Abnormal Functional Activity in the Cerebellar Crus Can Distinguish Patients with Migraine Combined with Insomnia

Background: Migraine is a prevalent neurological condition that is frequently observed in clinical practice and is often associated with insomnia. Insomnia can exacerbate and precipitate migraine attacks, with both conditions exerting a reciprocal influence on one another. cerebellum Crus (Crus) regions are significantly associated with the pathophysiology of migraine and insomnia. The relationship between cerebellar crus functional alterations and migraine-associated insomnia remains unclear. This study utilizes resting-state functional magnetic resonance imaging (rs-fMRI) to examine functional alterations in the cerebellar crus of patients with migraine and concurrent insomnia. Methods: Participants underwent resting-state functional magnetic resonance imaging. Subsequently, the disparity in amplitude of low-frequency fluctuations (ALFF) values among groups was analyzed, followed by functional connectivity (FC) investigations employing the cerebellum Crus as seed regions. Results: Migraine patients frequently experience neuropsychological disorders and insomnia, which are interconnected. Both groups of migraine with insomnia (MwI) and migraine without insomnia (MwoI) exhibit elevated ALFF of the left Crus I and Crus II relative to the healthy controls (HCs) group, with the MwI group showing more pronounced alterations. Furthermore, there is diminished FC between the right Crus I and the left superior parietal lobule (SPL) and inferior parietal lobule (IPL) in both the MwI and MwoI cohorts. A negative correlation was discovered between the ALFF of the left Crus I and Crus II and the Pittsburgh Sleep Quality Index (PSQI) scores in the MwoI group. In the MwoI and MwI cohorts, anomalous FC of the right Crus I with the left SPL and IPL exhibited a positive connection with PSQI scores. Conclusion: This study identified abnormalities in localized functional activity within the cerebellar crus and in FC with other brain regions among MwI. These findings further clarify the neural mechanisms linking migraines and insomnia, making them useful for identifying neuroimaging biomarkers and exploring therapeutic targets.