Proton Magnetic Resonance Spectroscopy to Detect Correlations between Clinical Symptoms and Brain Metabolite Levels in Patients with Tension-type Headache

Background: Proton magnetic resonance spectroscopy (¹HMRS) is a noninvasive method to quantify pain. A ¹HMRS spectrum is a group of peaks at different radiofrequencies, showing proton nuclei in various chemical environments. These MR spectra provide information about metabolite concentrations, and make MRS a useful procedure to monitor metabolic fluctuations due to disease, and to track the efficacy of treatment.

Objective: This study aims to identify correlations between clinical symptoms in patients with tension-type headache (TTH) and concentrations of brain metabolites.

Material and methods: In this observational study, twenty-four patients (4 men and 20 women) with chronic TTH were included. To evaluate their clinical symptoms, the number of trigger points, headache frequency and headache intensity were recorded. The levels of anxiety and depression were recorded with the Beck Anxiety Inventory (BAI) and Beck Depression Inventory II (BDI- II). Concentrations of brain metabolites were determined in the anterior cingulate cortex, thalamus and primary somatosensory cortex of left hemisphere with ¹HMRS.

Results: There was a negative correlation between trigger point count and choline/creatine (Cho/Cr) ratio in the primary somatosensory cortex [r= -0.509, n= 24, p= 0.01]. There were no correlations between other clinical symptoms of TTH and concentrations of brain metabolites.

Conclusion: Patients with more trigger points had a lower Cho/Cr ratio, which may indicate alterations in brain metabolic activity.