Objective: To observe therapeutic effect of acupuncture on migraine without aura and the changes of brain functional connectivity (FC) using resting-state functional magnetic resonance imaging (rs-fMRI).
Methods: Thirty-four patients with migraine without aura were included into an observation group and treated with acupuncture at Baihui (GV 20), Xuanlu (GB 5), Shuaigu (GB 8), Taiyang (EX-HN 5), etc. Using G6805-Ⅱ electric acupuncture apparatus, the ipsilateral Fengchi (GB 20) and Shuaigu (GB 8) were connected and stimulated with continuous wave, 2 Hz in frequency and 0.1 mA to 1.0 mA in current intensity, depending on patient's tolerance. Acupuncture stimulation lasted 20 min each time, twice weekly (at the interval>2 days). A total of 6 weeks of treatment (12 times) was required. Matching the gender and age as those of the observation group, 16 healthy subjects were recruited into a control group and no any intervention was provided. The headache days, the score of visual analogue scale (VAS) for headache severity, the total score of headache symptoms, the score of migraine-specific quality of life questionnaire (MSQ), the score of self-rating anxiety scale (SAS), and the score of self-rating depression scale (SDS) were compared before and after acupuncture, and the clinical efficacy was assessed in the observation group. The data of the resting-state functional magnetic resonance were collected in the observation group before and after treatment as well as the control group at baseline. The periaqueductal gray (PAG) was taken as the seed to analyze the effect of acupuncture on the brain FC and the correlation between FC and VAS scores, headache days in the patients of migraine without aura.
Results: After treatment, the headache days, VAS score, the total score of headache symptoms, SAS score and SDS score were all reduced (P<0.01); and the scores of the restrictive, preventive, and emotional functional domains of the MSQ were increased (P<0.01) in the observation group compared with those before treatment. The total effective rate was 94.1% (32/34). Compared with the control group, FC between PAG and the right cerebellum Ⅷ was decreased in the observation group before treatment (P<0.05). FC of PAG with the bilateral cerebellum Ⅷ and the left precuneus was increased in the observation group after treatment compared with those before treatment (P<0.05). In the observation group, the FC intensity of PAG and the right cerebellum Ⅷ was negatively correlated with VAS score (r =-0.41, P<0.05) before treatment, while the FC intensity of PAG and the left precuneus was positively correlated with the improvement in headache days (r =0.40, P<0.05) after treatment.
Conclusion: Acupuncture is effective on migraine without aura. The brain functional connectivity is abnormal in the patients. The effect onset of acupuncture is obtained probably by regulating the abnormal brain regions and activating brain regions relevant with pain and emotions.
目的：基于静息态功能磁共振成像（rs-fMRI），观察针刺治疗无先兆偏头痛的疗效及针刺前后静息态脑功能连接（FC）的变化。方法：纳入34例无先兆偏头痛患者作为观察组，予针刺治疗，穴取百会、悬颅、率谷、太阳等，同侧风池、率谷连接G6805-Ⅱ型电针仪，予连续波，频率2 Hz，强度0.1~1.0 mA，以患者舒适为度，每次针刺20 min，每周2次（间隔>2 d），共6周（12次）。招募性别、年龄相匹配的16例健康受试者作为对照组，不进行任何针刺干预。比较观察组针刺治疗前后头痛天数、头痛程度视觉模拟量表（VAS）评分、头痛症状总积分、偏头痛特异生活质量问卷（MSQ）评分、焦虑自评量表（SAS）评分、抑郁自评量表（SDS）评分，并评定临床疗效。采集观察组针刺治疗前后及对照组基线期的静息态功能磁共振数据，以中脑导水管周围灰质（PAG）为种子点，分析针刺对无先兆偏头痛患者全脑FC的影响及FC与VAS评分、头痛天数的相关性。结果：与治疗前比较，治疗后观察组头痛天数减少（P<0.01），头痛VAS评分、头痛症状总积分、SAS评分、SDS评分降低（P<0.01），MSQ功能受限、功能障碍、情感领域评分升高（P<0.01），总有效率为94.1%（32/34）。与对照组比较，治疗前观察组PAG与右侧小脑8区FC降低（P<0.05）；与治疗前比较，治疗后观察组PAG与双侧小脑8区、左侧楔前叶FC升高（P<0.05）；治疗前，观察组PAG-右侧小脑8区FC强度与头痛VAS评分呈负相关（r =-0.41，P<0.05）；治疗后，观察组PAG-左侧楔前叶FC强度与头痛天数改善值呈正相关（r =0.40，P<0.05）。结论：针刺治疗无先兆偏头痛疗效良好，无先兆偏头痛患者存在脑FC的异常变化，针刺可能通过调节功能异常脑区及激活疼痛情感相关脑区起效。.
Keywords: acupuncture; functional connectivity; migraine without aura; resting-state functional magnetic resonance imaging.