TY - JOUR
T1 - Brainstem 1H-MR spectroscopy in episodic and chronic migraine
AU - Lai, Tzu Hsien
AU - Fuh, Jong Ling
AU - Lirng, Jiing Feng
AU - Lin, Ching Po
AU - Wang, Shuu Jiun
N1 - Funding Information:
Acknowledgments This study was supported in part by grants from Taiwan National Science Council (100-2314-B-010-019-MY2, 100-2314-B-010-018-MY3), Taipei Veterans General Hospital (VGHU ST101-G7-1-1, V101C-106, V101E7-003), NSC support for the Center for Dynamical Biomarkers and Translational Medicine, National Central University, Taiwan (NSC 100-2911-I-008-001), Brain Research Center, National Yang-Ming University and a grant from Ministry of Education, Aim for the Top University Plan.
PY - 2012/11
Y1 - 2012/11
N2 - The pathogenesis of evolution from episodic migraine (EM) to chronic migraine (CM) has not yet been clearly determined. Some studies revealed that dysfunction of the brainstem may play a role. We aimed to determine the brainstem 1H-MR spectroscopic (MRS) findings in episodic and chronic migraine. We recruited patients with EM, CM and controls. Patients with CM were divided into subgroups with and without medication overuse (MO). The 1H-MRS metabolite ratios at the periaqueductal gray (PAG) and bilateral dorsal pons were measured and compared with those in controls. A total of 19 patients with EM, 53 patients with CM (with MO n = 30, without MO n = 23) and 16 control subjects completed the study. Patients with EM had the highest N-acetylaspartate (NAA)/ creatine (Cr) ratio at the dorsal pons (right, P = 0.014; left, P = 0.034) in comparison with those of CM and controls. The latter two groups did not differ. Among migraine patients, NAA/Cr ratios at dorsal pons were inversely correlated with headache frequency (right, r = -0.350, P = 0.004; left, r = -0.284, P = 0.019) and intensity (right, r = -0.286, P = 0.019; left, r = -0.244, P = 0.045), but not disease duration. In contrast, the metabolite ratios did not differ at the PAG among the study groups. Of note, MO was not associated with brainstem MRS ratios in patients with CM. The increased NAA/Cr levels may suggest neuronal hypertrophy at the dorsal pons in EM. A progressive dysfunction of this region may occur from EM to CM since the levels declined with increasing headache frequency and intensity.
AB - The pathogenesis of evolution from episodic migraine (EM) to chronic migraine (CM) has not yet been clearly determined. Some studies revealed that dysfunction of the brainstem may play a role. We aimed to determine the brainstem 1H-MR spectroscopic (MRS) findings in episodic and chronic migraine. We recruited patients with EM, CM and controls. Patients with CM were divided into subgroups with and without medication overuse (MO). The 1H-MRS metabolite ratios at the periaqueductal gray (PAG) and bilateral dorsal pons were measured and compared with those in controls. A total of 19 patients with EM, 53 patients with CM (with MO n = 30, without MO n = 23) and 16 control subjects completed the study. Patients with EM had the highest N-acetylaspartate (NAA)/ creatine (Cr) ratio at the dorsal pons (right, P = 0.014; left, P = 0.034) in comparison with those of CM and controls. The latter two groups did not differ. Among migraine patients, NAA/Cr ratios at dorsal pons were inversely correlated with headache frequency (right, r = -0.350, P = 0.004; left, r = -0.284, P = 0.019) and intensity (right, r = -0.286, P = 0.019; left, r = -0.244, P = 0.045), but not disease duration. In contrast, the metabolite ratios did not differ at the PAG among the study groups. Of note, MO was not associated with brainstem MRS ratios in patients with CM. The increased NAA/Cr levels may suggest neuronal hypertrophy at the dorsal pons in EM. A progressive dysfunction of this region may occur from EM to CM since the levels declined with increasing headache frequency and intensity.
KW - Brainstem
KW - MR spectroscopy
KW - Migraine
KW - Periaqueductal gray
KW - Pons
UR - http://www.scopus.com/inward/record.url?scp=84870362784&partnerID=8YFLogxK
U2 - 10.1007/s10194-012-0491-0
DO - 10.1007/s10194-012-0491-0
M3 - Article
C2 - 23070401
AN - SCOPUS:84870362784
SN - 1129-2369
VL - 13
SP - 645
EP - 651
JO - Journal of Headache and Pain
JF - Journal of Headache and Pain
IS - 8
ER -