What has functional neuroimaging done for primary headache … and for the clinical neurologist?

Sprenger, Till; Goadsby, Peter J.

doi:10.1016/j.jocn.2009.09.030

Cited by 48 publications

(22 citation statements)

References 98 publications

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“…The exact site of origin of migraine attacks is still unknown Lambert and Zagami 2009;Cutrer 2010). Despite the numerous controversial clinical and experimental data concerning the cortical (Cao et al 1999;Hadjikhani et al 2001;Bolay et al 2002) and brainstem priority (Bahra et al 2001;Afridi et al 2005;Aurora et al 2007;Sprenger and Goadsby 2010), the role of the activation of these structures seems certain (Gupta 2006;Levy et al 2009;Messlinger 2009;Cutrer 2010;Ho et al 2010).…”

Section: Introductionmentioning

confidence: 99%

Where does a migraine attack originate? In the brainstem

et al. 2012

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Migraine is a common, paroxysmal, highly disabling primary headache disorder. The origin of migraine attacks is enigmatic. Numerous clinical and experimental results suggest that the activation of distinct brainstem nuclei is crucial in its pathogenesis, but the primary cause of this activation is not fully understood. We conclude that the initialization of a migraine attack can be explained as an altered function of the neuronal elements of the brainstem nuclei. In light of our findings and the literature data, we can assume that migraine is a subcortical disorder of a specific brainstem area.

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Section: Introductionmentioning

confidence: 99%

Where does a migraine attack originate? In the brainstem

et al. 2012

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“…These findings led the authors to propose that a ''generator'' located within the superior brainstem might initiate the development of migraine headache. Subsequent imaging studies have replicated and extended these findings and now it seems clear that a brainstem activation is highly specific to migraine [20][21][22], implying that the activation is involved in the pain process either with a permissive or a triggering mechanism.…”

Section: Introductionmentioning

confidence: 86%

“…However, many of the questions about cerebral networks and their functions in headaches are strictly dependent on the refinement of neuroimaging technology, such as PET and blood oxygenation level-dependent (BOLD) fMRI. The latter has some crucial advantages over PET: (1) PET relies on the injection of radioactive tracers, whereas fMRI is entirely non-invasive, and (2) fMRI has a higher spatial resolution and, especially with an eventrelated design, a superior temporal resolution [22].…”

Section: Introductionmentioning

confidence: 99%

Functional neuroimaging in migraine: usefulness for the clinical neurologist

2012

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Migraine is a common, multifactorial disorder, typically characterized by recurrent attacks of throbbing unilateral headache, autonomic nervous system dysfunction and, in approximately one-third of cases, neurological transient symptoms (migraineous aura). The diagnosis of primary headaches is exclusively a clinical task but, for this reason, it is sometimes subjective and arbitrary. However, until today no single diagnostic tool is able to define, ensure or differentiate idiopathic headache syndromes, although, in the clinical setting, conventional neuroimaging techniques are often widely and improperly used in headache patients. Recent years have seen rapid growth of neuroimaging methodology which has provided new insights into functional brain organization of migraine patients. Although functional magnetic resonance imaging has today little or no value in clinical practice, clinicians role is crucial since without a proper clinical selection neuroimaging studies could generate inconclusive results. Likewise, functional neuroimaging is crucial for clinicians in order to further elucidate pathophysiological mechanisms underlying this complex and often disabling disease and to provide new therapeutical approaches for migraine patients.

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“…In the last decades, blood oxygen level-dependent (BOLD) fMRI, due to its non-invasive nature, has been employed to investigate neuronal mechanisms involved in the migrainous phenomenon [5]. Oxygenated hemoglobin (diamagnetic) differs in its magnetic characteristics from deoxygenated hemoglobin (paramagnetic) and because of neurovascular coupling in the brain, the blood flow and thereby oxyhemoglobin content usually increases with increasing neuronal activity [6].…”

Section: Fmri In Migraine During Experimental Painmentioning

confidence: 99%

“…Among the possible approaches to experimental painful stimulation studies functional magnetic resonance imaging (fMRI) [5] has a fundamental prominence. In the present paper, we will discuss fMRI results that have advanced our understanding on migraine pathophysiology.…”

Section: Introductionmentioning

confidence: 99%

The pain in migraine beyond the pain of migraine

et al. 2012

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Migraine is a complex and often disabling brain disorder that affects about 15 % of the population. The diagnosis of migraine is based on clinical features as proposed by the International Headache Society criteria but they are somewhat subjective and arbitrary. Functional neuroimaging of patients with migraine has been recently employed to study the underlying pathophysiology of headache. These studies have suggested that migraine involves functional and structural plasticity of both central and peripheral nervous system. Insights into the fundamental physiology of migraine have been limited by the lack of methods available to detect the pathophysiological background of critical moment of migraine attack onset that is greatly different from the onset of pain or pain phase of a migraine attack. In order to overcome methodological caveats in detecting "migraine origin" or a "migraine generator", functional brain imaging has been lately dominated by experimental acute-pain research. Along this research line functional imaging using experimental pain stimulation have greatly improved our knowledge about physiological or dysfunctional neuronal activity pattern in patients with migraine, but at the same time, it is important to emphasize that experimental pain is different from spontaneous migraine pain.

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What has functional neuroimaging done for primary headache … and for the clinical neurologist?

Cited by 48 publications

References 98 publications

Where does a migraine attack originate? In the brainstem

Where does a migraine attack originate? In the brainstem

Functional neuroimaging in migraine: usefulness for the clinical neurologist

The pain in migraine beyond the pain of migraine

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