Vinod K.Gupta, Physician, Gupta Medical Center (New Delhi, India)
Submitted July 29, 2018
I read with interest the article by Messina et al. that focused on gray matter volume changes in migraine. [1] The number of episodic migraineurs evaluated (73) was too small for any biologically significant meaning to emerge. The limits of every research tool—including randomized controlled trial as well as advanced neuroimaging—have to be accepted, particularly in the absence of basic comprehension of disease mechanisms. [2,3] Statistical significance also may have no biological significance. [3] Messina et al. [1] offer no correlation between gray matter volume changes and lateralization of headache, the most important pathophysiologic facet of migraine. Migraine literature is deluged with perceived differences between migraine with aura (MwA) and migraine without aura (MwoA), the single most important nosologic stumbling block in the evolution of a comprehensive theory for the entity. [2,3] Messina et al. [1] offer no such distinction.
Experience-dependent secondary reactive or adaptive cortical plasticity—thickening or thinning underlying gray matter volume changes—is not unique or specific to either MwA or MwoA patients. Age, [4] gender, genetics, stress and its potential contribution to stress resilience/susceptibility, perception of pain, attention, state of hydration, [5] and many other factors confound this study besides the protean nature of migraine.
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.
Gupta VK. CSD, BBB and MMP-9 elevations: animal experiments versus clinical phenomena in migraine. Expert Rev Neurother 2009;9:1595-1614.
Gupta VK. Patent foramen ovale closure and migraine: science and sensibility. Expert Rev Neurother 2010;10:1409-1422.
Wierenga LM, Langen M, Oranje B, Durston S. Unique developmental trajectories of cortical thickness and surface area. Neuroimage 2014;87:120-126.
Biller A, Reuter M, Patenaude B, et al. Responses of the Human Brain to Mild Dehydration and Rehydration Explored In Vivo by 1H-MR Imaging and Spectroscopy. AJNR Am J Neuroradiol 2015;36:2277-2284.
I read with interest the article by Messina et al. that focused on gray matter volume changes in migraine. [1] The number of episodic migraineurs evaluated (73) was too small for any biologically significant meaning to emerge. The limits of every research tool—including randomized controlled trial as well as advanced neuroimaging—have to be accepted, particularly in the absence of basic comprehension of disease mechanisms. [2,3] Statistical significance also may have no biological significance. [3] Messina et al. [1] offer no correlation between gray matter volume changes and lateralization of headache, the most important pathophysiologic facet of migraine. Migraine literature is deluged with perceived differences between migraine with aura (MwA) and migraine without aura (MwoA), the single most important nosologic stumbling block in the evolution of a comprehensive theory for the entity. [2,3] Messina et al. [1] offer no such distinction.
Experience-dependent secondary reactive or adaptive cortical plasticity—thickening or thinning underlying gray matter volume changes—is not unique or specific to either MwA or MwoA patients. Age, [4] gender, genetics, stress and its potential contribution to stress resilience/susceptibility, perception of pain, attention, state of hydration, [5] and many other factors confound this study besides the protean nature of migraine.
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