffusion coefficient (ADC) in multiple brain subregions (p < 0.001). Post-hoc pair-wise analysis comparing individuals with medically refractory migraine headache to control patients revealed significantly decreased median ADC values for the thalamus, caudate, putamen, pallidum, amygdala, brainstem, and cerebral white matter. No volumetric differences were observed between groups.ConclusionsIn individuals with medically refractory MH, ADC changes are measurable in multiple brain structures at an early age, prior to the failure of multiple pharmacologic interventions and the diagnosis of medically refractory MH. This data supports the hypothesis that structural connectivity issues may predispose some patients toward more medically refractory pain disorders such as MH.

Publisher

Frontiers Media SA

Subject

Neurology (clinical),Neurology

Cited by 3 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. Refractory migraine;Neurology, Neuropsychiatry, Psychosomatics;2024-04-24

2. Resistant and refractory migraine: clinical presentation, pathophysiology, and management;eBioMedicine;2024-01

3. Protocolo diagnóstico y terapéutico de la cefalea crónica diaria;Medicine - Programa de Formación Médica Continuada Acreditado;2023-02

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