Cerebral perfusion variance in new daily persistent headache and chronic migraine: an arterial spin-labeled MR imaging study

Abstract

Background and purpose: New daily persistent headache (NDPH) and chronic migraine (CM) are two different types of headaches that might involve vascular dysregulation. There is still a lack of clarity about altered brain perfusion in NDPH and CM. This study aimed to investigate the cerebral perfusion variances of NDPH and CM using multi-delay pseudo-continuous arterial spin-labeled magnetic resonance imaging (pCASL-MRI).

Methods: Fifteen patients with NDPH, 18 patients with CM, and 15 age- and sex-matched healthy controls (HCs) were included. All participants underwent 3D multi-delay pCASL-MRI to obtain cerebral perfusion data, including arrival-time-corrected cerebral blood flow (CBF) and arterial cerebral blood volume (aCBV). The automated anatomical labeling atlas 3 (AAL3) was used to parcellate 170 brain regions. The CBF and aCBV values in each brain region were compared among the three groups. Correlation analyses between cerebral perfusion parameters and clinical variables were performed.

Results: Compared with HC participants, patients with NDPH were found to have decreased CBF and aCBV values in multiple regions in the right hemisphere, including the right posterior orbital gyrus (OFCpost.R), right middle occipital gyrus (MOG.R), and ventral anterior nucleus of right thalamus (tVA.R), while patients with CM showed increased CBF and aCBV values presenting in the ventral lateral nucleus of left thalamus (tVL.L) and right thalamus (tVL.R) compared with HCs (all p < 0.05). In patients with NDPH, after age and sex adjustment, the increased aCBV values of IFGorb. R were positively correlated with GAD-7 scores; and the increased CBF and aCBV values of tVA.R were positively correlated with disease duration.

Conclusion: The multi-delay pCASL technique can detect cerebral perfusion variation in patients with NDPH and CM. The cerebral perfusion changes may suggest different variations between NDPH and CM, which might provide hemodynamic evidence of these two types of primary headaches.

Keywords: Arterial spin labeling; Chronic migraine; Magnetic resonance imaging; New daily persistent headache; Perfusion.

Fig. 1

Diagram of cerebral perfusion by multi-delay ASL MR imaging. (A) The raw maps of ASL imaging, including different post label delays (PLDs) ranging from 1.00 to 3.66 seconds (s). (B) The arrival-time-corrected cerebral blood flow (CBF) colormaps. (C) The arterial arrival time (ATT) colormaps. (D) The arterial cerebral blood volume (aCBV) colormaps

Fig. 2

Brain regions with significant differences in CBF between NDPH and HC groups, NDPH and CM groups, as well as CM and HC groups (A-K). HC healthy control, NDPH new daily persistent headache, CM chronic migraine. IFGorb.R right inferior frontal gyrus pars orbitalis, OFCpost.R right posterior orbital gyrus, OFClat.R right lateral orbital gyrus, ACCsup.R right anterior cingulate cortex, supracallosal gyrus. TPOsup.R right superior temporal gyrus, temporal pole, MOG.R right middle occipital gyrus, Amygdala.R right amygdala, Pallidum.L left pallidum, tVA.R right thalamus, ventral anterior nucleus, tVL.L left thalamus, ventral lateral nucleus, tVL.R right thalamus, ventral lateral nucleus. * P<0.05, ** P<0.01

Fig. 3

Brain regions with significant differences in the aCBV between NDPH and HC groups, NDPH and CM groups, as well as CM and HC groups (A-J). HC healthy control, NDPH new daily persistent headache, CM chronic migraine. IFGorb.R right inferior frontal gyrus pars orbitalis, OFCpost.R right posterior orbital gyrus, OFClat.R right lateral orbital gyrus, TPOsup.R right superior temporal gyrus, temporal pole, MOG.R right middle occipital gyrus, Amygdala.R right amygdala, Pallidum.L left pallidum, tVA.R right thalamus, ventral anterior nucleus, tVL.L left thalamus, ventral lateral nucleus, tVL.R right thalamus, ventral lateral nucleus. * P<0.05, ** P<0.01

Fig. 4

The visualization of brain regions with significant differences in cerebral perfusion between NDPH and HC groups, CM and HC groups, as well as NDPH and CM groups. The brain regions with decreased cerebral perfusion in NDPH groups were presented compared with HC (A) and CM (B) groups, respectively. The brain regions with increased cerebral perfusion in CM groups were presented compared with HC groups (C). HC healthy control, NDPH new daily persistent headache, CM chronic migraine. IFGorb.R right inferior frontal gyrus pars orbitalis, OFCpost.R right posterior orbital gyrus, OFClat.R right lateral orbital gyrus, ACCsup.R right anterior cingulate cortex, supracallosal gyrus, TPOsup.R right superior temporal gyrus, temporal pole, MOG.R right middle occipital gyrus, Amygdala.R right amygdala, Pallidum.L left pallidum, tVA.R right thalamus, ventral anterior nucleus, tVL.L left thalamus, ventral lateral nucleus, tVL.R right thalamus, ventral lateral nucleus

Fig. 5

Correlation analysis between cerebral perfusion parameters and clinical variables in brain regions with significant differences of NDPH. The aCBV of the right inferior frontal gyrus pars orbitalis (IFGorb.R) was positively correlated with the GAD-7 score (A). The CBF of the right thalamus, ventral anterior nucleus (tVA.R) was positively correlated with disease duration (B), as well as the aCBV of tVA.R (C). NDPH new daily persistent headache, aCBV arterial cerebral blood volume, CBF cerebral blood flow, GAD-7 Generalized Anxiety Disorder-7