A neuropsychological profile-based classification outperforms ICHD-3 in terms of disability: exploratory analysis with anatomical correlates

CASTRO ZAMPARELLA, TATIANA; LISICKI, MARCO; CARPINELLA, MARIELA; CONCI MAGRIS, DIEGO MARTIN

Buenos Aires

Conferencia; 1st IHS Regional Headache Conference; 2023

International Headache Society

A neuropsychological profile-based classification outperformsICHD-3 in terms of disability: exploratory analysis withanatomical correlatesTatiana Castro Zamparella 1,2 , Mariela Carpinella 1 , Marcelo Filipchuk 1 , VerónicaBalaszczuk 2 , Carolina Maldonado 3 , Diego Conci Magris 1 , Marco Lisicki 11 Neuroscience Unit, Conci-Carpinella Institute, Córdoba, Argentina. 2 Psychological Research Institute, Faculty of Psychology, National University ofCórdoba (UNC) - National Council for Scientific and Technical Research (CONICET)3 Faculty of Exact, Physical and Natural Sciences, National University of Córdoba(UNC), ArgentinaIntroductionMigraine patients are not all equally affected by the condition. Recognizing the degreeof impairment is fundamental to personalize treatment. The International Classificationof Headache disorders recognizes two types of migraine with regards to severity (i.e.episodic and chronic), separated according to the frequency and characteristics ofheadache attacks. Although cumulative evidence supports the usefulness of thisclassification, it is well established that migraine is more than a headache. Therefore, itremains to be determined whether novel strategies could provide better outcomes. Inthis study, we compared migraine-related disability between patients classifiedaccording to the ICHD-3 or classified using a neuropsychological profile-basedclassification system and performed a supplementary gray matter (GM) volume analysisto better understand our findings. Materials and MethodsNeuropsychological evaluations of 135 migraine patients were included. The evaluationprotocol included Wechsler Word Pair memory, Wais forward and reverse Digitsattention, and Wais processing speed Digit-Symbol subtests, and Trail Making Test Aand B. Episodic or chronic migraine ICHD-3 diagnoses were performed by neurologistsbased on paper diaries filled by patients. For neuropsychological profile-basedclassification, results from the evaluation protocol were introduced in an automated k-means clustering algorithm. Headache Impact Test (HIT-6) and Migraine DisabilityAssessment (MIDAS) results were compared between groups. Voxel-basedMorphometry (VBM) supplementary analysis included a subgroup of 48 patients.Differences in GM (p<0.001 unc) are presented.ResultsSeventy-five patients were diagnosed as episodic and 60 were diagnosed as chronic.Non-supervised clustering allocated 49 participants to cluster 1 and 86 to cluster 2. Ageand gender proportions were similar between groups (overall mean age 39±12, 92%female). Statistically significant differences in HIT-6 results were observed betweenneuropsychological-driven groups (cluster1 65 ±9 vs cluster2 62 ±8; p=0.006) but notbetween ICHD-3 episodic and chronic patients (episodic 64 ±8 vs chronic 63 ±10; p=0.73). Differences in MIDAS results were also more pronounced betweenneuropsychological-driven groups (cluster1 81 ±70 vs cluster2 60 ±61; p=0.034)compared to the ICHD-3 (episodic 64 ±67 vs chronic 72 ±64; p= 0.27). VBM analysesshowed greater GM volume in the left superior temporal, left parahippocampal, rightinferior temporal, and right superior frontal gyri of chronic patients compared toepisodic, and increased GM in the right precuneus and left superior parietal lobe ofpatients in cluster1.ConclusionsOur results suggest that a neuropsychological profile-based classification system thatcould be readily implemented in the clinic would provide a better insight into migraineseverity. Differences in gray matter volume between episodic and chronic patients werefound in regions involved in nociception and analgesic dependence. In contrast,neuropsychological profile-based clustering segregated patients with different graymatter volume close to a region recently determined to be the hub of a commonmigraine network. If corroborated in larger cohorts, these findings have implications notonly at the single patient level, but also for epidemiological, pharmacological andpathophysiological studies.