Evaluation of structural changes in orbitofrontal cortex in relation to medication overuse in migraine patients: a diffusion tensor imaging study

Abstract

Background: Migraine is a prevalent neurological disease that leads to severe headaches. Moreover, it is the commonest among the primary headaches that cause medication overuse headache (MOH). The orbitofrontal cortex (OFC) is one of the structures most associated with medication overuse. Objective: To determine microstructural changes in the OFC among migraine patients who developed MOH, through the diffusion tensor imaging (DTI) technique. Methods: Fifty-eight patients who had been diagnosed with migraine based on the Classification of Headache Disorders (ICHD-III-B) were included in the study. Patients were sub-classified into two groups, with and without MOH, based on the MOH criteria of ICHD-III-B. DTI was applied to each patient. The OFC fractional anisotropy (FA), and apparent diffusion coefficient (ADC) values of the two groups were compared. Results: The mean age of all the patients was 35.98±7.92 years (range: 18-65), and 84.5% (n=49) of them were female. The two groups, with MOH (n=25) and without (n=33), were alike in terms of age, gender, family history, migraine with or without aura and duration of illness. It was found that there was a significant difference in FA values of the left OFC between the two groups (0.32±0.01 versus 0.29±0.01; p=0.04). Conclusions: An association was found between MOH and changes to OFC microstructure. Determination of neuropathology and factors associated with medication overuse among migraine patients is crucial in terms of identifying the at-risk patient population and improving proper treatment strategies specific to these patients.

Microstructural white matter alterations associated with migraine headaches: a systematic review of diffusion tensor imaging studies

“…Mean disease duration ranged from less than three years (Messina et al, 2015 ) to about 34 years (Schmitz et al, 2008 ) among the included articles. Several studies reported mean attack duration, defined as the number of hours each attack lasts (Coppola et al, 2014 , 2020 ; Liu et al, 2013 ), and pain intensity (Coppola et al, 2016a , b ; Coppola et al, 2020 ; Coppola et al, 2014 ; Li et al, 2011 ; Liu et al, 2013 ; Marciszewski & Meylakh, 2019 ; Marciszewski et al, 2018 ; Neeb et al, 2015 ; Russo et al, 2020 ; Tantik Pak et al, 2021 ; Tedeschi et al, 2016 ; Tessitore et al, 2015 ; Yu et al, 2013b ; Zhang et al, 2017 ), based on a pain scale continuum ranging from 0 (no pain) to 10 (severe pain).…”

“…Most of the studies investigated microstructural metrics at whole brain level. Nine studies focused on specific pathways as regions of interest: optic radiation (OR) (Rocca et al, 2008 ), corticospinal tract (CST) (Rocca et al, 2008 ), corpus callosum (CC) (Li et al, 2011 ; Rocca et al, 2008 ), red nuclei, PAG, thalami, posterior limbs of IC (PLICs), subcortical WM (Kara et al, 2013 ), thalamus (Coppola et al, 2016a , b ; Coppola et al, 2014 ), cerebellum and brainstem (Qin et al, 2019 ), anterior insula, cingulate gyrus, uncinate fasciculus (Gomez-Beldarrain et al, 2015 ), and orbitofrontal cortex (Tantik Pak et al, 2021 ). Table 2 summarizes the imaging methodologies of the included studies.…”