Szabo Edina, Bolo Nicolas R, Borsook David, Burstein Rami, Ashina Sait
Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Department of Anaesthesiology, Harvard Medical School, Boston, MA, USA.
Cephalalgia. 2025 Feb;45(2):3331024241313377. doi: 10.1177/03331024241313377.
In about half of migraine patients, anti-calcitonin gene-related peptide monoclonal antibodies reduce monthly migraine days by >50%. In these patients, this class of drugs may change cortical functions by decreasing nociceptive afferent barrage. This prospective study investigated functional connectivity changes in treatment responders after three-month treatment with galcanezumab.
Resting-state functional magnetic resonance imaging data were acquired for patients with high-frequency episodic or chronic migraine (= 36) before and after treatment. Of these, 19 patients were classified as treatment responders (≥50% reduction in monthly migraine days) and 17 were considered non-responders (<50% reduction). Functional connectivity across cortical regions was assessed using a region-of-interest (ROI)-to-ROI analysis approach.
At baseline, there were no significant differences between treatment responders and treatment non-responders. In the treatment responder group, reduced functional connectivity was observed after treatment between regions of the primary somatosensory and motor cortices, insula, and several occipital and temporo-occipital areas (within the visual network). In contrast, no such changes were seen in the non-responder group.
These findings suggest that even a relatively short period of reduced nociceptive signals may be sufficient to initiate a cortical recovery process in which its resting hyperexcitable mode shifts to a less excitable state.
在大约一半的偏头痛患者中，抗降钙素基因相关肽单克隆抗体可使每月偏头痛天数减少超过50%。在这些患者中，这类药物可能通过减少伤害性传入神经冲动来改变皮质功能。这项前瞻性研究调查了加卡尼单抗治疗三个月后治疗反应者的功能连接变化。
在治疗前后获取高频发作性或慢性偏头痛患者（=36例）的静息态功能磁共振成像数据。其中，19例患者被归类为治疗反应者（每月偏头痛天数减少≥50%），17例被视为无反应者（减少<50%）。使用感兴趣区域（ROI）到ROI分析方法评估皮质区域之间的功能连接。
在基线时，治疗反应者和无反应者之间没有显著差异。在治疗反应者组中，治疗后观察到初级体感和运动皮质、岛叶以及几个枕叶和颞枕叶区域（在视觉网络内）之间的功能连接减少。相比之下，无反应者组未观察到此类变化。
这些发现表明，即使是相对较短时间的伤害性信号减少，也可能足以启动皮质恢复过程，其中其静息时过度兴奋模式转变为兴奋性较低的状态。
