The Future of Classifying Migraine Through MRI
The American Headache Society (AHS) held its 57th Annual Conference in June 2015 in Washington, DC. This year’s Wolff Award was presented to Dr. Todd J. Schwedt, MD, FAHS, Professor of Neurology at the Mayo Clinic in Scottsdale, AZ. The Wolff Award, named after Harold G. Wolff, a neurologist considered the “father of modern headache research,” is awarded to the best scientific paper on headache, head or face pain and the nature of pain itself. The recipient’s work is highlighted at the annual conference of AHS and the findings are published in the magazine, Headache.
The subject of Dr. Schwedt’s work was to provide Accurate Classification of Chronic Migraine via Brain Magnetic Resonance Imaging. Here’s an overview of how the study was conducted and what the results mean for migraine patients.
There is currently no one medical test that is able to diagnose that a patient has migraines. MRI is used to rule out other possible neurological conditions (such as a tumor) that could be causing headache. There is a need to find objective biomarkers that could diagnose and subclassify migraine and that could lead to better treatment options for patients. This study had two purposes:
- Use MRI to classify participants as either episodic or chronic migraine versus a healthy participant.
- Use MRI to test the widely-held standard of having at least 15 headache days per month for defining chronic migraine. This threshold was previously established through the consensus of experts’ opinion, without using MRI.
- 66 Migraineurs
- 54 healthy participants
- 75% were female
- Average age of participant was 36 years old
MRI was used to study all 120 participants. Over 200 areas of the brain were studied including the temporal pole, anterior cingulate cortex, superior temporal sulcus, entorhinal cortex, medial orbital frontal gyrus, and pars triangularis. Measurements of these areas would hopefully aide in a correct diagnosis of each participant having either episodic, chronic or no migraines.
Dr. Schwedt and his associates were able to determine that measurements of cortical surface area, cortical thickness and volumes were different between chronic migraineurs and healthy participants. Using these measurements of brain structure, they were able to determine if an individual had chronic migraine or did not have migraine with 86% accuracy.
Drilling down further, the same measurements taken via MRI were used to differentiate between episodic and chronic migraineurs. This was identified with 84% accuracy.
Due to the differences found between both types of migraine participants, it was also determined that episodic and chronic patients could be most accurately segregated using the standard of 15 headache days per month.
What does this mean for the future of diagnosing migraine?
In speaking with Dr. Schwedt, his main objective was to find structural differences in the brains of migraine patients that could be used to accurately and objectively identify migraine. Using MRI to pinpoint these structural differences gives legitimacy that migraine is a disease.
Dr. Schwedt hopes that this study will lead to being able to objectively classify different types of migraines (such as hemiplegic or basilar-type) or even discover migraine types that are not currently named or recognized. Having better information could lead to better and more personalized prescribing methods.
In the short-term, however, imaging would not be used for initial diagnosis. There is still more work to be done before a single medical test can be used to accurately diagnose migraine. This study is the first of its kind to be able to use MRI to accurately classify chronic migraine. Dr. Schwedt and his team deserve the AHS Wolff Award for this ground-breaking work.
The abstract for this study can be found here:
How much has your migraine disease changed or evolved over time?