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The Migraine Brain in Transition: Girls versus Boys

By Vanda Faria, Nathalie Erpelding, Alyssa Lebel, Adriana Johnson, Robert Wolff, Damien Fair, Rami Burstein, Lino Becerra, and David Borsook | PAIN | July 13, 2015


The prevalence of migraine has an exponential trajectory that is most obvious in young females between puberty and early adulthood. Adult females are affected twice as much as males. During development, hormonal changes may act on predetermined brain circuits increasing the probability of migraine. However, little is known about the pediatric migraine brain and migraine evolution. Using magnetic resonance imaging (MRI), we evaluated 28 children with migraine (14 females and 14 males) and 28 sex-matched healthy controls to determine differences in brain structure and function between: (a) females and males with migraine, and (b) females and males with migraine during earlier (10-11 years old) vs later (14-16 years) developmental stages compared to matched healthy controls. Compared to males, females had more gray matter (GM) in the primary somatosensory cortex (S1), supplementary motor area (SMA), precuneus (PCu), basal ganglia (BG), and amygdala, as well as greater PCu functional resting state connectivity to the thalamus, amygdala and BG, and greater amygdala functional resting state connectivity to the thalamus, anterior midcingulate cortex, and SMA. Moreover, older females with migraine had more GM in the S1, amygdala, and caudate compared older males with migraine and matched healthy controls. This is the first study showing sex and developmental differences in pediatric migraineurs in brain regions associated with sensory, motor, and affective functions, providing insight into the neural mechanisms underlying distinct migraine sex phenotypes as well as their evolution that could result in important clinical implications increasing treatment effectiveness.

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