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White Matter Changes in Chronic and Episodic Migraine: A Diffusion Tensor Imaging Study


White Matter Changes in Chronic and Episodic Migraine: A Diffusion Tensor Imaging Study

Álvaro Planchuelo-Gómez et al. J Headache Pain.


Background: White matter alterations have been observed in patients with migraine. However, no microstructural white matter alterations have been found particularly in episodic or chronic migraine patients, and there is limited research focused on the comparison between these two groups of migraine patients.

Methods: Fifty-one healthy controls, 55 episodic migraine patients and 57 chronic migraine patients were recruited and underwent brain T1-weighted and diffusion-weighted MRI acquisition. Using Tract-Based Spatial Statistics (TBSS), fractional anisotropy, mean diffusivity, radial diffusivity and axial diffusivity were compared between the different groups. On the one hand, all migraine patients were compared against healthy controls. On the other hand, patients from each migraine group were compared between them and also against healthy controls. Correlation analysis between clinical features (duration of migraine in years, time from onset of chronic migraine in months, where applicable, and headache and migraine frequency, where applicable) and Diffusion Tensor Imaging measures was performed.

Results: Fifty healthy controls, 54 episodic migraine and 56 chronic migraine patients were finally included in the analysis. Significant decreased axial diffusivity (p < .05 false discovery rate and by number of contrasts corrected) was found in chronic migraine compared to episodic migraine in 38 white matter regions from the Johns Hopkins University ICBM-DTI-81 White-Matter Atlas. Significant positive correlation was found between time from onset of chronic migraine and mean fractional anisotropy in the bilateral external capsule, and negative correlation between time from onset of chronic migraine and mean radial diffusivity in the bilateral external capsule.

Conclusions: These findings suggest global white matter structural differences between episodic migraine and chronic migraine. Patients with chronic migraine could present axonal integrity impairment in the first months of chronic migraine with respect to episodic migraine patients. White matter changes after the onset of chronic migraine might reflect a set of maladaptive plastic changes.

Keywords: Chronic migraine; Diffusion tensor imaging; Magnetic resonance imaging (MRI); Migraine; Tract-based spatial statistics.

Conflict of interest statement

The authors declare that they have no competing interests.


Fig. 1
Fig. 1
White matter alterations in chronic migraine compared to episodic migraine patients. TBSS shows decreased AD values in CM compared to EM in widespread locations with no covariate corrections (top) and correcting for time from onset of CM (bottom). White matter skeleton is shown in green, and voxels with significant differences in red-yellow. The colour bar shows the p-values (uncorrected). The maximum uncorrected p-value for each case is given by FDR and number of contrasts corrections
Fig. 2
Fig. 2
Association graphs between clinical parameters and DTI measures. Significant association with the mean FA in the bilateral external capsule is shown in (a) and (b). Significant association with the mean RD is shown in (c) and (d). LEC = left external capsule; REC = right external capsule
Fig. 3
Fig. 3
DTI measures temporal change hypothesis. Illustrative values are shown for generalized trends in FA, RD and AD (from left to right) in each of the different migraine stages, including a previous healthy control stage. Stages are ordered chronologically from left to right in each subplot. The interpretation of different trends in DTI measures is given in each subplot. The values in the vertical axes should only be used as an orientation to watch the trends and differences between groups, not interpreted as real values

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