• Tzu-Hsien Lai, Kung-Hsien Chou, Jong-Ling Fuh, Pei-Lin Lee, Yi-Chia Kung, Ching-Po Lin, and Shuu-Jiun Wang.
• Program in Molecular Medicine, National Yang-Ming University and Academia Sinica, Taiwan.
• Cephalalgia. 2016 Dec 1; 36 (14): 1324-1333.

ObjectiveThe objective of this article is to investigate the neurological substrates associated with medication overuse (MO) in patients with chronic migraine (CM).MethodsWe recruited age- and sex-matched CM patients with MO (CMwMO), CM patients without MO (CMwoMO), and healthy controls (HCs). Magnetic resonance T1-weighted images were processed by voxel-based morphometry, and the findings were correlated with clinical variables and treatment responses.ResultsA total of 66 patients with CM (half with MO) and 33 HCs completed the study. Patients with CMwMO compared to the patients with CMwoMO showed gray matter volume (GMV) decrease in the orbitofrontal cortex and left middle occipital gyrus as well as GMV increase in the left temporal pole/parahippocampus. The GMV changes explained 31.1% variance of the analgesics use frequency. The patients who responded to treatment had greater GMV in the orbitofrontal cortex (p = 0.028). Patients with CM (with and without MO), compared with HCs, had decreased GMV at multiple brain areas including the frontal, temporal and occipital lobes, precuneus and cerebellum.ConclusionsOur study showed GMV changes in CMwMO patients compared to the CMwoMO patients. These three cerebral regions accounted for significant variance in analgesics use frequency. Moreover, the GMV of the orbitofrontal cortex was predictive of the response to MO treatments.© International Headache Society 2016.

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