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. 2018 Jan 15;19(1):4.
doi: 10.1186/s10194-018-0834-6.

Comparison of gray matter volume between migraine and "strict-criteria" tension-type headache

Wei-Ta Chen  1   2   3   4 , Kun-Hsien Chou  5   6 , Pei-Lin Lee  7 , Fu-Jung Hsiao  5 , David M Niddam  5   8 , Kuan-Lin Lai  9   10 , Jong-Ling Fuh  9   10   5 , Ching-Po Lin  5   8   6   7 , Shuu-Jiun Wang  9   10   5   8
Affiliations

Comparison of gray matter volume between migraine and "strict-criteria" tension-type headache

Wei-Ta Chen et al. J Headache Pain. .

Abstract

Background: Despite evidently distinct symptoms, tension-type headache (TTH) and migraine are highly comorbid and exhibit many similarities in clinical practice. The purpose of this study was to investigate whether both types of headaches are similar in brain morphology.

Methods: Consecutive patients with TTH and age- and sex-matched patients with migraine and healthy controls were enrolled for brain magnetic resonance imaging examination. Patients with TTH were excluded if they reported any headache features or associated symptoms of migraine. Changes in gray matter (GM) volume associated with headache diagnosis (TTH vs. migraine) and frequency (episodic vs. chronic) were examined using voxel-based morphometry. The correlation with headache profile and the discriminative ability between TTH and migraine were also investigated for these GM changes.

Results: In comparison with controls (n = 43), the patients with TTH (25 episodic and 24 chronic) exhibited a GM volume increase in the anterior cingulate cortex, supramarginal gyrus, temporal pole, lateral occipital cortex, and caudate. The patients with migraine (31 episodic and 25 chronic) conversely exhibited a GM volume decrease in the orbitofrontal cortex. These GM changes did not correlate with any headache profile. A voxel-wise 2 × 2 factorial analysis further revealed the substantial effects of headache types and frequency in the comparison of GM volume between TTH and migraine. Specifically, the migraine group (vs. TTH) had a GM decrease in the superior and middle frontal gyri, cerebellum, dorsal striatum, and precuneus. The chronic group (vs. episodic group) otherwise demonstrated a GM decrease in the bilateral insula and anterior cingulate cortex. In receiver operating characteristic analysis, the GM volumes of the left superior frontal gyrus and right cerebellum V combined had good discriminative ability for distinguishing TTH and migraine (area under the curve = 0.806).

Conclusions: TTH and migraine are separate headache disorders with different characteristics in relation to GM changes. The major morphological difference between the two types of headaches is the relative GM decrease of the prefrontal and cerebellar regions in migraine, which may reflect a higher allostatic load associated with this disabling headache.

Keywords: Gray matter; Magnetic resonance imaging (MRI); Migraine; Tension-type headache; Voxel-based morphometry.

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Conflict of interest statement

Authors’ information

None

Ethics approval and consent to participate

The Institutional Review Board of Taipei Veterans General Hospital approved the study protocol (Reference No. 2012–07-013 AC) and each participant provided written informed consent.

Consent for publication

Not applicable.

Competing interests

WT Chen, KH Chou, PL Lee, FJ Hsiao, DM Niddam, KL Lai, and CP Lin report no competing interests. SJ Wang has served on the advisory boards of Allergan, and Eli Lilly Taiwan. He has received honoraria as a moderator from local companies (Taiwan branches) of Pfizer, Eli Lilly and Esai. JL Fuh is a member of the scientific advisory board of Novartis, and has received research support from the Taiwan National Science Council and Taipei-Veterans General Hospital.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Altered gray matter volume in TTH and migraine. In comparison with controls, the patients with TTH exhibited a gray matter volume increase in the anterior cingulate cortex, supramarginal gyrus, temporal pole, lateral occipital cortex, and caudate. The patients with migraine conversely exhibited a gray matter volume decrease in the orbitofrontal cortex. HC: healthy controls; L: left; MIG: migraine; R: right; TTH: tension-type headache
Fig. 2
Fig. 2
Difference of gray matter volume between TTH and migraine. A 2 × 2 ANCOVA analysis was used to investigate the effects of headache types (TTH vs. migraine), headache frequency (episodic vs. chronic) and their interaction upon the gray matter volume difference between TTH and migraine. The brain regions with gray matter differences are color-coded in red (TTH > migraine), blue (episodic > chronic) and green (type × frequency interaction). L: left; MIG: migraine; R: right; TTH: tension-type headache
Fig. 3
Fig. 3
Post-hoc analysis for the gray matter volume difference between TTH and migraine (2 × 2 ANCOVA). The episodic TTH vs. episodic migraine groups demonstrated a higher gray matter volume in the bilateral putamen, right caudate, middle frontal gyrus, and cerebellum. Conversely, gray matter volume of the right lateral occipital cortex was lower in episodic TTH compared with episodic migraine. A comparison of gray matter volume between chronic TTH and chronic migraine only revealed a higher gray matter volume of the left cerebellum in chronic TTH. L: left; MIG: migraine; R: right; TTH: tension-type headache
Fig. 4
Fig. 4
Receiver operating characteristic (ROC) analysis to distinguish TTH from migraine. In ROC analysis, the gray matter volumes of the left superior frontal gyrus and right cerebellum V combined had excellent discriminative ability for distinguishing TTH and migraine (area under the curve [AUC] = 0.806)
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