Based On FMRI To Explore The Central Mechanism Of The Difference In Curative Effect Of Acupuncture In The Treatment Of Migraine

Background:Migraine is a kind of recurrent primary headache with high morbidity and disability rate,which seriously affects the work and study efficiency and quality of life of patients,and brings huge economic burden to patients and society.At present,acupuncture has certain advantages in the treatment of migraine,which can prevent the recurrence and chronic process of migraine,reduce the number of migraine days,reduce the frequency of migraine,reduce the degree of pain,and improve the quality of life.Therefore,acupuncture treatment is recommended as one of the important non-drug treatment methods for migraine.Despite the advantages of acupuncture in the treatment of migraine,we found that the clinical efficacy of some patients is still difficult to improve,which indicates that there are differences in efficacy between patients.For the treatment of migraine by acupuncture,the individual reasons for the differences in efficacy are not clear.The study of individual efficacy differences in acupuncture treatment of migraine may reveal the mechanism of acupuncture treatment for migraine on the other hand,and provide ideas for clinical treatment,so as to achieve precise treatment,personalized treatment and targeted treatment.With the increasing application of neuroimaging techniques in the study of migraine,we found that migraine patients have abnormalities in the structure and function of pain-related brain regions,and acupuncture treatment can modulate the abnormal functions of these brain regions.There are also studies that support the existence of individual differences in migraine patients and their brain function.Objective:By comparing the different functional connectivity of periaqueductal gray and whole brain in patients with different therapeutic effects after acupuncture treatment,we explore the central mechanism of the difference in the therapeutic effect of acupuncture treatment in migraine.And ideas were provided for clinical treatment with precise treatment,personalized treatment and targeted treatment.Method:60 patients with migraine without aura recruited from outpatient department of acupuncture would receive the same acupuncture therapy for 4 weeks,3 times a week,a total of 12 times.At the same time,rs-fMRI data and clinical data(including migraine days,VAS score,HIT-6,BAI,BDI-Ⅱ,MMSE,MoCA,PSQI)would be collected at baseline and after treatment.After the treatment,a 50%reduction in migraine days would be the evaluation index,and divide the patients into effective group and ineffective group.The different functional connectivity of periaquagtal gray and whole brain and the different clinical data in the two groups before and after treatment would be compared and analyzed,and the correlation analysis between rs-fMRI data and clinical data would be done.Result:Clinical data analysis showed that:①There was no significant difference in gender,age and course of disease between the effective group and the ineffective group.②There was no statistical difference in the migraine days,HIT-6,VAS score,BDI-II,BAI,MMSE,MoCA and PSQI in the baseline period between the two groups.③ After 4 weeks of the same acupuncture treatment,the migraine days,HIT-6 and PSQI scores of the effective group were significantly lower than those of the ineffective group.④ Comparison in the group showed that VAS score,HIT-6 and BAI in the two groups significantly decreased after acupuncture treatment,while MMSE significantly increased.Moreover,the change of VAS score and HIT-6 in the effective group were more significant than those in the ineffective group.⑤DAfter acupuncture treatment,migraine days,BDI-Ⅱ,PSQI and MoCA of patients in the effective group were significantly reduced,which were not significant in the ineffective group.Rs-fMRI data analysis and correlation analysis results:① Compared with ineffective group,the FC of effective group of left PAG and left cerebellum anterior lobe(IX)was significantly weakened,while the FC of right PAG and right cerebellum posterior lobe(CrusI),right superior/middle frontal gyrus,left superior/middle frontal gyrus were significantly strengthen.Partial correlation analysis showed that rs-fMRI data had no significant correlation with clinical data after Bonferroni correction at baseline.② The difference of FC of PAG and whole brain before and after treatment of the two groups showed that there was significantly different in FC between right PAG and right superior/middle frontal gyrus,right paracingulate cortex(supplementary motor area)/anterior cingulate cortex,left paracingulate cortex(medial superior frontal gyrus/supplementary motor area)before and after treatment of the two groups.Partial correlation analysis showed that,after correction by Bonferroni,the FC difference between right PAG and right superior/middle frontal gyrus,right paracingulate cortex/anterior cingulate cortex,and left paracingulate cortex were significantly positively correlated with the difference of migraine days.Conclusion:Compared with the ineffective group,the migraine days and the degree of headache in the effective group were significantly decreased after acupuncture treatment,and the quality of life such as mood,cognition and sleep were significantly improved.Patients with different acupuncture efficacy showed differences not only in the response of migraine days,but also in the response of other clinical indicators,and patients with headache days reduced>50%had better overall clinical improvement.Acupuncture treatment may have different modulation effect on patients with different therapeutic effects,which may due to the differences in the modulation of the descending inhibition system of pain,the modulation of migraine anticipation and the resulting sense of helplessness.In terms of the prognosis of acupuncture,the sensitivity of simple demographic indicators and clinical scale scores to distinguish the responers of different acupuncture effects was not high,that is,the prognosis of the selected points on migraine could not be accurately evaluated by simple patient information and clinical scale scores.Patients with different acupuncture effects had differences in brain function before acupuncture treatment.These differences may indicate that patients in the ineffective group had more obvious damage to the descending inhibition system of pain and lower response rate.The effective group had more advantages in pain inhibition.At the same time,they have different modulation functions in pain perception and cognition.