Anesthesiology, Perioperative & Pain Medicine, University of Calgary, Calgary, AB, Canada; Vi Riddell Children's Pain & Rehabilitation Centre, Alberta Children's Hospital, Calgary, AB, Canada; Behaviour & The Developing Brain, Alberta Children's Hospital Research Institute, Calgary, AB, Canada.
Medicine, University of Alberta, Edmonton, AB, Canada.
Neuroimage Clin. 2021;30:102627. doi: 10.1016/j.nicl.2021.102627. Epub 2021 Mar 13.
BACKGROUND/AIMS: Post-traumatic stress symptoms (PTSS) and chronic pain often co-occur at high rates in youth. PTSS may alter brain structure thereby contributing to headache chronicity. This study examined whether PTSS and altered limbic circuitry were associated with headache frequency in youth.
Thirty youth aged 10-18 years with chronic headaches and 30 age- and sex-matched controls underwent a 3T MRI scan. Volumes of the hippocampus and amygdala were obtained from T1-weighted images. Mean fractional anisotropy (FA, an index of white matter structure) axial and radial diffusivity values of the cingulum and uncinate fasciculus were extracted from diffusion-weighted images. Youth reported on their headaches daily, for one-month, and self-reported pubertal status, emotion regulation, adverse childhood experiences (ACEs) and PTSS using validated measures. Volumes of the hippocampus and amygdala and diffusivity values of the cingulum and uncinate were compared between patients and controls. Hierarchical linear regressions were used to examine the association between PTSS, subcortical volumes and/or diffusivity values and headache frequency.
Mean FA values of the cingulum were higher in patients compared to controls (P = 0.02, Cohen's d = 0.69). Greater PTSS (P = 0.04), smaller amygdala volumes (P = 0.01) and lower FA of the cingulum (P = 0.04) were associated with greater headache frequency, after accounting for age, puberty, pain duration, emotion regulation, and ACEs (Adjusted R ≥ 0.15). Headache frequency was associated with increases in radial diffusivity (P = 0.002, Adjusted R = 0.59), as opposed to axial diffusivity (n.s.).
PTSS, smaller amygdalar volume, and poorer cingulum structural connectivity were associated with headache frequency in youth, and may underlie headache chronicity.
背景/目的：创伤后应激症状 (PTSS) 和慢性疼痛在青少年中经常同时高频率出现。PTSS 可能改变大脑结构，从而导致头痛的持续性。本研究旨在探讨青少年中 PTSS 和边缘回路改变是否与头痛频率有关。
30 名年龄在 10-18 岁之间的患有慢性头痛的青少年和 30 名年龄和性别匹配的对照组接受了 3T MRI 扫描。从 T1 加权图像中获得海马体和杏仁核的体积。从弥散加权图像中提取扣带和钩束的平均分数各向异性 (FA，白质结构的指标) 轴向和径向扩散系数值。青少年使用经过验证的测量工具报告他们的头痛情况，为期一个月，并报告青春期状态、情绪调节、不良童年经历 (ACEs) 和 PTSS。将患者和对照组之间的海马体和杏仁核体积以及扣带和钩束的扩散系数值进行比较。使用分层线性回归来检验 PTSS、皮质下体积和/或弥散系数值与头痛频率之间的关系。
与对照组相比，患者的扣带平均 FA 值更高 (P = 0.02，Cohen's d = 0.69)。PTSS 较高 (P = 0.04)、杏仁核体积较小 (P = 0.01) 和扣带 FA 较低 (P = 0.04) 与头痛频率增加相关，在考虑年龄、青春期、疼痛持续时间、情绪调节和 ACEs 后 (调整后的 R ≥ 0.15)。头痛频率与径向扩散增加相关 (P = 0.002，调整后的 R = 0.59)，而不是轴向扩散 (无统计学意义)。
PTSS、杏仁核体积较小和扣带结构连接不良与青少年头痛频率有关，可能是头痛持续性的基础。
