title: Cortical plasticity between the pain and pain-free phases in patients with episodic tension-type headache.
abstract: BACKGROUND
  State-related brain structural alterations in patients with episodic tension-type headache (ETTH) are unclear. We aimed to conduct a longitudinal study to explore dynamic gray matter (GM) changes between the pain and pain-free phases in ETTH.
  
  
  METHODS
  We recruited 40 treatment-naïve ETTH patients and 40 healthy controls. All participants underwent brain structural scans on a 3.0-T MRI system. ETTH patients were scanned in and out of pain phases. Voxel-based morphometry analysis was used to determine the differences in regional gray matter density (GMD) between groups. Additional regression analysis was used to identify any associations between regional GMD and clinical symptoms.
  
  
  RESULTS
  ETTH patients exhibited reduced GMD in the bilateral primary somatosensory cortex, and increased GMD in the bilateral anterior cingulate cortex (ACC) and anterior insula for the in pain phase compared with the out of pain phase. The out of pain phase of ETTH patients exhibited no regions with higher or lower GMD compared with healthy controls. GMD in the left ACC and left anterior insula was negatively correlated with headache days. GMD in the left ACC was negatively correlated with anxiety and depressive symptoms in ETTH patients.
  
  
  CONCLUSIONS
  This is the first study to demonstrate dynamic and reversible GMD changes between the pain and pain-free phases in ETTH patients. However, this balance might be disrupted by increased headache days and progressive anxiety and depressive symptoms.
authors.affiliation: Department of Neurology, Huai'an First People's Hospital Affiliated to Nanjing Medical University, 223300, , Beijing West Road 6#, Huai'an, Jiangsu Province, People's Republic of China.
authors.forename: Bing
authors.initials: B
authors.lastname: Chen
authors.affiliation: Department of Gastrointestinal Surgery, Huai'an Hospital Affiliated to Xuzhou Medical College and Huai'an Second People's Hospital, Huai'an, People's Republic of China.
authors.forename: Yuan
authors.initials: Y
authors.lastname: He
authors.affiliation: Department of Neurology, Huai'an First People's Hospital Affiliated to Nanjing Medical University, 223300, , Beijing West Road 6#, Huai'an, Jiangsu Province, People's Republic of China.
authors.forename: Lei
authors.initials: L
authors.lastname: Xia
authors.affiliation: Department of Medical Imaging, Huai'an First People's Hospital Affiliated to Nanjing Medical University, Huai'an, People's Republic of China.
authors.forename: Li-Li
authors.initials: LL
authors.lastname: Guo
authors.affiliation: Department of Neurology, Huai'an First People's Hospital Affiliated to Nanjing Medical University, 223300, , Beijing West Road 6#, Huai'an, Jiangsu Province, People's Republic of China. zhenghayy@sina.com.
authors.forename: Jin-Long
authors.initials: JL
authors.lastname: Zheng
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology; D001921:Brain / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D002540:Cerebral Cortex / Q000000981:diagnostic imaging*; D003863:Depression / Q000523:psychology; D005260:Female; D066128:Gray Matter / Q000000981:diagnostic imaging*; D006179:Gyrus Cinguli / Q000000981:diagnostic imaging*; D006801:Humans; D008137:Longitudinal Studies; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009473:Neuronal Plasticity; D010146:Pain / Q000000981:diagnostic imaging* / Q000523:psychology; D013003:Somatosensory Cortex / Q000000981:diagnostic imaging*; D018781:Tension-Type Headache / Q000000981:diagnostic imaging* / Q000523:psychology
keywords: Anterior cingulate cortex; Anterior insula; Episodic tension-type headache; Gray matter density; Primary somatosensory cortex; Voxel-based morphometry