Functional connectivity of the visual cortex in chronic migraine before and after medication withdrawal therapy

• Published in: NeuroImage clinical Vol. 40; p. 103543
• Main Authors: Mäki-Marttunen, Veronica, Kies, Dennis A., Pijpers, Judith A., Louter, Mark A., van der Wee, Nic J., Rombouts, Serge A.R.B., Nieuwenhuis, Sander, Kruit, Mark, Terwindt, Gisela M.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 2023; Elsevier
• Subjects: Brain - diagnostic imaging; fMRI; Functional connectivity; Headache; Humans; Magnetic Resonance Imaging - methods; Migraine; Migraine Disorders - diagnostic imaging; Migraine Disorders - drug therapy; Radiology; Visual cortex; Visual Cortex - diagnostic imaging; Withdrawal therapy; Functional connectivity; fMRI; Visual cortex; Withdrawal therapy; Migraine
• ISSN: 2213-1582; 2213-1582
• DOI: 10.1016/j.nicl.2023.103543

•First large-scale whole-brain fMRI study of FC in patients with chronic migraine.•Comparison with healthy controls, episodic migraine, chronic pain and depression.•Most of differences in FC in chronic migraine patients involved the visual cortex.•Response to medication withdrawal showed differences in FC of visual cortex at baseline. Acute withdrawal of headache medication in chronic migraine patients with medication overuse may lead to a dramatic reduction in headache frequency and severity. However, the brain networks underlying chronic migraine and a favorable response to acute withdrawal are still poorly understood. The goal of the present study was to characterize the pattern of intrinsic magnetic resonance imaging (MRI) functional connectivity (FC) specific to chronic migraine and to identify changes in FC that characterize subjects with CM reverting to less frequent headaches. Subjects with chronic migraine (N = 99) underwent a resting-state functional MRI scan before and after three months of medication withdrawal therapy. In addition, we included four control groups who were scanned once: healthy participants (N = 27), patients with episodic migraine (N = 25), patients with chronic back pain (N = 22), and patients with clinical depression (N = 17). Using dual regression analysis, we compared whole-brain voxel-level functional connectivity with ten well-known resting-state networks between chronic migraine and control groups, and between responders to treatment (≥50 % reduction in monthly headache days) and non-responders (<50 % reduction), before and after treatment. Subjects with chronic migraine showed differences in FC with a number of RS-networks, most of which involved the visual cortex, compared with healthy controls. A comparison with patients with episodic migraine, chronic pain and depression showed differences in the same direction, suggesting that altered patterns of functional connectivity in chronic migraine patients could to some extent be explained by shared symptomatology with other pain, depression, or migraine conditions. A comparison between responders and non-responders indicated that effective withdrawal reduced FC with the visual cortex for responders. Interestingly, responders already differed in functional connectivity of the visual cortex at baseline compared with non-responders. Altogether, we show that chronic migraine and successful medication withdrawal therapy are linked to changes in the functional connectivity of the visual cortex. These neuroimaging findings provide new insights into the pathways underlying migraine chronification and its reversibility.