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Distinct brain metabolic patterns reflect biological heterogeneity and relate to clinical outcome in chronic migraine with medication overuse
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DOI：10.1177/03331024261476230.png)
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Abstract
En 中文
<jats:sec>
<jats:title>Aim</jats:title>
<jats:p>Chronic migraine with medication overuse (CMwMO) is a disabling phenotype of migraine with heterogenous responses to medication withdrawal and preventive treatments. We investigated whether baseline brain metabolic patterns reflect biological heterogeneity associated with 1-year clinical outcome in CMwMO.</jats:p>
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<jats:sec>
<jats:title>Methods</jats:title>
<jats:p>We prospectively enrolled patients with CMwMO and healthy controls and obtained baseline headache profiles, psychological and dependence-related assessment as well as FDG-PET/MRI data. Patients received preventive treatments along with structured medication-withdrawal education. Poor outcome (n = 13) was defined as ongoing analgesic overuse together with <50% reduction in monthly headache days compared with baseline at one year follow-up. All other patients (n = 14) were classified as having a good outcome. Whole-brain metabolic comparisons, seed-based metabolic covariance analyses, and correlations with clinical variables were performed.</jats:p>
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<jats:title>Results</jats:title>
<jats:p>Among 27 patients with CMwMO, baseline headache frequency, disability, and medication use were similar between good and poor outcome groups, but the poor-outcome group was older, showed greater dependence severity, and had a longer duration of chronic headache. Compared with healthy controls (n = 17), only the poor-outcome group demonstrated hypermetabolism in the nucleus accumbens, thalamus, orbitofrontal cortex, and cerebellum. When compared to the good-outcome group, the poor-outcome group exhibited cerebellar hypermetabolism and stronger cerebellar metabolic covariance with the putamen and occipital cortex. Integrities of cerebellar-putamen metabolic coupling correlated with dependence severity, whereas cerebellar-occipital coupling correlated with duration of chronic headache and 1-year clinical outcomes.</jats:p>
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<jats:title>Conclusions</jats:title>
<jats:p>CMwMO appears to comprise biologically distinct subgroups with different baseline metabolic patterns. Treatment-refractory patients were characterized by metabolic alterations involving reinforcement and sensory prediction networks. Early identification of this subgroup may facilitate more individualized management targeting both headache burden and dependence-related behaviors.</jats:p>
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