Functional MRI analysis of pain processing in patients with chronic migraine
Abstract
Chronic migraine remains a disabling condition lacking objective biomarkers to guide personalized treatment. In this problem‐based study, we combined resting‐state and task‐evoked functional MRI with qualitative pain‐experience interviews in 40 adults (mean age 42.3 ± 10.5 years; 12 men) meeting ICHD-3 criteria for chronic migraine. Participants reported a mean of 20.5 ± 3.4 headache days per month (VAS pain intensity 7.2 ± 1.1) and moderate anxiety (HADS-A 8.5 ± 3.2) and depression (HADS-D 7.1 ± 2.8). Resting-state analyses revealed elevated default mode network (DMN) connectivity (z = 0.42 ± 0.15) that correlated with headache frequency (r = 0.48, p = 0.003) and heightened salience-network (SN) coherence (z = 0.35 ± 0.12) that correlated with headache days (r = 0.52, p = 0.001). Sliding-window connectivity demonstrated dynamic SN and DMN fluctuations tracking migraine burden. During thermal nociceptive stimulation, we observed robust anterior insula (t = 6.2) and secondary somatosensory cortex (t = 5.8) activations, with insular responsivity strongly associated with patient-reported pain intensity (r = 0.60, p < 0.001). Qualitative thematic analysis identified catastrophizing as the predominant cognitive–affective theme (25/40 participants), suggesting maladaptive appraisal contributes to chronification. A modest inverse relationship between central executive network connectivity and anxiety scores (r = –0.30, p = 0.050) further implicated affective dysregulation in…
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