Background

There is evidence of altered resting hypothalamic activity patterns and connectivity prior to a migraine, however it remains unknown if these changes are driven by changes in overall hypothalamic activity levels. If they are, it would corroborate the idea that changes in hypothalamic function result in alteration in brainstem pain processing sensitivity, which either triggers a migraine headache itself or allows an external trigger to initiate a migraine headache. We hypothesise that hypothalamic activity increases immediately prior to a migraine headache and this is accompanied by altered functional connectivity to pain processing sites in the brainstem.

Methods

In 34 migraineurs and 26 healthy controls, we collected a series comprising 108 pseudo-continuous arterial spin labelling images and 180 gradient-echo echo planar resting-state functional magnetic resonance volumes to measure resting regional cerebral blood flow and functional connectivity respectively. Images were pre-processed and analysed using custom SPM12 and Matlab software.

Results

Our results reflect that immediately prior to a migraine headache, resting regional cerebral blood flow decreases in the lateral hypothalamus. In addition, resting functional connectivity strength decreased between the lateral hypothalamus and important regions of the pain processing pathway, such as the midbrain periaqueductal gray, dorsal pons, rostral ventromedial medulla and cingulate cortex, only during this critical period before a migraine headache.

Conclusion

These data suggest altered hypothalamic function and connectivity in the period immediately prior to a migraine headache and supports the hypothesis that the hypothalamus is involved in migraine initiation.

中文翻译：

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在偏头痛之前立即改变局部脑血流和下丘脑连接

背景

有证据表明在偏头痛之前静息下丘脑活动模式和连接性发生了改变，但是这些变化是否是由整体下丘脑活动水平的变化驱动的仍然未知。如果是这样，它将证实下丘脑功能的变化会导致脑干疼痛处理敏感性的改变，这要么触发偏头痛本身，要么允许外部触发引发偏头痛。我们假设下丘脑活动在偏头痛之前立即增加，并且伴随着与脑干中疼痛处理部位的功能连接的改变。

方法

在 34 名偏头痛患者和 26 名健康对照者中，我们收集了一系列包括 108 个伪连续动脉自旋标记图像和 180 个梯度回波平面静息状态功能磁共振体积，分别测量静息区域脑血流量和功能连通性。使用定制的 SPM12 和 Matlab 软件对图像进行预处理和分析。

结果

我们的结果反映了在偏头痛发生之前，下丘脑外侧的静息区域脑血流量减少。此外，仅在偏头痛前的这个关键时期，下丘脑外侧与疼痛处理途径的重要区域（如中脑导水管周围灰质、脑桥背侧、延髓腹内侧延髓和扣带回皮质）之间的静息功能连接强度降低。

结论

这些数据表明，在偏头痛发作前的那段时间里，下丘脑功能和连通性发生了改变，并支持下丘脑参与偏头痛发作的假设。