Key result
Severe mTBI-related headache linked to decreased right insula resting activity versus moderate headache.
Why the study?
The relationship between supraspinal pain modulatory functional deficit and the severity of mild traumatic brain injury related headache (MTBI-HA) was largely unknown.
Is the severity of mild traumatic brain injury related headache associated with changes in supraspinal pain modulatory functions?
Cross-Sectional (n=64)
Is the severity of mild traumatic brain injury related headache associated with changes in supraspinal pain modulatory functions?
Increased severity of MTBI-HA is associated with an imbalance in the supraspinal pain network, characterized by a decline in pain modulatory function and enhanced sensory decoding.
Severity of MTBI headache may involve insular changes; hypothesis-generating for pain network imbalance and should not yet change practice.
Emerging evidence suggests mild traumatic brain injury related headache (MTBI-HA) is a form of neuropathic pain state. Previous supraspinal mechanistic studies indicate patients with MTBI-HA demonstrate a dissociative state with diminished levels of supraspinal prefrontal pain modulatory functions and enhanced supraspinal sensory response to pain in comparison to healthy controls. However, the relationship between supraspinal pain modulatory functional deficit and severity of MTBI-HA is largely unknown. Understanding this relationship may provide enhanced levels of insight about MTBI-HA and facilitate the development of treatments. This study assessed pain related supraspinal resting states among MTBI-HA patients with various headache intensity phenotypes with comparisons to controls via functional magnetic resonance imaging (fMRI). Resting state fMRI data was analyzed with self-organizing-group-independent-component-analysis in three MTBI-HA intensity groups (mild, moderate, and severe) and one control group (n = 16 per group) within a pre-defined supraspinal pain network based on prior studies. In the mild-headache group, significant increases in supraspinal function were observed in the right premotor cortex (T = 3.53, p < 0.001) and the left premotor cortex (T = 3.99, p < 0.0001) when compared to the control group. In the moderate-headache group, a significant (T = -3.05, p < 0.01) decrease in resting state activity was observed in the left superior parietal cortex when compared to the mild-headache group. In the severe-headache group, significant decreases in resting state supraspinal activities in the right insula (T = -3.46, p < 0.001), right premotor cortex (T = -3.30, p < 0.01), left premotor cortex (T = -3.84, p < 0.001), and left parietal cortex (T = -3.94, p < 0.0001), and an increase in activity in the right secondary somatosensory cortex (T = 4.05, p < 0.0001) were observed when compared to the moderate-headache group. The results of the study suggest that the increase in MTBI-HA severity may be associated with an imbalance in the supraspinal pain network with decline in supraspinal pain modulatory function and enhancement of sensory/pain decoding.
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Flowers et al. (2021) conducted a cross-sectional in Mild traumatic brain injury related headache (n=64). Mild traumatic brain injury related headache vs. Healthy controls and lower severity groups was evaluated on Pain related supraspinal resting states via functional magnetic resonance imaging. Severe mild traumatic brain injury related headache was associated with decreased resting state activity in the right insula (T = -3.46, p < 0.001) compared to moderate headache.
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