Gomez-Beldarrain Marian, Oroz Isabel, Zapirain Begoña Garcia, Ruanova Begoña Fernandez, Fernandez Yolanda Garcia, Cabrera Alberto, Anton-Ladislao Ane, Aguirre-Larracoechea Urko, Garcıa-Monco Juan Carlos
Service of Neurology Hospital de Galdakao-Usansolo, Galdakao, 48960, Vizcaya, Spain.
DeustoTech-LIFE/eVIDA, Universidad de Deusto, Vizcaya, Spain.
J Headache Pain. 2015;17:4. doi: 10.1186/s10194-016-0593-1. Epub 2016 Feb 1.
Structural white matter abnormalities in pain-modulating, regions are present in migraine. Whether they are associated with pain chronification and with cognitive reserve is unclear.
Prospective, cohort, six-month study of adult patients with episodic or chronic migraine, and controls. Cognitive reserve, quality of life, impact of pain on daily living, depression and anxiety were assessed. Participants underwent a diffusion-tensor MRI to establish the integrity of white matter tracts of three regions of interest (ROIs) implicated in pain modulation, emotion, cognition and resilience (anterior insula, anterior cingulate gyrus, and uncinate fasciculus).
Fifty-two individuals were enrolled: 19 episodic migraine patients, 18 chronic migraine patients, and 15 controls. The analysis of the fractional anisotropy in the ROIs showed that those patients with the poorest prognosis (i.e., those with chronic migraine despite therapy at six months--long-term chronic migraneurs) had a significantly lower fractional anisotropy in the right ROIs. Participants with higher cognitive reserve also had greater fractional anisotropy in the right anterior insula and both cingulate gyri. Multivariate analysis showed a significant association between cognitive reserve, migraine frequency, and fractional anisotropy in the right-sided regions of interest.
Long-term chronic migraine patients show abnormalities in anterior white matter tracts, particularly of the right hemisphere, involved in pain modulation emotion, cognition and resilience. Robustness in these areas is associated with a higher cognitive reserve, which in turn might result in a lower tendency to migraine chronification.
偏头痛患者存在疼痛调节区域的白质结构异常。这些异常是否与疼痛慢性化及认知储备相关尚不清楚。
对发作性或慢性偏头痛成年患者及对照进行为期6个月的前瞻性队列研究。评估认知储备、生活质量、疼痛对日常生活的影响、抑郁和焦虑情况。参与者接受扩散张量磁共振成像，以确定与疼痛调节、情绪、认知和恢复力相关的三个感兴趣区域（前岛叶、前扣带回和钩束）白质束的完整性。
共纳入52人，其中发作性偏头痛患者19例，慢性偏头痛患者18例，对照15例。感兴趣区域分数各向异性分析显示，预后最差的患者（即6个月治疗后仍为慢性偏头痛患者——长期慢性偏头痛患者）右侧感兴趣区域分数各向异性显著降低。认知储备较高的参与者右侧前岛叶和双侧扣带回分数各向异性也更高。多变量分析显示，认知储备、偏头痛发作频率与右侧感兴趣区域分数各向异性之间存在显著关联。
长期慢性偏头痛患者在参与疼痛调节、情绪、认知和恢复力的前部白质束，尤其是右侧半球，存在异常。这些区域的稳固性与较高的认知储备相关，这反过来可能导致偏头痛慢性化倾向降低。
