Increased hippocampal efficiency is associated with greater headache frequency in adolescents with chronic headache

Adults with chronic headache have altered brain hippocampal efficiency networks. Less is known about the mechanisms underlying chronic headache in youth. In total, 29 youth with chronic headache (10–18 years), and 29 healthy, age- and sex-matched controls tracked their headache attacks daily for 1-month period. Following this, they underwent a resting state functional magnetic resonance imaging scan and self-reported on their pubertal status, post-traumatic stress, anxiety, and depression symptoms. Graph-based topological analyses of brain networks, rendering hippocampal efficiency values were performed. T-tests were used to compare hippocampal efficiency metrics between patients and controls. Linear regression was used to examine significant hippocampal efficiency metrics in relation to headache frequency in patients, controlling for age, sex, pubertal status, post-traumatic stress, anxiety, and depression symptoms. Patients had higher right hippocampal global efficiency, shorter right hippocampal path length, and higher right hippocampal clustering coefficient compared to controls (P < 0.05). Higher right hippocampal global efficiency, shorter right hippocampal path length, and higher right hippocampal clustering coefficients were positively associated with greater headache frequency (P < 0.05). The hippocampus is largely involved in memory formation and retrieval, and this data provides additional support for previous findings demonstrating the importance of the hippocampus and pain memories for the chronification of pain.