Neurochemical and Structural Characteristics of Migraine Pathophysiology with Neuroimaging

Abstract

Chronic migraine is a highly restrictive disease that has a deleterious impact on the socioeconomic functioning and quality of life of those affected. The development of chronic migraine from episodic migraine is typically characterised by an increase in the frequency of attacks, which lends support to the view that migraine can be considered a spectrum disorder. The precise pathophysiological mechanisms responsible for the chronicity of migraine remain unclear. Similarly, chronic migraine patients exhibit extensive functional and structural alterations in cortical and subcortical regions associated with pain perception. However, patients with chronic migraine exhibit a more pronounced dysfunction in the pain inhibitory network and an increased sensitivity in central pain pathways, which may explain their higher susceptibility to migraine attacks. Imaging studies have highlighted the potential involvement of brain regions that are crucial for the onset of migraine attacks, such as the pons and hypothalamus, in the chronicity of migraine. The question of whether changes in the brain are biomarkers predisposing migraineurs to chronicity or reflect adaptive or maladaptive responses to increased headache frequency remains a topic of debate. The central mechanisms of action of preventive treatments for chronic migraine and imaging biomarkers that may predict patients' treatment response have also been investigated. The aim of this review is to synthesise the current literature on neurochemical and structural analyses. Brain imaging has been used to investigate the pathophysiology of chronic migraine, to further discuss its clinical implications and to assess its utility in treatment.

Keywords

• Migraine
• Neuroimaging
• Migraine Treatment
• Magnetic resonance imaging

Nörogörüntüleme ile Migren Patofizyolojisinin Nörokimyasal ve Yapısal Özellikleri

Abstract

Kronik migren, migren hastalarının sosyoekonomik işlevleri ve yaşam kaliteleri üzerinde olumsuz etkisi olan, oldukça kısıtlayıcı bir hastalıktır. Kronik migren genellikle atak sıklığı giderek artan epizodik migrenden gelişir ve migrenin bir spektrum bozukluğu olduğu görüşünü destekler. Migrenin kronikleşmesinden sorumlu patofizyolojik mekanizmalar tam olarak anlaşılamamıştır. Epizodik migrende olduğu gibi, kronik migren hastalarında da kortikal ve subkortikal ağrıyla ilişkili beyin bölgelerinde yaygın işlevsel ve yapısal değişiklikler görülmektedir. Bununla birlikte, kronik migren hastaları ağrı engelleyici ağda daha belirgin bir işlev bozukluğu ve merkezi ağrı yollarında artmış bir duyarlılık yaşarlar, bu da migren ataklarına karşı daha yüksek duyarlılığı açıklayabilir. Görüntüleme çalışmaları, pons ve hipotalamus gibi migren ataklarının oluşumunda kilit rol oynayan beyin bölgelerinin migrenin kronikleşmesinde de rol oynayabileceğini vurgulamıştır. Beyindeki değişikliklerin migren hastalarını kronikleşmeye yatkın hale getiren biyobelirteçler mi olduğu yoksa artan baş ağrısı sıklığına karşı adaptif veya maladaptif yanıtları mı yansıttığı hala tartışma konusudur. Kronik migreni önleyici tedavilerin merkezi etki mekanizmaları ve hastaların tedavi yanıtını öngörebilecek görüntüleme biyobelirteçleri de araştırılmıştır.Bu derlemenin amacı, nörokimyasal ve yapısal analizleri içeren güncel literatürü gözden geçirmek ve sentezlemektir. Kronik migren patofizyolojisini araştırmak, klinik sonuçlarını daha fazla tartışmak ve tedavide kullanılabilirliğini değerlendirmek için beyin görüntülemesi kullanılmıştır.

Keywords

• Migren
• Nörogörüntüleme
• Migren Tedavisi
• Manyetik rezonans görüntüleme

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