In this study, they gave intensive treatment. Daily acupuncture for 5 days, 2 days off for 4 weeks. I was surprised that their results were not better. They also used three different treatment protocols, two relied heavily on gall bladder points, one with St 37 and Pianli. In sum, quite different protocols than what I use. What they find is that the connectivity is changed in the interictal period. This makes sense to me from what I see in patients. Somehow the acupuncture affects the resting state in migraineurs which make them more “sturdy.”
Altered periaqueductal gray resting state functional connectivity in migraine and the modulation effect of treatment.
The aims of this study were to 1) compare resting state functional connectivity (rs-fc) of the periaqueductal gray (PAG), a key region in the descending pain modulatory system (DPMS) between migraine without aura (MwoA) patients and healthy controls (HC), and 2) investigate how an effective treatment can influence the PAG rs-fc in MwoA patients. One hundred MwoA patients and forty-six matched HC were recruited. Patients were randomized to verum acupuncture, sham acupuncture, and waiting list groups. Resting state fMRI data were collected and seed based functional connectivity analysis was applied. Compared with HC, MwoA patients showed reduced rs-fc between the PAG and rostral anterior cingulate cortex/medial prefrontal cortex (rACC/mPFC), key regions in the DPMS and other pain related brain regions. The reduced rs-fc between the PAG and rACC/mPFC was associated with increased migraine headache intensity at the baseline. After treatments, rs-fc between the PAG and the rACC in MwoA patients significantly increased. The changes of rs-fc among the PAG, rACC and ventral striatum were significantly associated with headache intensity improvement. Impairment of the DPMS is involved in the neural pathophysiology of migraines. Impaired DPMS in migraine patients can be normalized after effective treatment.