Abstract
Objective The objective was to develop classification models differentiating persistent PTH (PPTH) and migraine using clinical data and MRI-based measures of brain structure and functional connectivity.
Background PTH and migraine commonly have similar phenotypes. Furthermore, migraine is a risk factor for developing PTH, sometimes making it difficult to differentiate PTH from exacerbation of migraine symptoms.
Design/Methods Thirty-four individuals with migraine without history of TBI and 48 individuals with mild TBI attributed to PPTH but without history of migraine or prior frequent tension type headache were included. Subjects completed questionnaires assessing headache characteristics, mood, sensory hypersensitivities and cognitive function and underwent MRI imaging during the same day. Clinical features and structural brain measures from T1-weighted imaging, diffusion tensor imaging and functional resting-state measures were included as potential variables. A classifier using ridge logistic regression of principal components (PC) was fit. Since PCs can hinder identification of significant variables in a model, a second regression model was fit directly to the data. In the non-PC based model, input variables were selected based on lowest t-test or chi-square p-value by modality. Average accuracy was calculated using leave-one-out cross validation. The importance of variables to the classifier were examined.
Results The PC-based classifier achieved an average classification accuracy of 85%. The non-PC based classifier achieved an average classification accuracy of 74.4%. Both classifiers were more accurate at classifying migraine subjects than PPTH. The PC-based model incorrectly classified 9/48 (18.8%) PPTH subjects compared to 3/34 (8.8%) migraine patients, whereas the non-PC classifier incorrectly classed 16/48 (33.3%) vs 5/34 (14.7%) of migraine subjects. Important variables in the non-PC model included static and dynamic functional connectivity values, several questions from the Beck Depression Inventory, and worsening symptoms and headaches with mental activity.
Conclusions Multivariate models including clinical characteristics, functional connectivity, and brain structural data accurately classify and differentiate PPTH vs migraine.
Footnotes
Disclosure: Gina Dumkrieger has received personal compensation for serving as an employee of Mayo Clinic. The institution of Gina Dumkrieger has received research support from NIH. The institution of Gina Dumkrieger has received research support from DOD. The institution of Gina Dumkrieger has received research support from AMGEN. An immediate family member of Dr. Chong has received personal compensation for serving as an employee of Mayo Clinic. The institution of Dr. Chong has received personal compensation in the range of $500-$4,999 for serving as a Consultant for AMGEN. The institution of Dr. Chong has received research support from AMGEN. The institution of Dr. Chong has received research support from Department of Defense. The institution of Dr. Chong has received research support from NIH. The institution of Dr. Chong has received research support from Department of Defense. An immediate family member of Dr. Chong has received intellectual property interests from a discovery or technology relating to health care. Katherine Ross has nothing to disclose. Visar Berisha has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cytokinetics. Visar Berisha has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Boehringer Ingelheim. Visar Berisha has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Aural Analytics. Visar Berisha has received stock or an ownership interest from Aural Analytics. The institution of Visar Berisha has received research support from Boheringer Ingelheim. Visar Berisha has received intellectual property interests from a discovery or technology relating to health care. Dr. Schwedt has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alder. Dr. Schwedt has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Allergan. Dr. Schwedt has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Biohaven. Dr. Schwedt has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cipla. Dr. Schwedt has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Click Therapeutics. Dr. Schwedt has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Eli Lilly. Dr. Schwedt has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Equinox. Dr. Schwedt has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Lundbeck. Dr. Schwedt has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Novartis. Dr. Schwedt has received personal compensation in the range of $500-$4,999 for serving as a Consultant for XoC Pharmaceuticals. Dr. Schwedt has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Weber & Weber. Dr. Schwedt has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Headache Society. Dr. Schwedt has received stock or an ownership interest from Aural Analytics. Dr. Schwedt has received stock or an ownership interest from Nocira. The institution of Dr. Schwedt has received research support from Amgen. Dr. Schwedt has received publishing royalties from a publication relating to health care.
- © 2021 American Academy of Neurology
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