Koreki Akihiro, Bhatia Vilomi, Logan Anne-Marie, Khan Usman, Onaya Mitsumoto, Garfinkel Sarah, Critchley Hugo, Edwards Mark, Nirmalananthan Niranjanan, Yogarajah Mahinda
Department of Clinical and Experimental Epilepsy, Institute of Neurology, University College London, London, United Kingdom.
Department of Psychiatry, NHO Shimofusa Psychiatric Medical Center, Chiba, Japan.
Front Neurol. 2025 Aug 20;16:1643260. doi: 10.3389/fneur.2025.1643260. eCollection 2025.
Migraine is one of the most common neurological disorders. Despite advances in understanding of episodic migraine, little is understood about the mechanisms underlying the chronification of migraine. Recently, increasing attention has been given to the potential roles of interoceptive abnormalities and dissociation. Therefore, we sought to explore differences in interoception and dissociation in individuals with episodic and chronic migraine versus individuals without migraine.
A total of 49 participants were analysed of which 26 had migraine (15 chronic and 11 episodic) and 23 were control subjects without a headache disorder. Their objective interoceptive accuracy was assessed using the heartbeat tracking and discrimination tasks. Interoceptive sensibility was assessed using the Porges body perception questionnaire. Interoceptive trait prediction error (ITPE) was calculated based on the discrepancy between their task performance and sensibility. Interoceptive state prediction error (ISPE) was calculated based on the trial-by-trial correspondence between task performance and confidence. The level of their dissociation was assessed via self-report questionnaires.
Patients with migraine had lower interoceptive accuracy for the tracking task (median (interquartile range) 0.50 (0.43) in migraine vs. 0.78 (0.26) in control, Mann-Whitney U test, effect size r = 0.35, = 0.014), higher interoceptive sensibility (110 (52) vs. 39 (14), r = 0.74, < 0.001), and greater ITPE than controls (for the tracking task: 1.08 (1.78) vs. - 1.16 (0.88), r = 0.72, < 0.001 / for the discrimination task: 0.87 (1.44) vs. - 0.62 (0.97), r = 0.69, < 0.001). Greater ISPE was also found in patients with chronic migraine than episodic migraine (2.30 (0.35) in chronic vs. 1.75 (0.19) in episodic, r = 0.39, = 0.046). A greater level of somatoform dissociation was found in individuals with chronic, compared to episodic, migraine (27 (11) vs. 22 (2), r = 0.43, = 0.029).
This is the first study to demonstrate interoceptive abnormalities in migraine, specifically of greater interoceptive prediction errors. Interoceptive abnormalities may represent a transdiagnostic mechanisms relevant to the chronification of migraine, and to frequent co-morbidities such as dissociation.
偏头痛是最常见的神经系统疾病之一。尽管在发作性偏头痛的认识上取得了进展，但对于偏头痛慢性化的潜在机制了解甚少。最近，人们越来越关注内感受异常和分离的潜在作用。因此，我们试图探讨发作性和慢性偏头痛患者与无偏头痛个体在内感受和分离方面的差异。
共分析了49名参与者，其中26人患有偏头痛（15例慢性偏头痛和11例发作性偏头痛），23名是无头痛疾病的对照受试者。使用心跳跟踪和辨别任务评估他们的客观内感受准确性。使用Porges身体感知问卷评估内感受敏感性。根据任务表现和敏感性之间的差异计算内感受特质预测误差（ITPE）。根据任务表现和信心之间的逐次试验对应关系计算内感受状态预测误差（ISPE）。通过自我报告问卷评估他们的分离水平。
偏头痛患者在跟踪任务中的内感受准确性较低（偏头痛患者的中位数（四分位间距）为0.50（0.43），对照组为0.78（0.26），Mann-Whitney U检验，效应大小r = 0.35，P = 0.014），内感受敏感性较高（110（52）对39（14），r = 0.74，P < 0.001），且ITPE比对照组更大（跟踪任务：1.08（1.78）对 - 1.16（0.88），r = 0.72，P < 0.001 /辨别任务：0.87（1.44）对 - 0.62（0.97），r = 0.69，P < 0.001）。慢性偏头痛患者的ISPE也比发作性偏头痛患者更大（慢性偏头痛患者为2.30（0.35），发作性偏头痛患者为1.75（0.19），r = 0.39，P = 0.046）。与发作性偏头痛个体相比，慢性偏头痛个体的躯体形式分离水平更高（27（11）对22（2），r = （此处原文可能有误，推测应为0.43），P = 0.029）。
这是第一项证明偏头痛内感受异常的研究，特别是更大的内感受预测误差。内感受异常可能代表与偏头痛慢性化以及解离等常见共病相关的一种跨诊断机制。
