Diffusion tensor imaging in chronic tension-type headache

Tension-type headache (TTH) is the most common primary headache disorder and chronic tension-type headache (CTTH) is difficult to treat. Despite this clinical importance, the pathophysiology especially of CTTH remains unclear. Therefore, the aim of this study was to search for microstructural changes in CTTH to further evaluate the pathogenesis of CTTH.

Nine female patients suffering from CTTH and ten healthy controls matched by age and gender were included. All participants underwent a magnetic resonance imaging (MRI) scan with a diffusion tensor imaging (DTI) sequence. From the diffusion tensor the Fractional Anisotropy (FA), the Axial Diffusivity (AD), the Radial Diffusivity (RD), the NODDI parameters, the Orientation Dispersion Index (ODI), and the Neurite Density Index (NDI) were calculated.

Microstructural changes were found in the right cerebellum, tectum, right occipital fusiform gyrus, left inferior temporal gyrus, left cingulate gyrus (anterior and posterior devision), right thalamic radiation, right lateral occipital cortex (inferior division), left cerebellum, left insular cortex, left precuneous, left central opercular cortex, left inferior frontal gyrus, left middle temporal gyrus, right middle temporal gyrus, left middle frontal gyrus, right postcentral gyrus, left superior longitudinal fasciculus, and the right paracingulate gyrus.

Patients suffering from CTTH had microstructural changes in multiple brain areas. Those were related to brain regions that belong to or interact with the pain matrix, trigeminal system or association fibers.