Department of Radiology, Chinese People's Liberation Army General Hospital, Beijing 100853; Department of Radiology, Hainan Branch of Chinese People's Liberation Army General Hospital, Sanya, Hainan 572013; Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing 100853, China.
Chin Med J (Engl). 2018 Sep 20;131(18):2158-2163. doi: 10.4103/0366-6999.240807.
Histopathology identified the anatomical and molecular abnormalities of brainstem nuclei in migraine patients. However, the exact whole brainstem structural changes in vivo have not yet been identified in medication-overuse headache (MOH) transformed from migraine. The aim of this study was to investigate the regional volume changes over the whole brainstem in the MOH patients using voxel-based morphometry (VBM) in vivo.
High-resolution three-dimensional structural images were obtained using a 3.0-Tesla magnetic resonance system from 36 MOH patients and 32 normal controls (NCs) who were consecutively recruited from the International Headache Center, Chinese People's Liberation Army General Hospital, from March 2013 to June 2016. VBM was used to assess the brainstem structural alteration in the MOH patients, and voxel-wise correlation was performed to evaluate the relationship with the clinical characteristics.
The brainstem region with increased volume located in the left ventrolateral periaqueductal gray (MNI coordinate: -1, -33, -8), ventral tegmental area (MNI coordinate: 0, -22, -12), bilateral substantia nigra (MNI coordinate: -8, -16, -12, 9, -16, -12), and trigeminal root entry zone (MNI coordinate: -19, -29, -31; 19, -32, -29) in MOH patients compared with NCs. The headache visual analog scale score was positively related with the left rostral ventromedial medulla (RVM) (MNI coordinate: -1, -37, -56; cluster size: 20; r = 0.602) in the MOH patients.
The regional volume gain of brainstem could underlie the neuromechanism of impaired ascending and descending pathway in the MOH patients, and the left RVM volume alteration could imply the impaired tolerance of nociceptive pain input and could be used to assess the headache disability in the MOH patients.
组织病理学确定了偏头痛患者脑干核的解剖和分子异常。然而，在由偏头痛转化而来的药物过度使用性头痛（MOH）中，尚未在体内确定整个脑干的具体结构变化。本研究旨在使用基于体素的形态计量学（VBM）活体研究 MOH 患者整个脑干的区域体积变化。
2013 年 3 月至 2016 年 6 月，连续从中国人民解放军总医院国际头痛中心招募 36 例 MOH 患者和 32 例正常对照者（NCs），使用 3.0T 磁共振系统获得高分辨率三维结构图像。使用 VBM 评估 MOH 患者的脑干结构改变，并进行体素相关性分析以评估与临床特征的关系。
与 NCs 相比，MOH 患者的脑干区域体积增加，位于左侧腹外侧导水管周围灰质（MNI 坐标：-1、-33、-8）、腹侧被盖区（MNI 坐标：0、-22、-12）、双侧黑质（MNI 坐标：-8、-16、-12、9、-16、-12）和三叉神经根入口区（MNI 坐标：-19、-29、-31；19、-32、-29）。MOH 患者的头痛视觉模拟评分与左侧吻端延髓腹内侧（RVM）（MNI 坐标：-1、-37、-56；簇大小：20；r=0.602）呈正相关。
脑干区域体积增加可能是 MOH 患者上行和下行通路受损的神经机制，左侧 RVM 体积改变可能意味着疼痛输入的耐受受损，可用于评估 MOH 患者的头痛残疾。
