Periaqueductal gray matter echogenicity: An irreversible marker of chronic migraine?

This study investigated the periaqueductal gray matter (PAG) in migraine patients. Researchers aimed to see if PAG changes correlate with migraine classification shifts. They reanalyzed data from 115 participants, including 65 migraine patients and 50 controls. After three years, they re-evaluated 94 participants. Among patients who transitioned from episodic to chronic migraine, PAG area significantly increased. These patients also showed greater PAG echogenicity reduction and higher heterogeneity at baseline. In contrast, those who remained with episodic migraines did not show significant PAG changes. Chronic migraine patients who improved did not exhibit notable differences in PAG characteristics either. This indicates that certain PAG alterations may persist even with clinical improvement. However, there were encouraging findings in the small group that transformed to chronic migraine. Researchers suggest further studies with larger sample sizes are necessary to confirm these important results regarding PAG changes and migraine classification. Clinical relevance: This research indicates that PAG changes may persist despite clinical improvement in migraines.