Abstract Details

Title Elevated Peak Width of Skeletonized Mean Diffusivity Indicates a Transient Disease-like White Matter State in Status Migrainosus

Topic Headache

Presentation(s) P3 - Poster Session 3 (5:00 PM-6:00 PM)

Poster/Presentation
Number 15-015

Objective To determine whether status migrainosus (SM) is associated with transient, diffuse alterations in white matter microstructure that may underlie attack refractoriness and network instability.

Background

SM is a severe migraine attack lasting more than 72 hours, yet its pathophysiology remains unknown. While migraine is linked to microstructural and volumetric brain changes, diffusion tensor imaging (DTI) during SM has not been studied.

Design/Methods This preplanned secondary analysis of a prospective within-subject MRI cohort included all participants (n=11) with ICHD-3 migraine who completed diffusion MRI during SM and at interictal baseline. Diffusion preprocessing and tract-based spatial statistics (TBSS) were performed in FSL. Fractional anisotropy maps defined the white matter skeleton onto which mean diffusivity (MD) maps were projected. The primary outcome, peak width of skeletonized mean diffusivity (PSMD), was calculated as the difference between the 95th and 5th percentiles of MD values within the skeleton. Linear mixed-effects models with random intercepts tested ictal–interictal differences, adjusted for age. Exploratory voxelwise analyses used single-tailed signed-rank tests (p<0.05).

Results Participants had a mean age of 47.6±17.2 years; nine (82%) were women, and all had chronic migraine. Median SM duration was 600 hours (IQR 264–936). PSMD values were higher during SM than at baseline. In adjusted models, right-hemispheric PSMD was significantly greater during SM (p=0.037), with a trend on the left (p=0.062). Voxelwise TBSS showed multifocal clusters of increased diffusivity across the subcortical white matter (corpus callosum, internal and external capsules, cingulum, longitudinal fasciculi, and corona radiata) extending into superficial white matter.

Conclusions SM is associated with diffuse, reversible increases in white matter diffusivity heterogeneity. Elevated PSMD, a validated marker of microvascular and microstructural disease burden, indicates that SM induces a transient, “disease-like” white matter state. These findings support a model of widespread but reversible white matter disruption consistent with transient brain-network instability.

Authors/Disclosures
Jennifer V. Robblee, MD (Barrow Neurological Institute) PRESENTER	Dr. Robblee has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Impel. Dr. Robblee has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Abbvie. Dr. Robblee has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Tonix. An immediate family member of Dr. Robblee has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Scottsdale Providence. The institution of Dr. Robblee has received research support from Eli Lilly. The institution of Dr. Robblee has received research support from AbbVie. The institution of Dr. Robblee has received research support from Barrow Neurological Institute. Dr. Robblee has received publishing royalties from a publication relating to health care. Dr. Robblee has received publishing royalties from a publication relating to health care.
Timothy Hutson, PhD	Dr. Hutson has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for EpiFocus LLC. Dr. Hutson has received research support from Barrow Neurological Foundation.
Rachel Stancl, MPA, BS	Ms. Stancl has nothing to disclose.
Susan Criswell, MD (Washington University)	Dr. Criswell has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Abbvie.

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