Department of Neurology, Mayo Clinic, Phoenix, AZ, USA.
School of Electrical, Computer and Energy Engineering and Department of Speech and Hearing Science, Arizona State University, Tempe, AZ, USA.
Headache. 2018 Jan;58(1):53-61. doi: 10.1111/head.13223. Epub 2017 Nov 15.
To investigate differences in cortical thickness in patients with persistent post-traumatic headache (PPTH) relative to healthy controls and to interrogate whether cortical morphology relates to headache burden (headache frequency, years with post-traumatic headache, PTH) in patients with PPTH.
PTHs are one of the most common symptoms following concussion. In some patients, PTHs continue for longer than three months and are classified as PPTH. This study has two main goals: (1) To delineate the neuropathology of PPTH, by interrogating differences in cortical thickness in patients with PPTH relative to healthy controls. (2) To interrogate potential associations between brain morphology and headache burden in patients with PPTH by examining whether cortical thickness relates to frequency of headaches or years lived with PTH.
Adults with PPTH diagnosed according to ICHD 3 beta diagnostic criteria and healthy controls underwent brain MRI on a 3 Tesla scanner. Vertex-by-vertex whole brain estimates of cortical thickness were automatically calculated using FreeSurfer v5.3. Differences in cortical thickness in patients with PPTH relative to healthy controls were determined using a general linear model design. Associations were explored between regional clusters where patients with PPTH showed cortical thickness differences compared with healthy controls with headache frequency and years lived with PPTH.
This study included 33 patients with PPTH and 33 healthy control subjects (healthy controls: median age = 33.0, IQR = 15.5; patients with PPTH: median age = 36.0, IQR = 20.5; P = .56). Patients with PPTH had less cortical thickness relative to healthy controls in the left and right superior frontal, caudal middle frontal, and precentral cortex as well as less cortical thickness in the right supramarginal, right superior and inferior parietal, and right precuneus region (P < .05, Monte Carlo corrected for multiple comparisons). There were no regions where patients with PPTH had more cortical thickness relative to healthy controls. A correlation analysis of regions that showed less cortical thickness in patients with PPTH demonstrated a negative correlation between left and right superior frontal thickness with headache frequency (P < .05). There was no association between regional cortical thickness and years lived with PPTH.
Compared with healthy controls, patients with PPTH had less cortical thickness in bilateral frontal regions and right hemisphere parietal regions. For patients with PPTH, more frequent headaches were related to less thickness in the left and right superior frontal regions, potentially indicating that brain morphology changes in the superior frontal regions in patients with PPTH are modified by headache frequency.
研究持续性创伤后头痛（PPTH）患者与健康对照组之间皮质厚度的差异，并探讨皮质形态是否与 PPTH 患者的头痛负担（头痛频率、创伤后头痛持续时间）相关。
创伤后头痛是脑震荡后最常见的症状之一。在一些患者中，头痛持续时间超过三个月，并被归类为 PPTH。本研究有两个主要目标：（1）通过研究 PPTH 患者与健康对照组之间皮质厚度的差异，描绘 PPTH 的神经病理学。（2）通过检查皮质厚度是否与头痛频率或 PTH 持续时间相关，探讨 PPTH 患者脑形态与头痛负担之间的潜在关联。
根据 ICHD 3β诊断标准诊断为 PPTH 的成年人和健康对照者在 3T 扫描仪上进行脑部 MRI。使用 FreeSurfer v5.3 自动计算顶点到顶点的皮质厚度全脑估计值。使用一般线性模型设计确定 PPTH 患者与健康对照组之间皮质厚度的差异。比较了患者与健康对照组之间皮质厚度存在差异的区域与头痛频率和 PTH 持续时间之间的相关性。
本研究纳入了 33 名 PPTH 患者和 33 名健康对照者（健康对照组：中位年龄=33.0，IQR=15.5；PPTH 患者：中位年龄=36.0，IQR=20.5；P=0.56）。与健康对照组相比，PPTH 患者的左侧和右侧额上回、额中下回后部以及中央前回皮质厚度较低，右侧缘上回、顶下小叶和楔前叶皮质厚度也较低（P<0.05，经蒙特卡罗校正后用于多次比较）。患者与健康对照组相比，没有任何区域皮质厚度更高。对患者皮质厚度较低的区域进行相关性分析表明，左侧和右侧额上回厚度与头痛频率呈负相关（P<0.05）。区域皮质厚度与 PTH 持续时间无关联。
与健康对照组相比，PPTH 患者双侧额区和右侧顶叶区皮质厚度较低。对于 PPTH 患者，更频繁的头痛与左侧和右侧额上回厚度较低有关，这可能表明 PPTH 患者额上回的脑形态变化与头痛频率有关。
