The following is a summary of “Specific cognitive and psychological alterations are more strongly linked to increased migraine disability than chronic migraine diagnosis,” published in the March 2024 issue of Pain by Zamparella et al.

A study investigates if clinical features beyond pain are better indicators of brain impairment than the International Classification of Headache Disorders (ICHD-3) for migraine disability.

Researchers conducted a retrospective study to compare migraine disability using machine learning and ICHD-3 criteria, along with voxel-based morphometry (VBM), to explore brain structure differences between the groups.

They examined patients with episodic and chronic migraines at a specialized headache clinic. They conducted a neuropsychological assessment using validated tests for cognition, anxiety, depression, perceived stress, headache impact (HIT-6), and disability (MIDAS). The results were fed into an automated K-means clustering algorithm with a predefined K=2. Additionally, a Voxel-based Morphometry (VBM) analysis compared neuroanatomical differences between the two groups.

The results showed 111 participants, 49 had chronic migraine, and 62 had episodic migraine. Cluster One had 74 patients, while Cluster Two had 37 patients. Cluster two displayed higher levels of depression, anxiety, and perceived stress, along with poorer performance in attention tests. Differences in HIT-6 and MIDAS scores between episodic and chronic migraine patients weren’t statistically significant (HIT-6: 64.39 (±7.31) vs. 62.92 (±11.61); P=0.42 / MIDAS: 73.63 (±68.61) vs. 84.33 (±63.62); P=0.40). However, cluster two had significantly higher HIT-6 (62.32 (±10.11) vs. 66.57 (±7.21); P=0.03) and MIDAS (68.69 (±62.58) vs. 97.68 (±70.31); P=0.03) scores than cluster one. After correcting for multiple comparisons, significant gray matter volume differences were noted between the two clusters but not between chronic and episodic migraine patients.

They concluded that classifying migraine patients based on neuropsychological testing provided a better understanding of disability than the traditional ICHD-3 classification.

Source: thejournalofheadacheandpain.biomedcentral.com/articles/10.1186/s10194-024-01734-1