Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China.
Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No.1, Jianshe East Road, Zhengzhou, Henan Province, 450000, China.
J Headache Pain. 2022 Jul 15;23(1):83. doi: 10.1186/s10194-022-01452-6.
The pathogenesis of migraine chronification remains unclear. Functional and structural magnetic resonance imaging studies have shown impaired functional and structural alterations in the brains of patients with chronic migraine. The cerebellum and periaqueductal gray (PAG) play pivotal roles in the neural circuits of pain conduction and analgesia in migraine. However, few neurotransmitter metabolism studies of these migraine-associated regions have been performed. To explore the pathogenesis of migraine chronification, we measured gamma-aminobutyric acid (GABA) and glutamate/glutamine (Glx) levels in the dentate nucleus (DN) and PAG of patients with episodic and chronic migraine and healthy subjects.
Using the MEGA-PRESS sequence and a 3-Tesla magnetic resonance scanner (Signa Premier; GE Healthcare, Chicago, IL, USA), we obtained DN and PAG metabolite concentrations from patients with episodic migraine (n = 25), those with chronic migraine (n = 24), and age-matched and sex-matched healthy subjects (n = 16). Patients with chronic migraine were further divided into those with (n = 12) and without (n = 12) medication overuse headache. All scans were performed at the Beijing Tiantan Hospital, Capital Medical University.
We found that patients with chronic migraine had significantly lower levels of GABA/water (p = 0.011) and GABA/creatine (Cr) (p = 0.026) in the DN and higher levels of Glx/water (p = 0.049) in the PAG than healthy controls. In all patients with migraine, higher GABA levels in the PAG were significantly associated with poorer sleep quality (GABA/water: r = 0.515, p = 0.017, n = 21; GABA/Cr: r = 0.522, p = 0.015, n = 21). Additionally, a lower Glx/Cr ratio in the DN may be associated with more severe migraine disability (r = -0.425, p = 0.055, n = 20), and lower GABA/water (r = -0.424, p = 0.062, n = 20) and Glx/Water (r = -0.452, p = 0.045, n = 20) may be associated with poorer sleep quality.
Neurochemical levels in the DN and PAG may provide evidence of the pathological mechanisms of migraine chronification. Correlations between migraine characteristics and neurochemical levels revealed the pathological mechanisms of the relevant characteristics.
偏头痛慢性化的发病机制仍不清楚。功能和结构磁共振成像研究表明，慢性偏头痛患者的大脑存在功能和结构改变。小脑和导水管周围灰质（periaqueductal gray，PAG）在偏头痛的神经传导和镇痛神经回路中起着关键作用。然而，针对这些与偏头痛相关区域的神经递质代谢研究较少。为了探讨偏头痛慢性化的发病机制，我们测量了发作性和慢性偏头痛患者以及健康对照者齿状核（dentate nucleus，DN）和 PAG 中的γ-氨基丁酸（gamma-aminobutyric acid，GABA）和谷氨酸/谷氨酰胺（glutamate/glutamine，Glx）水平。
使用 MEGA-PRESS 序列和 3T 磁共振扫描仪（Signa Premier；GE Healthcare，芝加哥，IL，美国），我们从发作性偏头痛患者（n=25）、慢性偏头痛患者（n=24）和年龄匹配、性别匹配的健康对照者（n=16）中获得了 DN 和 PAG 代谢物浓度。慢性偏头痛患者进一步分为药物过度使用头痛有（n=12）和无（n=12）的患者。所有扫描均在北京天坛医院完成。
我们发现，与健康对照组相比，慢性偏头痛患者的 DN 中 GABA/水（p=0.011）和 GABA/Cr（p=0.026）水平显著降低，而 PAG 中的 Glx/水（p=0.049）水平升高。在所有偏头痛患者中，PAG 中 GABA 水平与睡眠质量较差呈显著相关（GABA/水：r=0.515，p=0.017，n=21；GABA/Cr：r=0.522，p=0.015，n=21）。此外，DN 中较低的 Glx/Cr 比值可能与偏头痛残疾程度更严重有关（r=-0.425，p=0.055，n=20），而较低的 GABA/水（r=-0.424，p=0.062，n=20）和 Glx/水（r=-0.452，p=0.045，n=20）可能与睡眠质量较差有关。
DN 和 PAG 中的神经化学水平可能为偏头痛慢性化的病理机制提供证据。偏头痛特征与神经化学水平之间的相关性揭示了相关特征的病理机制。
Zotero 插件
