From the Xi'an Key Laboratory of Intelligent Sensing and Regulation of trans-Scale Life Information (J.L., S.Q., K.Y.), School of Life Science and Technology, Xidian University, Shaanxi; Acupuncture and Tuina School (L.Z., Y.W., Y.Z., Z.W., M.S.), Chengdu University of Traditional Chinese Medicine; CAS Key Laboratory of Mental Health (L.H.), Institute of Psychology, Chinese Academy of Sciences; and Department of Psychology (L.H.), University of Chinese Academy of Sciences, Beijing, China.
Neurology. 2023 Aug 15;101(7):e699-e709. doi: 10.1212/WNL.0000000000207484. Epub 2023 Jun 22.
The objective of this study was to propose a clustering approach to identify migraine subgroups and test the clinical usefulness of the approach by providing prognostic information for electroacupuncture treatment selection.
Participants with migraine without aura (MWoA) were asked to complete a daily headache diary, self-rating depression and anxiety, and quality-of-life questionnaires. Whole-brain functional connectivities (FCs) were assessed on resting-state functional MRI (fMRI). By integrating clinical measurements and fMRI data, partial least squares correlation and hierarchical clustering analysis were used to cluster participants with MWoA. Multivariate pattern analysis was applied to validate the proposed subgrouping strategy. Some participants had an 8-week electroacupuncture treatment, and the response rate was compared between different MWoA subgroups.
In study 1, a total of 97 participants (age of 28.2 ± 1.0 years, 70 female participants) with MWoA and 77 healthy controls (HCs) (age of 26.8 ± 0.1 years, 61 female participants) were enrolled (dataset 1), and 2 MWoA subgroups were defined. The participants in subgroup 1 had a significantly lower headache frequency (times/month of 4.4 ± 1.1) and significantly higher self-ratings of depression (depression score of 49.5 ± 2.3) when compared with participants in subgroup 2 (times/month of 7.0 ± 0.6 and depression score of 43.4 ± 1.2). The between-group differences of FCs were predominantly related to the amygdala, thalamus, hippocampus, and parahippocampal area. In study 2, 33 participants with MWoA (age of 30.9 ± 2.0 years, 28 female participants) and 23 HCs (age of 29.8 ± 1.1 years, 13 female participants) were enrolled as an independent dataset (dataset 2). The classification analysis validated the effectiveness of the 2-cluster solution of participants with MWoA in datasets 1 and 2. In study 3, 58 participants with MWoA were willing to receive electroacupuncture treatment and were assigned to different subgroups. Participants in different subgroups exhibited different response rates ( = 0.03, OR CI 0.086-0.93) to electroacupuncture treatment (18% and 44% for subgroups 1 and 2, respectively).
Our study proposed a novel clustering approach to define distinct MWoA subgroups, which could be useful for refining the diagnosis of participants with MWoA and guiding individualized strategies for pain prophylaxis and analgesia.
本研究旨在提出一种聚类方法来识别偏头痛亚组，并通过为电针治疗选择提供预后信息来检验该方法的临床实用性。
无先兆偏头痛（MWoA）患者需填写每日头痛日记、抑郁自评和焦虑自评量表以及生活质量问卷。采用静息态功能磁共振成像（rs-fMRI）评估全脑功能连接（FCs）。通过整合临床测量和 fMRI 数据，采用偏最小二乘相关分析和层次聚类分析对 MWoA 患者进行聚类。采用多变量模式分析对所提出的分组策略进行验证。部分患者接受 8 周的电针治疗，比较不同 MWoA 亚组之间的应答率。
在研究 1 中，共纳入 97 例 MWoA 患者（年龄 28.2±1.0 岁，70 例女性）和 77 例健康对照者（年龄 26.8±0.1 岁，61 例女性）（数据集 1），并定义了 2 个 MWoA 亚组。与亚组 2（每月头痛次数 7.0±0.6 和抑郁评分 43.4±1.2）相比，亚组 1 的患者头痛发作频率（每月头痛次数 4.4±1.1）显著降低，抑郁自评评分（抑郁评分 49.5±2.3）显著升高。FCs 的组间差异主要与杏仁核、丘脑、海马和海马旁回有关。在研究 2 中，纳入 33 例 MWoA 患者（年龄 30.9±2.0 岁，28 例女性）和 23 例健康对照者（年龄 29.8±1.1 岁，13 例女性）作为独立数据集（数据集 2）。分类分析验证了数据集 1 和 2 中 MWoA 患者 2 聚类解决方案的有效性。在研究 3 中，58 例 MWoA 患者愿意接受电针治疗，并被分配到不同的亚组。不同亚组的患者对电针治疗的反应率不同（ =0.03，OR CI 0.086-0.93）（亚组 1 和 2 分别为 18%和 44%）。
本研究提出了一种新的聚类方法来定义不同的 MWoA 亚组，这可能有助于细化 MWoA 患者的诊断，并为疼痛预防和镇痛的个体化策略提供指导。
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