Evaluation of structural changes in orbitofrontal cortex in relation to medication overuse in migraine patients: a
Aygul Tantik Pak1, Sebahat Nacar Dogan2, Yildizhan Sengul1
1Gaziosmanpasa Training and Research Hospital, Department of Neurology, Istanbul, Turkey.
Background:
Migraine is a prevalent neurological disease that leads to severe headaches. Moreover, it is the commonest among the primary headaches that cause medication overuse headache (MOH). The orbitofrontal cortex (OFC) is one of the structures most associated with medication overuse.
Objective:
To determine microstructural changes in the OFC among migraine patients who developed MOH, through the diffusion tensor imaging (DTI) technique.
Methods:
Fifty-eight patients who had been diagnosed with migraine based on the Classification of Headache Disorders (ICHD-III-B) were included in the study. Patients were sub-classified into two groups, with and without MOH, based on the MOH criteria of ICHD-III-B. DTI was applied to each patient. The OFC fractional anisotropy (FA), and apparent diffusion coefficient (ADC) values of the two groups were compared.
Results:
The mean age of all the patients was 35.98±7.92 years (range: 18-65), and 84.5% (n=49) of them were female. The two groups, with MOH (n=25) and without (n=33), were alike in terms of age, gender, family history, migraine with or without aura and duration of illness. It was found that there was a significant difference in FA values of the left OFC between the two groups (0.32±0.01 versus 0.29±0.01; p=0.04).
Conclusions:
An association was found between MOH and changes to OFC microstructure. Determination of neuropathology and factors associated with medication overuse among migraine patients is crucial in terms of identifying the at-risk patient population and improving proper treatment strategies specific to these patients.
Insights
Medication overuse headache (MOH) is linked to microstructural changes in the orbitofrontal cortex (OFC) of migraine patients. Diffusion tensor imaging revealed significant differences in OFC fractional anisotropy between groups with and without MOH.
Area of Science:
- Neurology
- Neuroimaging
- Neuroscience
Background:
- Migraine is a common neurological disorder causing severe headaches.
- Medication overuse headache (MOH) is frequently associated with migraine.
- The orbitofrontal cortex (OFC) is implicated in medication overuse.
Purpose of the Study:
- To investigate microstructural alterations in the OFC of migraine patients with MOH.
- Utilizing diffusion tensor imaging (DTI) to assess OFC changes.
Main Methods:
- Included 58 migraine patients classified by MOH status (ICHD-III-B criteria).
- Applied DTI to analyze fractional anisotropy (FA) and apparent diffusion coefficient (ADC) in the OFC.
- Compared OFC DTI metrics between patients with and without MOH.
Main Results:
- No significant differences in age, gender, or migraine characteristics between groups.
- Found a significant difference in left OFC fractional anisotropy (FA) between migraine patients with and without MOH (p=0.04).
Conclusions:
- Microstructural changes in the OFC are associated with MOH in migraine patients.
- Identifying neuropathology and risk factors for MOH is vital for targeted treatment strategies.
