Abstract | BACKGROUND: METHODS: Adults with 6-25 migraine days per month during a 4-week headache diary run-in phase underwent pre-treatment brain functional MRI (fMRI) that included resting-state functional connectivity and BOLD measurements in response to moderately painful heat stimulation to the forearm. This was followed by two treatments with 140 mg erenumab, at baseline and 4 weeks later. Post-treatment fMRI was performed 2 weeks and 8 weeks following the first erenumab treatment. A longitudinal Sandwich estimator analysis was used to identify pre- to post-treatment changes in resting-state functional connectivity and brain activations in response to thermal pain. fMRI findings were compared between erenumab treatment-responders vs. erenumab non-responders. RESULTS: Pre- and post-treatment longitudinal imaging data were available from 32 participants. Average age was 40.3 (+/- 13) years and 29 were female. Pre-treatment average migraine day frequency was 13.8 (+/- 4.7) / 28 days and average headache day frequency was 15.8 (+/- 4.4) / 28 days. Eighteen of 32 (56%) were erenumab responders. Compared to erenumab non-responders, erenumab responders had post-treatment differences in 1) network functional connectivity amongst pain-processing regions, including higher global efficiency, clustering coefficient, node degree, regional efficiency, and modularity, 2) region-to-region functional connectivity between several regions including temporal pole, supramarginal gyrus, and hypothalamus, and 3) pain-induced activations in the middle cingulate, posterior cingulate, and periaqueductal gray matter. CONCLUSIONS: Reductions in migraine day frequency accompanying erenumab treatment are associated with changes in resting state functional connectivity and central processing of extracranial painful stimuli that differ from erenumab non-responders. TRIAL REGISTRATION: clinicaltrials.gov (NCT03773562).
|
Authors | Todd J Schwedt, Simona Nikolova, Gina Dumkrieger, Jing Li, Teresa Wu, Catherine D Chong |
Journal | The journal of headache and pain
(J Headache Pain)
Vol. 23
Issue 1
Pg. 159
(Dec 14 2022)
ISSN: 1129-2377 [Electronic] England |
PMID | 36517767
(Publication Type: Clinical Trial, Journal Article)
|
Copyright | © 2022. The Author(s). |
Chemical References |
- erenumab
- Receptors, Calcitonin Gene-Related Peptide
|
Topics |
- Adult
- Female
- Humans
- Male
- Brain
(diagnostic imaging)
- Headache
- Magnetic Resonance Imaging
- Migraine Disorders
(diagnostic imaging, drug therapy)
- Receptors, Calcitonin Gene-Related Peptide
- Middle Aged
|