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Electron Microscopy And Proteomics Confirm Structural Changes In Nerves Affected By Migraine Headaches But Not Control Nerves
Harvey Chim, Elizabeth Yohannes, Robert Miller, Deborah Reed, Mark Chance, Bahman Guyuron
University Hospitals Case Medical Center
2013-01-30
Presenter: Harvey Chim
Affidavit:
The above work represents the original work of the resident.
Director Name: Hooman Soltanian
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: Craniomaxillofacial
Introduction: While migraine surgery has been successful in treating patients with symptomatic migraine headaches (MH) through nerve decompression or ablation, an unanswered question is whether there exists structural changes in affected nerves of migraine patients that might correlate with the presence of MH.
Objectives: The purpose of this study was to compare ultrastructural appearance and protein expression of the zygomaticotemporal branch of the trigeminal nerve (ZTBTN) in patients with and without MH.
Methods: A 5mm segment of the ZTBTN routinely removed during migraine surgery for a temporal trigger site was compared to a similar nerve segment removed from patients without MH who underwent endoscopic forehead lift, where the nerve is routinely transected by the senior author. Electron microscopy was used to determine cytoarchitectural differences between control and MH nerves, while proteomics analysis was used to determine changes in protein expression.
Results: In migraine derived nerves, electron microscopy showed striking discontinuity and poor registration of neurofilaments, suggesting axonal pathology. In addition, there was excessive myelin folded around and constricting axons, leaving little axonal cytoplasm. Proteomics revealed downregulation of molecules involved in establishment of normal axonal caliber and myelination of axons, with upregulation of proteins involved in free radical scavenging to address oxidative insult. These changes were absent in control nerves.
Conclusions: These findings provide evidence from electron microscopy and proteomics to support structural changes in nerves affected in MH. Findings suggest that the etiology of MH is related to deregulation of normal axonal myelination as well as inflammation and oxidative insult.
