Conference Coverage
SAN FRANCISCO—Chronic migraine is associated with increased age-related cortical thinning of some brain areas and decreased age-related cortical thinning in other areas, according to research presented at the 60th Annual Scientific Meeting of the American Headache Society. It remains uncertain whether these cortical changes are a cause or an effect of chronic migraine.
Age-related cortical integrity had not been explored in chronic migraine previously. To investigate this topic, Yohannes Woubishet Woldeamanuel, MD, Instructor in Neurology and Neurologic Sciences at Stanford University in California, and colleagues enrolled 30 patients with chronic migraine and 30 age- and sex-matched healthy controls into a study. All participants were right-handed. The mean age in the chronic migraine group was 40.5, and the male-to-female ratio was 1:4. Investigators obtained the duration of chronic migraine and lifetime migraine from participants with chronic migraine.
Yohannes Woubishet Woldeamanuel, MD
Dr. Woldeamanuel and colleagues acquired T1-weighted brain images on a 3T MRI from all participants. They analyzed whole-brain cortical thickness on unmasked images. The investigators used linear regression to examine group differences on age by cortical thickness between people with chronic migraine and controls. Multiple regression enabled the researchers to control for the confounding effect of duration of chronic migraine and lifetime migraine on age-related cortical thickness changes.
Compared with controls, patients with chronic migraine had significant age-related thinning of the lateral orbitofrontal and supramarginal cortex of the left hemisphere. Patients with chronic migraine had a lack of age-related thinning of the pars orbitalis, superior and inferior parietal, superior temporal, pars opercularis, posterior cingulate, precuneus, superior frontal of the left hemisphere, and the left hemisphere mean cortical thickness, however. In the right hemisphere, the chronic migraine group had significant age-related thinning of the banks of the superior temporal sulcus, caudal anterior cingulate, inferior parietal, precuneus, and supramarginal cortex. The chronic migraine group lacked age-related thinning of the caudal middle frontal, isthmus cingulate, lateral orbitofrontal, paracentral, pars orbitalis, posterior cingulate, rostral middle frontal, superior frontal, and temporal pole of the right hemisphere. These results were not influenced by duration of chronic migraine and lifetime migraine.
The absence of normative age-related cortical thinning in implicated brain areas possibly indicates a perpetually enhanced headache response, head pain cognition, visual and auditory processing, affective behavior, interaction with internal and external cues, and multisensory integration, said the researchers. Accelerated age-related thinning in brain areas involved in sensory pain pathways could represent reduced habituation in chronic migraine, they added. In addition, age-related cortical thinning might indicate progressive loss of migraine modulation. The investigators hypothesized that repetitive migraine attacks might increase allostatic load from headache and nonheadache migraine symptoms.
“We are following these cohorts to determine whether these age-related cortical thickness changes signify cause or effect of chronic migraine,” said Dr. Woldeamanuel.
Suggested Reading
Chong CD, Dodick DW, Schlaggar BL, Schwedt TJ. Atypical age-related cortical thinning in episodic migraine. Cephalalgia. 2014;34(14):1115-1124.
Schwedt TJ, Berisha V, Chong CD. Temporal lobe cortical thickness correlations differentiate the migraine brain from the healthy brain. PLoS One. 2015 Feb 13;10(2):e0116687.