title: Structural alterations of the brainstem in migraine.
abstract: Atypical brainstem modulation of pain might contribute to changes in sensory processing typical of migraine. The study objective was to investigate whether migraine is associated with brainstem structural alterations that correlate with this altered pain processing. MRI T1-weighted images of 55 migraine patients and 58 healthy controls were used to: (1) create deformable mesh models of the brainstem that allow for shape analyses; (2) calculate volumes of the midbrain, pons, medulla and the superior cerebellar peduncles; (3) interrogate correlations between regional brainstem volumes, cutaneous heat pain thresholds, and allodynia symptoms. Migraineurs had smaller midbrain volumes (healthy controls = 61.28 mm3, SD = 5.89; migraineurs = 58.80 mm3, SD = 6.64;p= 0.038), and significant (p< 0.05) inward deformations in the ventral midbrain and pons, and outward deformations in the lateral medulla and dorsolateral pons relative to healthy controls. Migraineurs had anegativecorrelation between ASC-12 allodynia symptom severity with midbrain volume (r= - 0.32;p= 0.019) and apositivecorrelation between cutaneous heat pain thresholds with medulla (r= 0.337;p= 0.012) and cerebellar peduncle volumes (r= 0.435;p= 0.001). Migraineurs with greater symptoms of allodynia have smaller midbrain volumes and migraineurs with lower heat pain thresholds have smaller medulla and cerebellar peduncles. The brainstem likely plays a role in altered sensory processing in migraine and brainstem structure might reflect severity of allodynia and hypersensitivity to pain in migraine.
authors.affiliation: Mayo Clinic-Arizona, Department of Neurology, Phoenix, AZ, USA.
authors.forename: Catherine D
authors.initials: CD
authors.lastname: Chong
authors.affiliation: Arizona State University, School of Biological and Health Systems Engineering, Tempe, AZ, USA.
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Plasencia
authors.affiliation: Arizona State University, School of Biological and Health Systems Engineering, Tempe, AZ, USA; Arizona State University, School of Electrical, Computer and Energy Engineering, Tempe, AZ, USA.
authors.forename: David H
authors.initials: DH
authors.lastname: Frakes
authors.affiliation: Mayo Clinic-Arizona, Department of Neurology, Phoenix, AZ, USA.
authors.forename: Todd J
authors.initials: TJ
authors.lastname: Schwedt
mesh_terms: D000328:Adult; D001933:Brain Stem / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D006801:Humans; D006930:Hyperalgesia / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology*; D017288:Pain Threshold / Q000502:physiology*
keywords: Allodynia; Brainstem; Magnetic resonance imaging; Migraine