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AAN 2022 | Pontine-hypothalamic interplay for predicting migraine progression

Roberta Messina, MD, Vita-Salute San Raffaele University, Milan, Italy, comments on evidence showing changes in the pons and hypothalamus in the premonitory and interictal phases of migraines. Only one previous study has demonstrated how the pons and hypothalamus interact in the pain phase of migraine attacks, therefore the aim of Dr Messina’s study was to investigate the resting-state effective connectivity abnormalities between the pons and hypothalamus in episodic migraine patients. The study found that migraine patients had a higher inhibitory effective connectivity in the left pons, and from the right and left pons to the ipsilateral and contralateral hypothalamus, compared to controls. Additionally, migraine patients had a lower inhibitory effective connectivity from the left hypothalamus to the left pons, and a higher excitatory effective connectivity from the right pons to the left pons. Interestingly, in migraine patients, a higher inhibitory resting-state effective connectivity from the pons to the hypothalamus predicted clinical improvement in terms of a reduction in attack frequency over time. In the interictal phase, a prominent inhibitory influence of the pons over the hypothalamus could prevent the transition into the acute phase of migraine attacks, hence reducing migraine attack frequency. This higher pontine-hypothalamic inhibitory activity may also become a prognostic marker for migraine improvement over the years. This interview took place at the American Academy of Neurology 2022 Congress in Seattle, WA.