Neuronal Dynamics of Menstrually Related Migraine: A Longitudinal Task-Based fMRI Study
Abstract
BACKGROUND AND OBJECTIVES: Recent fMRI research has identified hypothalamic activation in the preictal phase of migraine, thereby suggesting that the hypothalamus plays a pivotal role in subsequent headaches. However, menstrual migraine (MM) attacks differ from nonmenstrual attacks because of prominent hormonal changes, which are suggested to be the cause of such attacks. This raises questions as to whether MM has different neuronal attack generators. We aimed to use longitudinal daily task-based fMRI to investigate the central changes before MM attacks.
METHODS: Patients with pure menstrual migraine or menstrually related migraine (≤1 extramenstrual attack monthly), as per International Classification of Headache Disorders criteria, were recruited and compared with age-matched and sex-matched healthy controls. Longitudinal daily task-based fMRI was conducted, commencing 6 days before expected menstruation and continuing until spontaneous migraine onset and the menstruation, respectively. Per the task-based protocol, electrical stimulation was administered to the left forehead to activate the trigeminal nociceptive system, with the stimulus intensity tailored to the individual's daily pain threshold, ensuring minimal discomfort and absence of peripheral sensitization. Brain activation before the onset of MM was the primary outcome.
RESULTS: Ten patients and 13 healthy controls (mean age, 28.8 ± 4.9 vs 27.4 ± 2.7 years, all female) were recruited, with each participant…
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Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence.
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