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Gosalia H, Moreno-Ajona D, Goadsby PJ. Medication-overuse headache: a narrative review. J Headache Pain 2024; 25:89. [PMID: 38816828 PMCID: PMC11140994 DOI: 10.1186/s10194-024-01755-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 03/22/2024] [Indexed: 06/01/2024] Open
Abstract
Medication-overuse headache (MOH), which potentially involves 1-2% of the population, is defined as a headache, on ≥ 15 days a month affected, along with overuse of one or other acute attack medications. MOH presents with significant challenges in the headache community, particularly in clinical settings raising various questions about its pathophysiology. Through a review of the current literature and our clinical experience, we have explored the mechanisms through which MOH may occur, provide an understanding of the current state of treatment and detail some possible views on the understanding and treatment of this condition. We evaluate the variations in treatment methods offered globally and understanding of the disorder. Above all interventions, patient education is crucial, which is underscored by an analysis of the academic publications. Given the condition is preventable, early intervention is imperative and patient awareness is highlighted as key. Globally, there is no uniform treatment methodology, which may be advantageous as approaches need to take local circumstances into account.
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Affiliation(s)
- Helin Gosalia
- NIHR King's Clinical Research Facility, & SLaM Biomedical Research Centre, The Wolfson Sensory, Pain and Regeneration Centre (SPaRC), Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - David Moreno-Ajona
- NIHR King's Clinical Research Facility, & SLaM Biomedical Research Centre, The Wolfson Sensory, Pain and Regeneration Centre (SPaRC), Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- Department of Neurology, Queen Elizabeth Hospital, London, UK
| | - Peter J Goadsby
- NIHR King's Clinical Research Facility, & SLaM Biomedical Research Centre, The Wolfson Sensory, Pain and Regeneration Centre (SPaRC), Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK.
- Department of Neurology, University of California, Los Angeles, CA, USA.
- Wellcome Foundation Building, King's College Hospital, London, SE5 9PJ, UK.
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Rizzoli P. Medication-Overuse Headache. Continuum (Minneap Minn) 2024; 30:379-390. [PMID: 38568489 DOI: 10.1212/con.0000000000001403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
OBJECTIVE Medication-overuse headache (MOH) has been described for almost 100 years and is characterized as a daily or near-daily headache that usually presents in patients with preexisting primary headache disorders who are overusing one or more acute or symptomatic headache medications. This article reviews the diagnosis and management of patients with MOH. LATEST DEVELOPMENTS The International Classification of Headache Disorders criteria for MOH have changed over time. The worldwide prevalence appears to be between 1% and 2%. Together, headache disorders, including MOH, are currently ranked as the second leading cause of years lived with disability in the Global Burden of Disease world health survey. Significant neurophysiologic changes are seen in the brains of patients with MOH, including functional alterations in central pain processing and modulating systems and central sensitization. Research supports updates to the principles of management, including weaning off the overused medication, preventive therapy, biobehavioral therapy, and patient education. ESSENTIAL POINTS MOH is a fairly common and treatable secondary headache disorder that produces significant disability and a substantial reduction in quality of life. The costs related to lost income and disability are substantial. MOH is intimately related to chronic migraine, which continues to be underrecognized and undertreated. Treatment focuses on both the institution of effective preventive migraine therapy and the reduction or removal of the overused medications. Educational efforts directed toward both providers and patients have been shown to be effective in reducing the effect of MOH.
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Ljubisavljevic S, Ljubisavljevic M, Damjanovic R, Kalinic S. A Descriptive Review of Medication-Overuse Headache: From Pathophysiology to the Comorbidities. Brain Sci 2023; 13:1408. [PMID: 37891777 PMCID: PMC10605322 DOI: 10.3390/brainsci13101408] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/19/2023] [Accepted: 09/25/2023] [Indexed: 10/29/2023] Open
Abstract
PURPOSE OF REVIEW Medication-overuse headache (MOH) is an important problem worldwide, with different areas of controversy regarding its entity. This article reviews the risk factors, comorbidities, pathophysiology, clinical presentation, effective management, and prognosis of MOH by summarizing and integrating the results and findings from previously performed more than 15,000 studies (from 2010 to 2023) available from the scientific database of the University Medical Library in the University Clinical Center of Niš, which aimed to investigate and define the complexity of this type of headache. RECENT FINDING It has been proposed that all acute migraine medications can lead to MOH, with differences in the propensity of different agents to cause the problem. Early data suggests that triptans and other painkillers used for the acute treatment of migraine may be an exception. Recent studies show that practitioners and the general public are still largely unaware of the problem of medication overuse and its damaging effects. SUMMARY Although it is likely that MOH does occur, restricting the number of acute medications is necessary to prevent it. It is also possible that increasing amounts of acute medications are simply a reflection of poorly controlled headaches rather than a cause. Further research needs to be developed to identify more precise mechanisms for effective MOH management and its evolution.
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Affiliation(s)
- Srdjan Ljubisavljevic
- Department for Neurology, University Clinical Centre of Nis, 18000 Nis, Serbia; (M.L.); (R.D.); (S.K.)
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Sebastianelli G, Casillo F, Abagnale C, Renzo AD, Cioffi E, Parisi V, Lorenzo CD, Fazio F, Petricola F, Mattia C, Serrao M, Schoenen J, Coppola G. Central sensitization mechanisms in chronic migraine with medication overuse headache: a study of thalamocortical activation and lateral cortical inhibition. Cephalalgia 2023; 43:3331024231202240. [PMID: 37795647 DOI: 10.1177/03331024231202240] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
BACKGROUND It is unclear whether cortical hyperexcitability in chronic migraine with medication overuse headache (CM-MOH) is due to increased thalamocortical drive or aberrant cortical inhibitory mechanisms. METHODS Somatosensory evoked potentials (SSEP) were performed by electrical stimulation of the median nerve (M), ulnar nerve (U) and simultaneous stimulation of both nerves (MU) in 27 patients with CM-MOH and, for comparison, in 23 healthy volunteers (HVs) of a comparable age distribution. We calculated the degree of cortical lateral inhibition using the formula: 100 - [MU/(M + U) × 100] and the level of thalamocortical activation by analyzing the high frequency oscillations (HFOs) embedded in parietal N20 median SSEPs. RESULTS Compared to HV, CM-MOH patients showed higher lateral inhibition (CM-MOH 52.2% ± 15.4 vs. HV 40.4% ± 13.3; p = 0.005), which positively correlated with monthly headache days, and greater amplitude of pre-synaptic HFOs (p = 0.010) but normal post-synaptic HFOs (p = 0.122). CONCLUSION Our findings suggest that central neuronal circuits are highly sensitized in CM-MOH patients, at both thalamocortical and cortical levels. The observed changes could be due to the combination of dysfunctional central pain control mechanisms, hypersensitivity and hyperresponsiveness directly linked to the chronic intake of acute migraine drugs.
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Affiliation(s)
- Gabriele Sebastianelli
- Sapienza University of Rome Polo Pontino ICOT, Department of Medico-Surgical Sciences and Biotechnologies, Latina, Italy
| | - Francesco Casillo
- Sapienza University of Rome Polo Pontino ICOT, Department of Medico-Surgical Sciences and Biotechnologies, Latina, Italy
| | - Chiara Abagnale
- Sapienza University of Rome Polo Pontino ICOT, Department of Medico-Surgical Sciences and Biotechnologies, Latina, Italy
| | | | - Ettore Cioffi
- Sapienza University of Rome Polo Pontino ICOT, Department of Medico-Surgical Sciences and Biotechnologies, Latina, Italy
| | | | - Cherubino Di Lorenzo
- Sapienza University of Rome Polo Pontino ICOT, Department of Medico-Surgical Sciences and Biotechnologies, Latina, Italy
| | - Federica Fazio
- Specialization School in Medicine and Palliative Care, Sapienza University of Rome Polo Pontino ICOT, Latina, Italy
| | - Fausto Petricola
- Specialization School in Medicine and Palliative Care, Sapienza University of Rome Polo Pontino ICOT, Latina, Italy
| | - Consalvo Mattia
- Specialization School in Medicine and Palliative Care, Sapienza University of Rome Polo Pontino ICOT, Latina, Italy
| | - Mariano Serrao
- Sapienza University of Rome Polo Pontino ICOT, Department of Medico-Surgical Sciences and Biotechnologies, Latina, Italy
| | - Jean Schoenen
- CHU de Liège, Neurology, Headache Research Unit, Citadelle Hospital, Liège, Belgium
| | - Gianluca Coppola
- Sapienza University of Rome Polo Pontino ICOT, Department of Medico-Surgical Sciences and Biotechnologies, Latina, Italy
- Specialization School in Medicine and Palliative Care, Sapienza University of Rome Polo Pontino ICOT, Latina, Italy
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Niddam DM, Wu SW, Lai KL, Yang YY, Wang YF, Wang SJ. An altered reward system characterizes chronic migraine with medication overuse headache. Cephalalgia 2023; 43:3331024231158088. [PMID: 36855934 DOI: 10.1177/03331024231158088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND Medication overuse headache shares several characteristics with substance use disorders. However, key features of substance use disorders such as increased impulsivity and alterations in reward processing remain little explored in medication overuse headache. METHODS Temporal discounting and impulsive decision making behavior and the associated brain mechanisms were assessed in 26 chronic migraine patients with medication overuse headache and in 28 healthy controls. Regions-of-interest analyses were first performed for task-related regions, namely the ventral striatum and the ventromedial and dorsomedial prefrontal cortices. Resting-state functional connectivity between these regions were then explored. An additional 27 chronic migraine patients without medication overuse headache were included for comparison in the latter analysis. RESULTS Patients with medication overuse headache showed steeper temporal discounting behavior than healthy controls. They also showed weaker subjective value representations in the dorsomedial prefrontal cortex, when accepting larger delayed rewards, and in ventral striatum and ventromedial prefrontal cortex, when accepting the smaller immediate reward. Resting-state functional connectivity was reduced among the valuation regions when comparing patients with medication overuse headache to the other two control groups. CONCLUSIONS Patients with medication overuse headache were characterized by altered processing and dysconnectivity in the reward system during intertemporal choices and in the resting-state.
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Affiliation(s)
- David M Niddam
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Brain Science, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Neuroscience, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Wei Wu
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Neuroscience, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Kuan-Lin Lai
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Neurology, The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yun-Yen Yang
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yen-Fang Wang
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Neurology, The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shuu-Jiun Wang
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Neurology, The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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6
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Li X, Liu M, Fan W, Xu H, Chen Z. Altered cerebral neurovascular coupling in medication-overuse headache: A study combining multi-modal resting-state fMRI with 3D PCASL. Front Neurosci 2023; 17:1139086. [PMID: 37008219 PMCID: PMC10050465 DOI: 10.3389/fnins.2023.1139086] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 02/16/2023] [Indexed: 03/17/2023] Open
Abstract
AimStructural and functional changes in the brain have been identified in individuals with medication-overuse headache (MOH) using MRI. However, it has not been clearly established whether neurovascular dysfunction occurs in MOH, which could be elucidated by examining neurovascular coupling (NVC) from the viewpoints of neuronal activity and cerebral blood flow. The aim of this study was to investigate potential alterations in NVC function of the brain in individuals with MOH using resting-state functional MRI (rs-fMRI) and 3D pseudo-continuous arterial spin labeling (3D PCASL) imaging techniques.MethodsA total of 40 patients with MOH and 32 normal controls (NCs) were recruited, and rs-fMRI and 3D PCASL data were obtained using a 3.0 T MR scanner. Standard preprocessing of the rs-fMRI data was performed to generate images representing regional homogeneity (ReHo), fractional amplitude of low-frequency fluctuation (fALFF), and degree centrality (DC); cerebral blood flow (CBF) images were generated using 3D PCASL sequence data. These functional maps were all normalized into Montreal Neurological Institute (MNI) space, and NVC was subsequently determined on the basis of Pearson correlation coefficients between the rs-fMRI maps (ReHo, fALFF, and DC) and CBF maps. The statistical significance of differences between the MOH and NC groups in terms of NVC in different brain regions was established via Z-test. Further analysis was performed to examine correlations between NVC in the brain regions with NVC dysfunction and clinical variables among patients with MOH.ResultsNVC mainly presented a negative correlation in patients with MOH and NCs. No significant difference between the two groups was detected in terms of average NVC over the entire gray matter area. However, several brain regions with significantly decreased NVC in patients with MOH compared to NCs were identified: the left orbital region of the superior frontal gyrus, the bilateral gyrus rectus, and the olfactory cortex (P < 0.05). A correlation analysis revealed that the DC of the brain regions with NVC dysfunction was significantly positively correlated with disease duration (r = 0.323, P = 0.042), and DC–CBF connectivity was negatively correlated with VAS score (r = −0.424, P = 0.035).ConclusionThe current study demonstrated that cerebral NVC dysfunction occurs in patients with MOH, and the NVC technique could function as a new imaging biomarker in headache research.
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Affiliation(s)
- Xin Li
- Department of Radiology, Hainan Hospital of PLA General Hospital, Sanya, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Mengqi Liu
- Department of Radiology, Hainan Hospital of PLA General Hospital, Sanya, China
| | - Wenping Fan
- Department of Radiology, Hainan Hospital of PLA General Hospital, Sanya, China
| | - Huan Xu
- Department of Radiology, Hainan Hospital of PLA General Hospital, Sanya, China
| | - Zhiye Chen
- Department of Radiology, Hainan Hospital of PLA General Hospital, Sanya, China
- The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China
- *Correspondence: Zhiye Chen
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Diener HC, Rizzoli P. Chronic migraine and medication overuse. HANDBOOK OF CLINICAL NEUROLOGY 2023; 198:187-200. [PMID: 38043961 DOI: 10.1016/b978-0-12-823356-6.00008-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Though clearly described as far back as the 17th century, chronic migraine has defied precise categorization and has continued to develop as an important diagnostic concept with significant societal impact. Worldwide prevalence is estimated to be between 1% and 3%, and these patients form a dynamic group cycling between chronic and episodic migraine. Theories of pathogenesis are developing supported by recent imaging and other findings. Of the many determinants of progression to chronic migraine, overuse of acute abortive headache medications may be one of the most important modifiable factors. Treatment strategies, in addition to educational measures, have included various preventive migraine medications such as topiramate, valproate, and onabotulinumtoxinA. CGRP monoclonal antibodies are efficacious for the management of chronic migraine both with and without medication overuse.
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Affiliation(s)
- Hans Christoph Diener
- Department of Neuroepidemiology, Institute for Medical Informatics, Biometry and Epidemiology (IMIBE), Medical Faculty of the University Duisburg-Essen, Essen, Germany.
| | - Paul Rizzoli
- Department of Neurology, Brigham and Women's Hospital; John R Graham Headache Center, Brigham and Women's Faulkner Hospital, Harvard Medical School, Boston, MA, United States
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Li C, Dai W, Miao S, Xie W, Yu S. Medication overuse headache and substance use disorder: A comparison based on basic research and neuroimaging. Front Neurol 2023; 14:1118929. [PMID: 36937526 PMCID: PMC10017752 DOI: 10.3389/fneur.2023.1118929] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 02/10/2023] [Indexed: 03/06/2023] Open
Abstract
It has yet to be determined whether medication overuse headache (MOH) is an independent disorder or a combination of primary headache and substance addiction. To further explore the causes of MOH, we compared MOH with substance use disorder (SUD) in terms of the brain regions involved to draw more targeted conclusions. In this review, we selected alcohol use disorder (AUD) as a representative SUD and compared MOH and AUD from two aspects of neuroimaging and basic research. We found that in neuroimaging studies, there were many overlaps between AUD and MOH in the reward circuit, but the extensive cerebral cortex damage in AUD was more serious than that in MOH. This difference was considered to reflect the sensitivity of the cortex structure to alcohol damage. In future research, we will focus on the central amygdala (CeA), prefrontal cortex (PFC), orbital-frontal cortex (OFC), hippocampus, and other brain regions for interventions, which may have unexpected benefits for addiction and headache symptoms in MOH patients.
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Expression of Selected microRNAs in Migraine: A New Class of Possible Biomarkers of Disease? Processes (Basel) 2021. [DOI: 10.3390/pr9122199] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Preliminary but convergent findings suggest a role for microRNAs (miRNAs) in the generation and maintenance of chronic pain and migraine. Initial observations showed that serum levels of miR-382-5p and miR-34a-5p expression were increased in serum during the migraine attack, with miR-382-5p increasing in the interictal phase as well. By contrast, miR-30a-5p levels were lower in migraine patients compared to healthy controls. Of note, antimigraine treatments proved to be capable of influencing the expression of these miRNAs. Altogether, these observations suggest that miRNAs may represent migraine biomarkers, but several points are yet to be elucidated. A major concern is that these miRNAs are altered in a broad spectrum of painful and non-painful conditions, and thus it is not possible to consider them as truly “migraine-specific” biomarkers. We feel that these miRNAs may represent useful tools to uncover and define different phenotypes across the migraine spectrum with different treatment susceptibilities and clinical features, although further studies are needed to confirm our hypothesis. In this narrative review we provide an update and a critical analysis of available data on miRNAs and migraines in order to propose possible interpretations. Our main objective is to stimulate research in an area that holds promise when it comes to providing reliable biomarkers for theoretical and practical scientific advances.
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Dai W, Qiu E, Chen Y, Xing X, Xi W, Zhang M, Li K, Tian L, Dong Z, Yu S. Enhanced functional connectivity between habenula and salience network in medication-overuse headache complicating chronic migraine positions it within the addiction disorders: an ICA-based resting-state fMRI study. J Headache Pain 2021; 22:107. [PMID: 34503441 PMCID: PMC8428097 DOI: 10.1186/s10194-021-01318-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 08/12/2021] [Indexed: 12/20/2022] Open
Abstract
Background Medication-overuse headache (MOH) is a relatively frequently occurring secondary headache caused by overuse of analgesics and/or acute migraine medications. It is believed that MOH is associated with dependence behaviors and substance addiction, in which the salience network (SN) and the habenula may play an important role. This study aims to investigate the resting-state (RS) functional connectivity between the habenula and the SN in patients with MOH complicating chronic migraine (CM) compared with those with episodic migraine (EM) and healthy controls (HC). Methods RS-fMRI and 3-dimensional T1-weighted images of 17 patients with MOH + CM, 18 patients with EM and 30 matched healthy HC were obtained. The RS-fMRI data were analyzed using the independent component analysis (ICA) method to investigate the group differences of functional connectivity between the habenula and the SN in three groups. Correlation analysis was performed thereafter with all clinical variables by Pearson correlation. Results Increased functional connectivity between bilateral habenula and SN was detected in patients with MOH + CM compared with patients with EM and HC respectively. Correlation analysis showed significant correlation between medication overuse duration and habenula-SN connectivity in MOH + CM patients. Conclusions The current study supported MOH to be lying within a spectrum of dependence and addiction disorder. The enhanced functional connectivity of the habenula with SN may correlate to the development or chronification of MOH. Furthermore, the habenula may be an indicator or treatment target for MOH for its integrative role involved in multiple aspects of MOH.
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Affiliation(s)
- Wei Dai
- Department of Neurology, Chinese PLA General Hospital, 28 Fuxing Road, 100853, Beijing, China.,Chinese PLA Medical School, 100853, Beijing, China
| | - Enchao Qiu
- Department of Neurology, Chinese PLA General Hospital, 28 Fuxing Road, 100853, Beijing, China
| | - Yun Chen
- Department of Neurology, Chinese PLA General Hospital, 28 Fuxing Road, 100853, Beijing, China.,Chinese PLA Medical School, 100853, Beijing, China
| | - Xinbo Xing
- Department of Radiology, Fourth Medical Center of Chinese PLA General Hospital, 100048, Beijing, China
| | - Wei Xi
- Department of Radiology, Fourth Medical Center of Chinese PLA General Hospital, 100048, Beijing, China
| | - Meichen Zhang
- Department of Neurology, Chinese PLA General Hospital, 28 Fuxing Road, 100853, Beijing, China
| | - Ke Li
- Department of Neurology, Chinese PLA General Hospital, 28 Fuxing Road, 100853, Beijing, China.,Chinese PLA Medical School, 100853, Beijing, China
| | - Lixia Tian
- School of Computer and Information Technology, Beijing Jiaotong University, 100044, Beijing, China
| | - Zhao Dong
- Department of Neurology, Chinese PLA General Hospital, 28 Fuxing Road, 100853, Beijing, China.
| | - Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, 28 Fuxing Road, 100853, Beijing, China.
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Mungoven TJ, Henderson LA, Meylakh N. Chronic Migraine Pathophysiology and Treatment: A Review of Current Perspectives. FRONTIERS IN PAIN RESEARCH 2021; 2:705276. [PMID: 35295486 PMCID: PMC8915760 DOI: 10.3389/fpain.2021.705276] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 07/31/2021] [Indexed: 11/13/2022] Open
Abstract
Chronic migraine is a disabling neurological disorder that imposes a considerable burden on individual and socioeconomic outcomes. Chronic migraine is defined as headaches occurring on at least 15 days per month with at least eight of these fulfilling the criteria for migraine. Chronic migraine typically evolves from episodic migraine as a result of increasing attack frequency and/or several other risk factors that have been implicated with migraine chronification. Despite this evolution, chronic migraine likely develops into its own distinct clinical entity, with unique features and pathophysiology separating it from episodic migraine. Furthermore, chronic migraine is characterized with higher disability and incidence of comorbidities in comparison to episodic migraine. While existing migraine studies primarily focus on episodic migraine, less is known about chronic migraine pathophysiology. Mounting evidence on aberrant alterations suggest that pronounced functional and structural brain changes, central sensitization and neuroinflammation may underlie chronic migraine mechanisms. Current treatment options for chronic migraine include risk factor modification, acute and prophylactic therapies, evidence-based treatments such as onabotulinumtoxinA, topiramate and newly approved calcitonin gene-related peptide or receptor targeted monoclonal antibodies. Unfortunately, treatments are still predominantly ineffective in aborting migraine attacks and decreasing intensity and frequency, and poor adherence and compliance with preventative medications remains a significant challenge. Novel emerging chronic migraine treatments such as neuromodulation offer promising therapeutic approaches that warrant further investigation. The aim of this narrative review is to provide an update of current knowledge and perspectives regarding chronic migraine background, pathophysiology, current and emerging treatment options with the intention of facilitating future research into this debilitating and largely indeterminant disorder.
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Affiliation(s)
| | | | - Noemi Meylakh
- Department of Anatomy and Histology, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia
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12
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Documento de revisión y actualización de la cefalea por uso excesivo de medicación (CUEM). Neurologia 2021; 36:229-240. [DOI: 10.1016/j.nrl.2020.04.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 04/06/2020] [Accepted: 04/16/2020] [Indexed: 11/17/2022] Open
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13
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Document of revision and updating of medication overuse headache (MOH). NEUROLOGÍA (ENGLISH EDITION) 2021. [DOI: 10.1016/j.nrleng.2020.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Gao W, Biswal B, Chen S, Wu X, Yuan J. Functional coupling of the orbitofrontal cortex and the basolateral amygdala mediates the association between spontaneous reappraisal and emotional response. Neuroimage 2021; 232:117918. [PMID: 33652140 DOI: 10.1016/j.neuroimage.2021.117918] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/02/2021] [Accepted: 02/22/2021] [Indexed: 11/17/2022] Open
Abstract
Emotional regulation is known to be associated with activity in the amygdala. The amygdala is an emotion-generative region that comprises of structurally and functionally distinct nuclei. However, little is known about the contributions of different frontal-amygdala sub-region pathways to emotion regulation. Here, we investigated how functional couplings between frontal regions and amygdala sub-regions are involved in different spontaneous emotion regulation processes by using an individual-difference approach and a generalized psycho-physiological interaction (gPPI) approach. Specifically, 50 healthy participants reported their dispositional use of spontaneous cognitive reappraisal and expressive suppression in daily life and their actual use of these two strategies during the performance of an emotional-picture watching task. Results showed that functional coupling between the orbitofrontal cortex (OFC) and the basolateral amygdala (BLA) was associated with higher scores of both dispositional and actual uses of reappraisal. Similarly, functional coupling between the dorsolateral prefrontal cortex (dlPFC) and the centromedial amygdala (CMA) was associated with higher scores of both dispositional and actual uses of suppression. Mediation analyses indicated that functional coupling of the right OFC-BLA partially mediated the association between reappraisal and emotional response, irrespective of whether reappraisal was measured by dispositional use (indirect effect(SE)=-0.2021 (0.0811), 95%CI(BC)= [-0.3851, -0.0655]) or actual use (indirect effect(SE)=-0.1951 (0.0796), 95%CI(BC)= [-0.3654, -0.0518])). These findings suggest that spontaneous reappraisal and suppression involve distinct frontal- amygdala functional couplings, and the modulation of BLA activity from OFC may be necessary for changing emotional response during spontaneous reappraisal.
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Affiliation(s)
- Wei Gao
- The Affect Cognition and Regulation Laboratory (ACRLab), Institute of Brain and Psychological Science, Sichuan Normal University, Chengdu, Sichuan, China; Faculty of Psychology, Southwest University, Chongqing, China
| | - Bharat Biswal
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey, United States
| | - ShengDong Chen
- School of Psychology, Qufu Normal University, Qufu, Shandong, China
| | - XinRan Wu
- Institute of Science and Technology for Brain-inspired Intelligence, Fudan University, Shanghai, China
| | - JiaJin Yuan
- The Affect Cognition and Regulation Laboratory (ACRLab), Institute of Brain and Psychological Science, Sichuan Normal University, Chengdu, Sichuan, China.
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Newman-Norlund RD, Rorden C, Maleki N, Patel M, Cheng B, Androulakis XM. Cortical and subcortical changes following sphenopalatine ganglion blocks in chronic migraine with medication overuse headache: a preliminary longitudinal study. Womens Midlife Health 2020; 6:7. [PMID: 32774872 PMCID: PMC7409446 DOI: 10.1186/s40695-020-00055-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 07/13/2020] [Indexed: 01/28/2023] Open
Abstract
Objective The purpose of this pilot study was to investigate potential changes in brain morphology (cortical thickness and cortical/subcortical volume) accompanying a series of sphenopalatine ganglion (SPG) blockade treatments in chronic migraine with medication overuse headaches (CMw/MOH). Background Local anesthetization of the SPG via intranasal application is used for the treatment for multiple types of headache disorders, including CM. Our previous longitudinal fMRI study revealed improved network connectivity after such treatment. However, the impact of SPG blocks on cortical, subcortical gray matter volume and cortical thickness has yet to be assessed. Methods Using magnetic resonance imaging (MRI), cortical/subcortical volume were measured in 12 chronic migraine patients before and after a series of 12 SPG blocks administered over a 6-week period (2 per week). The average time between MRI assessments was 6 weeks. Targeted, within-subjects t-tests comparing pre-treatment and post-treatment values in specific apriori brain regions of interest, including the hippocampus, amygdala, basal ganglia, somatosensory cortex, temporal cortex and occipital cortex, were used to estimate the impact of repetitive SPG blocks treatment on brain morphology in CMw/MOH. Results Compared to baseline values, the number of moderate/severe headache days per month, HIT-6, PHQ-9 scores and allodynia scores were all significantly improved at the end of treatment. Analysis of MRI data revealed that the volume of the right hippocampus and the right palladium significantly decreased following SPG block treatment, while the volume of the left nucleus accumbens significantly increased following treatment. Cortical thickness in the left temporal pole and left lateral occipito-temporal gyrus significantly decreased following SPG block treatment. Conclusion Our results suggest SPG block treatment is associated with significant symptom improvement as well as significant structural brain changes in regions known to be associated with migraine and chronic pain processing in CMw/MOH.
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Affiliation(s)
- Roger D Newman-Norlund
- Department of Psychology, University of South Carolina, 915 Greene Street, Discovery I Building, Office 138, Columbia, SC 29208 USA
| | - Chris Rorden
- Department of Psychology, University of South Carolina, 915 Greene Street, Discovery I Building, Office 138, Columbia, SC 29208 USA
| | | | - Milap Patel
- Department of Neurology, University of South Carolina, Columbia, SC USA
| | - Brian Cheng
- Department of Neurology, University of South Carolina, Columbia, SC USA
| | - X Michelle Androulakis
- Department of Neurology, University of South Carolina, Columbia, SC USA.,Division of Neurology, WJB Dorn VA Medical Center, Columbia, SC USA
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16
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Lau CI, Liu MN, Chen WH, Walsh V, Wang SJ. Clinical and biobehavioral perspectives: Is medication overuse headache a behavior of dependence? PROGRESS IN BRAIN RESEARCH 2020; 255:371-402. [PMID: 33008514 DOI: 10.1016/bs.pbr.2020.05.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 04/28/2020] [Accepted: 05/01/2020] [Indexed: 02/08/2023]
Abstract
Medication overuse headache (MOH), previously known as analgesic abuse headache or medication misuse headaches, is a common form of chronic headache disorder that has a detrimental impact on health and society. Although it has been widely accepted that overusing abortive medications is paradoxically the cause of MOH and drug discontinuation is the treatment of choice, ongoing debates exist as to whether drug consumption per se is the cause or consequence of headache chronification. Certain features in MOH such as their compulsive drug-seeking behavior, withdrawal headaches and high relapse rates share similarities with drug dependence, suggesting that there might be common underlying biological and psychobehavioral mechanisms. In this regard, this article will discuss the updated evidence and current debates on the possible biobehavioral overlap between MOH and drug dependence. To begin with, we will discuss whether MOH has characteristics of substance dependence based on standard psychiatry diagnostic criteria and other widely used dependence scales. Recent epidemiological studies underscoring common psychiatric comorbidities between the two disorders will also be presented. Although both demonstrate seemingly distinct personality traits, recent studies revealed similar decision-making impairment from a cognitive perspective, indicating the presence of a maladaptive reward system in both disorders. In addition, emerging imaging studies also support this notion by showing reversible morphological and functional brain changes related to the mesocorticolimbic reward circuitry in MOH, with a strong resemblance to those in addiction. Finally, an increased familial risk for drug dependence and genetic association with dopaminergic and drug dependence molecular pathways in MOH also support a possible link between MOH and addiction. Understanding the role of dependence in MOH will have a great impact on disease management as this will provide the missing piece of the puzzle in current therapeutic strategies.
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Affiliation(s)
- Chi Ieong Lau
- Dementia Center, Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; Applied Cognitive Neuroscience Group, Institute of Cognitive Neuroscience, University College London, London, United Kingdom; Institute of Biophotonics, National Yang-Ming University, Taipei, Taiwan; College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan; University Hospital, Taipa, Macau
| | - Mu-N Liu
- Institute of Brain Science, National Yang-Ming University, Taipei, Taiwan; Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Neurology, Memory and Aging Centre, University of California, San Francisco, CA, United States
| | - Wei-Hung Chen
- Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Vincent Walsh
- Applied Cognitive Neuroscience Group, Institute of Cognitive Neuroscience, University College London, London, United Kingdom
| | - Shuu-Jiun Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan; Brain Research Center and School of Medicine, National Yang-Ming University, Taipei, Taiwan.
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17
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Zucca M, Rubino E, Vacca A, De Martino P, Roveta F, Govone F, Gai A, Caglio M, Gentile S, Giordana MT, Rainero I. Metacognitive impairment in patients with episodic and chronic migraine. J Clin Neurosci 2020; 72:119-123. [DOI: 10.1016/j.jocn.2019.12.048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 12/20/2019] [Indexed: 12/20/2022]
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18
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Chong CD. Brain Structural and Functional Imaging Findings in Medication-Overuse Headache. Front Neurol 2020; 10:1336. [PMID: 32047470 PMCID: PMC6997335 DOI: 10.3389/fneur.2019.01336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 12/02/2019] [Indexed: 12/14/2022] Open
Abstract
This chapter overviews research neuroimaging findings of patients with medication-overuse headache (MOH). Results indicate; (i) correlations between neuropathology and medication-overuse; (ii) changes in brain morphology and cortical function; and (iii) brain recovery subsequent to withdrawal of medication that was overused. Results of this narrative review indicate exacerbated brain structural and functional changes in regions of the pain-matrix and in regions of the mesocortical-limbic circuit in patients with MOH compared to patients with migraine or compared to healthy controls. Modification of brain morphology as well as an association between brain recovery and medication withdrawal suggest that the MOH disease process involves state (brain modification) and trait-like (brain adaptation and recovery) neuromechanisms.
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19
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Abe N, Kato M, Fujieda Y, Narita H, Tha KK, Atsumi T. Tumour necrosis factor alpha blockade for non-inflammatory pain: beyond inflammation? Scand J Rheumatol Suppl 2019; 48:519-521. [DOI: 10.1080/03009742.2019.1597383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- N Abe
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - M Kato
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Y Fujieda
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - H Narita
- Department of Psychiatry, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - KK Tha
- Department of Radiation Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - T Atsumi
- Department of Rheumatology, Endocrinology and Nephrology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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20
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Chong CD, Schwedt TJ, Hougaard A. Brain functional connectivity in headache disorders: A narrative review of MRI investigations. J Cereb Blood Flow Metab 2019; 39:650-669. [PMID: 29154684 PMCID: PMC6446420 DOI: 10.1177/0271678x17740794] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Resting-state functional magnetic resonance imaging (rs-fMRI) is used to interrogate the functional connectivity and network organization amongst brain regions. Functional connectivity is determined by measuring the extent of synchronization in the spontaneous fluctuations of blood oxygenation level dependent (BOLD) signal. Here, we review current rs-fMRI studies in headache disorders including migraine, trigeminal autonomic cephalalgias, and medication overuse headache. We discuss (1) brain network alterations that are shared amongst the different headache disorders and (2) network abnormalities distinct to each headache disorder. In order to focus the section on migraine, the headache disorder that has been most extensively studied, we chose to include articles that interrogated functional connectivity: (i) during the attack phase; (ii) in migraine patients with aura compared to migraine patients without aura; and (iii) of regions within limbic, sensory, motor, executive and default mode networks and those which participate in multisensory integration. The results of this review show that headache disorders are associated with atypical functional connectivity of regions associated with pain processing as well as atypical functional connectivity of multiple core resting state networks such as the salience, sensorimotor, executive, attention, limbic, visual, and default mode networks.
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Affiliation(s)
| | - Todd J Schwedt
- 1 Department of Neurology, Mayo Clinic, Arizona, AZ, USA
| | - Anders Hougaard
- 2 Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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21
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Jeong H, Moye LS, Southey BR, Hernandez AG, Dripps I, Romanova EV, Rubakhin SS, Sweedler JV, Pradhan AA, Rodriguez-Zas SL. Gene Network Dysregulation in the Trigeminal Ganglia and Nucleus Accumbens of a Model of Chronic Migraine-Associated Hyperalgesia. Front Syst Neurosci 2018; 12:63. [PMID: 30618656 PMCID: PMC6305622 DOI: 10.3389/fnsys.2018.00063] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 12/03/2018] [Indexed: 12/28/2022] Open
Abstract
The pharmacological agent nitroglycerin (NTG) elicits hyperalgesia and allodynia in mice. This model has been used to study the neurological disorder of trigeminovascular pain or migraine, a debilitating form of hyperalgesia. The present study validates hyperalgesia in an established mouse model of chronic migraine triggered by NTG and advances the understanding of the associated molecular mechanisms. The RNA-seq profiles of two nervous system regions associated with pain, the trigeminal ganglia (TG) and the nucleus accumbens (NAc), were compared in mice receiving chronic NTG treatment relative to control (CON) mice. Among the 109 genes that exhibited an NTG treatment-by-region interaction, solute carrier family 32 (GABA vesicular transporter) member 1 (Slc32a1) and preproenkephalin (Penk) exhibited reversal of expression patterns between the NTG and CON groups. Erb-b2 receptor tyrosine kinase 4 (Erbb4) and solute carrier family 1 (glial high affinity glutamate transporter) member 2 (Slc1a2) exhibited consistent differential expression between treatments across regions albeit at different magnitude. Period circadian clock 1 (Per1) was among the 165 genes that exhibited significant NTG treatment effect. Biological processes disrupted by NTG in a region-specific manner included adaptive and innate immune responses; whereas glutamatergic and dopaminergic synapses and rhythmic process were disrupted in both regions. Regulatory network reconstruction highlighted the widespread role of several transcription factors (including Snrnp70, Smad1, Pax6, Cebpa, and Smpx) among the NTG-disrupted target genes. These results advance the understanding of the molecular mechanisms of hyperalgesia that can be applied to therapies to ameliorate chronic pain and migraine.
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Affiliation(s)
- Hyeonsoo Jeong
- Department of Animal Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Laura S. Moye
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - Bruce R. Southey
- Department of Animal Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Alvaro G. Hernandez
- Roy J. Carver Biotechnology Center, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Isaac Dripps
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - Elena V. Romanova
- Department of Chemistry and the Beckman Institute, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Stanislav S. Rubakhin
- Department of Chemistry and the Beckman Institute, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Jonathan V. Sweedler
- Department of Chemistry and the Beckman Institute, University of Illinois at Urbana-Champaign, Urbana, IL, United States
| | - Amynah A. Pradhan
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States
| | - Sandra L. Rodriguez-Zas
- Department of Animal Sciences, University of Illinois at Urbana-Champaign, Urbana, IL, United States
- Department of Statistics, University of Illinois at Urbana-Champaign, Urbana, IL, United States
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22
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Chen ZY, Chen XY, Liu MQ, Ma L, Yu SY. Volume Gain of Brainstem on Medication-Overuse Headache Using Voxel-Based Morphometry. Chin Med J (Engl) 2018; 131:2158-2163. [PMID: 30203789 PMCID: PMC6144843 DOI: 10.4103/0366-6999.240807] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: Histopathology identified the anatomical and molecular abnormalities of brainstem nuclei in migraine patients. However, the exact whole brainstem structural changes in vivo have not yet been identified in medication-overuse headache (MOH) transformed from migraine. The aim of this study was to investigate the regional volume changes over the whole brainstem in the MOH patients using voxel-based morphometry (VBM) in vivo. Methods: High-resolution three-dimensional structural images were obtained using a 3.0-Tesla magnetic resonance system from 36 MOH patients and 32 normal controls (NCs) who were consecutively recruited from the International Headache Center, Chinese People's Liberation Army General Hospital, from March 2013 to June 2016. VBM was used to assess the brainstem structural alteration in the MOH patients, and voxel-wise correlation was performed to evaluate the relationship with the clinical characteristics. Results: The brainstem region with increased volume located in the left ventrolateral periaqueductal gray (MNI coordinate: -1, -33, -8), ventral tegmental area (MNI coordinate: 0, -22, -12), bilateral substantia nigra (MNI coordinate: -8, -16, -12, 9, -16, -12), and trigeminal root entry zone (MNI coordinate: -19, -29, -31; 19, -32, -29) in MOH patients compared with NCs. The headache visual analog scale score was positively related with the left rostral ventromedial medulla (RVM) (MNI coordinate: -1, -37, -56; cluster size: 20; r = 0.602) in the MOH patients. Conclusions: The regional volume gain of brainstem could underlie the neuromechanism of impaired ascending and descending pathway in the MOH patients, and the left RVM volume alteration could imply the impaired tolerance of nociceptive pain input and could be used to assess the headache disability in the MOH patients.
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Affiliation(s)
- Zhi-Ye Chen
- Department of Radiology, Chinese People's Liberation Army General Hospital, Beijing 100853; Department of Radiology, Hainan Branch of Chinese People's Liberation Army General Hospital, Sanya, Hainan 572013; Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Xiao-Yan Chen
- Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Meng-Qi Liu
- Department of Radiology, Chinese People's Liberation Army General Hospital, Beijing 100853; Department of Radiology, Hainan Branch of Chinese People's Liberation Army General Hospital, Sanya, Hainan 572013, China
| | - Lin Ma
- Department of Radiology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
| | - Sheng-Yuan Yu
- Department of Neurology, Chinese People's Liberation Army General Hospital, Beijing 100853, China
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23
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Vandenbussche N, Laterza D, Lisicki M, Lloyd J, Lupi C, Tischler H, Toom K, Vandervorst F, Quintana S, Paemeleire K, Katsarava Z. Medication-overuse headache: a widely recognized entity amidst ongoing debate. J Headache Pain 2018; 19:50. [PMID: 30003412 PMCID: PMC6043466 DOI: 10.1186/s10194-018-0875-x] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 06/13/2018] [Indexed: 12/30/2022] Open
Abstract
Medication overuse in primary headache disorders is a worldwide phenomenon and has a role in the chronification of headache disorders. The burden of disease on individuals and societies is significant due to high costs and comorbidities. In the Third Edition of the International Classification of Headache Disorders, medication-overuse headache is recognized as a separate secondary entity next to mostly primary headache disorders, although many clinicians see the disease as a sole complication of primary headache disorders. In this review, we explore the historical background of medication-overuse headache, its epidemiology, phenomenology, pathophysiology and treatment options. The review explores relevant unanswered questions and summarizes the current debates in medication-overuse headache.
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Affiliation(s)
- Nicolas Vandenbussche
- Headache Group, Department of Basic and Clinical Neuroscience, King’s College London, and NIHR-Wellcome Trust King’s Clinical Research Facility, King’s College Hospital, Denmark Hill, London, SE5 9PJ UK
| | - Domenico Laterza
- Department of Neuroscience, St. Agostino Estense Hospital, University of Modena and Reggio Emilia, via P. Giardini 1355, 41100 Modena, Italy
| | - Marco Lisicki
- Headache Research Unit, Université de Liège, Liège, Belgium
| | - Joseph Lloyd
- Headache Research-Wolfson CARD, King’s College London, London, UK
| | - Chiara Lupi
- Headache Centre, Careggi University Hospital, Health Sciences Department, University of Florence, Viale Pieraccini 6, 50139 Florence, Italy
| | - Hannes Tischler
- Department of Neurology, Medical University Innsbruck, Innsbruck, Austria
| | - Kati Toom
- Department of Neurology, Tartu University Clinics, Tartu, Estonia
- Estonian Headache Society, Tartu, Estonia
| | | | - Simone Quintana
- Headache Center, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Koen Paemeleire
- Department of Neurology, Ghent University Hospital, Corneel Heymanslaan 10, B-9000 Ghent, Belgium
| | - Zaza Katsarava
- Evangelical Hospital Unna and University of Duisburg-Essen, Duisburg, Germany
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Mehnert J, Hebestreit J, May A. Cortical and Subcortical Alterations in Medication Overuse Headache. Front Neurol 2018; 9:499. [PMID: 29988531 PMCID: PMC6026656 DOI: 10.3389/fneur.2018.00499] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/07/2018] [Indexed: 01/05/2023] Open
Abstract
Medication-overuse headache is an increasing problem in headache clinics and therapy includes drug withdrawal. Although it has been shown that the orbitofrontal cortex is hypo-metabolic and exhibits less gray matter in these patients the functional role of this finding is still unclear as virtually no functional imaging studies exploring withdrawal of medication have been published. We compared structural and functional magnetic resonance images of 18 patients before and after drug withdrawal with age and gender matched controls using a well-established trigeminal, nociceptive fMRI paradigm. We reproduced structural changes in the orbitofrontal cortex of the patients which highly correlated with the clinical outcome of medication withdrawal. The neuronal activity before drug withdrawal in pain related regions (operculum, insula, spinal trigeminal nucleus) was reduced compared to after drug withdrawal and the orbitofrontal cortex showed a reduced functional connectivity to the nociceptive input region (spinal trigeminal nucleus) and the cerebellum which regained after withdrawal. These data suggest the seminal role of the orbitofrontal cortex as a mediator between bottom-up and top-down stream in headache processing.
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Affiliation(s)
- Jan Mehnert
- Department of Systems Neuroscience, University Medical Center Eppendorf, Hamburg, Germany
| | - Julia Hebestreit
- Department of Systems Neuroscience, University Medical Center Eppendorf, Hamburg, Germany
| | - Arne May
- Department of Systems Neuroscience, University Medical Center Eppendorf, Hamburg, Germany
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25
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Russo A, Silvestro M, Tessitore A, Tedeschi G. Functional Neuroimaging Biomarkers in Migraine: Diagnostic, Prognostic and Therapeutic Implications. Curr Med Chem 2018; 26:6236-6252. [PMID: 29623825 DOI: 10.2174/0929867325666180406115427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 03/20/2018] [Accepted: 03/22/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND In current migraine clinical practice, conventional neuroimaging examinations are often sought to exclude possible causes of secondary headaches or migraineassociated disorders. Contrariwise, although advanced Magnetic Resonance Imaging (MRI) has improved tremendously our understanding of human brain processes in migraine patients, to the state of the art they have not superseded the conventional neuroimaging techniques in the migraine clinical setting. METHODS A comprehensive review was conducted of PubMed citations by entering the keyword "marker" and/or "biomarker" combined with "migraine" and/or "headache". Other keywords included "imaging" or "neuroimaging", "structural" or "functional". The only restriction was English-language publication. The abstracts of all articles meeting these criteria were reviewed, and the full text was retrieved and examined for relevant references. RESULTS Several authors tried to identify imaging biomarkers able to identify different migraine phenotypes or, even better, to follow-up the same migraine patients during the course of the disease, to predict the evolution into more severe phenotypes and, finally, the response to specific treatment. CONCLUSION The identification of diagnostic, prognostic and therapeutic advanced neuroimaging biomarkers in the migraine clinical setting, in order to approach to patients in a more and more rational and "tailored" way, is extremely intriguing and futuristic. Unfortunately, reliable and robust neuroimaging biomarkers are still lacking for migraine, probably due to both not completely understood pathogenesis and clinical and neuroimaging heterogeneity. Although further longitudinal advanced neuroimaging studies, aimed to identify effective neuroimaging biomarkers, are needed, this review aims to collect the main and most recent works on this topic.
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Affiliation(s)
- Antonio Russo
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Campania "Luigi Vanvitelli", Naples, Italy.,MRI Research Center SUN-FISM, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Marcello Silvestro
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Campania "Luigi Vanvitelli", Naples, Italy.,MRI Research Center SUN-FISM, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Alessandro Tessitore
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Campania "Luigi Vanvitelli", Naples, Italy.,MRI Research Center SUN-FISM, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Gioacchino Tedeschi
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Campania "Luigi Vanvitelli", Naples, Italy.,MRI Research Center SUN-FISM, University of Campania "Luigi Vanvitelli", Naples, Italy.,Institute for Diagnosis and Care "Hermitage Capodimonte", Naples, Italy
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26
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27
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Chen Z, Chen X, Liu M, Dong Z, Ma L, Yu S. Altered functional connectivity architecture of the brain in medication overuse headache using resting state fMRI. J Headache Pain 2017; 18:25. [PMID: 28220377 PMCID: PMC5318354 DOI: 10.1186/s10194-017-0735-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Accepted: 02/01/2017] [Indexed: 12/24/2022] Open
Abstract
Background Functional connectivity density (FCD) could identify the abnormal intrinsic and spontaneous activity over the whole brain, and a seed-based resting-state functional connectivity (RSFC) could further reveal the altered functional network with the identified brain regions. This may be an effective assessment strategy for headache research. This study is to investigate the RSFC architecture changes of the brain in the patients with medication overuse headache (MOH) using FCD and RSFC methods. Methods 3D structure images and resting-state functional MRI data were obtained from 37 MOH patients, 18 episodic migraine (EM) patients and 32 normal controls (NCs). FCD was calculated to detect the brain regions with abnormal functional activity over the whole brain, and the seed-based RSFC was performed to explore the functional network changes in MOH and EM. Results The decreased FCD located in right parahippocampal gyrus, and the increased FCD located in left inferior parietal gyrus and right supramarginal gyrus in MOH compared with NC, and in right caudate and left insula in MOH compared with EM. RSFC revealed that decreased functional connectivity of the brain regions with decreased FCD anchored in the right dorsal-lateral prefrontal cortex, right frontopolar cortex in MOH, and in left temporopolar cortex and bilateral visual cortices in EM compared with NC, and in frontal-temporal-parietal pattern in MOH compared with EM. Conclusions These results provided evidence that MOH and EM suffered from altered intrinsic functional connectivity architecture, and the current study presented a new perspective for understanding the neuromechanism of MOH and EM pathogenesis.
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Affiliation(s)
- Zhiye Chen
- Department of Radiology, Chinese PLA General Hospital, Beijing, 100853, China.,Department of Neurology, Chinese PLA General Hospital, Beijing, 100853, China.,Department of Radiology, Hainan Branch of Chinese PLA General Hospital, Beijing, 100853, China
| | - Xiaoyan Chen
- Department of Neurology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Mengqi Liu
- Department of Radiology, Chinese PLA General Hospital, Beijing, 100853, China.,Department of Radiology, Hainan Branch of Chinese PLA General Hospital, Beijing, 100853, China
| | - Zhao Dong
- Department of Neurology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Lin Ma
- Department of Radiology, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, Beijing, 100853, China.
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28
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Schwedt TJ, Chong CD. Medication Overuse Headache: Pathophysiological Insights from Structural and Functional Brain MRI Research. Headache 2017; 57:1173-1178. [PMID: 28160280 DOI: 10.1111/head.13037] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND Research imaging of brain structure and function has helped to elucidate the pathophysiology of medication overuse headache (MOH). METHODS This is a narrative review of imaging research studies that have investigated brain structural and functional alterations associated with MOH. Studies included in this review have investigated abnormal structure and function of pain processing regions in people with MOH, functional patterns that might predispose individuals to development of MOH, similarity of brain functional patterns in patients with MOH to those found in people with addiction, brain structure that could predict headache improvement following discontinuation of the overused medication, and changes in brain structure and function after discontinuation of medication overuse. RESULTS AND CONCLUSIONS MOH is associated with atypical structure and function of brain regions responsible for pain processing as well as brain regions that are commonly implicated in addiction. Several studies have shown "normalization" of structure and function in pain processing regions following discontinuation of the overused medication and resolution of MOH. However, some of the abnormalities in regions also implicated in addiction tend to persist following discontinuation of the overused medication, suggesting that they are a brain trait that predisposes certain individuals to medication overuse and MOH.
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Chen Z, Chen X, Liu M, Liu S, Ma L, Yu S. Texture features of periaqueductal gray in the patients with medication-overuse headache. J Headache Pain 2017; 18:14. [PMID: 28155029 PMCID: PMC5289934 DOI: 10.1186/s10194-017-0727-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 01/20/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Periaqueductal gray (PAG) is the descending pain modulatory center, and PAG dysfunction had been recognized in migraine. Here we propose to investigate altered PAG texture features (quantitative approach for extracting texture descriptors for images) in the patients with medication-overuse headache (MOH) based on high resolution brain structural image to understand the MOH pathogenesis. METHODS The brain structural images were obtained from 32 normal controls (NC) and 44 MOH patients on 3.0 T MR system. PAG template was created based on the ICBM152 gray matter template, and the individual PAG segment was performed by applying the deformation field to the PAG template after structural image segment. Grey-level co-occurrence matrix (GLCM) was performed to measure the texture parameters including angular second moment (ASM), Contrast, Correlation, inverse difference moment (IDM) and Entropy. RESULTS Contrast was increased in MOH patients (9.28 ± 3.11) compared with that in NC (7.94 ± 0.65) (P < 0.05), and other texture features showed no significant difference between MOH and NC (P > 0.05). The area under the ROC curve was 0.697 for Contrast in the distinction of MOH from NC, and the cut-off value of Contrast was 8.11 with sensitivity 70.5% and specificity 62.5%. The contrast was negatively with the sleep scores (r = -0.434, P = 0.003). CONCLUSION Texture Contrast could be used to identify the altered MR imaging characteristics in MOH in understanding the MOH pathogenesis, and it could also be considered as imaging biomarker in for MOH diagnosis.
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Affiliation(s)
- Zhiye Chen
- Department of Radiology, Chinese PLA General Hospital, Beijing, 100853, China.,Department of Neurology, Chinese PLA General Hospital, Beijing, 100853, China.,Department of Radiology, Hainan Branch of Chinese PLA General Hospital, Beijing, 100853, China
| | - Xiaoyan Chen
- Department of Neurology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Mengqi Liu
- Department of Radiology, Chinese PLA General Hospital, Beijing, 100853, China.,Department of Radiology, Hainan Branch of Chinese PLA General Hospital, Beijing, 100853, China
| | - Shuangfeng Liu
- Department of Radiology, Chinese PLA General Hospital, Beijing, 100853, China
| | - Lin Ma
- Department of Radiology, Chinese PLA General Hospital, Beijing, 100853, China.
| | - Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, Beijing, 100853, China.
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Li J, Du D, Gao W, Sun X, Xie H, Zhang G, Li J, Li H, Li K. The regional neuronal activity in left posterior middle temporal gyrus is correlated with the severity of chronic aphasia. Neuropsychiatr Dis Treat 2017; 13:1937-1945. [PMID: 28790829 PMCID: PMC5530067 DOI: 10.2147/ndt.s140091] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Aphasia is one of the most disabling cognitive deficits affecting >2 million people in the USA. The neuroimaging characteristics of chronic aphasic patients (>6 months post onset) remain largely unknown. OBJECTIVE The objective of this study was to investigate the regional signal changes of spontaneous neuronal activity of brain and the inter-regional connectivity in chronic aphasia. MATERIALS AND METHODS Resting-state blood oxygenation level-dependent functional magnetic resonance imaging (fMRI) was used to obtain fMRI data from 17 chronic aphasic patients and 20 healthy control subjects in a Siemens Verio 3.0T MR Scanner. The amplitude of low-frequency fluctuation (ALFF) was determined, which directly reflects the regional neuronal activity. The functional connectivity (FC) of fMRI was assessed using a seed voxel linear correlation approach. The severity of aphasia was evaluated by aphasia quotient (AQ) scores obtained from Western Aphasia Battery test. RESULTS Compared with normal subjects, aphasic patients showed decreased ALFF values in the regions of left posterior middle temporal gyrus (PMTG), left medial prefrontal gyrus, and right cerebellum. The ALFF values in left PMTG showed strong positive correlation with the AQ score (coefficient r=0.79, P<0.05). There was a positive FC in chronic aphasia between left PMTG and left inferior temporal gyrus (BA20), fusiform gyrus (BA37), and inferior frontal gyrus (BA47\45\44). CONCLUSION Left PMTG might play an important role in language dysfunction of chronic aphasia, and ALFF value might be a promising indicator to evaluate the severity of aphasia.
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Affiliation(s)
- Jianlin Li
- Department of Radiology, Yantai Yuhuangding Hospital
| | - Dunren Du
- Department of Radiology, Yantai Laishan Branch Hospital of Yuhuangding Hospital, Medical College of Qingdao University
| | - Wei Gao
- Department of Radiology, Yantai Yuhuangding Hospital
| | - Xichun Sun
- Department of Radiology, Yantai Hospital of Traditional Chinese Medicine, Yantai, China
| | - Haizhu Xie
- Department of Radiology, Yantai Yuhuangding Hospital
| | - Gang Zhang
- Department of Radiology, Yantai Yuhuangding Hospital
| | - Jian Li
- Department of Radiology, Yantai Yuhuangding Hospital
| | - Honglun Li
- Department of Radiology, Yantai Yuhuangding Hospital
| | - Kefeng Li
- School of Medicine, University of California, San Diego, CA, USA
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