• Aimie L Peek, Andrew M Leaver, Sheryl Foster, Georg Oeltzschner, Nicolaas A Puts, Graham Galloway, Michele Sterling, Karl Ng, Kathryn Refshauge, Maria-Eliza R Aguila, and Trudy Rebbeck.
• Faculty of Medicine and Health, University of Sydney, Sydney, Australia; NHMRC Centre of Research Excellence in Road Traffic Injury Recovery, Queensland, Australia. Electronic address: apee6909@uni.sydney.edu.au.
• J Pain. 2021 Dec 1; 22 (12): 1631-1645.

AbstractTreatment outcomes for migraine and other chronic headache and pain conditions typically demonstrate modest results. A greater understanding of underlying pain mechanisms may better inform treatments and improve outcomes. Increased GABA+ has been identified in recent studies of migraine, however, it is unclear if this is present in other headache, and pain conditions. We primarily investigated GABA+ levels in the posterior cingulate gyrus (PCG) of people with migraine, whiplash-headache and low back pain compared to age- and sex-matched controls, GABA+ levels in the anterior cingulate cortex (ACC) and thalamus formed secondary aims. Using a cross-sectional design, we studied people with migraine, whiplash-headache or low back pain (n = 56) and compared them with a pool of age- and sex-matched controls (n = 22). We used spectral-edited magnetic resonance spectroscopy at 3T (MEGA-PRESS) to determine levels of GABA+ in the PCG, ACC and thalamus. PCG GABA+ levels were significantly higher in people with migraine and low back pain compared with controls (eg, migraine 4.89 IU ± 0.62 vs controls 4.62 IU ± 0.38; P = .02). Higher GABA+ levels in the PCG were not unique to migraine and could reflect a mechanism of chronic pain in general. A better understanding of pain at a neurochemical level informs the development of treatments that target aberrant brain neurochemistry to improve patient outcomes. PERSPECTIVE: This study provides insights into the underlying mechanisms of chronic pain. Higher levels of GABA+ in the PCG may reflect an underlying mechanism of chronic headache and pain conditions. This knowledge may help improve patient outcomes through developing treatments that specifically address this aberrant brain neurochemistry.Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

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