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Insular functional connectivity in migraine with aura.

Cédric Gollion1,2, Fleur Lerebours3, Federico Nemmi4

  • 1Department of Neurology, University Hospital of Toulouse, 31059 cedex 9, Toulouse, France. gollion.c@chu-toulouse.fr.

The Journal of Headache and Pain
|August 18, 2022
PubMed
Summary

Migraine with aura patients show altered brain connectivity between the anterior insula and the superior cerebellum (vermis VI). This finding may explain cardiovascular changes associated with migraine with aura.

Keywords:
Cerebellum vermisFunctional MRIInsulaMRIMigraineMigraine with aura

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Area of Science:

  • Neuroscience
  • Neuroimaging
  • Migraine Research

Background:

  • The insula integrates sensory, emotional, and autonomic functions, crucial in migraine, particularly migraine with aura (MA).
  • Insula subregions (dorsoanterior, ventroanterior, posterior) are linked to cognition, emotion, and somatosensation.
  • Understanding insula connectivity is vital for elucidating MA pathophysiology.

Purpose of the Study:

  • To investigate the functional connectivity of insula subregions in patients with migraine with aura (MA).
  • To compare insula functional connectivity in MA patients with healthy controls (HC) and migraine without aura (MO) patients.

Main Methods:

  • Functional MRI (fMRI) during resting state was used.
  • Twenty-one interictal MA patients, 18 HC, and 12 interictal MO patients were included.
  • Seed-to-voxel analysis tested functional coupling of 12 insula seeds (bilateral, various subregions).

Main Results:

  • MA patients exhibited strong functional coupling between the right and left antero-dorsal insula and the superior cerebellum (vermis VI).
  • This specific cerebellar connectivity was unique to MA patients and not observed in MO patients or HC.
  • The observed functional couplings were not correlated with MA duration, attack frequency, or time since the last attack.

Conclusions:

  • The anterior insula and superior cerebellum (vermis VI) are part of the central Autonomic Nervous System (ANS) network.
  • This identified connectivity in MA patients may reflect underlying cardiovascular features.
  • The study highlights a novel insula-cerebellum pathway potentially involved in MA pathophysiology.