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The hypothalamus may mediate migraine and ictal photophobia: evidence from Granger causality analysis

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Abstract

Background

The hypothalamus plays a central role in the pathophysiology of migraine and is considered to be the “migraine generator.” It participates in initiating a migraine attack through its connectivity to regions of the brain involved in processing and modulating pain. However, the underlying mechanisms of hypothalamic effective functional connectivity that bring about migraines remain unclear. This study investigated the hypothalamus-based directional effective connectivity in migraine without aura patients and assessed associations among the clinical characteristics.

Methods

Seven patients with migraine without aura during the attack (MWoA-DA) (four with photophobia (MWoA-DAWP) and three without photophobia (MWoA-DAWoP)), twenty-seven patients with migraine without aura during the interictal period (MWoA-DI), and twenty-nine healthy controls (HC) were included in this study. Granger causality analysis (GCA) was used to investigate the directional effective connectivity between the hypothalamus and other brain regions.

Results

MWoA-DA patients exhibited decreased outflow from the bilateral hypothalamus to the visual cortex compared with the MWoA-DI patients and HCs. The MWoA-DAWP group primarily contributed to this result. The MWoA-DA patients showed decreased outflow from the bilateral hypothalamus to the right inferior parietal gyrus compared with the HCs. The visual analogue scale (VAS) was negatively correlated with abnormal effective functional connectivity from the right hypothalamus to the right inferior parietal gyrus in the MWoA-DA group.

Conclusions

These data provide evidence that the hypothalamus might serve as a central component of a multisystem network implicated in migraine and ictal photophobia, which includes hypothalamus and the visual and trigeminovascular systems.

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Abbreviations

MWoA-DA:

Migraine without aura during the attack

MWoA-DI:

Migraine without aura during the interictal period

MWoA-DAWP:

Migraine without aura patients during attack with photophobia

MWoA-DAWoP:

Migraine without aura patients during attack without photophobia

HC:

Healthy controls

GCA:

Granger causality analysis

FC:

Functional connectivity

VAS:

Visual analogue scale

MIDAS:

Migraine Disability Assessment Scale

HIT-6:

Headache Impact Test

SF-MPQ-2:

Short-form McGill Pain Questionnaire-2 scores

CSD:

Cortical spreading depression

HP:

Hypothalamus

IPG:

Inferior parietal gyrus

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Acknowledgements

We would like to thank the volunteers for their involvement in the study.

Funding

This study was supported by Science and Technology Planning Project of Traditional Chinese Medicine of Zhejiang Province (grant number 2021ZB101) and Medical and Health Research Project of Zhejiang Province (grant number 2020KY665).

Author information

Authors and Affiliations

  1. Department of Radiology, Hangzhou TCM Hospital Affiliated to Zhejiang Chinese Medical University, Hangzhou, China

    Luping Zhang & Feng Cui

  2. The First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China

    Wenjing Yu

  3. Department of Radiology, Zhejiang Provincial Hospital of Traditional Chinese Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China

    Maosheng Xu, Wenwen Song & Zhijian Cao

  4. Department of Neurology, Zhejiang Provincial Hospital of Traditional Chinese Medicine, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China

    Minli Yan & Zhengxiang Zhang

Authors
  1. Luping Zhang
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  4. Feng Cui
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  5. Wenwen Song
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  6. Minli Yan
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  7. Zhijian Cao
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  8. Zhengxiang Zhang
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Corresponding authors

Correspondence to Zhijian Cao or Zhengxiang Zhang.

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Statement of ethics

The study was carried out in accordance with the Code of Ethics of the World Medical Association (Declaration of Helsinki) and was approved by the Ethics Committee of the first Affiliated Hospital of Zhejiang Chinese Medical University.

Conflict of interest

The authors declare no competing interests.

Ethical approval and Informed consent

The study was carried out in accordance with the Code of Ethics of the World Medical Association (Declaration of Helsinki) and was approved by the Ethics Committee of the first Affiliated Hospital of Zhejiang Chinese Medical University (2018-KL-081-02).

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Zhang, L., Yu, W., Xu, M. et al. The hypothalamus may mediate migraine and ictal photophobia: evidence from Granger causality analysis. Neurol Sci 43, 6021–6030 (2022). https://doi.org/10.1007/s10072-022-06245-y

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  • DOI: https://doi.org/10.1007/s10072-022-06245-y

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