Menstrual migraine (MM) is a special type of migraine associated with the ovarian cycle, which imposes a marked burden on female patients. However, the pathogenesis of MM is not completely understood. We investigated gray matter volume (GMV) and functional connectivity (FC) alterations in patients with MM to explore whether there are changes in resting-state FC (rsFC) in brain regions with structural GMV abnormalities and investigated their relevance to pain and concomitant symptoms.

Seventy-five patients with MM and 54 female healthy controls underwent functional magnetic resonance imaging and examination. The patients completed a patient’s headache diary, which included the frequency of migraine attacks, a visual analog scale for pain, a self-rating anxiety scale, and a self-rating depression scale. We used voxel-based morphometry (VBM) to examine the GMV differences between the MM and healthy control groups. The identified brain areas were selected as seeds to assess functional changes in the MM group. Correlation analysis between the altered VBM/rsFC and clinical outcomes was performed.

Compared with healthy controls, patients with MM showed decreased GMV in the right anterior cingulum cortex (ACC) and increased GMV in the right superior parietal cortex. Pearson’s correlation analysis illustrated that only GMV in the right ACC was associated with visual analogue scale pain scores in the MM group. RsFC with the ACC as the seed showed that patients with MM exhibited increased FC between the ACC and the left inferior temporal gyrus, bilateral angular gyrus, and right precuneus. Correlation analysis showed that the change in FC between the right ACC and the right precuneus was positively correlated with headache frequency, and the change in FC between the right ACC and the right angular gyrus was positively correlated with the depression score.

Our results suggested that the ACC may be an important biomarker in MM, and its structural and functional impairments are significantly associated with the severity of pain and pain-related impairment of emotion in patients with MM. These findings demonstrated that headache-associated structural and functional abnormalities in the ACC may can provide integrative evidence on the physiological mechanisms of MM.

月经性偏头痛（MM）是一种与卵巢周期相关的特殊偏头痛，给女性患者带来了显着的负担。然而，MM的发病机制尚不完全清楚。我们调查了 MM 患者的灰质体积 (GMV) 和功能连接性 (FC) 改变，以探索具有结构性 GMV 异常的大脑区域的静息状态 FC (rsFC) 是否存在变化，并研究了它们与疼痛和伴随症状的相关性。

75 名 MM 患者和 54 名女性健康对照者接受了功能性磁共振成像和检查。患者完成了患者的头痛日记，其中包括偏头痛发作的频率、疼痛的视觉模拟量表、自评焦虑量表和自评抑郁量表。我们使用基于体素的形态测量 (VBM) 来检查 MM 和健康对照组之间的 GMV 差异。选择确定的大脑区域作为种子，以评估 MM 组的功能变化。进行了改变的 VBM/rsFC 与临床结果之间的相关性分析。

与健康对照组相比，MM 患者右侧前扣带皮层 (ACC) 的 GMV 降低，而右侧顶叶上皮层的 GMV 升高。Pearson 的相关分析表明，只有右侧 ACC 中的 GMV 与 MM 组的视觉模拟量表疼痛评分相关。以 ACC 为种子的 RsFC 显示 MM 患者在 ACC 与左侧颞下回、双侧角回和右侧楔前叶之间的 FC 增加。相关性分析显示，右侧ACC与右楔前叶FC的变化与头痛频率呈正相关，右侧ACC与右角回FC的变化与抑郁评分呈正相关。

我们的研究结果表明，ACC 可能是 MM 的重要生物标志物，其结构和功能损伤与 MM 患者疼痛的严重程度和疼痛相关的情绪障碍显着相关。这些发现表明，与头痛相关的 ACC 结构和功能异常可能可以为 MM 的生理机制提供综合证据。