Abnormal functional activity in the cerebellar crus can distinguish patients with migraine with comorbid insomnia

Migraine is a prevalent neurological disorder that is frequently observed in clinical practice and is commonly comorbid with insomnia. Insomnia can exacerbate and precipitate migraine attacks, with both conditions exerting a reciprocal influence on one another. The cerebellar crus is significantly associated with the pathophysiology of migraine and insomnia. The relationship between cerebellar crus functional alterations and migraine-associated insomnia remains unclear. This study utilizes resting-state functional magnetic resonance imaging (rs-fMRI) to examine functional alterations in the cerebellar crus of patients with migraine and concurrent insomnia.

Participants underwent resting-state functional magnetic resonance imaging. Subsequently, the disparity in amplitude of low-frequency fluctuations (ALFF) values among groups was analyzed, followed by functional connectivity (FC) investigations employing the cerebellum crus as seed regions.

Migraine patients frequently experience neuropsychological disorders and insomnia, which are interconnected. Both migraine with insomnia (MwI) and migraine without insomnia (MwoI) groups demonstrated elevated amplitude of low-frequency fluctuations (ALFF) in the left Crus I and II compared to the healthy controls (HC) group, with the MwI group exhibiting more pronounced alterations. Additionally, both patient groups showed decreased FC between the left Crus I and the right middle temporal gyrus (MTG) and inferior temporal gyrus (ITG) relative to the HC group. The MwoI group showed significantly lower FC compared to both the HC and MwI groups. A significant negative correlation was observed between ALFF in the left Crus I/II and Pittsburgh Sleep Quality Index (PSQI) scores in the MwoI group. Conversely, in the combined migraine cohort, FC between the left Crus I and the right MTG/ITG showed a positive correlation with PSQI scores.

This study identified a correlation between aberrant functional activity in the left Crus I/II and migraine comorbidity with insomnia. These findings provide fresh perspectives on the neural mechanisms underlying the migraine-insomnia relationship, thereby facilitating the identification of potential neuroimaging biomarkers and the exploration of targeted interventions for this patient subgroup.