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Published on: June 2, 2014
Iron concentration in the ventral pallidum of chronic migraine with medication-overuse headache
Xiaopei Xu1, Jiahui He2, Mengting Zhou3
1Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, No 88 Jiefang Road, Hangzhou, Zhejiang, 310009, China.
Background:
Chronic migraine (CM) imposes a significant disease burden and frequently co-occurs with medication-overuse headache (MOH). MOH is a secondary headache disorder occurring especially in individuals with primary migraine and associated with excessive analgesic use. Impaired iron homeostasis may be related to the medication overuse behavior, however, its' pathophysiology is complex and incompletely understood. This study examines regional iron deposition in the subcortical nuclei in two comparisons: (1) controls versus chronic migraine patients; and (2) CM patients with medication-overuse headache (wMOH) versus those without MOH (woMOH). Furthermore, it investigates the association between iron deposition and disease outcomes.
Methods:
We recruited 38 controls and 72 CM patients (40 wMOH, 32 woMOH). All participants underwent MRI and assessments of migraine duration, analgesic use, and health metrics. CM patients with MOH were further evaluated for one-year relapse rates and Severity of Dependence Scale scores. Quantitative susceptibility mapping (QSM) was used to measure iron content in subcortical regions, and correlations with clinical variables. ROC curve analysis was performed to evaluate the QSM's predictive value for MOH relapse.
Results:
CM patients with MOH had lower iron content in the ventral pallidum (VeP, 0.178 ± 0.112 ppm vs. 0.183 ± 0.082 ppm, p < 0.001) compared to those without MOH. Notably, VeP iron content negatively correlated with analgesic excessive use (r = -0.557, p < 0.001) and relapse rates (r = -0.360, p < 0.05). ROC analyses demonstrated significant discriminative capacity for relapse prediction (VeP: AUC = 0.900, 95% CI [0.773-0.999], p < 0.001) in wMOH.
Conclusions:
The reduced iron in subcortical nuclei, especially the VeP, relates to analgesic excessive use and relapse in MOH. This insight enhances our understanding of MOH's neurobiological basis and supports the potential development of QSM-based biomarkers for relapse risk prediction.
Insights
Chronic migraine patients with medication-overuse headache show reduced iron in the ventral pallidum, linked to increased analgesic use and relapse risk. This finding may aid in developing biomarkers for predicting headache relapse.
Area of Science:
- Neuroimaging
- Neurology
- Medical Biomarkers
Background:
- Chronic migraine (CM) frequently co-occurs with medication-overuse headache (MOH), a disorder linked to excessive analgesic use.
- Impaired iron homeostasis is a potential factor in medication overuse behavior, but its role in MOH pathophysiology is not fully understood.
- This study investigates regional iron deposition in subcortical nuclei in CM patients, comparing those with and without MOH, and explores associations with disease outcomes.
Purpose of the Study:
- To examine regional iron deposition differences in subcortical nuclei between controls, CM patients, and CM patients with MOH (wMOH) versus without MOH (woMOH).
- To investigate the association between iron deposition in subcortical nuclei and clinical outcomes in CM patients, including analgesic use and relapse rates.
- To assess the potential of quantitative susceptibility mapping (QSM) as a biomarker for predicting MOH relapse.
Main Methods:
- Recruited 38 controls and 72 CM patients (40 wMOH, 32 woMOH) for MRI scans.
- Utilized quantitative susceptibility mapping (QSM) to measure iron content in subcortical nuclei.
- Correlated QSM-derived iron content with clinical variables like migraine duration, analgesic use, and relapse rates; performed ROC analysis for relapse prediction.
Main Results:
- CM patients with MOH exhibited significantly lower iron content in the ventral pallidum (VeP) compared to those without MOH.
- VeP iron content showed a negative correlation with excessive analgesic use and one-year relapse rates in wMOH patients.
- ROC analysis indicated that VeP iron content has significant discriminative capacity for predicting MOH relapse (AUC = 0.900).
Conclusions:
- Reduced iron deposition in subcortical nuclei, particularly the VeP, is associated with excessive analgesic use and higher relapse rates in MOH.
- These findings enhance the understanding of the neurobiological underpinnings of MOH.
- QSM-based measurement of iron deposition may serve as a valuable biomarker for predicting relapse risk in patients with MOH.
