1 University of South Carolina, Department of Neurology, Columbia, SC, USA.
2 University of South Carolina, Department of Psychology, Columbia, SC, USA.
Cephalalgia. 2018 Oct;38(11):1731-1741. doi: 10.1177/0333102417748570. Epub 2017 Dec 13.
Objective To investigate the intranetwork resting state fMRI connectivity within the Salience Network of chronic migraine with and without medication overuse headache. Methods We compared 351 pairs of intranetwork connectivity in chronic migraine (n = 13) and chronic migraine with medication overuse headache (n = 16) compared to matched controls, and between each chronic migraine subgroup. Results Compared to controls, 17 pairs of intranetwork connections in chronic migraine and 27 pairs in chronic migraine with medication overuse headache were decreased. When comparing chronic migraine with medication overuse headache versus chronic migraine, connectivity between bilateral extended amygdala, and between paracingulate to right ventral tegmental area/substantia nigra were decreased in chronic migraine (chronic migraine < chronic migraine with medication overuse headache). Connectivity between left dorsolateral prefrontal cortex to bilateral ventral striatum/pallidum, to bilateral dorsal anterior cingulate cortex; left anterior prefrontal cortex to contralateral orbitofrontal insula; and left ventral striatum/pallidum to ipsilateral supplementary motor area (SMA)/preSMA were decreased in chronic migraine with medication overuse headache (chronic migraine with medication overuse headache < chronic migraine). Conclusion Both chronic migraine subgroups had shared intranetwork connectivity abnormality, however, each subgroup had unique pattern of disruption within the salience network. The results suggest that the aberrant assignment of salience to external and internal stimuli plays an important role in chronic migraine and chronic migraine with medication overuse headache interictally, mostly involving mesolimbic pathways (especially bilateral extended amygdala) in chronic migraine, and prefrontal-subcortical limbic pathways in chronic migraine with medication overuse headache.
目的 探讨慢性偏头痛伴和不伴药物过度使用性头痛患者中突显网络内网络静息状态功能磁共振连接。
方法 我们比较了 351 对慢性偏头痛（n = 13）和慢性偏头痛伴药物过度使用性头痛（n = 16）与匹配对照，以及每个慢性偏头痛亚组之间的网络内连接。
结果 与对照组相比，慢性偏头痛中有 17 对网络内连接减少，慢性偏头痛伴药物过度使用性头痛中有 27 对网络内连接减少。当比较慢性偏头痛伴药物过度使用性头痛与慢性偏头痛时，双侧扩展杏仁核之间、旁中央回与右侧腹侧被盖区/黑质之间的连接在慢性偏头痛中减少（慢性偏头痛 < 慢性偏头痛伴药物过度使用性头痛）。左侧背外侧前额叶皮层到双侧腹侧纹状体/苍白球，到双侧背侧前扣带回皮质；左侧前前额叶皮层到对侧眶额回岛叶；以及左侧腹侧纹状体/苍白球到同侧辅助运动区（SMA）/前 SMA 的连接在慢性偏头痛伴药物过度使用性头痛中减少（慢性偏头痛伴药物过度使用性头痛 < 慢性偏头痛）。
结论 两个慢性偏头痛亚组都存在共享的网络内连接异常，但每个亚组在突显网络内都有独特的破坏模式。结果表明，突显对外部和内部刺激的异常分配在慢性偏头痛和慢性偏头痛伴药物过度使用性头痛发作间期起着重要作用，主要涉及中边缘通路（特别是双侧扩展杏仁核）在慢性偏头痛中，以及慢性偏头痛伴药物过度使用性头痛中的前额叶-皮质下边缘通路。
