Functional MRI Marker Can Diagnose Migraine Without Aura
Key findings
- Research in neurology and psychiatry has moved beyond brain network–specific analyses to investigating the connectome, the map of neural connections in the brain
- Using functional MRI, researchers at Massachusetts General Hospital identified a connectome-based marker that discriminated between 70 patients who had migraine without aura and 46 matched controls
- The researchers tested the neural marker in a separate sample of 19 patients who had migraine without aura and 19 controls
- The marker was 76% specific to migraine when discriminating migraine from chronic low back pain and fibromyalgia
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Neuroimaging of patients with migraine has demonstrated alterations of brain networks that might influence pain experience and multisensory integration. However, research in neurology and psychiatry has moved beyond network-specific analyses to connectome-based investigations. The connectome is the map of neural connections in an organism's brain (the complete human connectome is still being worked out).
Researchers Yiheng Tu, PhD, and Jian Kong, MD, MS, MPH, of the Athinoula A. Martinos Center for Biomedical Imaging and Department of Psychiatry at Massachusetts General Hospital, and colleagues recently identified and validated a connectome-based marker—a map of functional brain connections—that distinguishes patients who have migraine without aura (MwoA) from healthy controls. Their report appears in Neurology.
Identifying the Marker
To begin, the researchers acquired resting-state functional MRI (fMRI) scans of 70 patients who had a diagnosis of migraine without aura according to the consensus of three neurologists and had been pain-free for at least 72 hours. They also scanned 46 demographically matched controls.
The researchers divided the brain into 160 regions and six networks, and analyzed connections between them with a machine learning tool. This process identified a dysfunctional connectome that discriminated MwoA patients from controls with 93% sensitivity and 89% specificity.
Abnormal functional connectivity was located primarily within the occipital lobe. The sensorimotor network, part of the medial-cerebellum, the cingulo-opercular network, the default mode network and the frontal-parietal network were also affected.
Validating the Marker
To test the generalizability of the neural marker, the researchers scanned a separate sample of 19 patients with MwoA and 19 controls. The marker was 84% sensitive and 84% specific in distinguishing the two groups.
Specificity for Migraine
The marker was specific to migraine:
- It was only 53% accurate in distinguishing 17 patients with chronic low back pain from 19 controls and 56% accurate in distinguishing 11 patients with fibromyalgia from 11 controls
- It did discriminate between 18 additional patients with MwoA and the 58 non-migraineurs (the patients with back pain, those with fibromyalgia and the controls); overall sensitivity was 78% and specificity was 76%
Toward Precision Treatment of CNS Disorders
fMRI could be a supplement for clinical diagnosis of MwoA, for example in challenging cases or in situations where self-reports are unreliable. Furthermore, the study results suggest additional areas of the brain to explore as targets for migraine therapies.
It should be possible to identify more connectome-based markers that could be applied to other neuropsychiatric diseases.
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