METABOLIC CHANGES IN THE MIGRAINE BRAIN IN RELATION TO AGEING AND DISEASE LOAD

Introduction: Migraine prevalence tends to decrease
with advancing age. Morphological and functional brain
changes occuring in migraine could be secondary to
repeated attacks and/or to abnormal sensory processing.
In normal ageing, brain modifications could traduce a progressive
refinement to cope with the environment, associated
with a reduction in the complexity of brain
connections. We hypothesized that metabolism in various
brain regions might be differentially modified by age in
migraine patients.
Materials and methods: Forty-one subjects underwent
a FDG-PET scan: 21 patients with interictal episodic
migraine without aura (MO, age range: 20–63 years, 5M)
and 20 healthy controls (HV, 21–59 years, 5 M).
Results: In MO vs. HV, the overall FDG uptake was
reduced in the left visual cortex, left medial frontal gyrus
and bilaterally in the insula, somatosensory and motor
cortices. Metabolisms of the posterior thalamus, brainstem
including the periaqueductal gray (PAG), visual
cortex, and (para)hippocampus, strongly increased with
age in MO patients but not in HV. Disease duration positively
correlated with PAG, (para)hippocampus and rostral
anterior cingulate cortex (rACC) metabolisms in MO.
Conclusion: Migraine patients, compared to HV, have a
decreased resting metabolism in several areas belonging to
the ‘‘pain/salience matrix’’, which is in line with previous
neuroimaging studies. Metabolism of the rACC is specifically
related to disease load whereas metabolism of other
sensory processing regions is more affected by age.
Whether these functional changes are due to repeated
stereotyped attack-related stimulations and to a learning
process with complexity reduction of neuronal connections
and/or compensatory age-related hyperactivity,
remains to be demonstrated