Medication–overuse headache: pathophysiological insights

Calabresi, Paolo; Cupini, Letizia Maria

doi:10.1007/s10194-005-0184-z

Cited by 31 publications

(13 citation statements)

References 15 publications

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“…Among others, dysfunction of descending antinociceptive network at brainstem and disturbance of serotonin system has been proposed [30]. However, our study failed to show any relationship between MO and brainstem MRS metabolite ratios in patients with CM.…”

Section: Discussioncontrasting

confidence: 80%

Brainstem 1H-MR spectroscopy in episodic and chronic migraine

et al. 2012

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The pathogenesis of evolution from episodic migraine (EM) to chronic migraine (CM) has not yet been clearly determined. Some studies revealed that dysfunction of the brainstem may play a role. We aimed to determine the brainstem 1H-MR spectroscopic (MRS) findings in episodic and chronic migraine. We recruited patients with EM, CM and controls. Patients with CM were divided into subgroups with and without medication overuse (MO). The 1H-MRS metabolite ratios at the periaqueductal gray (PAG) and bilateral dorsal pons were measured and compared with those in controls. A total of 19 patients with EM, 53 patients with CM (with MO n = 30, without MO n = 23) and 16 control subjects completed the study. Patients with EM had the highest N-acetylaspartate (NAA)/creatine (Cr) ratio at the dorsal pons (right, P = 0.014; left, P = 0.034) in comparison with those of CM and controls. The latter two groups did not differ. Among migraine patients, NAA/Cr ratios at dorsal pons were inversely correlated with headache frequency (right, r = −0.350, P = 0.004; left, r = −0.284, P = 0.019) and intensity (right, r = −0.286, P = 0.019; left, r = −0.244, P = 0.045), but not disease duration. In contrast, the metabolite ratios did not differ at the PAG among the study groups. Of note, MO was not associated with brainstem MRS ratios in patients with CM. The increased NAA/Cr levels may suggest neuronal hypertrophy at the dorsal pons in EM. A progressive dysfunction of this region may occur from EM to CM since the levels declined with increasing headache frequency and intensity.

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Section: Discussioncontrasting

confidence: 80%

Brainstem 1H-MR spectroscopy in episodic and chronic migraine

et al. 2012

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“…This is a potential confounder of the data in that the drug may itself produce changes in brain structure and function, albeit intermittent use with the use with migraine attacks. While the direct effects of triptans are still a matter of debate (Tfelt-Hansen 2010), and longitudinal studies will be needed to clarify their impact on the central nervous system central nervous system central nervous system, there are studies supporting direct effects of triptans on CNS (Boshuisen and den Boer 2000; Cupini and Calabresi 2005; Dodick and Martin 2004). …”

Section: Discussionmentioning

confidence: 99%

Common hippocampal structural and functional changes in migraine

et al. 2012

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The hippocampus is classically involved in memory consolidation, spatial navigation and is involved in the stress response. Migraine is an episodic disorder characterized by intermittent attacks with a number of physiological and emotional stressors associated with or provoking each attack. Given that migraine attacks can be viewed as repeated stressors, alterations in hippocampal function and structure may play an important role in migraine pathophysiology. Using high-resolution magnetic resonance imaging, hippocampal morphometric and functional differences (in response to noxious heat stimulation) were compared in age and gender-matched acute episodic migraineurs with high (HF) versus low (LF) frequency of migraine attacks. Morphometric results were compared with age and gender-matched healthy control (HC) cohort. Significant larger bilateral hippocampal volume was found in LF group relative to the HF and HC groups suggestive of an initial adaptive plasticity that may then become dysfunctional with increased frequency. Functional correlates of greater deactivation (LF > HF) in the same hippocampal regions in response to noxious stimulation was also accompanied by overall reduction in functional connectivity of the hippocampus with other brain regions involved in pain processing in the HF group. The results implicate involvement of hippocampus in the pathophysiology of the migraine.

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“…A component of some of these treatment options is caffeine, a non-specific adenosine receptor antagonist [11]. Combining caffeine with other treatments can improve pain relief by as much as 40% in patients [12,13,14,15,16]. Caffeine was originally included in many migraine treatments due to the previous assumption that migraine was a vascular disorder.…”

Section: Introductionmentioning

confidence: 99%

The Role of Adenosine Signaling in Headache: A Review

2017

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Migraine is the third most prevalent disease on the planet, yet our understanding of its mechanisms and pathophysiology is surprisingly incomplete. Recent studies have built upon decades of evidence that adenosine, a purine nucleoside that can act as a neuromodulator, is involved in pain transmission and sensitization. Clinical evidence and rodent studies have suggested that adenosine signaling also plays a critical role in migraine headache. This is further supported by the widespread use of caffeine, an adenosine receptor antagonist, in several headache treatments. In this review, we highlight evidence that supports the involvement of adenosine signaling in different forms of headache, headache triggers, and basic headache physiology. This evidence supports adenosine A2A receptors as a critical adenosine receptor subtype involved in headache pain. Adenosine A2A receptor signaling may contribute to headache via the modulation of intracellular Cyclic adenosine monophosphate (cAMP) production or 5' AMP-activated protein kinase (AMPK) activity in neurons and glia to affect glutamatergic synaptic transmission within the brainstem. This evidence supports the further study of adenosine signaling in headache and potentially illuminates it as a novel therapeutic target for migraine.

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Medication–overuse headache: pathophysiological insights

Cited by 31 publications

References 15 publications

Brainstem 1H-MR spectroscopy in episodic and chronic migraine

Brainstem 1H-MR spectroscopy in episodic and chronic migraine

Common hippocampal structural and functional changes in migraine

The Role of Adenosine Signaling in Headache: A Review

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