A New Way to Think About Migraines
This is the second of three research findings highlighted by Dr. Rost, vice chair of the American Academy of Neurology Science Committee, at the AAN 67th annual meeting.
This study, titled “Adults with migraine have atypical correlation between the brain cortical thickness and pain thresholds,” was presented at the contemporary clinical issues plenary session by Todd J. Schwedt, M.D. Mayo Clinic.
With migraine pain a widespread issue, the findings point to a new way to think about migraine pain.
The study
“The object of the study was to evaluate the cortical thickness in the areas that are potentially associated with pain processing,” said Rost, who is also director of the acute stroke services at Massachusetts General Hospital, and associate professor of neurology at Harvard Medical School. According to her there have been some prior reports that indicated people with migraine pain might be hypersensitive to the way they perceive pain, perhaps because they are hypervigilant to painful stimuli and don’t demonstrate an ability to distract from the particular pain stimulus.
Researchers compared the pain perception threshold in 31 migraine patients with 32 healthy controls, using a specific standardized applied heat stimulation.
“They also investigated the cortical thickness on MRIs of these patients using T-1 sequences, which is also a standardized approach to this methodology, and then calculated the region-by-region cortical thickness to pain threshold statistics in this case control study,” Rost said. “What they found among the control subjects, who were patients without evidence of migraines, was that there was what they called a negative correlation between the pain threshold and the cortical thickness in a number of areas. The way I interpreted it is that patients who had higher tolerance for specific painful stimulus had a lower thickness of the cortices in the area of their interest. Patients with migraines happened to have positive correlations, so the thickness of the cortex was correlated in the same direction with tolerance of specific stimulus.”
The researchers did a statistical analysis and determined that the left-superior temporal anterior parietal region of the brain was significant in the difference between the cortical thickness and pain thresholds compared with the controls and migraine cases.
“Interestingly enough, this is in fact a region of the brain that participates in attention to painful stimulus and orientation to that stimulus,” Rost said. This leads to the conclusion that the absence of normal correlation in patients with migraines may point to an inability to inhibit pain sensation by distracting from the pain.
Different approach to migraine pain?
The findings indicate that neurologists should consider not only the standard approach to migraine treatment, but additional techniques, Rost said. “For example, cognitive behavioral treatments where patients may learn biofeedback and mechanisms of distracting or reorienting in the moment of pain, may be useful.”
She said that this study opens an interesting segway into studying “the dynamic interaction of neurons during a migraine.” Rost thinks there is a way to retrain the brain, and that plasticity, biofeedback and other therapies, play a role in that.
Up next Bioscience Technology discusses a landmark stroke study presented by Diederik Dippel, M.D., Ph.D., and professor of neurology at Erasmus MC University Medical Center in Rotterdam.
