MassimoFilippi, Neurologist, San Raffaele Scientific Institute, Vita-Salute San Raffaele University (Milan, Italy)
RobertaMessina, Medical Doctor, San Raffaele Scientific Institute, Vita-Salute San Raffaele University (Milan, Italy)
Peter J.Goadsby, Neurologist, King’s College London (London, England)
Maria A.Rocca, Neurologist, San Raffaele Scientific Institute, Vita-Salute San Raffaele University (Milan, Italy)
Submitted August 16, 2018
We thank Dr. Gupta for his interest in our study. [1] We agree that many variables can confound volumetric measurements and more effort is needed to minimize these factors in neuroimaging studies. Although migraine is one of the most common neurologic diseases, the number of patients with migraine enrolled in MRI studies remains relatively low (on average, around 20). Only a few studies succeeded in including a larger sample of patients. [2]
Migraine patients with and without aura have different phenotypic manifestations; this is why we explored whether gray matter (GM) volume changes are associated with the phenotypic difference. We could not investigate the correlation between morphometric abnormalities and headache lateralization, because—similar to previous investigations—[3] most of our patients reported bilateral or unilateral pain without side predominance. Dr. Gupta noted that lateralisation is the "most important pathophysiologic facet of migraine;" this is an adamantine view at best.
Another important point is whether morphometric brain changes are migraine-specific. Two recent studies revealed distinct GM-volume patterns that distinguish migraineurs from patients with tension-type [4] or persistent post-traumatic headache. [5] Future studies comparing migraineurs to patients with other chronic pain disorders may be useful, although regarding migraine as having a versatile nature seems a jejune conclusion with regard to its complex biology.
Messina R, Rocca MA, Colombo B, et al. Gray matter volume modifications in migraine: A cross-sectional and longitudinal study. Neurology 2018;91:e280-e292.
Messina R, Rocca MA, Colombo B, et al. Cortical abnormalities in patients with migraine: a surface-based analysis. Radiology 2013;268:170-180.
Loder E, Weizenbaum E, Giddon D. Migraine Pain Location and Measures of Healthcare Use and Distress: An Observational Study. Pain Res Manag 2018;2018:6157982.
Chen WT, Chou KH, Lee PL, et al. Comparison of gray matter volume between migraine and "strict-criteria" tension-type headache. J Headache Pain 2018;19:4.
Schwedt TJ, Chong CD, Peplinski J, Ross K, Berisha V. Persistent post-traumatic headache vs. migraine: an MRI study demonstrating differences in brain structure. J Headache Pain 2017;18:87.
We thank Dr. Gupta for his interest in our study. [1] We agree that many variables can confound volumetric measurements and more effort is needed to minimize these factors in neuroimaging studies. Although migraine is one of the most common neurologic diseases, the number of patients with migraine enrolled in MRI studies remains relatively low (on average, around 20). Only a few studies succeeded in including a larger sample of patients. [2]
Migraine patients with and without aura have different phenotypic manifestations; this is why we explored whether gray matter (GM) volume changes are associated with the phenotypic difference. We could not investigate the correlation between morphometric abnormalities and headache lateralization, because—similar to previous investigations—[3] most of our patients reported bilateral or unilateral pain without side predominance. Dr. Gupta noted that lateralisation is the "most important pathophysiologic facet of migraine;" this is an adamantine view at best.
Another important point is whether morphometric brain changes are migraine-specific. Two recent studies revealed distinct GM-volume patterns that distinguish migraineurs from patients with tension-type [4] or persistent post-traumatic headache. [5] Future studies comparing migraineurs to patients with other chronic pain disorders may be useful, although regarding migraine as having a versatile nature seems a jejune conclusion with regard to its complex biology.
For disclosures, please contact the editorial office at journal@neurology.org.