Clinical correlates of hypothalamic functional changes in migraine patients

Messina, Roberta; Rocca, Maria; Valsasina, Paola; Misci, Paolo; Filippi, Massimo

doi:10.1177/03331024211046618

Cited by 16 publications

(21 citation statements)

References 35 publications

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“…Russo et al [45] found by thermal stimulation of the trigeminal nerve in the maxillary region that the activity in the higher visual processing areas, including the lingual gyrus, increased in patients with migraine with aura compared with HC and those with migraine without aura. Messina et al [46] found that the functional connectivity between the right hypothalamus and ipsilateral lingual gyrus decreased in patients with migraine compared with HC, and was associated with a higher frequency of migraine attacks. The lingual gyrus is associated with psychiatric disorders such as depression, anxiety, and panic attacks [47,48].…”

Section: Compared With the Baseline The Dalff Values Decreased In Tri...mentioning

confidence: 99%

Amplitude of low-frequency fluctuation after a single-trigger pain in patients with classical trigeminal neuralgia

Wang

Pan

et al. 2022

J Headache Pain

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Objective This study aimed to explore the central mechanism of classical trigeminal neuralgia (CTN) by analyzing the static amplitude of low-frequency fluctuation (sALFF) and dynamic amplitude of low-frequency fluctuation (dALFF) in patients with CTN before and after a single-trigger pain. Methods This study included 48 patients (37 women and 11 men, age 55.65 ± 11.41 years) with CTN. All participants underwent 3D-T1WI and three times resting-state functional magnetic resonance imaging. The images were taken before stimulating the trigger zone (baseline), within 5 s after stimulating the trigger zone (triggering-5 s), and in the 30th minute after stimulating the trigger zone (triggering-30 min). The differences between the three measurements were analyzed using a repeated-measures analysis of variance. Results The sALFF values of the bilateral middle occipital gyrus and right cuneus gradually increased, and the values of the left posterior cingulum gyrus and bilateral superior frontal gyrus gradually decreased in triggering-5 s and triggering-30 min. The values of the right middle temporal gyrus and right thalamus decreased in triggering-5 s and subsequently increased in triggering-30 min. The sALFF values of the left superior temporal gyrus increased in triggering-5 s and then decreased in triggering-30 min. The dALFF values of the right fusiform gyrus, bilateral lingual gyrus, left middle temporal gyrus, and right cuneus gyrus gradually increased in both triggering-5 s and triggering-30 min. Conclusions The sALFF and dALFF values changed differently in multiple brain regions in triggering-5 s and triggering-30 min of CTN patients after a single trigger of pain, and dALFF is complementary to sALFF. The results might help explore the therapeutic targets for relieving pain and improving the quality of life of patients with CTN.

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Section: Compared With the Baseline The Dalff Values Decreased In Tri...mentioning

confidence: 99%

Amplitude of low-frequency fluctuation after a single-trigger pain in patients with classical trigeminal neuralgia

Wang

Pan

et al. 2022

J Headache Pain

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“…In a selective group of migraine with aura patients, who always had side-fixed aura symptoms, hyperexcitability was reported in the symptomatic hemisphere during the asymptomatic phase [17]. The application of fMRI techniques to study asymptomatic migraine patients has also recently provided new insights into imaging prognostic markers for migraine disability and severity [16,18]. Future larger studies are needed to confirm these findings.…”

Section: Imaging In the Asymptomatic Phase Of Migrainementioning

confidence: 99%

“…Other studies suggested that functional brain alterations might be dynamic, as they change according to migraine severity [12]. The functional interplay between the hypothalamus and other brain regions may be implicated in pain and visual processing changes over time according to patients’ clinical features [16]. In a selective group of migraine with aura patients, who always had side-fixed aura symptoms, hyperexcitability was reported in the symptomatic hemisphere during the asymptomatic phase [17].…”

Section: Imaging In the Asymptomatic Phase Of Migrainementioning

confidence: 99%

Functional MRI in migraine

Messina

Gollion

Christensen

et al. 2022

Current Opinion in Neurology

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Purpose of reviewThe underlying mechanisms of migraine are complex and heterogenous. Advances in neuroimaging techniques during the past few decades have contributed to our understanding of migraine pathophysiology. Brain function in migraine patients has been widely explored using functional MRI (fMRI). This review will highlight the major fMRI findings that characterize the different phases of migraine. Recent findingsThe migraine attack starts with hypothalamic hyperexcitability and early reorganization of the common ascending pain and central trigeminovascular pathways. Moreover, the visual cortex becomes hyperexcitable during the aura phase. During the headache phase, further disruptions of the pontine, thalamic, sensorimotor and visual networks occur, although the hypothalamic activity and connectivity normalizes. The visual cortex remains hyperexcitable during the postdromal phase. Asymptomatic migraine patients can also experience functional alternations of pain and visual processing brain areas. At present, the heterogeneity of the asymptomatic phase and fMRI findings make it difficult to find common denominator.Summary fMRI studies have captured functional brain changes associated with migraine phases, leading to an improvement of our understanding of migraine pathophysiology. Further MRI studies are needed to disclose whether the migraine attack is triggered by intrinsic brain dysfunction or external factors. Keywords chronic migraine, functional connectivity, headache, migraine with aura, migraine without aura FUNCTIONAL MRI SEQUENCES USED TO STUDY MIGRAINETwo main fMRI sequences have been applied in migraine studies to investigate brain function: task-based fMRI, and resting-state (i.e. functional

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“…Melatonin is an endogenous hormone responsible for the regulation of the sleep-wake cycle and other circadian rhythms [100], and it is pharmaceutically available for the treatment of insomnia. Given the relationship between migraine and sleep [101], and the postulated role of the hypothalamus in migraine [102], melatonin has been suggested to have Post-hoc analysis of [65,66] Single attack Increased rates of normal function and treatment satisfaction in those with an insufficient triptan response previously compared with placebo a therapeutic role in migraine for several years. Its antinociceptive role has been suggested as occurring through a variety of receptor systems, including the μ opioid and GABA-B receptors [103], as well as the possibility that it exerts a therapeutic effect on anxiety and sleep, causing a secondary impact on pain perception.…”

Section: Melatonin: Preventive Treatmentmentioning

confidence: 99%

New Oral Drugs for Migraine

Karsan

Goadsby

2022

CNS Drugs

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Migraine is a common and disabling neurological disorder, with several manifestations, of which pain is just one. Despite its worldwide prevalence, there remains a paucity of targeted and effective treatments for the condition, leaving many of those affected underserved by available treatments. Work over the last 30+ years has recently led to the emergence of the first targeted acute and preventive treatments in our practice since the triptan era in the early 1990s, which are changing the landscape of migraine treatment. These include the monoclonal antibodies targeting calcitonin gene-related peptide or its receptor. Evolving work on novel therapeutic targets, as well as continuing to exploit drugs used in other disorders that may also have a therapeutic effect in migraine, is likely to lead to more and more treatments being able to be offered to migraineurs. Future work involves the development of agents that lack vasoconstrictive effects, such as lasmiditan, do not contribute to medication overuse, such as the gepants, and do not interact with other drugs that may be used for the disorder, as well as agents that can act both acutely and preventively, thereby utilising the quantum between acute and preventive drug effects which has been demonstrated with different migraine drugs before. Here we discuss the evolution of oral migraine treatments over the last 5 years, including those that have gained regulatory approval and reached clinical practice, those in development and potential other targets for the future.

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Clinical correlates of hypothalamic functional changes in migraine patients

Cited by 16 publications

References 35 publications

Amplitude of low-frequency fluctuation after a single-trigger pain in patients with classical trigeminal neuralgia

Amplitude of low-frequency fluctuation after a single-trigger pain in patients with classical trigeminal neuralgia

Functional MRI in migraine

New Oral Drugs for Migraine

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