Volume Gain of Brainstem on Medication-Overuse Headache Using Voxel-Based Morphometry.

Area of Science:

• Neuroimaging
• Neurology
• Radiology

Background:

• Migraine is linked to brainstem abnormalities, but in vivo structural changes in medication-overuse headache (MOH) are unclear.
• Previous studies identified histopathological changes in migraine brainstem nuclei.
• This research addresses the gap in understanding whole brainstem structural alterations in MOH.

Purpose of the Study:

• To investigate in vivo whole brainstem regional volume changes in medication-overuse headache (MOH) patients.
• To identify specific brainstem areas affected by structural alterations in MOH.
• To correlate brainstem structural changes with clinical characteristics of MOH.

Main Methods:

• Utilized voxel-based morphometry (VBM) on high-resolution 3D structural MRI scans.
• Analyzed data from 36 MOH patients and 32 normal controls (NCs).
• Performed voxel-wise correlation to link brainstem alterations with clinical data.

Main Results:

• MOH patients exhibited increased brainstem volume in the left ventrolateral periaqueductal gray, ventral tegmental area, bilateral substantia nigra, and trigeminal root entry zone compared to NCs.
• A positive correlation was found between headache visual analog scale scores and left rostral ventromedial medulla (RVM) volume.
• Specific MNI coordinates were identified for these volumetric changes.

Conclusions:

• Regional brainstem volume increases in MOH may underlie impaired ascending and descending pain pathways.
• Left RVM volume alterations suggest impaired nociceptive pain input tolerance in MOH.
• Brainstem volume changes, particularly in the left RVM, could serve as a biomarker for headache disability in MOH.