Department of Radiology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China.
The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China.
Neurol Sci. 2022 Oct;43(10):6021-6030. doi: 10.1007/s10072-022-06245-y. Epub 2022 Jul 6.
The hypothalamus plays a central role in the pathophysiology of migraine and is considered to be the "migraine generator." It participates in initiating a migraine attack through its connectivity to regions of the brain involved in processing and modulating pain. However, the underlying mechanisms of hypothalamic effective functional connectivity that bring about migraines remain unclear. This study investigated the hypothalamus-based directional effective connectivity in migraine without aura patients and assessed associations among the clinical characteristics.
Seven patients with migraine without aura during the attack (MWoA-DA) (four with photophobia (MWoA-DAWP) and three without photophobia (MWoA-DAWoP)), twenty-seven patients with migraine without aura during the interictal period (MWoA-DI), and twenty-nine healthy controls (HC) were included in this study. Granger causality analysis (GCA) was used to investigate the directional effective connectivity between the hypothalamus and other brain regions.
MWoA-DA patients exhibited decreased outflow from the bilateral hypothalamus to the visual cortex compared with the MWoA-DI patients and HCs. The MWoA-DAWP group primarily contributed to this result. The MWoA-DA patients showed decreased outflow from the bilateral hypothalamus to the right inferior parietal gyrus compared with the HCs. The visual analogue scale (VAS) was negatively correlated with abnormal effective functional connectivity from the right hypothalamus to the right inferior parietal gyrus in the MWoA-DA group.
These data provide evidence that the hypothalamus might serve as a central component of a multisystem network implicated in migraine and ictal photophobia, which includes hypothalamus and the visual and trigeminovascular systems.
下丘脑在偏头痛的病理生理学中起着核心作用，被认为是“偏头痛发生器”。它通过与大脑中参与处理和调节疼痛的区域的连接来启动偏头痛发作。然而，导致偏头痛的下丘脑有效功能连接的潜在机制尚不清楚。本研究调查了无先兆偏头痛患者基于下丘脑的定向有效连接，并评估了临床特征之间的关联。
本研究纳入了 7 例偏头痛发作期无先兆偏头痛患者（MWoA-DA）（4 例畏光（MWoA-DAWP）和 3 例无畏光（MWoA-DAWoP））、27 例偏头痛间歇期无先兆偏头痛患者（MWoA-DI）和 29 例健康对照者（HC）。采用格兰杰因果分析（GCA）研究下丘脑与其他脑区之间的定向有效连接。
MWoA-DA 患者与 MWoA-DI 患者和 HC 相比，双侧下丘脑至视觉皮层的传出减少。MWoA-DAWP 组主要导致了这一结果。MWoA-DA 患者与 HC 相比，双侧下丘脑至右侧顶下小叶的传出减少。视觉模拟量表（VAS）与 MWoA-DA 组右侧下丘脑至右侧顶下小叶异常有效功能连接呈负相关。
这些数据提供了证据表明，下丘脑可能是涉及偏头痛和发作性畏光的多系统网络的一个核心组成部分，该网络包括下丘脑和视觉及三叉血管系统。
