A 2015 study published in the journal PAIN reports less gray matter loss with age in female migraineurs. Previous studies have found that migraine changes the structure of the cerebral cortex. This study targeted an area of the brain called the insula. Functional imaging studies have supported the insula as a hub of activity in migraine.1

Researchers compared the insular cortex of 46 female migraineurs to 46 women without migraine. The report concluded that the thinning of the cortex that normally occurs with age did not occur in the migraineurs.1 Women in the study ranged from age 20 to 65. The study adds to the sparse amount of data that we have on how chronic pain affects the brain over time.2

“The differences found between women and healthy controls with aging suggest that migraine may be a driver of altered insula thickening with age. The insula is involved in a number of functions including autonomic, sensory, and interoceptive,” said David Borsook, MD, lead author of the study, codirector of the Center for Pain and the Brain at Boston Children’s Hospital, and professor of anesthesiology at the Harvard Medical School.

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Migraine, Cortical Excitability and the Insula

“Age involves loss of brain volume. If you get an MRI of an older adult, it will usually say there is mild to moderate loss of volume consistent with aging. This study supports the theory of cortical spreading depression in migraine. Long-term hyperexcitability may prevent the normal thinning of the brain’s cortex,” said Emad Estemalik, MD, neurologist at the Cleveland Clinic Center for Neuro-Restoration.

Pain processing in migraine involves a large-scale interaction of neuroanatomical structures. Finding of a lack of thinning in the insula is particularly interesting when you consider that in people without migraine the insula loses twice as much gray matter with aging than other areas of the cerebral cortex. Supporting MRI evidence that the insula may act as a hub of activity in migraine.1