Abstract Details

Title Clinical Correlates of Longitudinal Hypothalamic-Pontine Functional Changes in Migraine Patients

Topic Headache

Presentation(s) S41 - Emergent Sciences and Top Headache Research (4:54 PM-5:06 PM)

Poster/Presentation
Number 008

Background The hypothalamus and pons play a pivotal role in migraine pathophysiology. Whether longitudinal hypothalamic-pontine RS EC changes could influence migraine disease activity has never been investigated.

Objective To explore longitudinal hypothalamic-pontine resting state (RS) effective connectivity (EC) changes in migraine patients and investigate their association with disease progression over the years.

Design/Methods RS functional magnetic resonance imaging were acquired from 92 headache-free episodic migraine patients and 73 controls. Twenty-three migraine patients and 23 controls were reexamined after 4 years. RS EC of bilateral pons and hypothalamus was performed using SPM12 and dynamic causal modelling. Longitudinal RS EC differences between groups were investigated using parametric empirical bayes models.

Results During the follow-up, 35% of patients reported an increased migraine attack frequency. Over the follow-up, migraine patients developed a higher inhibitory EC within the left pons, from the right pons to the ipsilateral hypothalamus, from the left hypothalamus to the ipsilateral and contralateral pons, and from the left pons to the ipsilateral and contralateral hypothalamus. Migraine patients experienced also a higher excitatory EC from the right pons to the left pons. At follow-up, greater headache impact correlated to higher inhibitory EC from the left pons to the ipsilateral and contralateral hypothalamus, while higher migraine attack frequency was associated with higher inhibitory left hypothalamic-left pontine EC. During the follow-up, the increased left pontine-right hypothalamic inhibitory EC was significantly associated to an increased migraine attack frequency. Lower inhibitory RS EC from the left pons to the left and right hypothalamus at baseline predicted clinical worsening over the years.

Conclusions Interictal migraine patients experience a prominent inhibitory influence of the pons over the hypothalamus and vice versa that could affect migraine progression over the years. An altered hypothalamic-pontine inhibitory activity may be a prognostic marker for migraine worsening after 4 years.

Authors/Disclosures
Roberta Messina, MD, PhD (San Raffaele Hospital) PRESENTER	Dr. Messina has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Eli Lilly. Dr. Messina has received personal compensation in the range of $0-$499 for serving on a Speakers Bureau for Eli Lilly.
Paola Valsasina	No disclosure on file
	No disclosure on file
Ilaria Cetta, MD (Ospedale San Raffaele)	Dr. Cetta has nothing to disclose.
Bruno Colombo	Bruno Colombo has nothing to disclose.
Maria A. Rocca (Neuroimaging Research Unit)	Maria Assunta Rocca has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen, Bristol Myers Squibb, Eli Lilly, Janssen, Roche. Maria Assunta Rocca has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for AstraZaneca, Biogen, Bristol Myers Squibb, Bromatech, Celgene, Genzyme, Horizon Therapeutics Italy, Merck Serono SpA, Novartis, Roche, Sanofi and Teva. The institution of Maria Assunta Rocca has received research support from MS Society of Canada, the Italian Ministry of Health, the Italian Ministry of University and Research, and Fondazione Italiana Sclerosi Multipla.
Massimo Filippi, MD, FAAN (Ospedale San Raffaele, Neuroimaging Research Unit)	Dr. Filippi has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Alexion, Almirall, Biogen, Merck, Novartis, Roche, Sanofi;. Dr. Filippi has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Alexion, Biogen, Bristol-Myers Squibb, Merck, Novartis, Roche, Sanofi, Sanofi-Aventis, Sanofi- Genzyme, Takeda. Dr. Filippi has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Bayer, Biogen, Celgene, Chiesi Italia SpA, Eli Lilly, Genzyme, Janssen, Merck-Serono, Neopharmed Gentili, Novartis, Novo Nordisk, Roche, Sanofi, Takeda, and TEVA. Dr. Filippi has received personal compensation in the range of $5,000-$9,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Springer Nature. The institution of Dr. Filippi has received research support from Biogen Idec, Merck-Serono, Novartis, Roche, the Italian Ministry of Health, the Italian Ministry of University and Research, and Fondazione Italiana Sclerosi Multipla.