title: Right fronto-insular white matter tracts link cognitive reserve and pain in migraine patients.
abstract: BACKGROUND
  Structural white matter abnormalities in pain-modulating, regions are present in migraine. Whether they are associated with pain chronification and with cognitive reserve is unclear.
  
  
  METHODS
  Prospective, cohort, six-month study of adult patients with episodic or chronic migraine, and controls. Cognitive reserve, quality of life, impact of pain on daily living, depression and anxiety were assessed. Participants underwent a diffusion-tensor MRI to establish the integrity of white matter tracts of three regions of interest (ROIs) implicated in pain modulation, emotion, cognition and resilience (anterior insula, anterior cingulate gyrus, and uncinate fasciculus).
  
  
  RESULTS
  Fifty-two individuals were enrolled: 19 episodic migraine patients, 18 chronic migraine patients, and 15 controls. The analysis of the fractional anisotropy in the ROIs showed that those patients with the poorest prognosis (i.e., those with chronic migraine despite therapy at six months--long-term chronic migraneurs) had a significantly lower fractional anisotropy in the right ROIs. Participants with higher cognitive reserve also had greater fractional anisotropy in the right anterior insula and both cingulate gyri. Multivariate analysis showed a significant association between cognitive reserve, migraine frequency, and fractional anisotropy in the right-sided regions of interest.
  
  
  CONCLUSIONS
  Long-term chronic migraine patients show abnormalities in anterior white matter tracts, particularly of the right hemisphere, involved in pain modulation emotion, cognition and resilience. Robustness in these areas is associated with a higher cognitive reserve, which in turn might result in a lower tendency to migraine chronification.
authors.affiliation: Service of Neurology Hospital de Galdakao-Usansolo, Galdakao, 48960, Vizcaya, Spain. mgomezab@sarenet.es.
authors.forename: Marian
authors.initials: M
authors.lastname: Gomez-Beldarrain
authors.affiliation: Service of Neurology Hospital de Galdakao-Usansolo, Galdakao, 48960, Vizcaya, Spain.
authors.forename: Isabel
authors.initials: I
authors.lastname: Oroz
authors.affiliation: DeustoTech-LIFE/eVIDA, Universidad de Deusto, Vizcaya, Spain.
authors.forename: Begoña Garcia
authors.initials: BG
authors.lastname: Zapirain
authors.affiliation: Research and Innovation Department, Magnetic Resonance Imaging Unit, OSATEK, Vizcaya, Spain.
authors.forename: Begoña Fernandez
authors.initials: BF
authors.lastname: Ruanova
authors.affiliation: DeustoTech-LIFE/eVIDA, Universidad de Deusto, Vizcaya, Spain.
authors.forename: Yolanda Garcia
authors.initials: YG
authors.lastname: Fernandez
authors.affiliation: Research and Innovation Department, Magnetic Resonance Imaging Unit, OSATEK, Vizcaya, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Cabrera
authors.affiliation: REDISSEC, Health Services Research on Chronic Patients Network Research Unit Hospital de Galdakao-Usansolo, Galdakao, Vizcaya, Spain.
authors.forename: Ane
authors.initials: A
authors.lastname: Anton-Ladislao
authors.affiliation: REDISSEC, Health Services Research on Chronic Patients Network Research Unit Hospital de Galdakao-Usansolo, Galdakao, Vizcaya, Spain.
authors.forename: Urko
authors.initials: U
authors.lastname: Aguirre-Larracoechea
authors.affiliation: Service of Neurology Hospital de Galdakao-Usansolo, Galdakao, 48960, Vizcaya, Spain.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Garcıa-Monco
mesh_terms: D000328:Adult; D016880:Anisotropy; D002540:Cerebral Cortex / Q000503:physiopathology*; D058245:Cognitive Reserve / Q000502:physiology*; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D005625:Frontal Lobe / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000503:physiopathology*; D010146:Pain / Q000503:physiopathology*; D011446:Prospective Studies; D011788:Quality of Life; D066127:White Matter / Q000503:physiopathology*
keywords: Chronic migraine; Cingulate gyri; Cognitive reserve; Fractional anisotropy; Insula; Migraine; Uncinate fasciculus
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