Functional Neuroimaging in Migraine: Chances and Challenges

Schulte, Laura H.; May, Arne

doi:10.1111/head.12944

Cited by 31 publications

(16 citation statements)

References 76 publications

(153 reference statements)

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“…In the present study we show a down regulatory mechanism of the functional connectivity between the orbitofrontal cortex and the trigeminal nociceptive brainstem nuclei and opercular and secondary somatosensory cortex. It seems that regular intake of pain killers initiates a central regulatory mechanism resulting in an attenuated coupling i.e., functional connectivity between the OFC and brain regions known to be altered in migraineurs ( 30 ). Importantly, this alteration reversed following medication withdrawal, e.g., at time point 2 the right MOG showed a significantly increased connectivity to the STN, and bilateral cerebellum in the patient group only.…”

Section: Discussionmentioning

confidence: 99%

Cortical and Subcortical Alterations in Medication Overuse Headache

2018

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Medication-overuse headache is an increasing problem in headache clinics and therapy includes drug withdrawal. Although it has been shown that the orbitofrontal cortex is hypo-metabolic and exhibits less gray matter in these patients the functional role of this finding is still unclear as virtually no functional imaging studies exploring withdrawal of medication have been published. We compared structural and functional magnetic resonance images of 18 patients before and after drug withdrawal with age and gender matched controls using a well-established trigeminal, nociceptive fMRI paradigm. We reproduced structural changes in the orbitofrontal cortex of the patients which highly correlated with the clinical outcome of medication withdrawal. The neuronal activity before drug withdrawal in pain related regions (operculum, insula, spinal trigeminal nucleus) was reduced compared to after drug withdrawal and the orbitofrontal cortex showed a reduced functional connectivity to the nociceptive input region (spinal trigeminal nucleus) and the cerebellum which regained after withdrawal. These data suggest the seminal role of the orbitofrontal cortex as a mediator between bottom-up and top-down stream in headache processing.

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Section: Discussionmentioning

confidence: 99%

Cortical and Subcortical Alterations in Medication Overuse Headache

2018

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“…The majority of studies have focused on the interictal migraine phase, as this is generally more practical, however, an increasing number of recent studies have also successfully investigated the ictal phase. This has been achieved either by imaging attacks of spontaneous onset (20) or by triggering headache through different forms of pharmacological provocation (21).…”

Section: The Visual Network In Migraine Biologymentioning

confidence: 99%

Imaging the Visual Network in the Migraine Spectrum

et al. 2019

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The involvement of the visual network in migraine pathophysiology has been well-known for more than a century. Not only is the aura phenomenon linked to cortical alterations primarily localized in the visual cortex; but also migraine without aura has shown distinct dysfunction of visual processing in several studies in the past. Further, the study of photophobia, a hallmark migraine symptom, has allowed unraveling of distinct connections that link retinal pathways to the trigeminovascular system. Finally, visual snow, a recently recognized neurological disorder characterized by a continuous visual disturbance, is highly comorbid with migraine and possibly shares with it some common pathophysiological mechanisms. Here, we review the most relevant neuroimaging literature to date, considering studies that have either attempted to investigate the visual network or have indirectly shown visual processing dysfunctions in migraine. We do this by taking into account the broader spectrum of migrainous biology, thus analyzing migraine both with and without aura, focusing on light sensitivity as the most relevant visual symptom in migraine, and finally analyzing the visual snow syndrome. We also present possible hypotheses on the underlying pathophysiology of visual snow, for which very little is currently known.

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“…Migraine is a cyclic disorder as evidenced by subjective symptoms and imaging and neurophysiological studies [ 1 – 7 ]. Therefore, it is preferable to investigate migraine physiology repeatedly during the different phases, i.e., between, before, during and after attacks (interictal, preictal, ictal and postictal phase, respectively) [ 8 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

Habituation of laser-evoked potentials by migraine phase: a blinded longitudinal study

et al. 2017

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BackgroundMigraineurs seem to have cyclic variations in cortical excitability in several neurophysiological modalities. Laser-evoked potentials (LEP) are of particular interest in migraine because LEP specifically targets pain pathways, and studies have reported different LEP-changes both between and during headaches. Our primary aim was to explore potential cyclic variations in LEP amplitude and habituation in more detail with a blinded longitudinal study design.MethodsWe compared N1 and N2P2 amplitudes and habituation between two blocks of laser stimulations to the dorsal hand, obtained from 49 migraineurs with four sessions each. We used migraine diaries to categorize sessions as interictal (> one day from previous and to next attack), preictal (< one day before the attack), ictal or postictal (< one day after the attack). Also, we compared 29 interictal recordings from the first session to 30 controls.ResultsN1 and N2P2 amplitudes and habituation did not differ between preictal, interictal and postictal phase sessions, except for a post hoc contrast that showed deficient ictal habituation of N1. Habituation is present and similar in migraineurs in the interictal phase and controls.ConclusionsHand-evoked LEP amplitudes and habituation were mainly invariable between migraine phases, but this matter needs further study. Because hand-evoked LEP-habituation was similar in migraineurs and controls, the present findings contradict several previous LEP studies. Pain-evoked cerebral responses are normal and show normal habituation in migraine.Electronic supplementary materialThe online version of this article (10.1186/s10194-017-0810-6) contains supplementary material, which is available to authorized users.

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Functional Neuroimaging in Migraine: Chances and Challenges

Cited by 31 publications

References 76 publications

Cortical and Subcortical Alterations in Medication Overuse Headache

Cortical and Subcortical Alterations in Medication Overuse Headache

Imaging the Visual Network in the Migraine Spectrum

Habituation of laser-evoked potentials by migraine phase: a blinded longitudinal study

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