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. 2024 Jan 5:14:1323290.
doi: 10.3389/fneur.2023.1323290. eCollection 2023.

Altered metabolites in the periaqueductal gray of COVID-19 patients experiencing headaches: a longitudinal MRS study

Ping Jin  1 , Feng Cui  1 , Luping Zhang  1
Affiliations

Altered metabolites in the periaqueductal gray of COVID-19 patients experiencing headaches: a longitudinal MRS study

Ping Jin et al. Front Neurol. .

Abstract

Background: Headache is one of the most common symptoms of acute COVID-19 infection. However, its mechanisms remain poorly understood, and there is a lack of studies investigating changes in the periaqueductal gray (PAG) in COVID-19 patients exhibiting headaches.

Purpose: The study aimed to explore the alterations in metabolites of the PAG pre- and post-COVID-19 infection in individuals who suffered from headaches during the acute phase of the disease using proton magnetic resonance spectroscopy (1H-MRS).

Methods: Fifteen participants who experienced headaches during the acute phase of COVID-19 were recruited. All subjects underwent two proton magnetic resonance spectroscopy (1H-MRS) examinations focusing on the PAG before and after they were infected. Metabolite changes were assessed between the pre- and post-infection groups.

Results: The combined glutamine and glutamate/total creatine ratio (Glx/tCr) was increased in the PAG following COVID-19 infection. The total choline/total creatine ratio (tCho/tCr) in the pre-infection group was negatively correlated with the duration of headache during the COVID-19 acute phase.

Conclusion: The present study indicates that PAG plays a pivotal role in COVID-19 headaches, thereby supporting the involvement of trigeminovascular system activation in the pathophysiology of COVID-19 headaches.

Keywords: COVID-19; headache; magnetic resonance spectroscopy; metabolites; periaqueductal gray.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Placement of the single voxel in the axial (A), sagittal (B), and coronal (C) planes in the periaqueductal gray.
Figure 2
Figure 2
Comparison of PAG Glx/tCr ratio between post- and pre-infection groups. Glx/tCr ratio was significantly increased in the post-infection group relative to the pre-infection group. PAG, periaqueductal gray; Glx, combined glutamine and glutamate; tCr, creatine plus phosphocreatine; Pre, pre-infection group; Post, post-infection group; *, p < 0.05.
Figure 3
Figure 3
Correlation between PAG tCho/tCr ratio in the pre-infection group and duration of headache during the acute phase of COVID-19. PAG, periaqueductal gray; tCho, total choline; tCr, creatine plus phosphocreatine.
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