Neurotransmitter-related functional connectivity changes after mindfulness practice in serotonin and dopamine systems of Medication Overuse Headache patients

Description: Background/Hypothesis: Mindfulness practice has gained attention in managing chronic migraine with medication overuse headache (CM-MOH), showing clinical improvements and functional connectivity (FC) reorganization. However, the relationship between these effects and the underlying neurotransmitter systems remains unexplored. Methods: Thirty-four CM-MOH patients were divided into treatment as usual (TaU, N=17) and mindfulness-added-to-TaU (TaU+MIND, N=17) groups. Participants underwent resting-state fMRI scans before treatment and after one year. We adopted the neutransmitter-related FC framework (REACT) to investigate longitudinal FC changes associated with the distribution of serotonin, dopamine, and norepinephrine systems by comparing TaU+MIND with TaU groups. Results: When compared with TaU, TaU+MIND patients longitudinally showed increased serotonin-enriched FC in the caudate and accumbens nuclei, and increased dopamine-enriched FC in the right insular cortex. Conclusion/Interpretation: These regions are involved in emotional, cognitive, and sensory modulation of pain and addiction. Our findings suggest the impact of mindfulness practice on serotonin and dopamine systems with potential beneficial effects in chronic pain management.