Department of Neurosciences, Neurology Service, University Hospital Germans Trias I Pujol, Carretera Canyet s/n, 08916, Badalona, Barcelona, Spain.
Institut de Recerca Germans Trias I Pujol (IGTP), Univesitat Autònoma de Barcelona, Badalona, Barcelona, Spain.
J Headache Pain. 2023 Apr 17;24(1):41. doi: 10.1186/s10194-023-01576-3.
Migraine is one of the most prevalent and disabling medical diseases in the world. The periaqueductal gray matter and the red nucleus play an important role in its pathogenesis. Our aim was to evaluate the echogenicity of the periaqueductal gray matter and the red nucleus in patients with migraine, by means of transcranial ultrasound.
In this cross-sectional study, a group of patients with migraine (according to the International Classification of Headache Disorders) and a group of control subjects with comparable age-and-sex distribution were prospectively included. We evaluated the area and echogenicity of the periaqueductal gray matter and the red nucleus by means of transcranial ultrasound, both bedside and posteriorly analyzed with the medical image viewer Horos.
We included 115 subjects: 65 patients with migraine (39 of them with chronic migraine and 26 with episodic migraine), and 50 controls. Median disease duration in patients with chronic migraine was 29 (IQR: 19; 40) years, with a median of 18 (IQR: 14; 27) days of migraine per month. The area of the periaqueductal gray matter was larger in patients with chronic migraine compared to episodic migraine and controls (0.15[95%CI 0.12;0.22]cm; 0.11[95%CI 0.10;0.14]cm and 0.12[95%CI 0.09;0.15]cm, respectively; p = 0.043). Chronic migraine patients showed an intensity of the periaqueductal gray matter echogenicity lower than controls (90.57[95%CI 70.87;117.26] vs 109.56[95%CI 83.30;122.64]; p = 0.035). The coefficient of variation of periaqueductal gray matter echogenicity was the highest in chronic migraine patients (p = 0.009). No differences were observed regarding the area or intensity of red nucleus echogenicity among groups.
Patients with chronic migraine showed a larger area of echogenicity of periaqueductal gray matter, a lower intensity of its echogenicity and a higher heterogenicity within this brainstem structure compared to patients with episodic migraine and controls. The echogenicity of the periaqueductal gray matter should be further investigated as a biomarker of migraine chronification.
偏头痛是世界上最常见和最致残的医学疾病之一。导水管周围灰质和红核在其发病机制中起着重要作用。我们的目的是通过经颅超声评估偏头痛患者导水管周围灰质和红核的回声强度。
在这项横断面研究中，我们前瞻性地纳入了一组偏头痛患者（根据国际头痛疾病分类）和一组年龄和性别分布相匹配的对照组。我们通过经颅超声评估了导水管周围灰质和红核的面积和回声强度，并用医疗图像查看器 Horos 进行了床旁和后处理分析。
我们纳入了 115 名受试者：65 名偏头痛患者（其中 39 名慢性偏头痛患者和 26 名发作性偏头痛患者）和 50 名对照组。慢性偏头痛患者的中位疾病持续时间为 29 年（IQR：19；40），每月偏头痛的中位天数为 18 天（IQR：14；27）。与发作性偏头痛和对照组相比，慢性偏头痛患者的导水管周围灰质面积更大（0.15[95%CI 0.12；0.22]cm；0.11[95%CI 0.10；0.14]cm 和 0.12[95%CI 0.09；0.15]cm；p=0.043）。慢性偏头痛患者的导水管周围灰质回声强度低于对照组（90.57[95%CI 70.87；117.26] vs 109.56[95%CI 83.30；122.64]；p=0.035）。导水管周围灰质回声强度的变异系数在慢性偏头痛患者中最高（p=0.009）。三组之间红核回声强度的面积或强度均无差异。
与发作性偏头痛和对照组相比，慢性偏头痛患者的导水管周围灰质回声强度更大，回声强度更低，且该脑干部位结构的异质性更高。导水管周围灰质的回声强度应作为偏头痛慢性化的生物标志物进一步研究。
