Less Cortical Thickness in Patients With Persistent Post-Traumatic Headache Compared With Healthy Controls: An MRI Study.
Less Cortical Thickness in Patients With Persistent Post-Traumatic Headache Compared With Healthy Controls: An MRI Study.
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作者：
Chong CD;Berisha V;Chiang CC;Ross K;Schwedt TJ
研究持续性创伤后头痛（PPTH）患者相对于健康对照的皮质厚度差异，并询问PPTH患者的皮质形态是否与头痛负担（头痛频率、创伤后头痛年数）相关。创伤后头痛是脑震荡后最常见的症状之一。在一些患者中，创伤后头痛持续超过三个月，并被归类为PPTH。本研究有两个主要目的：1）通过询问PPTH患者与健康对照组的皮质厚度差异，描述PPTH的神经病理学。2)通过检查皮质厚度是否与头痛的频率或创伤后头痛的生存年限相关，探讨PPTH患者脑形态学与头痛负担之间的潜在关联。根据ICHD 3 β诊断标准诊断的PPTH成人和健康对照在3特斯拉扫描仪上进行脑部MRI。使用FreeSurfer v5.3自动计算皮质厚度的逐顶点全脑估计值。使用一般线性模型设计确定PPTH患者相对于健康对照的皮质厚度差异。PPTH患者与健康对照组相比，皮质厚度差异与头痛频率和PPTH生存年限之间的相关性进行了探讨。本研究包括33例PPTH患者和33例健康对照受试者（健康对照：中位年龄=33.0，IQR=15.5; PPTH患者：中位年龄=36.0，IQR=20.5; p=0.56）。与健康对照组相比，PPTH患者的左、右上级额叶、中额叶尾部和中央前皮质的皮质厚度较薄，右边缘上、右上级和顶叶下部以及右楔前叶区域的皮质厚度也较薄（p<0.05，多重比较的蒙特卡罗校正）。与健康对照组相比，PPTH患者没有更多的皮质厚度。对PPTH患者皮质厚度较薄区域的相关性分析表明，左侧和右侧上级额叶厚度与头痛频率呈负相关（p<0.05）。区域皮质厚度与PPTH的生存年数之间无相关性。与健康对照组相比，PPTH患者双侧额叶和右半球顶叶皮质厚度较薄。对于PPTH患者，更频繁的头痛与左右上级额叶区域的厚度减少有关，这可能表明PPTH患者上级额叶区域的脑形态学变化受到头痛频率的影响。
To investigate differences in cortical thickness in patients with persistent post-traumatic headache (PPTH) relative to healthy controls and to interrogate whether cortical morphology relates to headache burden (headache frequency, years with post-traumatic headache) in patients with PPTH. Post-traumatic headaches are one of the most common symptoms following concussion. In some patients, post-traumatic headaches continue for longer than three months and are classified as PPTH. This study has two main goals: 1) To delineate the neuropathology of PPTH, by interrogating differences in cortical thickness in patients with PPTH relative to healthy controls. 2) To interrogate potential associations between brain morphology and headache burden in patients with PPTH by examining whether cortical thickness relates to frequency of headaches or years lived with post-traumatic headache. Adults with PPTH diagnosed according to ICHD 3 beta diagnostic criteria and healthy controls underwent brain MRI on a 3 Tesla scanner. Vertex-by-vertex whole brain estimates of cortical thickness were automatically calculated using FreeSurfer v5.3. Differences in cortical thickness in patients with PPTH relative to healthy controls were determined using a general linear model design. Associations were explored between regional clusters where patients with PPTH showed cortical thickness differences compared to healthy controls with headache frequency and years lived with PPTH. This study included 33 patients with PPTH and 33 healthy control subjects (healthy controls: median age=33.0, IQR=15.5; patients with PPTH: median age=36.0, IQR=20.5; p=0.56). Patients with PPTH had less cortical thickness relative to healthy controls in the left and right superior frontal, caudal middle frontal and precentral cortex as well as less cortical thickness in the right supramarginal, right superior and inferior parietal and right precuneus region (p<0.05, Monte Carlo corrected for multiple comparisons). There were no regions where patients with PPTH had more cortical thickness relative to healthy controls. A correlation analysis of regions that showed less cortical thickness in patients with PPTH demonstrated a negative correlation between left and right superior frontal thickness with headache frequency (p<0.05). There was no association between regional cortical thickness and years lived with PPTH. Compared to healthy controls, patients with PPTH had less cortical thickness in bilateral frontal regions and right hemisphere parietal regions. For patients with PPTH, more frequent headaches were related to less thickness in the left and right superior frontal regions potentially indicating that brain morphology changes in the superior frontal regions in patients with PPTH are modified by headache frequency.
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