The role of imaging in the pathophysiology and diagnosis of headache

May, Arne

doi:10.1097/01.wco.0000169748.44782.af

Cited by 19 publications

(12 citation statements)

References 43 publications

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“…So far a hypothalamic activation was only demonstrated in cluster headache 11 and related disorders with autonomic involvement such as trigemino‐autonomic‐cephalgias (TAC) in the absence of brainstem activation 12 . These data led to the conception that the pathophysiology of migraine and cluster headaches/TACs were clearly distinct 13,14 . Our results do not support this distinction.…”

Section: Commentscontrasting

confidence: 67%

Hypothalamic Activation in Spontaneous Migraine Attacks

et al. 2007

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Section: Commentscontrasting

confidence: 67%

Hypothalamic Activation in Spontaneous Migraine Attacks

et al. 2007

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“…The syndrome is well defined from a clinical point of view [56] and despite the fact that it has been recognised in the literature for more than two centuries [60], its pathophysiology has been hitherto poorly understood. Neuroimaging has made substantial contributions in recent times to understanding this relatively rare but important syndrome [61, 62]. …”

Section: Neuroimaging In Trigeminal Autonomic Cephalalgiasmentioning

confidence: 99%

A review of diagnostic and functional imaging in headache

May

2006

J Headache Pain

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The neuroimaging of headache patients has revolutionised our understanding of the pathophysiology of primary headaches and provided unique insights into these syndromes. Modern imaging studies point, together with the clinical picture, towards a central triggering cause. The early functional imaging work using positron emission tomography shed light on the genesis of some syndromes, and has recently been refined, implying that the observed activation in migraine (brainstem) and in several trigeminal-autonomic headaches (hypothalamic grey) is involved in the pain process in either a permissive or triggering manner rather than simply as a response to first-division nociception per se. Using the advanced method of voxel-based morphometry, it has been suggested that there is a correlation between the brain area activated specifically in acute cluster headache — the posterior hypothalamic grey matter — and an increase in grey matter in the same region. No structural changes have been found for migraine and medication overuse headache, whereas patients with chronic tension-type headache demonstrated a significant grey matter decrease in regions known to be involved in pain processing. Modern neuroimaging thus clearly suggests that most primary headache syndromes are predominantly driven from the brain, activating the trigeminovascular reflex and needing therapeutics that act on both sides: centrally and peripherally.

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“…The location of the gray matter decrease found in the brainstem coincides with the periaqueductal gray. In view of the functional data on migraine [28], it is striking that the decrease in gray matter in the PAG was present in patients with CT TH, but not in patients with MOH or migraine. This finding implies that the alterations are specific to CT TH rather than simply representing a response to chronic head pain or chronification per se.…”

Section: Structural Changes In the Brain In Patients With Chronic Tenmentioning

confidence: 96%

Tension-type headache

Mathew

2006

Curr Neurol Neurosci Rep

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Tension-type headache, the most common type of primary headache disorder, is reclassified in the second International Headache Society classification with clear diagnostic criteria. Chronic tension-type headache (CTTH) differs from episodic form in frequency, lack of response to most treatment strategies, more medication overuse, and more loss of quality of life. New concepts in the pathophysiology of CTTH emphasize the possible role of central nociceptive pathway sensitization in addition to peripheral myogenic factors. Mechanisms of central sensitization, even though poorly understood, may involve nitric oxide system and N-methyl-D-aspartate receptors. Future treatment modalities are likely to be based on such mechanisms. Using MRI and voxel-based morphometry, structural abnormalities have been found in patients with CTTH for the first time. Pain processing areas such as dorsal rostral and ventral pons, anterior cingulate cortex, anterior and posterior insular cortex, right posterior temporal lobe, orbitofrontal cortex, para hippocampus bilaterally, and the right cerebellum were found to have decreased gray matter in patients with CTTH compared with control subjects and patients with medication overuse headache. Amitriptyline remains the most effective preventive treatment so far. The role of botulinum toxin is not fully defined.

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The role of imaging in the pathophysiology and diagnosis of headache

Cited by 19 publications

References 43 publications

Hypothalamic Activation in Spontaneous Migraine Attacks

Hypothalamic Activation in Spontaneous Migraine Attacks

A review of diagnostic and functional imaging in headache

Tension-type headache

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