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Published on: June 2, 2014
Gray matter changes related to medication overuse in patients with chronic migraine
Tzu-Hsien Lai1,2,3,4, Kung-Hsien Chou5, Jong-Ling Fuh3,6
1Program in Molecular Medicine, National Yang-Ming University and Academia Sinica, Taiwan.
Objective:
The objective of this article is to investigate the neurological substrates associated with medication overuse (MO) in patients with chronic migraine (CM).
Methods:
We recruited age- and sex-matched CM patients with MO (CMwMO), CM patients without MO (CMwoMO), and healthy controls (HCs). Magnetic resonance T1-weighted images were processed by voxel-based morphometry, and the findings were correlated with clinical variables and treatment responses.
Results:
A total of 66 patients with CM (half with MO) and 33 HCs completed the study. Patients with CMwMO compared to the patients with CMwoMO showed gray matter volume (GMV) decrease in the orbitofrontal cortex and left middle occipital gyrus as well as GMV increase in the left temporal pole/parahippocampus. The GMV changes explained 31.1% variance of the analgesics use frequency. The patients who responded to treatment had greater GMV in the orbitofrontal cortex (p = 0.028). Patients with CM (with and without MO), compared with HCs, had decreased GMV at multiple brain areas including the frontal, temporal and occipital lobes, precuneus and cerebellum.
Conclusions:
Our study showed GMV changes in CMwMO patients compared to the CMwoMO patients. These three cerebral regions accounted for significant variance in analgesics use frequency. Moreover, the GMV of the orbitofrontal cortex was predictive of the response to MO treatments.
Insights
Medication overuse in chronic migraine patients is linked to specific brain gray matter volume changes, particularly in the orbitofrontal cortex, which also predicts treatment response.
Area of Science:
- Neurology
- Neuroimaging
- Migraine Research
Background:
- Chronic migraine (CM) is often associated with medication overuse (MO).
- Understanding the neurological underpinnings of MO in CM is crucial for effective treatment.
Purpose of the Study:
- To investigate the neurological substrates associated with medication overuse in chronic migraine patients.
- To correlate brain structure changes with clinical variables and treatment outcomes.
Main Methods:
- Recruited age- and sex-matched chronic migraine patients with medication overuse (CMwMO), chronic migraine patients without medication overuse (CMwoMO), and healthy controls (HCs).
- Utilized magnetic resonance T1-weighted imaging and voxel-based morphometry to analyze gray matter volume (GMV).
- Correlated GMV findings with clinical variables and treatment responses.
Main Results:
- CMwMO patients exhibited decreased GMV in the orbitofrontal cortex and left middle occipital gyrus, and increased GMV in the left temporal pole/parahippocampus compared to CMwoMO patients.
- GMV changes in these regions explained 31.1% of the variance in analgesic use frequency.
- Greater GMV in the orbitofrontal cortex was associated with positive treatment response.
Conclusions:
- Significant GMV differences exist between CM patients with and without medication overuse.
- Specific cerebral regions identified are significantly associated with analgesic use frequency.
- Orbitofrontal cortex GMV is a predictive marker for treatment response in medication overuse treatments.
