Ruiz-Tagle Amparo, Caetano Gina, Fouto Ana, Esteves Inês, Cabaço Inês, Da Silva Nuno, Vilela Pedro, Alves Pedro Nascimento, Martins Isabel Pavão, Gouveia Raquel Gil, Figueiredo Patrícia
ISR-Lisboa/LARSyS, Department of Bioengineering, Instituto Superior Técnico, Universidade de Lisboa, Lisbon, Portugal.
Faculty of Health Sciences and Nursing, Catholic University of Portugal, Lisbon, Portugal.
Headache. 2025 Mar;65(3):407-419. doi: 10.1111/head.14850. Epub 2024 Oct 13.
To analyze cognitive performance and brain activation during a working memory task in patients with migraine during various phases of the migraine cycle and compare to healthy participants.
Cognitive difficulties reported during migraine attacks remain poorly understood, despite evidence that the lateral frontoparietal network undergoes reversible disturbances and decreased activation during attacks. Recent findings in resting state functional magnetic resonance imaging suggest that brain areas involved in this network interact with subcortical regions during spontaneous migraine attacks.
In this prospective, within-subject study, 10 patients with diagnosed menstrual-related episodic migraine without aura underwent 3T functional magnetic resonance imaging assessments while performing a working memory task across four phases of the natural migraine cycle: peri-ictal (preictal, ictal, postictal) phases and interictally (between attacks). Migraine prophylaxis was an exclusion criterion. Fourteen healthy controls were assessed during the corresponding phases of their menstrual cycles.
The protocol was completed by 24 female participants aged 21 to 47 years: 10 with migraine (four sessions each) and 14 healthy controls (two sessions each) yielding a total of 68 analyzed datasets. Patients and controls showed similar performance on the working memory task and displayed increased brain activity in regions linked to this function, namely the middle frontal gyrus, inferior parietal lobe, and anterior cingulate cortex, during all phases of the migraine/menstrual cycle. Patients with migraine (N = 10) exhibited a significant decrease in hypothalamic activity (p = 0.007) as measured by the percent signal change (PSC) during the postictal phase compared to perimenstrual controls (N = 14), with -2 (16) and 31 (35) PSC, respectively. Comparing across the migraine cycle, the change in hypothalamic activity relative to controls in the postictal phase -0.33 (0.2) ΔPSC was significantly different from the ones in the interictal (0.006 [0.5] ΔPSC; p = 0.002) and preictal (-0.08 [0.4] ΔPSC; p = 0.034) phases.
During a working memory task, cognition-related brain activation was present across all phases of the migraine cycle similarly to healthy control participants. Patients with migraine, however, displayed lower neural activity at the subcortical level in the postictal phase. Nonetheless, the sample size is a limitation for the generalization of our results. More research is needed to fully understand how the brain copes with cognitive demands during spontaneous migraine attacks.
分析偏头痛患者在偏头痛周期各阶段进行工作记忆任务时的认知表现和大脑激活情况，并与健康参与者进行比较。
尽管有证据表明偏头痛发作时外侧额顶叶网络会经历可逆性干扰且激活减少，但偏头痛发作期间报告的认知困难仍未得到充分理解。静息态功能磁共振成像的最新研究结果表明，在自发性偏头痛发作期间，该网络中涉及的脑区与皮层下区域相互作用。
在这项前瞻性的自身对照研究中，10名被诊断为与月经相关的无先兆发作性偏头痛患者在自然偏头痛周期的四个阶段（发作期（发作前、发作期、发作后）和发作间期（发作之间））进行工作记忆任务时接受了3T功能磁共振成像评估。偏头痛预防性治疗是排除标准。14名健康对照者在其月经周期的相应阶段接受评估。
该方案由24名年龄在21至47岁的女性参与者完成：10名偏头痛患者（每人4次检查）和14名健康对照者（每人2次检查），共产生68个分析数据集。患者和对照者在工作记忆任务上表现相似，并且在偏头痛/月经周期的所有阶段，与该功能相关的区域（即额中回、顶下小叶和前扣带回皮质）的大脑活动均增加。与围经期对照者（n = 14）相比，偏头痛患者（n = 10）在发作后期通过信号变化百分比（PSC）测量的下丘脑活动显著降低（p = 0.007），PSC分别为-2（16）和31（35）。在整个偏头痛周期中进行比较，发作后期相对于对照者下丘脑活动的变化-0.33（0.2）ΔPSC与发作间期（0.006 [0.5] ΔPSC；p = 0.002）和发作前期（-0.08 [0.4] ΔPSC；p = 0.034）相比有显著差异。
在工作记忆任务期间，偏头痛周期的所有阶段均存在与认知相关的大脑激活，与健康对照参与者相似。然而，偏头痛患者在发作后期皮层下水平的神经活动较低。尽管如此，样本量是我们结果推广的一个限制因素。需要更多研究来充分了解大脑在自发性偏头痛发作期间如何应对认知需求。
