CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2021; 79(06): 483-488
DOI: 10.1590/0004-282X-ANP-2020-0360
Article

Evaluation of structural changes in orbitofrontal cortex in relation to medication overuse in migraine patients: a diffusion tensor imaging study

Avaliação das mudanças estruturais no córtex orbitofrontal em relação ao uso excessivo de medicamentos em pacientes com migrânea: um estudo de imagem por tensor de difusão
1   Gaziosmanpasa Training and Research Hospital, Department of Neurology, Istanbul, Turkey.
,
2   Gaziosmanpasa Training and Research Hospital, Department of Radiology, Istanbul, Turkey.
,
1   Gaziosmanpasa Training and Research Hospital, Department of Neurology, Istanbul, Turkey.
› Author Affiliations

Abstract

Background: Migraine is a prevalent neurological disease that leads to severe headaches. Moreover, it is the commonest among the primary headaches that cause medication overuse headache (MOH). The orbitofrontal cortex (OFC) is one of the structures most associated with medication overuse. Objective: To determine microstructural changes in the OFC among migraine patients who developed MOH, through the diffusion tensor imaging (DTI) technique. Methods: Fifty-eight patients who had been diagnosed with migraine based on the Classification of Headache Disorders (ICHD-III-B) were included in the study. Patients were sub-classified into two groups, with and without MOH, based on the MOH criteria of ICHD-III-B. DTI was applied to each patient. The OFC fractional anisotropy (FA), and apparent diffusion coefficient (ADC) values of the two groups were compared. Results: The mean age of all the patients was 35.98±7.92 years (range: 18-65), and 84.5% (n=49) of them were female. The two groups, with MOH (n=25) and without (n=33), were alike in terms of age, gender, family history, migraine with or without aura and duration of illness. It was found that there was a significant difference in FA values of the left OFC between the two groups (0.32±0.01 versus 0.29±0.01; p=0.04). Conclusions: An association was found between MOH and changes to OFC microstructure. Determination of neuropathology and factors associated with medication overuse among migraine patients is crucial in terms of identifying the at-risk patient population and improving proper treatment strategies specific to these patients.

RESUMO

Introdução: A migrânea é uma doença neurológica prevalente que causa fortes dores de cabeça. Além disso, é a mais comum entre as cefaleias primárias que causam cefaleia por uso excessivo de medicamentos (CUEM). O córtex orbitofrontal (OF) é uma das estruturas mais associadas ao uso excessivo de medicamentos. Objetivo: Determinar alterações microestruturais no córtex OF em pacientes com migrânea que desenvolveram CUEM, por meio da técnica de imagem por tensor de difusão (ITD). Métodos: Cinquenta e oito pacientes com diagnóstico de migrânea, com base na Classificação das Cefaleias (ICHD-III-B), foram incluídos no estudo. Os pacientes foram subclassificados em dois grupos, com e sem CUEM, com base nos critérios de CUEM da ICHD-III-B. A ITD foi aplicada a cada paciente. Os valores de anisotropia fracionada OFC (AF) e coeficiente de difusão aparente (CDA) dos dois grupos foram comparados. Resultados: A média de idade de todos os pacientes foi de 35,98±7,92 anos (variação: 18‒65), sendo 84,5% (n=49) do sexo feminino. Os dois grupos, com CUEM (n=25) e sem (n=33), são semelhantes em termos de idade, sexo, história familiar, migrânea com ou sem aura e duração da doença. Verificou-se que houve diferença significativa nos valores de AF do córtex OF esquerdo entre os dois grupos (0,32±0,01 versus 0,29±0,01; p=0,04). Conclusões: Foi encontrada associação entre o CUEM e as alterações na microestrutura do córtex OF. A determinação da neuropatologia e dos fatores associados ao uso excessivo de medicamentos entre pacientes com migrânea é crucial para identificar a população de pacientes em risco e melhorar as estratégias de tratamento adequadas específicas para esses pacientes.

Authors’ contributions:

ATP: made a substantial contribution to the acquisition of data. ATP, YS and SND: made substantial contributions to the conception or design of the study and the acquisition/interpretation of data. ATP, YS and SND: made substantial contributions to the conception or design of the study. All authors made substantial contributions to manuscript development, gave final approval of the manuscript for submission and agree to be accountable for all aspects of the work. ATP, YS and SND: are the guarantors for the overall content of the manuscript.




Publication History

Received: 10 August 2020

Accepted: 08 December 2020

Article published online:
04 July 2023

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  • References

  • 1 Lipton RB, Bigal ME. Migraine: epidemiology, impact, and risk factors for progression. Headache. 2005 Apr;45 Suppl 1:S3-S13. https://doi.org/10.1111/j.1526-4610.2005.4501001.x
  • 2 Breslau N, Davis GC. Migraine, physical health and psychiatric disorder: A prospective epidemiologic study in young adults. J Psychiatr Res. 1993 Apr-Jun;27(2):211-21. https://doi.org/10.1016/0022-3956(93)90009-q
  • 3 Radat F, Swendsen J. Psychiatric comorbidity in migraine: a review. Cephalalgia. 2005 Mar;25(3):165-78. https://doi.org/10.1111/j.1468-2982.2004.00839.x
  • 4 Ertas M, Baykan B, Orhan EK, Zarifoglu M, Karli N, Saip S, et al. One-year prevalence and the impact of migraine and tension-type headache in Turkey: a nationwide home-based study in adults. J Headache Pain. 2012 Mar;13(2):147-57. https://doi.org/10.1007/s10194-011-0414-5
  • 5 Katsarava Z, Muessig M, Dzagnidze A, Fritsche G, Diener H, Limmroth V. Medication overuse headache: rates and predictors for relapse in a 4-year prospective study. Cephalalgia. 2005 Jan;25(1):12-5. https://doi.org/10.1111/j.1468-2982.2004.00789.x
  • 6 Schoenbaum G, Shaham Y. The role of orbitofrontal cortex in drug addiction: a review of preclinical studies. Biol Psychiatry. 2008 Feb;63(3):256-62. https://doi.org/10.1016/j.biopsych.2007.06.003
  • 7 Shamay-Tsoory SG, Tomer R, Berger BD, Aharon-Peretz J. Characterization of empathy deficits following prefrontal brain damage: the role of the right ventromedial prefrontal cortex. J Cogn Neurosci. 2003 Apr;15(3):324-37. https://doi.org/10.1162/089892903321593063
  • 8 Crews FT, Boettiger CA. Impulsivity, frontal lobes and risk for addiction. Pharmacol Biochem Behav. 2009 Sep;93(3):237-47. https://doi.org/10.1016/j.pbb.2009.04.018.
  • 9 Hornak J, O'Doherty J, Bramham J, Rolls ET, Morris RG, Bullock PR, et al. Reward-related reversal learning after surgical excisions in orbito-frontal or dorsolateral prefrontal cortex in humans. J Cogn Neurosci. 2004 Apr;16(3):463-78. https://doi.org/10.1162/089892904322926791
  • 10 Fumal A, Laureys S, Di Clemente L, Boly M, Bohotin V, Vandenheede M, et al. Orbitofrontal cortex involvement in chronic analgesic-overuse headache evolving from episodic migraine. Brain. 2006 Feb;129(Pt 2):543-50. https://doi.org/10.1093/brain/awh691
  • 11 Mori S, Zhang J. Principles of diffusion tensor imaging and its applications to basic neuroscience research. Neuron. 2006 Sep;51(5):527-39. https://doi.org/10.1016/j.neuron.2006.08.012
  • 12 Shibata Y, Ishiyama S, Matsushita A. White matter diffusion abnormalities in migraine and medication overuse headache: A 1.5-T tract-based spatial statistics study. Clin Neurol Neurosurg. 2018 Nov;174:167-173. https://doi.org/10.1016/j.clineuro.2018.09.022
  • 13 Zheng Z, Xiao Z, Shi X, Ding M, Di W, Qi W, et al. White matter lesions in chronic migraine with medication overuse headache: a cross-sectional MRI study. J Neurol. 2014 Apr;261(4):784-90. https://doi.org/10.1007/s00415-014-7267-1
  • 14 The International Classification of Headache Disorders, 3rd edition (beta version). Cephalalgia. 2013 Jul;33(9):629-808. https://doi.org/10.1177/0333102413485658
  • 15 Hawker GA, Mian S, Kendzerska T, French M. Measures of adult pain: Visual Analog Scale for Pain (VAS Pain), Numeric Rating Scale for Pain (NRS Pain), McGill Pain Questionnaire (MPQ), Short-Form McGill Pain Questionnaire (SF-MPQ), Chronic Pain Grade Scale (CPGS), Short Form-36 Bodily Pain Scale (SF-36 BPS), and Measure of Intermittent and Constant Osteoarthritis Pain (ICOAP). Arthritis Care Res (Hoboken). 2011 Nov;63 Suppl 11:S240-52. https://doi.org/10.1002/acr.20543
  • 16 Gómez-Beldarrain M, Carrasco M, Bilbao A, García-Moncó JC. Orbitofrontal dysfunction predicts poor prognosis in chronic migraine with medication overuse. J Headache Pain. 2011 Aug;12(4):459-66. https://doi.org/10.1007/s10194-011-0340-6
  • 17 Biagianti B, Grazzi L, Gambini O, Usai S, Muffatti R, Scarone S, et al. Decision-making deficit in chronic migraine patients with medication overuse. Neurol Sci. 2012 May;33 Suppl 1:S151-5. https://doi.org/10.1007/s10072-012-1071-4
  • 18 Lai T-H, Chou K-H, Fuh J-L, Lee P-L, Kung Y-C, Lin C-P, et al. Gray matter changes related to medication overuse in patients with chronic migraine. Cephalalgia. 2016 Dec;36(14):1324-33. https://doi.org/10.1177/0333102416630593
  • 19 Riederer F, Gantenbein AR, Marti M, Luechinger R, Kollias S, Sándor PS. Decrease of gray matter volume in the midbrain is associated with treatment response in medication-overuse headache: possible influence of orbitofrontal cortex. J Neurosci. 2013 Sep;33(39):1543-9. https://doi.org/10.1523/JNEUROSCI.3804-12.2013
  • 20 Riederer F, Marti M, Luechinger R, Lanzenberger R, Meyenburg J von, Gantenbein AR, et al. Grey matter changes associated with medication-overuse headache: correlations with disease related disability and anxiety. World J Biol Psychiatry. 2012 Oct;13(7):517-25. https://doi.org/10.3109/15622975.2012.665175
  • 21 Ferraro S, Grazzi L, Mandelli ML, Aquino D, Di Fiore D, Usai S, et al. Pain Processing in medication overuse headache: a functional magnetic resonance imaging (fMRI) study. Pain Med. 2012 Feb;13(2):255-62. https://doi.org/10.1111/j.1526-4637.2011.01183.x
  • 22 London ED, Ernst M, Grant S, Bonson K, Weinstein A. Orbitofrontal cortex and human drug abuse: functional imaging. Cereb Cortex. 2000 Mar;10(3):334-42. https://doi.org/10.1093/cercor/10.3.334
  • 23 Volkow ND, Fowler JS, Wang G-J. The addicted human brain viewed in the light of imaging studies: brain circuits and treatment strategies. Neuropharmacology. 2004;47 Suppl 1:3-13. https://doi.org/10.1016/j.neuropharm.2004.07.019
  • 24 Zald D, Rauch S. The Orbitofrontal Cortex [Internet]. New York: Oxford University Press; 2006 [cited 2020 Jun 26]. Available at: http://gen.lib.rus.ec/book/index.php?md5=dcb9be87057bc080822cad45d88bf743