[Response prediction for chronic migraine preventive treatment by gray matter morphometry in magnetic resonance imaging: a pilot study].

INTRODUCTION

Topiramate is the only oral preventative with level of evidence I for the treatment of chronic migraine.

AIM

To evaluate gray matter parameters, obtained with magnetic resonance imaging (MRI), as biomarkers of the response to topiramate in chronic migraine patients.

PATIENTS AND METHODS

The sample was composed by 57 chronic migraine patients, screened for first time in a Headache Unit due to chronic migraine. MRI acquisitions were performed at a 3 T unit. Afterwards, topiramate preventive treatment began. Response and tolerability were evaluated after three months, defining response as at least 50% reduction in headache days per month. We included patients that tolerated topiramate. T1- and diffusion-weighted MRI were processed to obtain gray matter (68 cortical and 16 subcortical regions) descriptive parameters. A logistic regression model was employed for the predictive assessment.

RESULTS

Forty-two patients tolerated the treatment and were analyzed, responding 23 of them (54.7%). The final prediction model was built with gray matter parameters with significant results. In this model, higher left cuneus curvature and right insula area values were associated with a higher probability of response, while higher right inferior parietal cortex volume and left superior temporal gyrus area values were associated with a lower probability. The accuracy of the predictive model was 95%.

CONCLUSION

The gray matter parameters may be useful biomarkers of preventive treatment response with topiramate in chronic migraine.