Department of Neurology, Mayo Clinic, Phoenix, AZ, USA.
ASU-Mayo Center for Innovative Imaging, Tempe, AZ, USA.
Cephalalgia. 2022 Apr;42(4-5):357-365. doi: 10.1177/03331024211048509. Epub 2021 Oct 13.
Although iron accumulation in pain-processing brain regions has been associated with repeated migraine attacks, brain structural changes associated with post-traumatic headache have yet to be elucidated. To determine whether iron accumulation is associated with acute post-traumatic headache, magnetic resonance transverse relaxation rates (T2*) associated with iron accumulation were investigated between individuals with acute post-traumatic headache attributed to mild traumatic brain injury and healthy controls.
Twenty individuals with acute post-traumatic headache and 20 age-matched healthy controls underwent 3T brain magnetic resonance imaging including quantitative T2* maps. T2* differences between individuals with post-traumatic headache versus healthy controls were compared using age-matched paired t-tests. Associations of T2* values with headache frequency and number of mild traumatic brain injuries were investigated using multiple linear regression in individuals with post-traumatic headache. Significance was determined using uncorrected -value and cluster size threshold.
Individuals with post-traumatic headache had lower T2* values compared to healthy controls in cortical (bilateral frontal, bilateral anterior and posterior cingulate, right postcentral, bilateral temporal, right supramarginal, right rolandic, left insula, left occipital, right parahippocampal), subcortical (left putamen, bilateral hippocampal) and brainstem regions (pons). Within post-traumatic headache subjects, multiple linear regression showed a negative association between T2* in the right inferior parietal/supramarginal regions and number of mild traumatic brain injuries and a negative association between T2* in bilateral cingulate, bilateral precuneus, bilateral supplementary motor areas, bilateral insula, right middle temporal and right lingual areas and headache frequency.
Acute post-traumatic headache is associated with iron accumulation in multiple brain regions. Correlations with headache frequency and number of lifetime mild traumatic brain injuries suggest that iron accumulation is part of the pathophysiology or a marker of mild traumatic brain injury and post-traumatic headache.
尽管铁在疼痛处理脑区的积累与反复偏头痛发作有关，但与创伤后头痛相关的脑结构变化尚未阐明。为了确定铁的积累是否与急性创伤后头痛有关，研究了归因于轻度创伤性脑损伤的急性创伤后头痛患者与健康对照组之间与铁积累相关的磁共振横向弛豫率（T2*）。
20 名急性创伤后头痛患者和 20 名年龄匹配的健康对照者接受了 3T 脑部磁共振成像，包括定量 T2图谱。使用年龄匹配的配对 t 检验比较创伤后头痛患者与健康对照组之间 T2的差异。使用多元线性回归分析创伤后头痛患者 T2*值与头痛频率和轻度创伤性脑损伤次数的相关性。使用未校正的 P 值和簇大小阈值确定显著性。
与健康对照组相比，创伤后头痛患者的皮质（双侧额部、双侧前扣带回和后扣带回、右侧中央后回、双侧颞部、右侧缘上回、右侧 Rolandic 区、左侧岛叶、左侧枕叶、右侧海马旁回）、皮质下（左侧豆状核、双侧海马）和脑干（脑桥）区域的 T2值较低。在创伤后头痛患者中，多元线性回归显示右侧顶下/缘上回区域的 T2值与轻度创伤性脑损伤次数呈负相关，双侧扣带回、双侧楔前叶、双侧辅助运动区、双侧岛叶、右侧颞中回和右侧舌回区域的 T2*值与头痛频率呈负相关。
急性创伤后头痛与多个脑区的铁积累有关。与头痛频率和一生中轻度创伤性脑损伤次数的相关性提示铁的积累是创伤后头痛病理生理学的一部分或轻度创伤性脑损伤和创伤后头痛的标志物。
