A machine generated summary based on the work of Chen, Zhiye; Jia, Zhihua; Chen, Xiaoyan; Liu, Mengqi; Liu, Shuangfeng; Ma, Lin; Yu, Shengyuan. 2017 in The Journal of Headache and Pain.

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3 Diagnosis

Volume gain of periaqueductal gray in medication-overuse headache

DOI: https://doi.org/10.1186/s10194- 016- 0715- 9

Abstract-Summary The aim of this study is to investigate altered PAG volume in MOH using an auto- mated PAG segment method to measure the true PAG volume.

There was a significant increased volume of PAG in MOH (0.366 ± 0.005 ml)

than that in NC (0.341 ± 0.005 ml)(P < 0.05).

There was no significant correlation between the PAG volume and the clinical

variables in MOH patients (P > 0.05).

The present study demonstrated that the PAG volume gain was confirmed in MOH patients, and the automated individual PAG volume measure may be consid- ered as a simple and effective imaging biomarker in MOH diagnosis.

Extended: There was no significant difference for age and sex between MOH

(42.55 ± 10.31 years old) and NC (45.09 ± 10.50 years old).

The limits for this study included as follows: (1) The sample was relative small, and the large sample of MOH and NC should be needed in the future study; (2) The present study was a cross-sectional study, and the longitudinal observation and the treatment response evaluation should further be performed in future study.

Background The PAG columns had distinct connections with the forebrain, brainstem, and noci- ceptive neurons of lamina I of the spinal cord and trigeminal nucleus [534, 535].

Previous studies demonstrated that PAG activation was modulated by expecta-

tion of pain [536] and placebo analgesia [537].

The conventional MR imaging demonstrated that specific lesion such as multiple sclerosis and infarction in PAG may produced the migraine-like symptoms [538, 539].

As these methods were performed over the whole brain level, an automated indi- vidual PAG volume measurement was applied to MOH patients in the current study, and the expected cut-off value of PAG volume would be provided for the MOH diagnosis.

Methods Twenty-two MOH patients were recruited from the International Headache Center, Department of Neurology, Chinese PLA General Hospital.

All the following inclusion criteria should be fulfilled: (1) diagnosis of 8.2 MOH, and 1.1 and 1.2 migraine based on the International Classification of Headache Disorders, third Edition (beta version) (ICHD-III beta) [11]; (2) no migraine pre- ventive medication used in the past 3 months; (3) age between 20 and 60 years; (4) right-handed; (5) patient’s willingness to engage in the study.

The study protocol was approved by the Ethical Committee of Chinese PLA

General Hospital and complied with the Declaration of Helsinki.

3.5 Medication Overuse and Addiction

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The significance differences of PAG volume between MOH group and NC group were computed using general linear model (independent univariate t-test with age and sex as covariates).

Receiver operating characteristic (ROC) curve analysis was performed to iden-

tify the diagnostic efficacy and the cut-off value of PAG volume for MOH.

Results There was no significant difference for age and sex between MOH (42.55 ± 10.31 years old) and NC (45.09 ± 10.50 years old).

There was significant difference for the scores of HAMA, HAMD and MoCA in

MOH compared with that in NC (P < 0.05).

There was no significant correlation between the PAG volume and the clinical

variables in MOH patients (P > 0.05).

Discussion The present findings demonstrated the PAG volume gain in MOH compared with NC, which may explain the PAG dysfunction in MOH from the PAG structural pathophysiological change viewpoint.

These findings suggested that PAG volume gain may only be associated with the descending pain modulatory network, and the other clinical factor such as anxiety, depress and cognitive function could not influence the PAG structural change in MOH although anxiety scores, depression scores showed significant difference between MOH and NC.

The previous study [515] indicated that anxiety and depression scores was cor- related with gray matter volumes of some cerebral regions, therefore, it could assume that anxiety and depression might impair the cerebral regions, and PAG volume gain might be specific change in MOH patients.

Further ROC analysis demonstrated PAG volume measurement showed a good

level for the diagnosis of MOH from NC.

Acknowledgement A machine generated summary based on the work of Chen, Zhiye; Chen, Xiaoyan; Liu, Mengqi; Liu, Shuangfeng; Ma, Lin; Yu, Shengyuan. 2017  in The Journal of Headache and Pain.

The role of personality, disability and physical activity in the development of medication-overuse headache: a prospective observational study