Metabolic Changes From Age Associated With Migraine Pathophysiology

A study recently published in Cephalalgia showed that age correlates with metabolic changes in critical regions of the brain previously associated with migraine’s pathophysiology to a better extent than disease duration or the number of migraine days.

The study included 20 control participants and 21 participants with episodic migraine. The investigators analyzed the relation in uptake of brain glucose, ¹⁸F-fluorodeoxyglucose (¹⁸FDG), and age between both groups. In participants with migraine, investigators also compared the correlation between ¹⁸FDG uptake and disease duration and monthly migraine days. Positive and negative correlations with age were explored, and one-sided t-tests for positive and negative contrasts were made to compare resting ¹⁸FDG uptake in participants with migraine and controls with and without controlling for age.

Compared with controls, participants with migraine exhibited a significant increase in ¹⁸FDG uptake in the brainstem (especially the posterior pons) and clusters in the parahippocampal gyrus, fusiform gyrus, and the hippocampus. No significant correlations, positive or negative, were observed between disease duration or migraine days and ¹⁸FDG uptake by the brain.

Some of the limitations the authors realized are that positron emission tomography used to scan the individual’s brain has a limited spatial resolution, which can hinder a precise and unambiguous identification of small regions in the brain. Further, because age and disease duration were correlated, the effect of each one cannot be entirely separated. A positive control, such as chronic pain, is missing; therefore, the findings cannot be proven to be migraine-specific. Also, the number of individuals in the study was small, and recall bias could reduce precision when estimating disease duration. Finally, adding tests to evaluate cognitive and other cerebral functions could have improved the understanding of the study outcomes.

The investigators concluded that from a metabolic perspective, more than repeated headache attacks, the continuous interaction with the environment seems to model the brain of individuals with migraine in an adaptive manner.

Reference

Lisicki M, D’Ostilio K, Coppola G, et al. Age related metabolic modifications in the migraine brain [published online February 11, 2019]. Cephalalgia. doi: 10.1177/0333102419828984

This article originally appeared on Neurology Advisor