1. Structural: High-resolution images of the brain
2.
to assess the thickness of the gray matter of
the brain at a sub-millimeter level;
Functional: images that are sensitive to (and
reflective of) functional activity of the brain
when responding to painful heat applied to the
back of the hand.
Heat was applied three times, each time for 15
seconds, through a small metal cube. This study led
to four main findings:
1. We found increased gray matter thickness in
two areas of the brain that were specific only
to women with migraine. These areas included
insula, which is an area in the brain involved
in processing pain, and precuneus, which is
less known for pain processing but than with
self-awareness.
2. We also found a specific change in men with
migraine—the reduction of the volume of the
parahippocampal gyrus, which surrounds the
hippocampus and is involved in numerous
behaviors including stress and anxiety.
3. We found that in the brain of women with
migraine, the regions involved in emotional
processing (such as the amygdala) responded
more pronouncedly to pain and this was also
consistent with increased measures of pain
unpleasantness for these women.
4. In comparing the brain response to pain in men
versus women with migraine, we found the
two regions that had shown increased cortical
thickness in women with migraine also showed
a specific pattern of functional connectivity
(working together) with the rest of the brain.
These findings confirm that there are indeed differences in the brain of men and women who suffer from
migraine. These differences occur in the structure of
the brain (gray matter thickness or volume) as well as
the way in which the brain responds to pain. These
findings may not translate to any immediate change
in how we treat migraine in men versus women, but
it encourages researchers and drug developers to
consider sex when studying the migraine disease and
developing new drugs. It may lead to treatments that
would be more effective for both men and women.
This article is based on the author’s lecture, “Her Versus Him Migraine; Multiple Sex Differences in Brain
Function and Structure,” which was presented as the
Seymour Diamond, MD Lectureship on February 18,
2013, during the 26th Annual Practicing Physician’s
Approach to the Difficult Headache Patient, in Rancho
Mirage, California. The Seymour Diamond, MD
Lectureship recognizes the most significant paper in
headache that was published during the past year.
Doctor Maleki and her colleagues (Clas Linnman,
Jennifer Brawn, Rami Burstein, Lino Becerra, and
David Borsook), were awarded the Lectureship for
their article of the same name, which appeared in the
journal, Brain, volume 135, 2012.
www.headaches.org
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