Migren hastalarında ağrı merkezlerinin volümetrik analizi

Öz

Amaç: Kronik ağrısı olan, özellikle migren hastalarında ağrı merkezlerindeki anormallik paternlerini araştırmak. Çalışma, ağrı süresi ve migren tipleri ile olası korelasyonu keşfetmeyi ve kronik ağrı yönetimi için yeni müdahaleler önermeyi amaçlamaktadır. Gereç ve yöntem: Üniversite hastanemizde 2019-2023 yılları arasında üç boyutlu izo T1 ağırlıklı beyin MRG'si çekilen 32 migren hastası ve 28 sağlıklı kontrolün radyolojik verileri incelendi. En az 3 yıllık migren süresi olan hastalar çalışmaya dahil edildi ve aura yokluğu (Grup MwoA) veya varlığına (Grup MwA) göre iki gruba ayrıldı. Ek olarak hastalar migren ataklarının sıklığına göre epizodik (EM) veya kronik (CM) olarak sınıflandırıldı. Karşılaştırma için bir kontrol grubu da (Grup C) oluşturuldu. Kortikal ve subkortikal ağrıyla ilişkili yapılar dahil olmak üzere volümetrik analiz volBrain yazılımı kullanılarak yapıldı. Bulgular: Gruplar arasında gri madde (p=0,037), kortikal gri madde (p=0,022), serebrum gri maddesi (p=0,026), ön singulat korteks (ACC) (p=0,017), orta singulat korteks (MCC) (p=0,014) ve arka singulat korteks (PCC) (p=0,008) hacimlerinde anlamlı farklılıklar gözlendi. Grup karşılaştırmalarında ACC, MCC ve PCC'de Grup C ve MwoA arasında (sırasıyla p=0,047, p=0,040 ve p=0,047) ve PCC'de Grup C ve MwA arasında (p=0,026) muhtemelen aura patogeneziyle ilişkili anlamlı farklılıklar ortaya konuldu. Aurası olmayan hastalarda, potansiyel kortikal tutulumu düşündüren, istatistiksel olarak anlamlı olmayan (p=0,079) daha ince postcentral girus görüldü. Sonuç: Bu çalışma, migren hastalarında ağrı merkezi anormalliklerine ve bu durumun ağrı süresi ve migren tipi ile potansiyel ilişkisine dair anlayış sağlamaktadır.

Anahtar Kelimeler

• Kronik ağrı
• nörogörüntüleme
• voksel bazlı morfometri (VBM)
• auralı migren
• ağrı işleme merkezleri

Volumetric analysis of pain centers in migraine patients

Abstract

Purpose: To investigate patterns of abnormalities in pain centers among patients with chronic pain, particularly those with migraines. The study aims to explore the potential correlation with pain duration and migraine types, and to propose new interventions for managing chronic pain. Materials and methods: Radiologic data of 32 migraine patients and 28 healthy controls underwent threedimensional iso T1-weighted brain MRI between 2019 and 2023 at our university hospital were examined. Patients with a minimum migraine duration of three years were included and divided into two groups: patients without aura (MwoA group) and patients with aura (MwA group). Additionally, patients were categorized based on the frequency of their migraine attacks, either episodic (EM) or chronic (CM). A control group (Group C) was also established for comparison. Volumetric analysis, including cortical and subcortical pain-related structures, was performed using volBrain software. Results: Significant differences were observed in grey matter (p=0.037), cortical grey matter (p=0.022), cerebrum grey matter (p=0.026), anterior cingulate cortex (ACC) (p=0.017), middle cingulate cortex (MCC) (p=0.014), and posterior cingulate cortex (PCC) (p=0.008) volumes among the groups. Group comparisons revealed significant differences in the ACC, MCC, and PCC between Groups C and MwoA (p=0.047, p=0.040, and p=0.047, respectively) and PCC between Groups C and MwA (p=0.026), possibly related to aura pathogenesis. Patients without aura exhibited non-significantly thinner postcentral gyrus (p=0.079), suggesting potential cortical involvement. Conclusions: This study provides insights into pain center abnormalities in migraine patients and their potential relevance to pain duration and migraine type.

Keywords

• Chronic pain
• neuroimaging
• voxel-based morphometry (VBM)
• migraine with aura
• pain processing centers

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