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Ong JJY, Wei DYT, Goadsby PJ. Recent Advances in Pharmacotherapy for Migraine Prevention: From Pathophysiology to New Drugs. Drugs 2019; 78:411-437. [PMID: 29396834 DOI: 10.1007/s40265-018-0865-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Migraine is a common and disabling neurological disorder, with a significant socioeconomic burden. Its pathophysiology involves abnormalities in complex neuronal networks, interacting at different levels of the central and peripheral nervous system, resulting in the constellation of symptoms characteristic of a migraine attack. Management of migraine is individualised and often necessitates the commencement of preventive medication. Recent advancements in the understanding of the neurobiology of migraine have begun to account for some parts of the symptomatology, which has led to the development of novel target-based therapies that may revolutionise how migraine is treated in the future. This review will explore recent advances in the understanding of migraine pathophysiology, and pharmacotherapeutic developments for migraine prevention, with particular emphasis on novel treatments targeted at the calcitonin gene-related peptide (CGRP) pathway.
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Affiliation(s)
- Jonathan Jia Yuan Ong
- Headache Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital, Wellcome Foundation Building, London, SE5 9PJ, UK.,Division of Neurology, Department of Medicine, National University Health System, University Medicine Cluster, Singapore, Singapore
| | - Diana Yi-Ting Wei
- Headache Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital, Wellcome Foundation Building, London, SE5 9PJ, UK
| | - Peter J Goadsby
- Headache Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. .,NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital, Wellcome Foundation Building, London, SE5 9PJ, UK.
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52
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Lerebours F, Boulanouar K, Barège M, Denuelle M, Bonneville F, Payoux P, Larrue V, Fabre N. Functional connectivity of hypothalamus in chronic migraine with medication overuse. Cephalalgia 2019; 39:892-899. [PMID: 30836766 DOI: 10.1177/0333102419833087] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To investigate the functional connectivity of the hypothalamus in chronic migraine compared to interictal episodic migraine in order to improve our understanding of migraine chronification. METHODS Using task-free fMRI and ROI-to-ROI analysis, we compared anterior hypothalamus intrinsic connectivity with the spinal trigeminal nucleus in patients with chronic migraine (n = 25) to age- and sex-matched patients with episodic migraine in the interictal phase (n = 22). We also conducted a seed-to-voxel analysis with anterior hypothalamus as a seed. RESULTS All patients with chronic migraine had medication overuse. We found a significant connectivity (T = 2.08, p = 0.024) between anterior hypothalamus and spinal trigeminal nucleus in the chronic group, whereas these two regions were not connected in the episodic group. The strength of connectivity was not correlated with pain intensity (rho: 0.09, p = 0.655). In the seed-to-voxel analysis, three regions were more connected with the anterior hypothalamus in the chronic group: The spinal trigeminal nuclei (MNI coordinate x = 2, y = -44, z = -62), the right dorsal anterior insula (MNI coordinate x = 10, y = 10, z = 18), and the right caudate (MNI coordinate x = 12, y = 28, z = 6). However, these correlations were no longer significant after whole brain FWE correction. CONCLUSION An increased functional connectivity between the anterior hypothalamus and the spinal trigeminal nucleus, as previously reported in preictal episodic migraine, was demonstrated in chronic migraine with medication overuse. This finding confirms a major role of the anterior hypothalamus in migraine and suggests that chronic migraineurs are locked in the preictal phase.
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Affiliation(s)
- Fleur Lerebours
- 1 Department of Neurology, University Hospital of Toulouse, Toulouse, France
| | | | - Michèle Barège
- 1 Department of Neurology, University Hospital of Toulouse, Toulouse, France
| | - Marie Denuelle
- 1 Department of Neurology, University Hospital of Toulouse, Toulouse, France
| | - Fabrice Bonneville
- 3 Department of Radiology, University Hospital of Toulouse, Toulouse, France
| | - Pierre Payoux
- 2 UMR 1214, Toulouse NeuroImaging center, Toulouse, France
| | - Vincent Larrue
- 1 Department of Neurology, University Hospital of Toulouse, Toulouse, France
| | - Nelly Fabre
- 1 Department of Neurology, University Hospital of Toulouse, Toulouse, France
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Multivariate pattern classification of brain white matter connectivity predicts classic trigeminal neuralgia. Pain 2019; 159:2076-2087. [PMID: 29905649 DOI: 10.1097/j.pain.0000000000001312] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Trigeminal neuralgia (TN) is a severe form of chronic facial neuropathic pain. Increasing interest in the neuroimaging of pain has highlighted changes in the root entry zone in TN, but also group-level central nervous system gray and white matter (WM) abnormalities. Group differences in neuroimaging data are frequently evaluated with univariate statistics; however, this approach is limited because it is based on single, or clusters of, voxels. By contrast, multivariate pattern analyses consider all the model's neuroanatomical features to capture a specific distributed spatial pattern. This approach has potential use as a prediction tool at the individual level. We hypothesized that a multivariate pattern classification method can distinguish specific patterns of abnormal WM connectivity of classic TN from healthy controls (HCs). Diffusion-weighted scans in 23 right-sided TN and matched controls were processed to extract whole-brain interregional streamlines. We used a linear support vector machine algorithm to differentiate interregional normalized streamline count between TN and HC. This algorithm successfully differentiated between TN and HC with an accuracy of 88%. The structural pattern emphasized WM connectivity of regions that subserve sensory, affective, and cognitive dimensions of pain, including the insula, precuneus, inferior and superior parietal lobules, and inferior and medial orbital frontal gyri. Normalized streamline counts were associated with longer pain duration and WM metric abnormality between the connections. This study demonstrates that machine-learning algorithms can detect characteristic patterns of structural alterations in TN and highlights the role of structural brain imaging for identification of neuroanatomical features associated with neuropathic pain disorders.
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54
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Petrusic I, Dakovic M, Zidverc-Trajkovic J. Volume alterations of brainstem subregions in migraine with aura. NEUROIMAGE-CLINICAL 2019; 22:101714. [PMID: 30763903 PMCID: PMC6373203 DOI: 10.1016/j.nicl.2019.101714] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/12/2019] [Accepted: 02/03/2019] [Indexed: 12/02/2022]
Abstract
Background The brainstem plays a significant role in migraine pathogenesis, but a relationship between volume alterations of brainstem subregions and migraine aura characteristics has not been sufficiently investigated. The aim of this study is to compare the volume of the brainstem, and its subregions, between patients with a migraine with aura (MwA) and healthy controls (HC), and also to correlate characteristics of MwA and the volume of the brainstem subregions. Methods Forty-two MwA and 42 HCs, balanced by sex and age, were selected for this study. Total brainstem volume changes as well as volume changes in the pons, medulla, midbrain and the superior cerebellar peduncles were investigated in MwA relative to HCs. In addition, the relationships between brainstem subregions and aura characteristics (aura duration, the frequency of the aura, occurrence of somatosensory and dysphasic aura, duration of a headache, intensity of headache pain and disease duration) were explored in MwA. Results MwA patients had a larger brainstem volume relative to HCs (25,941.35 ± 2559.2 mm3 vs. 25,179.32 ± 2019.1 mm3; p = .008), as well as the midbrain and pons (6155.98 ± 565.7 mm3 vs. 5964.22 ± 457.0 mm3, p = .002; 15,105.13 ± 1765.5 mm3 vs. 14,539.89 ± 1408.4 mm3, p = .007, respectively). Total brainstem volume, as well as volumes of brainstem subregions, were not significantly correlated to the MwA characteristics. Conclusion The results of this study reveal that a migraine with aura is associated with a larger volume of the brainstem with a particular involvement of the midbrain and pons. Migraineurs with aura had larger volume of pons and midbrain relative to controls. Medulla did not significantly differ in volume size between migraineurs and controls. Volume of brainstem is not linked to disease duration and intensity of headache pain.
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Affiliation(s)
- Igor Petrusic
- Laboratory for advanced analysis of neuroimages, Faculty of Physical Chemistry, University of Belgrade, Serbia.
| | - Marko Dakovic
- Laboratory for advanced analysis of neuroimages, Faculty of Physical Chemistry, University of Belgrade, Serbia
| | - Jasna Zidverc-Trajkovic
- Faculty of Medicine, University of Belgrade, Serbia; Center for Headaches, Neurology Clinic, Clinical Center of Serbia, Serbia
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55
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Vila-Pueyo M, Strother LC, Kefel M, Goadsby PJ, Holland PR. Divergent influences of the locus coeruleus on migraine pathophysiology. Pain 2019; 160:385-394. [PMID: 30371556 PMCID: PMC6343946 DOI: 10.1097/j.pain.0000000000001421] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Migraine is a common disabling neurological condition that is associated with several premonitory symptoms that can occur days before the headache onset. The most commonly reported premonitory symptom is marked fatigue that has been shown to be highly predictive of an ensuing migraine attack. The locus coeruleus (LC) is a key nucleus involved in arousal that has also been shown to impact pain processing. It provides one of the major sources of noradrenaline to the dorsal horn of the spinal cord and neocortex. Given the clinical association between migraine, sleep-wake regulation, and fatigue, we sought to determine whether LC modulation could impact migraine-related phenotypes in several validated preclinical models of migraine. To determine its role in migraine-related pain, we recorded dural nociceptive-evoked responses of neurons in the trigeminocervical complex, which receives trigeminal primary afferents from the durovascular complex. In addition, we explored the susceptibility to cortical spreading depression initiation, the presumed underlying phenomenon of migraine aura. Our experiments reveal a potent role for LC disruption in the differential modulation of migraine-related phenotypes, inhibiting dural-evoked activation of wide dynamic neurons in the trigeminocervical complex while increasing cortical spreading depression susceptibility. This highlights the potential divergent impact of LC disruption in migraine physiology, which may help explain the complex interactions between dysfunctional arousal mechanisms and migraine.
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Affiliation(s)
- Marta Vila-Pueyo
- Headache Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Lauren C Strother
- Headache Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Malak Kefel
- Headache Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Peter J Goadsby
- Headache Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- NIHR-Wellcome Trust, King's Clinical Research Facility, King's College Hospital, London, United Kingdom
| | - Philip R Holland
- Headache Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
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Sklerov M, Dayan E, Browner N. Functional neuroimaging of the central autonomic network: recent developments and clinical implications. Clin Auton Res 2018; 29:555-566. [PMID: 30470943 PMCID: PMC6858471 DOI: 10.1007/s10286-018-0577-0] [Citation(s) in RCA: 83] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 11/07/2018] [Indexed: 12/08/2023]
Abstract
Purpose The central autonomic network (CAN) is an intricate system of brainstem, subcortical, and cortical structures that play key roles in the function of the autonomic nervous system. Prior to the advent of functional neuroimaging, in vivo studies of the human CAN were limited. The purpose of this review is to highlight the contribution of functional neuroimaging, specifically functional magnetic resonance imaging (fMRI), to the study of the CAN, and to discuss recent advances in this area. Additionally, we aim to emphasize exciting areas for future research. Methods We reviewed the existing literature in functional neuroimaging of the CAN. Here, we focus on fMRI research conducted in healthy human subjects, as well as research that has been done in disease states, to understand CAN function. To minimize confounding, papers examining CAN function in the context of cognition, emotion, pain, and affective disorders were excluded. Results fMRI has led to significant advances in the understanding of human CAN function. The CAN is composed of widespread brainstem and forebrain structures that are intricately connected and play key roles in reflexive and modulatory control of autonomic function. Conclusions fMRI technology has contributed extensively to current knowledge of CAN function. It holds promise to serve as a biomarker in disease states. With ongoing advancements in fMRI technology, there is great opportunity and need for future research involving the CAN.
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Affiliation(s)
- Miriam Sklerov
- Department of Neurology, University of North Carolina, 170 Manning Drive, CB# 7025, Chapel Hill, NC, 27599, USA.
| | - Eran Dayan
- Department of Radiology and Biomedical Research Imaging Center, University of North Carolina, 130 Mason Farm Road, CB# 7513, Chapel Hill, NC, 27599, USA
| | - Nina Browner
- Department of Neurology, University of North Carolina, 170 Manning Drive, CB# 7025, Chapel Hill, NC, 27599, USA
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57
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Do patients with interictal migraine modulate pain differently from healthy controls? A psychophysical and brain imaging study. Pain 2018; 159:2667-2677. [DOI: 10.1097/j.pain.0000000000001380] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Vila-Pueyo M, Hoffmann J, Romero-Reyes M, Akerman S. Brain structure and function related to headache: Brainstem structure and function in headache. Cephalalgia 2018; 39:1635-1660. [PMID: 29969040 DOI: 10.1177/0333102418784698] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To review and discuss the literature relevant to the role of brainstem structure and function in headache. BACKGROUND Primary headache disorders, such as migraine and cluster headache, are considered disorders of the brain. As well as head-related pain, these headache disorders are also associated with other neurological symptoms, such as those related to sensory, homeostatic, autonomic, cognitive and affective processing that can all occur before, during or even after headache has ceased. Many imaging studies demonstrate activation in brainstem areas that appear specifically associated with headache disorders, especially migraine, which may be related to the mechanisms of many of these symptoms. This is further supported by preclinical studies, which demonstrate that modulation of specific brainstem nuclei alters sensory processing relevant to these symptoms, including headache, cranial autonomic responses and homeostatic mechanisms. REVIEW FOCUS This review will specifically focus on the role of brainstem structures relevant to primary headaches, including medullary, pontine, and midbrain, and describe their functional role and how they relate to mechanisms of primary headaches, especially migraine.
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Affiliation(s)
- Marta Vila-Pueyo
- Headache Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jan Hoffmann
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Marcela Romero-Reyes
- Department of Neural and Pain Sciences, University of Maryland Baltimore, Baltimore, MD, USA
| | - Simon Akerman
- Department of Neural and Pain Sciences, University of Maryland Baltimore, Baltimore, MD, USA
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59
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Chen Z, Chen X, Liu M, Liu M, Ma L, Yu S. Evaluation of gray matter perfusion in episodic migraine using voxel-wise comparison of 3D pseudo-continuous arterial spin labeling. J Headache Pain 2018; 19:36. [PMID: 29796865 PMCID: PMC5966347 DOI: 10.1186/s10194-018-0866-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/10/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Although previous studies have demonstrated that structural and functional abnormalities in episodic migraine (EM), less is known about altered brain perfusion in the EM. The aim of this study is to investigate altered gray matter perfusion in EM using a 3D volumetric perfusion imaging. METHODS Fifteen EM patients and 15 normal controls (NC) underwent structural and 3D pseudo-continuous arterial spin labeling (3D pc-ASL). The structural images were segmented using DARTEL methods and the generated normalized T1 tissue probability maps were used to coregister the cerebral blood flow (CBF) images, which would further be performed with standardization using Fisher Z Transformation. Voxel-wise analysis was applied to CBF map with Z standardization, and the Z value of the abnormal brain region was extracted and performed with correlation with the clinical variables. RESULTS The increased CBF value located in the left Brodmann 38 (BA38) and no significantly decreased CBF value were detected in EM. HAMD scores presented significantly positive correlation with the CBF value of the left BA38. CONCLUSION The current study indicated that the pattern of cerebral hyperperfusion may elucidate the neurogenic mechanism in the EM genesis, and 3D pc-ASL technique would non-invasively provide valuable cerebral perfusion information for the further pathophysiological and neuropsychological study in EM.
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Affiliation(s)
- Zhiye Chen
- Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.,Department of Radiology, Hainan Branch of Chinese PLA General Hospital, Beijing, 100853, China.,Department of Neurology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Xiaoyan Chen
- Department of Neurology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Mengyu Liu
- Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China
| | - Mengqi Liu
- Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.,Department of Radiology, Hainan Branch of Chinese PLA General Hospital, Beijing, 100853, China
| | - Lin Ma
- Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
| | - Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, 28 Fuxing Road, Beijing, 100853, China.
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Modulation of brainstem activity and connectivity by respiratory-gated auricular vagal afferent nerve stimulation in migraine patients. Pain 2018; 158:1461-1472. [PMID: 28541256 DOI: 10.1097/j.pain.0000000000000930] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Migraine pathophysiology includes altered brainstem excitability, and recent neuromodulatory approaches aimed at controlling migraine episodes have targeted key brainstem relay and modulatory nuclei. In this study, we evaluated the impact of respiratory-gated auricular vagal afferent nerve stimulation (RAVANS), a novel neuromodulatory intervention based on an existing transcutaneous vagus nerve stimulation approach, in the modulation of brainstem activity and connectivity in migraine patients. We applied 3T-functional magnetic resonance imaging with improved in-plane spatial resolution (2.62 × 2.62 mm) in episodic migraine (interictal) and age- and sex-matched healthy controls to evaluate brain response to RAVANS (gated to either inhalation or exhalation) and sham stimulation. We further investigated RAVANS modulation of tactile trigeminal sensory afference response in the brainstem using air-puff stimulation directed to the forehead during functional magnetic resonance imaging. Compared with sham and inhalatory-gated RAVANS (iRAVANS), exhalatory-gated RAVANS (eRAVANS) activated an ipsilateral pontomedullary region consistent with nucleus tractus solitarii (NTS). During eRAVANS, NTS connectivity was increased to anterior insula and anterior midcingulate cortex, compared with both sham and iRAVANS, in migraine patients. Increased connectivity was inversely correlated with relative time to the next migraine attack, suggesting clinical relevance to this change in connectivity. Poststimulation effects were also noted immediately after eRAVANS, as we found increased activation in putative pontine serotonergic (ie, nucleus raphe centralis) and noradrenergic (ie, locus coeruleus) nuclei in response to trigeminal sensory afference. Regulation of activity and connectivity of brainstem and cortical regions involved in serotonergic and noradrenergic regulation and pain modulation may constitute an underlying mechanism supporting beneficial clinical outcomes for eRAVANS applied for episodic migraine.
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61
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Dodick DW. A Phase-by-Phase Review of Migraine Pathophysiology. Headache 2018; 58 Suppl 1:4-16. [DOI: 10.1111/head.13300] [Citation(s) in RCA: 187] [Impact Index Per Article: 31.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 03/21/2018] [Accepted: 03/21/2018] [Indexed: 02/06/2023]
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Close LN, Eftekhari S, Wang M, Charles AC, Russo AF. Cortical spreading depression as a site of origin for migraine: Role of CGRP. Cephalalgia 2018; 39:428-434. [PMID: 29695168 DOI: 10.1177/0333102418774299] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PREMISE Migraine is a complex neurologic disorder that leads to significant disability, yet remains poorly understood. PROBLEM One potential triggering mechanism in migraine with aura is cortical spreading depression, which can activate the trigeminal nociceptive system both peripherally and centrally in animal models. A primary neuropeptide of the trigeminal system is calcitonin gene-related peptide, which is a potent vasodilatory peptide and is currently a major therapeutic target for migraine treatment. Despite the importance of both cortical spreading depression and calcitonin gene-related peptide in migraine, the relationship between these two players has been relatively unexplored. However, recent data suggest several potential vascular and neural connections between calcitonin gene-related peptide and cortical spreading depression. CONCLUSION This review will outline calcitonin gene-related peptide-cortical spreading depression connections and propose a model in which cortical spreading depression and calcitonin gene-related peptide act at the intersection of the vasculature and cortical neurons, and thus contribute to migraine pathophysiology.
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Affiliation(s)
- Liesl N Close
- 1 Department of Neurosurgery, University of Iowa, Iowa City, IA, USA
| | - Sajedeh Eftekhari
- 2 UCLA Goldberg Migraine Program, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Minyan Wang
- 3 Centre for Neuroscience, Department of Biological Sciences, Xi'an Jiaotong-Liverpool University (XJTLU), SIP, Suzhou, China
| | - Andrew C Charles
- 2 UCLA Goldberg Migraine Program, Department of Neurology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Andrew F Russo
- 4 Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, IA, USA.,5 Department of Neurology, University of Iowa, Iowa City, IA, USA.,6 Veterans Affairs Medical Center, Iowa City, IA, USA
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63
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Altered functional connectivity of the periaqueductal gray in chronic neck and shoulder pain. Neuroreport 2018; 28:720-725. [PMID: 28574927 DOI: 10.1097/wnr.0000000000000819] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Chronic neck and shoulder pain with cervical spondylotic radiculopathy (CNSP-CSR) is one of the most common clinical chronic pain diseases. This study aimed to investigate the abnormal patterns in functional connectivity (FC) pertaining to the periaqueductal gray matter (PAG) in patients with CNSP-CSR. A seed-based FC analysis was carried out for the right ventrolateral PAG and a correlation analysis was carried out with pain intensity, duration, and the extracted mean z scores. The PAG FC was significantly positively associated with the right orbital inferior frontal gyrus, supramarginal gyrus/postcentral gyrus, putamen, and the left anterior cingulate cortex, and significant negative FC was observed in the right lingual gyrus/occipital cortex in patients with CNSP-CSR. A significant negative correlation was found between the pain intensity and the mean z scores in the left anterior cingulate cortex. Our study provides evidence to show that patients with CNSP-CSR have abnormal FC in the PAG-centered pain modulation network. Knowledge of this abnormal FC might lead to a better understanding of the mechanism underlying CNSP-CSR, especially the descending pain modulation system involved in chronic pain.
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Abstract
Acid-sensing ion channels (ASICs) are a family of ion channels, consisting of four members; ASIC1 to 4. These channels are sensitive to changes in pH and are expressed throughout the central and peripheral nervous systems-including brain, spinal cord, and sensory ganglia. They have been implicated in a number of neurological conditions such as stroke and cerebral ischemia, traumatic brain injury, and epilepsy, and more recently in migraine. Their expression within areas of interest in the brain in migraine, such as the hypothalamus and PAG, their demonstrated involvement in preclinical models of meningeal afferent signaling, and their role in cortical spreading depression (the electrophysiological correlate of migraine aura), has enhanced research interest into these channels as potential therapeutic targets in migraine. Migraine is a disorder with a paucity of both acute and preventive therapies available, in which at best 50% of patients respond to available medications, and these medications often have intolerable side effects. There is therefore a great need for therapeutic development for this disabling condition. This review will summarize the understanding of the structure and CNS expression of ASICs, the mechanisms for their potential role in nociception, recent work in migraine, and areas for future research and drug development.
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Affiliation(s)
- Nazia Karsan
- Headache Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, Denmark Hill, London, SE5 9PJ, UK
| | - Eric B Gonzales
- TCU and UNTHSC School of Medicine (applicant for LCME accreditation), Department of Medical Education, 3500 Camp Bowie Blvd., Fort Worth, TX, 76107, USA
| | - Gregory Dussor
- School of Behavioral and Brain Sciences, The University of Texas at Dallas, 800 West Campbell Road, BSB-14, Richardson, TX, 75080, USA.
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Abstract
Migraine is a chronic paroxysmal neurological disorder characterised by multiphase attacks of head pain and a myriad of neurological symptoms. The underlying genetic and biological underpinnings and neural networks involved are coming sharply into focus. This progress in the fundamental understanding of migraine has led to novel, mechanism-based and disease-specific therapeutics. In this Seminar, the clinical features and neurobiology of migraine are reviewed, evidence to support available treatment options is provided, and emerging drug, device, and biological therapies are discussed.
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66
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Taga A, Russo M, Genovese A, Manzoni GC, Torelli P. A case-report of migraine “sine headache”. Cephalalgia 2018; 38:592-594. [DOI: 10.1177/0333102417690892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and objectives We describe a case of a female patient whose otherwise “typical” migraine attacks turned into episodes with a full spectrum of associated symptoms but without headache. Case report We evaluated a 53-year-old woman with a long history of migraine without aura. In concomitance with premenopausal menstrual dysregulation, she reported episodes of nausea and vomiting, associated with photophobia, phonophobia and osmophobia, but without headache; these episodes were responsive to oral triptans. Alternative diagnoses were excluded through extensive examinations. Discussion To date, no reports have been published in the literature on otherwise typical migraine attacks that are not accompanied by headache, nor did our case seem comparable to cases of abdominal migraine and cyclic vomiting syndrome. Conclusion Pathophysiologically, we hypothesize that functional dysregulation of the hypothalamus-brainstem connectivity may generate migraine attacks with a full spectrum of associated symptoms but without pain.
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Affiliation(s)
- Arens Taga
- Headache Centre, Department of Emergency, General and Specialist Medical Area, University Hospital of Parma, Parma, Italy
| | - Marco Russo
- Headache Centre, Department of Emergency, General and Specialist Medical Area, University Hospital of Parma, Parma, Italy
| | - Antonio Genovese
- Headache Centre, Department of Emergency, General and Specialist Medical Area, University Hospital of Parma, Parma, Italy
| | - Gian Camillo Manzoni
- Headache Centre, Department of Emergency, General and Specialist Medical Area, University Hospital of Parma, Parma, Italy
| | - Paola Torelli
- Headache Centre, Department of Emergency, General and Specialist Medical Area, University Hospital of Parma, Parma, Italy
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Abstract
PURPOSE OF REVIEW Symptoms of autonomic dysfunction are common in patients with migraine, both during and between migraine attacks. Studies evaluating objective autonomic testing in patients have found significant, though somewhat conflicting results. The purposes of this review are to summarize and interpret the key findings of these studies, including those evaluating heart rate variability, autonomic reflex testing, and functional imaging in patients with migraine. The neuroanatomy of the central autonomic network as it relates to migraine is also reviewed. RECENT FINDINGS Several studies have evaluated autonomic balance in migraineurs, with conflicting results on the magnitude of sympathetic versus parasympathetic dysfunction. Most studies demonstrate sympathetic impairment, with a lesser degree of parasympathetic impairment. Three trends have emerged: (1) migraine with aura tends to produce more significant autonomic dysfunction than migraine without aura, (2) sympathetic impairment is more common than parasympathetic impairment, and (3) sympathetic impairment is common in the interictal period, with increased sympathetic responsiveness during the ictal period, suggesting adrenoreceptor hypersensitivity.
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Abstract
Background Although there is a great wealth of knowledge about the neurobiological processes underlying migraine and its accompanying symptoms, the mechanisms by which an attack starts remain elusive, and the disease remains undertreated. Although the vast majority of literature focuses on the involvement of the trigeminovascular systems and higher systems it innervates, such as thalamic and hypothalamic nuclei, several lines of evidence implicate the cerebellum in the pathophysiology of migraine. Aim In this review, we aim to summarize potential cerebellar involvement seen from different perspectives including the results from imaging studies, cerebellar connectivity to migraine-related brain structures, comorbidity with disorders implying cerebellar dysfunction, similarities in triggers precipitating both such disorders, and migraine and cerebellar expression of migraine-related genes and neuropeptides. We aim to inspire an increase in interest for future research on the subject. Conclusion It is hoped that future studies can provide an answer as to how the cerebellum may be involved and whether treatment options specifically targeting the cerebellum could provide alleviation of this disorder.
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Affiliation(s)
- Lieke Kros
- 1 Dominick P Purpura Department of Neuroscience, Albert Einstein College of Medicine, New York, NY, USA.,2 Department of Neuroscience, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Kamran Khodakhah
- 1 Dominick P Purpura Department of Neuroscience, Albert Einstein College of Medicine, New York, NY, USA
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69
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Affiliation(s)
- Parisa Gazerani
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Brian Edwin Cairns
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada
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Nyholt DR, Borsook D, Griffiths LR. Migrainomics — identifying brain and genetic markers of migraine. Nat Rev Neurol 2017; 13:725-741. [DOI: 10.1038/nrneurol.2017.151] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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71
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Magnetic resonance imaging of the human locus coeruleus: A systematic review. Neurosci Biobehav Rev 2017; 83:325-355. [PMID: 29107830 DOI: 10.1016/j.neubiorev.2017.10.023] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Revised: 09/21/2017] [Accepted: 10/24/2017] [Indexed: 01/21/2023]
Abstract
The locus coeruleus (LC), the major origin of noradrenergic modulation of the central nervous system, innervates extensive areas throughout the brain and is implicated in a variety of autonomic and cognitive functions. Alterations in the LC-noradrenergic system have been associated with healthy ageing and neuropsychiatric disorders including Parkinson's disease, Alzheimer's disease and depression. The last decade has seen advances in imaging the structure and function of the LC, and this paper systematically reviews the methodology and outcomes of sixty-nine structural and functional MRI studies of the LC in humans. Structural MRI studies consistently showed lower LC signal intensity and volume in clinical groups compared to healthy controls. Within functional studies, the LC was activated by a variety of tasks/stimuli and had functional connectivity to a range of brain regions. However, reported functional LC location coordinates were widely distributed compared to previously published neuroanatomical locations. Methodological and demographic factors potentially contributing to these differences are discussed, together with recommendations to optimize the reliability and validity of future LC imaging studies.
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Abstract
PURPOSE OF REVIEW This review aims to provide an overview of the most recent and significant functional neuroimaging studies which have clarified the complex mechanisms underlying migraine pathophysiology. RECENT FINDINGS The recent data allow us to overcome the concept of a migraine generator suggesting that functional networks abnormalities may lead to changes in different brain area activities and consequent reduced migraine thresholds susceptibility, likely associated with higher migraine severity and burden. Although functional magnetic resonance imaging studies have allowed recognition of several migraine mechanisms, its pathophysiology is not completely understood and is still a matter of research. Nevertheless, in recent years, functional magnetic resonance imaging studies have allowed us to implement our knowledge of migraine pathophysiology. The pivotal role of both the brainstem and the hippocampus in the first phase of a migraine attack, the involvement of limbic pathway in the constitution of a migrainous pain network, the disrupted functional connectivity in cognitive brain networks, as well as the abnormal function of the visual network in patients with migraine with aura are the main milestones in migraine imaging achieved through functional imaging advances. We believe that further studies based on combined functional and structural techniques and the investigation of the different phases of migraine cycle may represent an efficient methodological approach for comprehensively looking into the migrainous brain secrets.
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Puledda F, Messina R, Goadsby PJ. An update on migraine: current understanding and future directions. J Neurol 2017; 264:2031-2039. [PMID: 28321564 PMCID: PMC5587613 DOI: 10.1007/s00415-017-8434-y] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 02/20/2017] [Indexed: 01/16/2023]
Abstract
Migraine is a common brain disorder with high disability rates which involves a series of abnormal neuronal networks, interacting at different levels of the central and peripheral nervous system. An increase in the interest around migraine pathophysiology has allowed researchers to unravel certain neurophysiological mechanisms and neurotransmitter involvement culminating in the recent development of novel therapies, which might substantially change the clinical approach to migraine patients. The present review will highlight the current aspects of migraine pathophysiology, covering an understanding of the complex workings of the migraine state and the brain regions responsible for them. We will further discuss the therapeutic agents which have appeared in the most recent years for migraine care, from calcitonin gene-related peptide (CGRP) receptor antagonists, gepants; through serotonin 5-HT1F receptor agonists, ditans, and CGRP or CGRP receptor monoclonal antibodies to invasive and non-invasive neuromodulation techniques.
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Affiliation(s)
- Francesca Puledda
- Headache Group, Department of Basic and Clinical Neuroscience, King's College London, London, UK
- NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital, London, UK
| | - Roberta Messina
- Headache Group, Department of Basic and Clinical Neuroscience, King's College London, London, UK
- NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital, London, UK
| | - Peter J Goadsby
- Headache Group, Department of Basic and Clinical Neuroscience, King's College London, London, UK.
- NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital, London, UK.
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Central Sensitization-Based Classification for Temporomandibular Disorders: A Pathogenetic Hypothesis. Pain Res Manag 2017; 2017:5957076. [PMID: 28932132 PMCID: PMC5592418 DOI: 10.1155/2017/5957076] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 06/03/2017] [Accepted: 07/09/2017] [Indexed: 12/15/2022]
Abstract
Dysregulation of Autonomic Nervous System (ANS) and central pain pathways in temporomandibular disorders (TMD) is a growing evidence. Authors include some forms of TMD among central sensitization syndromes (CSS), a group of pathologies characterized by central morphofunctional alterations. Central Sensitization Inventory (CSI) is useful for clinical diagnosis. Clinical examination and CSI cannot identify the central site(s) affected in these diseases. Ultralow frequency transcutaneous electrical nerve stimulation (ULFTENS) is extensively used in TMD and in dental clinical practice, because of its effects on descending pain modulation pathways. The Diagnostic Criteria for TMD (DC/TMD) are the most accurate tool for diagnosis and classification of TMD. However, it includes CSI to investigate central aspects of TMD. Preliminary data on sensory ULFTENS show it is a reliable tool for the study of central and autonomic pathways in TMD. An alternative classification based on the presence of Central Sensitization and on individual response to sensory ULFTENS is proposed. TMD may be classified into 4 groups: (a) TMD with Central Sensitization ULFTENS Responders; (b) TMD with Central Sensitization ULFTENS Nonresponders; (c) TMD without Central Sensitization ULFTENS Responders; (d) TMD without Central Sensitization ULFTENS Nonresponders. This pathogenic classification of TMD may help to differentiate therapy and aetiology.
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Tseng MT, Lin CH. Pain in early-stage Parkinson's disease: Implications from clinical features to pathophysiology mechanisms. J Formos Med Assoc 2017; 116:571-581. [DOI: 10.1016/j.jfma.2017.04.024] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 03/30/2017] [Accepted: 04/25/2017] [Indexed: 12/13/2022] Open
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77
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Understanding migraine as a cycling brain syndrome: reviewing the evidence from functional imaging. Neurol Sci 2017; 38:125-130. [DOI: 10.1007/s10072-017-2866-0] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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78
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Gauci S, Hosking W, Bruck D. Narcolepsy, cataplexy, hypocretin and co-existing other health complaints: A review. COGENT MEDICINE 2017. [DOI: 10.1080/2331205x.2017.1312791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- Samantha Gauci
- Psychology Discipline, College of Arts, College of Health and Biomedicine, Victoria University, P.O. Box 14428, Melbourne 8001, Australia
| | - Warwick Hosking
- Psychology Discipline, College of Arts, College of Health and Biomedicine, Victoria University, P.O. Box 14428, Melbourne 8001, Australia
| | - Dorothy Bruck
- Psychology Discipline, College of Arts, College of Health and Biomedicine, Victoria University, P.O. Box 14428, Melbourne 8001, Australia
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Xie JY, De Felice M, Kopruszinski CM, Eyde N, LaVigne J, Remeniuk B, Hernandez P, Yue X, Goshima N, Ossipov M, King T, Streicher JM, Navratilova E, Dodick D, Rosen H, Roberts E, Porreca F. Kappa opioid receptor antagonists: A possible new class of therapeutics for migraine prevention. Cephalalgia 2017; 37:780-794. [PMID: 28376659 DOI: 10.1177/0333102417702120] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Stress is the most commonly reported migraine trigger. Dynorphin, an endogenous opioid peptide acting preferentially at kappa opioid receptors (KORs), is a key mediator of stress responses. The aim of this study was to use an injury-free rat model of functional cephalic pain with features of migraine and medication overuse headache (MOH) to test the possible preventive benefit of KOR blockade on stress-induced cephalic pain. Methods Following sumatriptan priming to model MOH, rats were hyper-responsive to environmental stress, demonstrating delayed cephalic and extracephalic allodynia and increased levels of CGRP in the jugular blood, consistent with commonly observed clinical outcomes during migraine. Nor-binaltorphimine (nor-BNI), a long-acting KOR antagonist or CYM51317, a novel short-acting KOR antagonist, were given systemically either during sumatriptan priming or immediately before environmental stress challenge. The effects of KOR blockade in the amygdala on stress-induced allodynia was determined by administration of nor-BNI into the right or left central nucleus of the amygdala (CeA). Results KOR blockade prevented both stress-induced allodynia and increased plasma CGRP. Stress increased dynorphin content and phosphorylated KOR in both the left and right CeA in sumatriptan-primed rats. However, KOR blockade only in the right CeA prevented stress-induced cephalic allodynia as well as extracephalic allodynia, measured in either the right or left hindpaws. U69,593, a KOR agonist, given into the right, but not the left, CeA, produced allodynia selectively in sumatriptan-primed rats. Both stress and U69,593-induced allodynia were prevented by right CeA U0126, a mitogen-activated protein kinase inhibitor, presumably acting downstream of KOR. Conclusions Our data reveal a novel lateralized KOR circuit that mediated stress-induced cutaneous allodynia and increased plasma CGRP in an injury-free model of functional cephalic pain with features of migraine and medication overuse headache. Selective, small molecule, orally available, and reversible KOR antagonists are currently in development and may represent a novel class of preventive therapeutics for migraine.
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Affiliation(s)
- Jennifer Y Xie
- 1 Department of Pharmacology, Arizona Health Sciences Center, University of Arizona, Tucson, AZ, USA
| | - Milena De Felice
- 2 School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - Caroline M Kopruszinski
- 3 Department of Pharmacology, Biological Sciences Section, Federal University of Parana, Curitiba, Brazil
| | - Nathan Eyde
- 1 Department of Pharmacology, Arizona Health Sciences Center, University of Arizona, Tucson, AZ, USA
| | - Justin LaVigne
- 1 Department of Pharmacology, Arizona Health Sciences Center, University of Arizona, Tucson, AZ, USA
| | - Bethany Remeniuk
- 1 Department of Pharmacology, Arizona Health Sciences Center, University of Arizona, Tucson, AZ, USA
| | - Pablo Hernandez
- 1 Department of Pharmacology, Arizona Health Sciences Center, University of Arizona, Tucson, AZ, USA
| | - Xu Yue
- 1 Department of Pharmacology, Arizona Health Sciences Center, University of Arizona, Tucson, AZ, USA
| | - Naomi Goshima
- 1 Department of Pharmacology, Arizona Health Sciences Center, University of Arizona, Tucson, AZ, USA
| | - Michael Ossipov
- 1 Department of Pharmacology, Arizona Health Sciences Center, University of Arizona, Tucson, AZ, USA
| | - Tamara King
- 4 Department of Biomedical Sciences, College of Osteopathic Medicine, Center for Excellence in the Neurosciences, University of New England, Biddeford, ME, USA
| | - John M Streicher
- 1 Department of Pharmacology, Arizona Health Sciences Center, University of Arizona, Tucson, AZ, USA
| | - Edita Navratilova
- 1 Department of Pharmacology, Arizona Health Sciences Center, University of Arizona, Tucson, AZ, USA
| | | | - Hugh Rosen
- 6 Scripps Research Institute, La Jolla, CA, USA
| | - Ed Roberts
- 6 Scripps Research Institute, La Jolla, CA, USA
| | - Frank Porreca
- 1 Department of Pharmacology, Arizona Health Sciences Center, University of Arizona, Tucson, AZ, USA.,5 Mayo Clinic, Phoenix, AZ USA
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Sclocco R, Beissner F, Bianciardi M, Polimeni JR, Napadow V. Challenges and opportunities for brainstem neuroimaging with ultrahigh field MRI. Neuroimage 2017; 168:412-426. [PMID: 28232189 DOI: 10.1016/j.neuroimage.2017.02.052] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 01/30/2017] [Accepted: 02/19/2017] [Indexed: 12/19/2022] Open
Abstract
The human brainstem plays a central role in connecting the cerebrum, the cerebellum and the spinal cord to one another, hosting relay nuclei for afferent and efferent signaling, and providing source nuclei for several neuromodulatory systems that impact central nervous system function. While the investigation of the brainstem with functional or structural magnetic resonance imaging has been hampered for years due to this brain structure's physiological and anatomical characteristics, the field has seen significant advances in recent years thanks to the broader adoption of ultrahigh-field (UHF) MRI scanning. In the present review, we focus on the advantages offered by UHF in the context of brainstem imaging, as well as the challenges posed by the investigation of this complex brain structure in terms of data acquisition and analysis. We also illustrate how UHF MRI can shed new light on the neuroanatomy and neurophysiology underlying different brainstem-based circuitries, such as the central autonomic network and neurotransmitter/neuromodulator systems, discuss existing and foreseeable clinical applications to better understand diseases such as chronic pain and Parkinson's disease, and explore promising future directions for further improvements in brainstem imaging using UHF MRI techniques.
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Affiliation(s)
- Roberta Sclocco
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, CNY 149-2301, 13th St. Charlestown, Boston, MA 02129, USA; Department of Radiology, Logan University, Chesterfield, MO, USA.
| | - Florian Beissner
- Somatosensory and Autonomic Therapy Research, Institute for Neuroradiology, Hannover Medical School, Hannover, Germany
| | - Marta Bianciardi
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, CNY 149-2301, 13th St. Charlestown, Boston, MA 02129, USA
| | - Jonathan R Polimeni
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, CNY 149-2301, 13th St. Charlestown, Boston, MA 02129, USA; Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Vitaly Napadow
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, CNY 149-2301, 13th St. Charlestown, Boston, MA 02129, USA; Department of Radiology, Logan University, Chesterfield, MO, USA
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Wang M, Wang L, Liu C, Bian X, Dong Z, Yu S. Cardiac cephalalgia: one case with cortical hypoperfusion in headaches and literature review. J Headache Pain 2017; 18:24. [PMID: 28220375 PMCID: PMC5318311 DOI: 10.1186/s10194-017-0732-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 02/07/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Cardiac cephalalgia (CC) is a rare disease occurring during an episode of myocardial ischemia and relieved by nitroglycerine. Though more than 30 cases of CC have been reported since 1997, the mechanism is yet obscure. Herein, a case of CC is presented and discussed in relevance with previous literature to propose a novel hypothesis about the mechanism of CC. METHOD A CC patient with cortical hypoperfusion during headache attacks was presented, which has never been reported. All published cases of CC via PubMed ( http://www.ncbi.nlm.nih.gov/pubmed ) in English literature, between 1997 and 2016, were reviewed. RESULTS A patient suffering from CC presented a cerebral hypoperfusion during a headache attack. This phenomenon had not been observed since CC was introduced in 1997. The literature review summarized the clinical presentations, neuroimaging features, ECG, and coronary angiography features of 35 CC patients. CONCLUSION Based on the phenomenon of hypoperfusion in the event of a headache, the vessel constriction hypothesis was proposed including two potential physiological mechanisms underlying the pathophysiology of CC.
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Affiliation(s)
- Miao Wang
- The Department of Geriatric Neurology, Chinese PLA General Hospital, Beijing, China
| | - Lu Wang
- The Outpatient Department of Fuxing Road No. 7, the First Affiliated Hospital of PLA General Hospital, Beijing, China
| | - Changfu Liu
- The Department of of Cardiology, Chinese PLA General Hospital, Beijing, China
| | - Xiangbing Bian
- The Department of of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Zhao Dong
- Department of Neurology, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China.
| | - Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
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82
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Jacobs B, Dussor G. Neurovascular contributions to migraine: Moving beyond vasodilation. Neuroscience 2016; 338:130-144. [PMID: 27312704 PMCID: PMC5083225 DOI: 10.1016/j.neuroscience.2016.06.012] [Citation(s) in RCA: 106] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 05/27/2016] [Accepted: 06/07/2016] [Indexed: 12/31/2022]
Abstract
Migraine is the third most common disease worldwide, the most common neurological disorder, and one of the most common pain conditions. Despite its prevalence, the basic physiology and underlying mechanisms contributing to the development of migraine are still poorly understood and development of new therapeutic targets is long overdue. Until recently, the major contributing pathophysiological event thought to initiate migraine was cerebral and meningeal arterial vasodilation. However, the role of vasodilation in migraine is unclear and recent findings challenge its necessity. While vasodilation itself may not contribute to migraine, it remains possible that vessels play a role in migraine pathophysiology in the absence of vasodilation. Blood vessels consist of a variety of cell types that both release and respond to numerous mediators including growth factors, cytokines, adenosine triphosphate (ATP), and nitric oxide (NO). Many of these mediators have actions on neurons that can contribute to migraine. Conversely, neurons release factors such as norepinephrine and calcitonin gene-related peptide (CGRP) that act on cells native to blood vessels. Both normal and pathological events occurring within and between vascular cells could thus mediate bi-directional communication between vessels and the nervous system, without the need for changes in vascular tone. This review will discuss the potential contribution of the vasculature, specifically endothelial cells, to current neuronal mechanisms hypothesized to play a role in migraine. Hypothalamic activity, cortical spreading depression (CSD), and dural afferent input from the cranial meninges will be reviewed with a focus on how these mechanisms can influence or be impacted by blood vessels. Together, the data discussed will provide a framework by which vessels can be viewed as important potential contributors to migraine pathophysiology, even in light of the current uncertainty over the role of vasodilation in this disorder.
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Affiliation(s)
- Blaine Jacobs
- Behavioral and Brain Sciences, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080, United States
| | - Gregory Dussor
- Behavioral and Brain Sciences, The University of Texas at Dallas, 800 West Campbell Road, Richardson, TX 75080, United States.
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Coppola G, Di Renzo A, Tinelli E, Lepre C, Di Lorenzo C, Di Lorenzo G, Scapeccia M, Parisi V, Serrao M, Colonnese C, Schoenen J, Pierelli F. Thalamo-cortical network activity between migraine attacks: Insights from MRI-based microstructural and functional resting-state network correlation analysis. J Headache Pain 2016; 17:100. [PMID: 27778244 PMCID: PMC5078119 DOI: 10.1186/s10194-016-0693-y] [Citation(s) in RCA: 63] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2016] [Accepted: 10/18/2016] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Resting state magnetic resonance imaging allows studying functionally interconnected brain networks. Here we were aimed to verify functional connectivity between brain networks at rest and its relationship with thalamic microstructure in migraine without aura (MO) patients between attacks. METHODS Eighteen patients with untreated MO underwent 3 T MRI scans and were compared to a group of 19 healthy volunteers (HV). We used MRI to collect resting state data among two selected resting state networks, identified using group independent component (IC) analysis. Fractional anisotropy (FA) and mean diffusivity (MD) values of bilateral thalami were retrieved from a previous diffusion tensor imaging study on the same subjects and correlated with resting state ICs Z-scores. RESULTS In comparison to HV, in MO we found significant reduced functional connectivity between the default mode network and the visuo-spatial system. Both HV and migraine patients selected ICs Z-scores correlated negatively with FA values of the thalamus bilaterally. CONCLUSIONS The present results are the first evidence supporting the hypothesis that an abnormal resting within networks connectivity associated with significant differences in baseline thalamic microstructure could contribute to interictal migraine pathophysiology.
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Affiliation(s)
- Gianluca Coppola
- Research Unit of Neurophysiology of Vision and Neurophthalmology, G.B. Bietti Foundation-IRCCS, Via Livenza 3, 00198, Rome, Italy.
| | - Antonio Di Renzo
- Research Unit of Neurophysiology of Vision and Neurophthalmology, G.B. Bietti Foundation-IRCCS, Via Livenza 3, 00198, Rome, Italy
| | - Emanuele Tinelli
- Department of Neurology and Psychiatry, Neuroradiology Section, "Sapienza" University of Rome, Rome, Italy
| | - Chiara Lepre
- Department of Medico-Surgical Sciences and Biotechnologies, Neurology Section, "Sapienza" University of Rome, Rome, Italy
| | | | - Giorgio Di Lorenzo
- Laboratory of Psychophysiology, Psychiatric Clinic, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy
| | - Marco Scapeccia
- Department of Neurology and Psychiatry, Neuroradiology Section, "Sapienza" University of Rome, Rome, Italy
| | - Vincenzo Parisi
- Research Unit of Neurophysiology of Vision and Neurophthalmology, G.B. Bietti Foundation-IRCCS, Via Livenza 3, 00198, Rome, Italy
| | - Mariano Serrao
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome Polo Pontino, Latina, Italy
| | - Claudio Colonnese
- Department of Neurology and Psychiatry, Neuroradiology Section, "Sapienza" University of Rome, Rome, Italy
- IRCCS Neuromed, Pozzilli, (IS), Italy
| | - Jean Schoenen
- Headache Research Unit, Department of Neurology-CHR Citadelle, University of Liège, Liège, Belgium
| | - Francesco Pierelli
- Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University of Rome Polo Pontino, Latina, Italy
- IRCCS Neuromed, Pozzilli, (IS), Italy
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Borsook D, Veggeberg R, Erpelding N, Borra R, Linnman C, Burstein R, Becerra L. The Insula: A "Hub of Activity" in Migraine. Neuroscientist 2016; 22:632-652. [PMID: 26290446 PMCID: PMC5723020 DOI: 10.1177/1073858415601369] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The insula, a "cortical hub" buried within the lateral sulcus, is involved in a number of processes including goal-directed cognition, conscious awareness, autonomic regulation, interoception, and somatosensation. While some of these processes are well known in the clinical presentation of migraine (i.e., autonomic and somatosensory alterations), other more complex behaviors in migraine, such as conscious awareness and error detection, are less well described. Since the insula processes and relays afferent inputs from brain areas involved in these functions to areas involved in higher cortical function such as frontal, temporal, and parietal regions, it may be implicated as a brain region that translates the signals of altered internal milieu in migraine, along with other chronic pain conditions, through the insula into complex behaviors. Here we review how the insula function and structure is altered in migraine. As a brain region of a number of brain functions, it may serve as a model to study new potential clinical perspectives for migraine treatment.
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Affiliation(s)
- David Borsook
- Pain/Analgesia Imaging Neuroscience (P.A.I.N.) Group, Department of Anesthesia, Boston Children's Hospital, Center for Pain and the Brain, Harvard Medical School, Waltham, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Departments of Psychiatry and Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
| | - Rosanna Veggeberg
- Pain/Analgesia Imaging Neuroscience (P.A.I.N.) Group, Department of Anesthesia, Boston Children's Hospital, Center for Pain and the Brain, Harvard Medical School, Waltham, MA, USA
| | - Nathalie Erpelding
- Pain/Analgesia Imaging Neuroscience (P.A.I.N.) Group, Department of Anesthesia, Boston Children's Hospital, Center for Pain and the Brain, Harvard Medical School, Waltham, MA, USA
| | - Ronald Borra
- Pain/Analgesia Imaging Neuroscience (P.A.I.N.) Group, Department of Anesthesia, Boston Children's Hospital, Center for Pain and the Brain, Harvard Medical School, Waltham, MA, USA
| | - Clas Linnman
- Pain/Analgesia Imaging Neuroscience (P.A.I.N.) Group, Department of Anesthesia, Boston Children's Hospital, Center for Pain and the Brain, Harvard Medical School, Waltham, MA, USA
| | - Rami Burstein
- Department of Anesthesia, Beth Israel Deaconess Hospital, Harvard Medical School, Boston, MA, USA
| | - Lino Becerra
- Pain/Analgesia Imaging Neuroscience (P.A.I.N.) Group, Department of Anesthesia, Boston Children's Hospital, Center for Pain and the Brain, Harvard Medical School, Waltham, MA, USA
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, USA
- Departments of Psychiatry and Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA, USA
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Lovati C, Giani L, D'Amico D, Mariani C. Sleep, headaches and cerebral energy control: a synoptic view. Expert Rev Neurother 2016; 17:239-250. [PMID: 27547918 DOI: 10.1080/14737175.2016.1226133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION The amount of cerebral functions is particularly elevated. This intense activity requires a great expenditure of energy: the restoration of energy is the fundamental function of sleep whilst the slowdown in energy consumption may be considered the physiological effect of primary headaches. The continuous interaction of sleep and primary headaches is possible as they share many anatomical and functional cerebral systems. Areas covered: This review describes how sleep and headaches are reciprocally involved in preservation and restoration of brain energy. Data were obtained from the most relevant and recent works available in PubMed about this topic. Expert commentary: The energetic view of sleep, primary headaches and their relationship may have relevant clinical consequences: the investigation and the modification of the multiple aspects, primarily environmental, that may influence sleep and headache, become mandatory to facilitate the cerebral energy preservation by reducing its consumption and by ensuring its recovery.
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Affiliation(s)
| | - Luca Giani
- b Neurology Unit , Luigi Sacco Hospital, Milan Study University , Milan , Italy
| | - Domenico D'Amico
- c Headache Center , C. Besta Neurological Institute and Foundation , Milan , Italy
| | - Claudio Mariani
- b Neurology Unit , Luigi Sacco Hospital, Milan Study University , Milan , Italy
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86
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Li TQ, Wang Y, Hallin R, Juto JE. Resting-state fMRI study of acute migraine treatment with kinetic oscillation stimulation in nasal cavity. NEUROIMAGE-CLINICAL 2016; 12:451-9. [PMID: 27622142 PMCID: PMC5008046 DOI: 10.1016/j.nicl.2016.08.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 07/22/2016] [Accepted: 08/13/2016] [Indexed: 12/17/2022]
Abstract
Kinetic oscillatory stimulation (KOS) in the nasal cavity is a non-invasive cranial nerve stimulation method with promising efficacy for acute migraine and other inflammatory disorders. For a better understanding of the underlying neurophysiological mechanisms of KOS treatment, we conducted a resting-state functional magnetic resonance imaging (fMRI) study of 10 acute migraine patients and 10 normal control subjects during KOS treatment in a 3 T clinical MRI scanner. The fMRI data were first processed using a group independent component analysis (ICA) method and then further analyzed with a voxel-wise 3-way ANOVA modeling and region of interest (ROI) of functional connectivity metrics. All migraine participants were relieved from their acute migraine symptoms after 10–20 min KOS treatment and remained migraine free for 3–6 months. The resting-state fMRI result indicates that migraine patients have altered intrinsic functional activity in the anterior cingulate, inferior frontal gyrus and middle/superior temporal gyrus. KOS treatment gave rise to up-regulated intrinsic functional activity for migraine patients in a number of brain regions involving the limbic and primary sensory systems, while down regulating temporally the activity for normal controls in a few brain areas, such as the right dorsal posterior insula and inferior frontal gyrus. The result of this study confirms the efficacy of KOS treatment for relieving acute migraine symptoms and reducing attack frequency. Resting-state fMRI measurements demonstrate that migraine is associated with aberrant intrinsic functional activity in the limbic and primary sensory systems. KOS in the nasal cavity gives rise to the adjustment of the intrinsic functional activity in the limbic and primary sensory networks and restores the physiological homeostasis in the autonomic nervous system. Efficacy and neurological mechanisms underlying kinetic oscillatory stimulation treatment of migraine Dependence of ICA (independent component analysis) results on the number of independent components. Modulation of ANS (autonomic nervous system) function via the limbic network
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Affiliation(s)
- Tie-Qiang Li
- Department of Medical Physics, Karolinska University Hospital Huddinge, Sweden; Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Yanlu Wang
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
| | - Rolf Hallin
- Department of Physiology and Pharmacology, Division of Clinical Neurophysiology, Karolinska University Hospital, Huddinge, Sweden
| | - Jan-Erik Juto
- Department of Clinical Science, Intervention and Technology, Karolinska Institute, Stockholm, Sweden
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87
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Schulte LH, May A. The migraine generator revisited: continuous scanning of the migraine cycle over 30 days and three spontaneous attacks. Brain 2016; 139:1987-93. [PMID: 27190019 DOI: 10.1093/brain/aww097] [Citation(s) in RCA: 381] [Impact Index Per Article: 47.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 03/24/2016] [Indexed: 12/11/2022] Open
Abstract
Functional imaging using positron emission tomography and later functional magnetic resonance imaging revealed a particular brainstem area that is believed to be specifically activated in migraine during, but not outside of the attack, and consequently has been coined the 'migraine generator'. However, the pathophysiological concept behind this term is not undisputed and typical migraine premonitory symptoms such as fatigue and yawning, but also a typical association of attacks to circadian and menstrual cycles, all make the hypothalamus a possible regulating region of migraine attacks. Neuroimaging studies investigating native human migraine attacks however are scarce and for methodological but also clinical reasons there are currently no studies investigating the last 24 h before headache onset. Here we report a migraine patient who had magnetic resonance imaging every day for 30 days, always in the morning, to cover, using functional imaging, a whole month and three complete, untreated migraine attacks. We found that hypothalamic activity as a response to trigeminal nociceptive stimulation is altered during the 24 h prior to pain onset, i.e. increases towards the next migraine attack. More importantly, the hypothalamus shows altered functional coupling with the spinal trigeminal nuclei and the region of the migraine generator, i.e. the dorsal rostral pons during the preictal day and the pain phase of native human migraine attacks. These data suggest that although the brainstem is highly linked to the migraine biology, the real driver of attacks might be the functional changes in hypothalamo-brainstem connectivity.
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Affiliation(s)
- Laura H Schulte
- Department of Systems Neuroscience, Center for Experimental Medicine, University Medical Center Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Arne May
- Department of Systems Neuroscience, Center for Experimental Medicine, University Medical Center Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
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88
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Wu D, Zhou Y, Xiang J, Tang L, Liu H, Huang S, Wu T, Chen Q, Wang X. Multi-frequency analysis of brain connectivity networks in migraineurs: a magnetoencephalography study. J Headache Pain 2016; 17:38. [PMID: 27090418 PMCID: PMC4835413 DOI: 10.1186/s10194-016-0636-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 04/12/2016] [Indexed: 12/26/2022] Open
Abstract
Background Although alterations in resting-state neural network have been previously reported in migraine using functional MRI, whether this atypical neural network is frequency dependent remains unknown. The aim of this study was to investigate the alterations of the functional connectivity of neural network and their frequency specificity in migraineurs as compared with healthy controls by using magnetoencephalography (MEG) and concepts from graph theory. Methods Twenty-three episodic migraine patients with and without aura, during the interictal period, and 23 age- and gender-matched healthy controls at resting state with eye-closed were studied with MEG. Functional connectivity of neural network from low (0.1–1 Hz) to high (80–250 Hz) frequency ranges was analyzed with topographic patterns and quantified with graph theory. Results The topographic patterns of neural network showed that the migraineurs had significantly increased functional connectivity in the slow wave (0.1–1 Hz) band in the frontal area as compared with controls. Compared with the migraineurs without aura (MwoA), the migraineurs with aura (MwA) had significantly increased functional connectivity in the theta (4–8 Hz) band in the occipital area. Graph theory analysis revealed that the migraineurs had significantly increased connection strength in the slow wave (0.1–1 Hz) band, increased path length in the theta (4–8 Hz) and ripple (80–250 Hz) bands, and increased clustering coefficient in the slow wave (0.1–1 Hz) and theta (4–8 Hz) bands. The clinical characteristics had no significant correlation with interictal MEG parameters. Conclusions Results indicate that functional connectivity of neural network in migraine is significantly impaired in both low- and high-frequency ranges. The alteration of neural network may imply that migraine is associated with functional brain reorganization.
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Affiliation(s)
- Di Wu
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, 264 Guangzhou Road, Nanjing, Jiangsu, 210029, China
| | - Yuchen Zhou
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, 264 Guangzhou Road, Nanjing, Jiangsu, 210029, China
| | - Jing Xiang
- MEG Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45220, USA
| | - Lu Tang
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, 264 Guangzhou Road, Nanjing, Jiangsu, 210029, China
| | - Hongxing Liu
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, 264 Guangzhou Road, Nanjing, Jiangsu, 210029, China
| | - Shuyang Huang
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, 264 Guangzhou Road, Nanjing, Jiangsu, 210029, China
| | - Ting Wu
- MEG Center, Nanjing Brain Hospital, Nanjing, Jiangsu, 210029, China
| | - Qiqi Chen
- MEG Center, Nanjing Brain Hospital, Nanjing, Jiangsu, 210029, China
| | - Xiaoshan Wang
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, 264 Guangzhou Road, Nanjing, Jiangsu, 210029, China.
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89
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Alabwah Y, Ji Y, Seminowicz DA, Quiton RL, Masri R. Alcohol-triggered signs of migraine: An animal model. Somatosens Mot Res 2016; 33:35-41. [PMID: 27021138 DOI: 10.3109/08990220.2016.1163258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
We describe an animal model where characteristics of migraine can be triggered by alcohol administration. In rats chronically implanted with a cannula overlying the transverse sinus, we applied potassium chloride (KCl) (or saline) to the meninges to sensitize trigeminovascular afferents. We assessed effects of repeated KCl application on animal behavior using conditioned place avoidance paradigm. In KCl-treated rats we discovered that alcohol injections (0.2 mg/kg), but not saline, resulted in the development of extracephalic allodynia and signs of ongoing pain.
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Affiliation(s)
- Yaqoub Alabwah
- a Department of Endodontics, Prosthodontics and Operative Dentistry , University of Maryland School of Dentistry , Baltimore , MD , USA
| | - Yadong Ji
- a Department of Endodontics, Prosthodontics and Operative Dentistry , University of Maryland School of Dentistry , Baltimore , MD , USA
| | - David A Seminowicz
- b Department of Neural and Pain Sciences , University of Maryland School of Dentistry , Baltimore , MD , USA ;,c Program in Neuroscience , University of Maryland , Baltimore , MD , USA
| | - Raimi L Quiton
- b Department of Neural and Pain Sciences , University of Maryland School of Dentistry , Baltimore , MD , USA ;,d Department of Psychology , University of Maryland, Baltimore County , Baltimore , MD , USA ;,e Department of Anatomy and Neurobiology , University of Maryland School of Medicine , Baltimore , MD , USA
| | - Radi Masri
- a Department of Endodontics, Prosthodontics and Operative Dentistry , University of Maryland School of Dentistry , Baltimore , MD , USA ;,c Program in Neuroscience , University of Maryland , Baltimore , MD , USA ;,e Department of Anatomy and Neurobiology , University of Maryland School of Medicine , Baltimore , MD , USA
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90
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91
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Maleki N, Gollub RL. What Have We Learned From Brain Functional Connectivity Studies in Migraine Headache? Headache 2016; 56:453-61. [PMID: 26924634 DOI: 10.1111/head.12756] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2015] [Indexed: 12/16/2022]
Abstract
Over the past 20 years, headache syndromes, especially migraine, have benefited significantly from the knowledge gained through neuroimaging studies. This article is focused on the neuroimaging studies of the functional organization and connectivity of the migraine brain. First, data sources and the study design elements in functional neuroimaging studies of the brain connectivity in migraine headaches are discussed. Then, the article reviews the findings to date and discusses how functional connectivity studies have contributed to a better understanding of the mechanisms of the migraine disease by extending the focus from a single region or structure to a network of regions and structures and the interactions among them. Finally, the potential scenarios for the translation of connectivity knowledge to the benefit for patients are discussed.
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Affiliation(s)
- Nasim Maleki
- Psychiatric Neuroimaging Division, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Randy L Gollub
- Psychiatric Neuroimaging Division, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.,Department of Radiology, A.A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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92
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Abstract
PURPOSE OF REVIEW Over the last several years, a growing number of brain functional imaging studies have provided insights into mechanisms underlying migraine. This article reviews the recent migraine functional neuroimaging literature and provides recommendations for future studies that will help fill knowledge gaps. RECENT FINDINGS PET and functional MRI studies have identified brain regions that might be responsible for mediating the onset of a migraine attack and those associated with migraine symptoms. Enhanced activation of brain regions that facilitate processing of sensory stimuli suggests a mechanism by which migraineurs are hypersensitive to visual, olfactory, and cutaneous stimuli. Resting state functional connectivity MRI studies have identified numerous brain regions and functional networks with atypical functional connectivity in migraineurs, suggesting that migraine is associated with aberrant brain functional organization. SUMMARY Functional MRI and PET studies that have identified brain regions and brain networks that are atypical in migraine have helped to describe the neurofunctional basis for migraine symptoms. Future studies should compare functional imaging findings in migraine to other headache and pain disorders and should explore the utility of functional imaging data as biomarkers for diagnostic and treatment purposes.
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93
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Blessing EM, Beissner F, Schumann A, Brünner F, Bär KJ. A data-driven approach to mapping cortical and subcortical intrinsic functional connectivity along the longitudinal hippocampal axis. Hum Brain Mapp 2015; 37:462-76. [PMID: 26538342 DOI: 10.1002/hbm.23042] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 10/07/2015] [Accepted: 10/19/2015] [Indexed: 02/01/2023] Open
Abstract
The hippocampus (HPC) is functionally heterogeneous along the longitudinal anterior-posterior axis. In rodent models, gene expression maps define at least three discrete longitudinal subregions, which also differ in function, and in anatomical connectivity with the rest of the brain. In humans, equivalent HPC subregions are less well defined, resulting in a lack of consensus in neuroimaging approaches that limits translational study. This study determined whether a data-driven analysis, namely independent component analysis (ICA), could reproducibly define human HPC subregions, and map their respective intrinsic functional connectivity (iFC) with the rest of the brain. Specifically, we performed ICA of resting-state fMRI activity spatially restricted within the HPC, to determine the configuration and reproducibility of functional HPC components. Using dual regression, we then performed multivariate analysis of iFC between resulting HPC components and the whole brain, including detailed connectivity with the hypothalamus, a functionally important connection not yet characterized in human. We found hippocampal ICA resulted in highly reproducible longitudinally discrete components, with greater functional heterogeneity in the anterior HPC, consistent with animal models. Anterior hippocampal components shared iFC with the amygdala, nucleus accumbens, medial prefrontal cortex, posterior cingulate cortex, midline thalamus, and periventricular hypothalamus, whereas posterior hippocampal components shared iFC with the anterior cingulate cortex, retrosplenial cortex, and mammillary bodies. We show that spatially masked hippocampal ICA with dual regression reproducibly identifies functional subregions in the human HPC, and maps their respective brain intrinsic connectivity. Hum Brain Mapp 37:462-476, 2016. © 2015 Wiley Periodicals, Inc.
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Affiliation(s)
- Esther M Blessing
- Steven and Alexandra Cohen Veterans Center for Posttraumatic Stress and Traumatic Brain Injury, Department of Psychiatry, New York University, NY, USA
| | - Florian Beissner
- Somatosensory and Autonomic Therapy Research, Institute for Neuroradiology, Hannover Medical School, Hannover, Germany.,Department of Psychiatry and Psychotherapy, Jena University Hospital, Pain and Autonomics Integrative Research, Jena, Germany
| | - Andy Schumann
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Pain and Autonomics Integrative Research, Jena, Germany
| | - Franziska Brünner
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Pain and Autonomics Integrative Research, Jena, Germany
| | - Karl-Jürgen Bär
- Department of Psychiatry and Psychotherapy, Jena University Hospital, Pain and Autonomics Integrative Research, Jena, Germany
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94
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Becerra L, Bishop J, Barmettler G, Xie Y, Navratilova E, Porreca F, Borsook D. Triptans disrupt brain networks and promote stress-induced CSD-like responses in cortical and subcortical areas. J Neurophysiol 2015; 115:208-17. [PMID: 26490291 DOI: 10.1152/jn.00632.2015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 10/18/2015] [Indexed: 12/24/2022] Open
Abstract
A number of drugs, including triptans, promote migraine chronification in susceptible individuals. In rats, a period of triptan administration over 7 days can produce "latent sensitization" (14 days after discontinuation of drug) demonstrated as enhanced sensitivity to presumed migraine triggers such as environmental stress and lowered threshold for electrically induced cortical spreading depression (CSD). Here we have used fMRI to evaluate the early changes in brain networks at day 7 of sumatriptan administration that may induce latent sensitization as well as the potential response to stress. After continuous infusion of sumatriptan, rats were scanned to measure changes in resting state networks and the response to bright light environmental stress. Rats receiving sumatriptan, but not saline infusion, showed significant differences in default mode, autonomic, basal ganglia, salience, and sensorimotor networks. Bright light stress produced CSD-like responses in sumatriptan-treated but not control rats. Our data show the first brain-related changes in a rat model of medication overuse headache and suggest that this approach could be used to evaluate the multiple brain networks involved that may promote this condition.
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Affiliation(s)
- L Becerra
- P.A.I.N. Group, Boston Children's Hospital, Waltham, Massachusetts; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts; and
| | - J Bishop
- P.A.I.N. Group, Boston Children's Hospital, Waltham, Massachusetts
| | - G Barmettler
- P.A.I.N. Group, Boston Children's Hospital, Waltham, Massachusetts
| | - Y Xie
- Department of Pharmacology, University of Arizona, Tucson, Arizona
| | - E Navratilova
- Department of Pharmacology, University of Arizona, Tucson, Arizona
| | - F Porreca
- Department of Pharmacology, University of Arizona, Tucson, Arizona
| | - D Borsook
- P.A.I.N. Group, Boston Children's Hospital, Waltham, Massachusetts; Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Charlestown, Massachusetts; and
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95
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Dussor G. ASICs as therapeutic targets for migraine. Neuropharmacology 2015; 94:64-71. [PMID: 25582295 PMCID: PMC4458434 DOI: 10.1016/j.neuropharm.2014.12.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 11/26/2014] [Accepted: 12/04/2014] [Indexed: 01/05/2023]
Abstract
Migraine is the most common neurological disorder and one of the most common chronic pain conditions. Despite its prevalence, the pathophysiology leading to migraine is poorly understood and the identification of new therapeutic targets has been slow. Several processes are currently thought to contribute to migraine including altered activity in the hypothalamus, cortical-spreading depression (CSD), and afferent sensory input from the cranial meninges. Decreased extracellular pH and subsequent activation of acid-sensing ion channels (ASICs) may contribute to each of these processes and may thus play a role in migraine pathophysiology. Although few studies have directly examined a role of ASICs in migraine, studies directly examining a connection have generated promising results including efficacy of ASIC blockers in both preclinical migraine models and in human migraine patients. The purpose of this review is to discuss the pathophysiology thought to contribute to migraine and findings that implicate decreased pH and/or ASICs in these events, as well as propose issues to be resolved in future studies of ASICs and migraine. This article is part of the Special Issue entitled 'Acid-Sensing Ion Channels in the Nervous System'.
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Affiliation(s)
- Greg Dussor
- The University of Texas at Dallas, School of Behavioral and Brain Sciences, GR-41, 800 West Campbell Road, Richardson, TX, 75080, USA.
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96
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Tso AR, Goadsby PJ. Recent Neuroimaging Advances in the Study of Primary Headaches. Curr Pain Headache Rep 2015; 19:15. [DOI: 10.1007/s11916-015-0487-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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97
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Ofte HK, von Hanno T, Alstadhaug KB. Reduced cranial parasympathetic tone during the remission phase of cluster headache. Cephalalgia 2014; 35:469-77. [PMID: 25143551 DOI: 10.1177/0333102414545893] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 07/12/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cluster headache (CH) attacks are accompanied by cranial autonomic symptoms indicative of parasympathetic hyperactivity and sympathetic dysfunction ipsilateral to the pain. We aimed to assess cranial autonomic function in CH patients during the remission phase of cluster headache. MATERIALS AND METHODS During a remission phase, 38 episodic CH patients underwent the following: dynamic pupillometry, measurement of the superficial temporal artery diameter by ultrasound, and measurement of the retinal vessel diameters from digital retinal photographs. Pupillometry was also performed on 30 age- and sex-matched healthy controls. RESULTS Thirty patients were included (27 men, three women, mean age 50.2 years ± 12.6). Seven patients reported occasional side shift of their headache, but with a clear predominating side. Significantly reduced average pupillary constriction velocity and retinal venular diameter on the CH pain side were found. There was no asymmetry of the superficial temporal artery diameters. Compared to healthy controls, cluster patients displayed bilaterally reduced pupillary average and maximum constriction velocities, reduced constriction in percentage and increased latency of the light reflex. CONCLUSIONS The present findings indicate a bilaterally reduced cranial parasympathetic tone in CH patients in remission phase, with significant lateralization to the CH pain side. This implies a central origin, and a central pathophysiological model of CH is discussed.
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Affiliation(s)
| | - Therese von Hanno
- Nordland Hospital Trust, Norway Institute of Clinical Medicine, UiT the Arctic University of Norway, Norway
| | - Karl B Alstadhaug
- Nordland Hospital Trust, Norway Institute of Clinical Medicine, UiT the Arctic University of Norway, Norway
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98
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Whitcup SM, Turkel CC, DeGryse RE, Brin MF. Development of onabotulinumtoxinA for chronic migraine. Ann N Y Acad Sci 2014; 1329:67-80. [DOI: 10.1111/nyas.12488] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
| | | | | | - Mitchell F. Brin
- Allergan, Inc Irvine California
- Department of Neurology University of California Irvine California
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