Wolff Award: Cognitive Networks Disarrangement in Patients with Migraine Predicts Cutaneous Allodynia

Antonio Russo, MD, PhD

AHSAM 2020 - Oral session
Published on July 17, 2020


5 minute read

Key messages

  • Two‐thirds of patients with migraine without aura (MwoA) experience ictal cutaneous allodynia (CA).
  • CA is a clinical sign of central nociceptive pathway sensitisation and an independent predictor for migraine chronification.
  • Abnormalities in the main cognitive networks (the default mode network [DMN] and the central executive network [CEN]) functional connectivity, and microstructural changes in the corpus callosum, could represent a prognostic imaging biomarker to identify migraine patients prone to experiencing CA and chronic migraine.

Key messages

  • Two‐thirds of patients with migraine without aura (MwoA) experience ictal cutaneous allodynia (CA).
  • CA is a clinical sign of central nociceptive pathway sensitisation and an independent predictor for migraine chronification.
  • Abnormalities in the main cognitive networks (the default mode network [DMN] and the central executive network [CEN]) functional connectivity, and microstructural changes in the corpus callosum, could represent a prognostic imaging biomarker to identify migraine patients prone to experiencing CA and chronic migraine.

Background

What do we already know about this topic?

  • Two-thirds of patients with MwoA report experiencing ictal CA, a perception of skin discomfort induced by trivial stimuli to the skin.
  • CA is a known prognostic factor for migraine chronification and for the likelihood that acute treatments will not be effective.
  • Microstructural or functional changes of the main cognitive networks (DMN, salience network [SN] and CEN) could predict the development of CA in patients with MwoA.

How was this study conducted?

  • A total of 50 drug-naïve patients with MwoA underwent three Tesla MRI brain scans at baseline.
  • Following a three-year period, patients were stratified into two groups based on CA development (as assessed by the ASC-12 scale) and compared with 19 matched healthy controls.
  • Both groups were analysed for intra- and inter-network functional connectivity differences within the cognitive resting-state networks, and whether differences in cognitive network functional connectivity were related to structural and microstructural abnormalities.
  • Logistic regression analysis was used to identify baseline imaging predictors of CA development.

Findings

What does this study add?

  • Patients with MwoA who developed CA (MwoA dCA) over time, had significantly reduced functional connectivity of the main cognitive networks, when compared with patients with MwoA who did not develop CA and the healthy control group.
  • Within the DMN, the reduced intrinsic posterior cingulate cortex/precuneus connectivity in patients with MwoA dCA could subtend abnormal inputs integration, from different sensory modalities, allowing the development of CA.
  • Within the CEN, reduced anterior cingulate cortex and middle frontal gyrus functional connectivity in MwoA dCA patients may represent the neuronal substrate of subclinical impairment of complex executive functions, making these patients more prone to migraine chronification. In addition, decreased anterior cingulate cortex-functional connectivity was significantly associated with CA development.
  • Significant microstructural changes in the corpus callosum were observed in patients with MwoA dCA.
  • There were no significant correlations between the functional and microstructural changes, and the clinical and neuropsychological parameters.

Perspectives

How does this study impact clinical practice?

  • The intrinsic functional abnormalities in cognitive networks and specific microstructural changes in patients with MwoA, may provide neuroimaging prognostic biomarkers that identify those patients who will develop CA over time and are more prone to migraine chronification.
  • The identification of migraine phenotypes with an unfavorable prognosis enables tailored effective treatment to maximize limited resources and improve patient outcomes.

This is a highlights summary of an oral session given at the AHSAM 2020 Virtual Annual Scientific Meeting and presented by:

Antonio Russo, MD, PhD
Associate Professor of Neurology
University of Campania "Luigi Vanvitelli"
Napoli, Campania, Italy

The content is produced by Infomedica, the official reporting partner of ASHAM 2020 Virtual Annual Scientific Meeting. The summary text was drafted by Goldcrest Medical Writing, reviewed by Marco Vercellino, MD, an independent external expert, and approved by Jessica Ailani, MD, FAHS and Mark J. Burish, MD, PhD, the scientific editors of the program.

The presenting authors of the original session had no part in the creation of this conference highlights summary.



Headache
Award lecture


Scan to open on your mobile device