Alterations in the structure and function of the brain in adolescents with new daily persistent headache: A pilot MRI study

Abstract

Objective The purpose of this study was to explore brain morphological and functional connectivity alterations in adolescents with new daily persistent headache (NDPH) compared to pain‐free, healthy controls. Background NDPH is one of the most disabling and least understood primary headache conditions. To date, no studies have considered the role of brain function and structure in pediatric patients with NDPH. Methods In this cross‐sectional study, resting‐state functional and structural images were acquired for 13 patients with NDPH (M age = 15.9, standard deviation [SD] ± 1.4) and 13 age‐ and sex‐matched controls (M age = 16.2, SD ± 1.8) using magnetic resonance imaging. Participants were recruited from the Pediatric Headache Program at Boston Children's Hospital and from the Greater Boston area. In patients, clinical features of NDPH, including disease duration, pain intensity ratings, pain sensitivity, and functional disability were also assessed, and their associations with functional and structural brain alterations were explored. Results Compared to controls, patients with NDPH demonstrated reduced cortical thickness in the bilateral superior temporal gyrus, left superior, and middle frontal gyrus areas (p < 0.05, Monte Carlo corrected for multiple comparisons). Furthermore, reduced cortical thickness of the left superior frontal gyrus was related to elevated pain sensitivity in NDPH (r = −0.79, p = 0.006). Patients showed altered functional connectivity between regions involved in emotional and cognitive networks of pain, including the amygdala, insula, frontal regions, and cerebellar subregions. Conclusion The present study provides the first preliminary evidence of functional and structural brain differences in pediatric patients with NDPH compared to controls. Identifying alterations in cortical thickness and resting‐state connectivity between specific brain regions could provide characteristics of NDPH and probable mechanisms that may guide personalized therapeutic interventions.

Cerebral perfusion variance in new daily persistent headache and chronic migraine: an arterial spin-labeled MR imaging study

“…Given an anticipated dropout rate of 20%, the total sample size required is 36 cases (18 HC group and 18 CM group). Fifteen NDPH cases were included in this study according to the previous similar studies [10, 21,22,33,34]. To match the age and sex of patients with NDPH, 15 HC and 18 patients with CM were included in this study.…”

“…A recent study showed that patients with NDPH had no structural brain changes [36]. Another study of adolescent found that patients with NDPH reduced cortical thickness in the bilateral superior temporal gyrus, left superior, and middle frontal gyrus areas compared with controls [34]. There is still some controversy regarding the alteration of NDPH structure.…”

Alterations in regional homogeneity and multiple frequency amplitudes of low-frequency fluctuation in patients with new daily persistent headache: a resting-state functional magnetic resonance imaging study

“…A cross-sectional voxel-based morphometry (VBM) and surface-based morphometry (SBM) study investigated 23 patients with NDPH and 23 age- and gender-matched healthy controls (HCs) and found no grey matter changes in patients with NDPH [ 32 ]. Another cross-sectional study in 13 adolescents with NDPH found reduced cortical thickness in the bilateral superior temporal gyrus, left superior, and middle frontal gyrus areas and altered functional connectivity in the amygdala, insula, frontal regions, and cerebellar subregions compared to 13 HCs [ 33 ].…”

Update in the understanding of new daily persistent headache

“…This is a substantial leap forward in studying this condition. So far in adults, no structural imaging changes have been noted; however, in a pediatric population with NDPH, there were unique alterations compared to age-matched controls, including a reduction in thickness in the left superior frontal gyrus, cortical thinning in the temporal and middle frontal gyrus, and altered functional connectivity between certain brain regions (51,52). The issue with these studies, however, is that they regard NDPH as a single homogenous entity which it is not; so, the study results have to be interpreted with some caution.…”