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Islam J, Rahman MT, Ali M, Kc E, Park YS. Potential hypothalamic mechanisms in trigeminal neuropathic pain: a comparative analysis with migraine and cluster headache. J Headache Pain 2024; 25:205. [PMID: 39587517 PMCID: PMC11587712 DOI: 10.1186/s10194-024-01914-z] [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: 09/26/2024] [Accepted: 11/15/2024] [Indexed: 11/27/2024] Open
Abstract
Trigeminal neuropathic pain (TNP), migraine, and cluster headache (CH) profoundly impact the quality of life and present significant clinical challenges due to their complex neurobiological underpinnings. This review delves into the pivotal role of the hypothalamus in the pathophysiology of these facial pain syndromes, highlighting its distinctive functions and potential as a primary target for research, diagnosis, and therapy. While the involvement of the hypothalamus in migraine and CH has been increasingly supported by imaging and clinical studies, the precise mechanisms of its role remain under active investigation. The role of the hypothalamus in TNP, in contrast, is less explored and represents a critical gap in our understanding. The hypothalamus's involvement varies significantly across these conditions, orchestrating a unique interplay of neural circuits and neurotransmitter systems that underlie the distinct characteristics of each pain type. We have explored advanced neuromodulation techniques, such as deep brain stimulation (DBS) and optogenetics, which show promise in targeting hypothalamic dysfunction to alleviate pain symptoms. Furthermore, we discuss the neuroplastic changes within the hypothalamus that contribute to the chronicity of these pains and the implications of these findings for developing targeted therapies. By offering a comprehensive examination of the hypothalamus's roles, this paper aims to bridge existing knowledge gaps and propel forward the understanding and management of facial neuralgias, underscoring the hypothalamus's critical position in future neurological research.
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Affiliation(s)
- Jaisan Islam
- Department of Medical Neuroscience, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Md Taufiqur Rahman
- Department of Medical Neuroscience, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
- Department of Neurosurgery, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Muhammad Ali
- Department of Medical Neuroscience, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Elina Kc
- Department of Neuroscience and Regenerative Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - Young Seok Park
- Department of Medical Neuroscience, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea.
- Department of Neurosurgery, Chungbuk National University Hospital, Cheongju, Republic of Korea.
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2
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May A. Beyond aura: Understanding migraine as a cycling pan-sensory threshold disease. Headache 2024; 64:715-717. [PMID: 38779974 DOI: 10.1111/head.14736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 05/25/2024]
Affiliation(s)
- Arne May
- Department of Systems Neuroscience, University Medical Center Hamburg Eppendorf, Hamburg, Germany
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3
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Davidson TL, Stevenson RJ. Vulnerability of the Hippocampus to Insults: Links to Blood-Brain Barrier Dysfunction. Int J Mol Sci 2024; 25:1991. [PMID: 38396670 PMCID: PMC10888241 DOI: 10.3390/ijms25041991] [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: 01/03/2024] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024] Open
Abstract
The hippocampus is a critical brain substrate for learning and memory; events that harm the hippocampus can seriously impair mental and behavioral functioning. Hippocampal pathophysiologies have been identified as potential causes and effects of a remarkably diverse array of medical diseases, psychological disorders, and environmental sources of damage. It may be that the hippocampus is more vulnerable than other brain areas to insults that are related to these conditions. One purpose of this review is to assess the vulnerability of the hippocampus to the most prevalent types of insults in multiple biomedical domains (i.e., neuroactive pathogens, neurotoxins, neurological conditions, trauma, aging, neurodegenerative disease, acquired brain injury, mental health conditions, endocrine disorders, developmental disabilities, nutrition) and to evaluate whether these insults affect the hippocampus first and more prominently compared to other brain loci. A second purpose is to consider the role of hippocampal blood-brain barrier (BBB) breakdown in either causing or worsening the harmful effects of each insult. Recent research suggests that the hippocampal BBB is more fragile compared to other brain areas and may also be more prone to the disruption of the transport mechanisms that act to maintain the internal milieu. Moreover, a compromised BBB could be a factor that is common to many different types of insults. Our analysis indicates that the hippocampus is more vulnerable to insults compared to other parts of the brain, and that developing interventions that protect the hippocampal BBB may help to prevent or ameliorate the harmful effects of many insults on memory and cognition.
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Affiliation(s)
- Terry L. Davidson
- Department of Neuroscience, Center for Neuroscience and Behavior, American University, 4400 Massachusetts Avenue, NW, Washington, DC 20016, USA
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4
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Chong CD, Nikolova J, Dumkrieger GM. Migraine and Posttraumatic Headache: Similarities and Differences in Brain Network Connectivity. Semin Neurol 2022; 42:441-448. [PMID: 36323298 DOI: 10.1055/s-0042-1757929] [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: 06/16/2023]
Abstract
Posttraumatic headache (PTH) is the most common symptom following mild traumatic brain injury (mTBI) (also known as concussion). Migraine and PTH have similar phenotypes, and a migraine-like phenotype is common in PTH. The similarities between both headache types are intriguing and challenge a better understanding of the pathophysiological commonalities involved in migraine and PTH due to mTBI. Here, we review the PTH resting-state functional connectivity literature and compare it to migraine to assess overlap and differences in brain network function between both headache types. Migraine and PTH due to mTBI have overlapping and disease-specific widespread alterations of static and dynamic functional networks involved in pain processing as well as dysfunctional network connections between frontal regions and areas of pain modulation and pain inhibition. Although the PTH functional network literature is still limited, there is some evidence that dysregulation of the top-down pain control system underlies both migraine and PTH. However, disease-specific differences in the functional circuitry are observed as well, which may reflect unique differences in brain architecture and pathophysiology underlying both headache disorders.
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5
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Kamm K. CGRP and Migraine: What Have We Learned From Measuring CGRP in Migraine Patients So Far? Front Neurol 2022; 13:930383. [PMID: 35968305 PMCID: PMC9363780 DOI: 10.3389/fneur.2022.930383] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 06/21/2022] [Indexed: 11/13/2022] Open
Abstract
The multi-functional neuropeptide calcitonin gene-related peptide (CGRP) plays a major role in the pathophysiology of migraine. The detection of elevated CGRP levels during acute migraine headache was the first evidence of the importance of the peptide. Since then, elevated CGRP levels have been detected not only during spontaneous and experimentally induced migraine attacks but also interictally. However, the detection of CGRP in peripheral blood shows conflicting results. In this respect, alternative detection methods are needed and have been already proposed. This article summarizes what we have learned from studies investigating CGRP in jugular and peripheral blood and reviews the latest state of research concerning the detection of CGRP in saliva and tear fluid as well as their contribution to our understanding of migraine pathophysiology.
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Gossrau G, Frost M, Klimova A, Koch T, Sabatowski R, Mignot C, Haehner A. Interictal osmophobia is associated with longer migraine disease duration. J Headache Pain 2022; 23:81. [PMID: 35840888 PMCID: PMC9284850 DOI: 10.1186/s10194-022-01451-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/01/2022] [Indexed: 11/20/2022] Open
Abstract
Background Sensitization to sensory stimuli is an essential feature of migraine attacks. The relationship between the clinical course of migraine and increased sensitivity to olfactory stimuli has been little studied so far. Methods We analyzed the frequency and quality of osmophobia depending on the phase of migraine in patients with episodic and chronic migraine treated in an tertiary headache center with regard to gender, age, medical history and migraine disability assessment score (MIDAS). Standardized diagnostic questions were used for the assessment of osmophobia. Results In our cross-sectional investigation (n = 113), 38.1% of the patients showed an increased preictal hypersensitivity to odors, whereas 61.9% described ictal and 31.9% interictal hypersensitivity to odors, odor-triggered migraine was described in 30.1%. Median migraine disease duration has been statistically significantly longer in patients who suffered from interictal hypersensitivity to odors (28.5 years vs. 20 years; p = 0.012). There was a significant correlation between interictal hypersensitivity and higher age (54.50 vs. 45; p = 0.015). Patients with higher migraine disability in MIDAS experienced more frequently preictal and interictal olfactory sensitization and odor triggered migraine attacks. Conclusions In patients with longer migraine disease duration and higher migraine-related impairment, osmophobia was more frequently observed. These results might support the hypothesis of increasing sensitization with increasing burden of migraine.
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Affiliation(s)
- Gudrun Gossrau
- University Pain Center Dresden, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Marie Frost
- University Pain Center Dresden, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Anna Klimova
- NCT Partner Site Dresden, Institute for Medical Informatics and Biometrics, Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Thea Koch
- Department of Anesthesiology and Intensive Care Medicine, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Rainer Sabatowski
- University Pain Center Dresden, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Germany.,Department of Anesthesiology and Intensive Care Medicine, University Hospital and Faculty of Medicine Carl Gustav Carus, TU Dresden, Dresden, Germany
| | - Coralie Mignot
- Department of Otorhinolaryngology, Smell & Taste Clinic, TU Dresden, Dresden, Germany
| | - Antje Haehner
- Department of Otorhinolaryngology, Smell & Taste Clinic, TU Dresden, Dresden, Germany
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Giniatullin R. 5-hydroxytryptamine in migraine: The puzzling role of ionotropic 5-HT 3 receptor in the context of established therapeutic effect of metabotropic 5-HT 1 subtypes. Br J Pharmacol 2021; 179:400-415. [PMID: 34643938 DOI: 10.1111/bph.15710] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 09/27/2021] [Accepted: 09/28/2021] [Indexed: 12/16/2022] Open
Abstract
5-hydroxytryptamine (5-HT; serotonin) is traditionally considered as a key mediator implicated in migraine. Multiple 5-HT receptor subtypes contribute to a variety of region-specific functional effects. The raphé nuclei control nociceptive inputs by releasing 5-HT in the brainstem, whereas dural mast cells provide the humoral source of 5-HT in the meninges. Triptans (5-HT1B/D agonists) and ditans (5-HT1F agonists) are the best established 5-HT anti-migraine agents. However, activation of meningeal afferents via ionotropic 5-HT3 receptors results in long-lasting excitatory drive suggesting a pro-nociceptive role for these receptors in migraine. Nevertheless, clinical data do not clearly support the applicability of currently available 5-HT3 antagonists to migraine treatment. The reasons for this might be the presence of 5-HT3 receptors on inhibitory interneurons dampening the excitatory drive, a lack of 5-HT3 A-E subunit-selective antagonists and gender/age-dependent effects. This review is focusing on the controversial role of 5-HT3 receptors in migraine pathology and related pharmacological perspectives of 5-HT ligands.
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Affiliation(s)
- Rashid Giniatullin
- A.I. Virtanen Institute for Molecular Sciences, University of Eastern Finland, Kuopio, Finland.,Laboratory of Neurobiology, Kazan Federal University, Kazan, Russia
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8
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Hormonal influences in migraine - interactions of oestrogen, oxytocin and CGRP. Nat Rev Neurol 2021; 17:621-633. [PMID: 34545218 DOI: 10.1038/s41582-021-00544-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 02/07/2023]
Abstract
Migraine is ranked as the second highest cause of disability worldwide and the first among women aged 15-49 years. Overall, the incidence of migraine is threefold higher among women than men, though the frequency and severity of attacks varies during puberty, the menstrual cycle, pregnancy, the postpartum period and menopause. Reproductive hormones are clearly a key influence in the susceptibility of women to migraine. A fall in plasma oestrogen levels can trigger attacks of migraine without aura, whereas higher oestrogen levels seem to be protective. The basis of these effects is unknown. In this Review, we discuss what is known about sex hormones and their receptors in migraine-related areas in the CNS and the peripheral trigeminovascular pathway. We consider the actions of oestrogen via its multiple receptor subtypes and the involvement of oxytocin, which has been shown to prevent migraine attacks. We also discuss possible interactions of these hormones with the calcitonin gene-related peptide (CGRP) system in light of the success of anti-CGRP treatments. We propose a simple model to explain the hormone withdrawal trigger in menstrual migraine, which could provide a foundation for improved management and therapy for hormone-related migraine in women.
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9
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Klein A, Schankin CJ. Visual snow syndrome, the spectrum of perceptual disorders, and migraine as a common risk factor: A narrative review. Headache 2021; 61:1306-1313. [PMID: 34570907 PMCID: PMC9293285 DOI: 10.1111/head.14213] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/06/2021] [Accepted: 08/19/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The aim of this narrative review is to explore the relationship between visual snow syndrome (VSS), migraine, and a group of other perceptual disorders. BACKGROUND VSS is characterized by visual snow and additional visual and nonvisual disturbances. The clinical picture suggests a hypersensitivity to internal and external stimuli. Imaging and electrophysiological findings indicate a hyperexcitability of the primary and secondary visual areas of the brain possibly due to an impairment of inhibitory feedback mechanisms. Migraine is the most frequent comorbidity. Epidemiological and clinical studies indicate that other perceptual disorders, such as tinnitus, fibromyalgia, and dizziness, are associated with VSS. Clinical overlaps and parallels in pathophysiology might exist in relation to migraine. METHODS We performed a PubMed and Google Scholar search with the following terms: visual snow syndrome, entoptic phenomenon, fibromyalgia, tinnitus, migraine, dizziness, persistent postural-perceptual dizziness (PPPD), comorbidities, symptoms, pathophysiology, thalamus, thalamocortical dysrhythmia, and salience network. RESULTS VSS, fibromyalgia, tinnitus, and PPPD share evidence of a central disturbance in the processing of different stimuli (visual, somatosensory/pain, acoustic, and vestibular) that might lead to hypersensitivity. Imaging and electrophysiological findings hint toward network disorders involving the sensory networks and other large-scale networks involved in the management of attention and emotional processing. There are clinical and epidemiological overlaps between these disorders. Similarly, migraine exhibits a multisensory hypersensitivity even in the interictal state with fluctuation during the migraine cycle. All the described perceptual disorders are associated with migraine suggesting that having migraine, that is, a disorder of sensory processing, is a common link. CONCLUSION VSS, PPPD, fibromyalgia, and chronic tinnitus might lie on a spectrum of perceptual disorders with similar pathophysiological mechanisms and the common risk factor migraine. Understanding the underlying network disturbances might give insights into how to improve these currently very difficult to treat conditions.
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Affiliation(s)
- Antonia Klein
- Department of NeurologyInselspitalBern University HospitalUniversity of BernBernSwitzerland
| | - Christoph J. Schankin
- Department of NeurologyInselspitalBern University HospitalUniversity of BernBernSwitzerland
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10
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Abstract
BACKGROUND Pain has been qualified under four categories: nociception, perception of pain, suffering, and pain behaviors. Most of the literature on migraine has devoted attention to the first two. The aim of the present cohort study was to investigate patients with migraine enrolled at a tertiary care unit to study suffering and mental pain and identify potential risk factors for migraine. METHODS An observational cross-sectional study was carried out on patients with chronic migraine (CM) and episodic migraine (EM), and healthy subjects (HS). The three groups were matched for age and sex. A comprehensive assessment of migraine disability, pain, psychiatric disorders, psychosomatic syndromes, depressive and anxious symptoms, euthymia, psychosocial variables, mental pain, and pain-proneness (PP) was performed. RESULTS Three hundred subjects were enrolled (100 CM, 100 EM, and 100 HS). Based on the multiple regression analyses, those presenting PP (social impairment: odds ratio [OR] = 3.59, 95% confidence interval [CI] = 1.14-11.29; depressive symptoms: OR = 3.82, 95% CI = 1.74-8.41) were more likely to be CM than HS. Those with higher levels of PP (social impairment: OR = 4.04, 95% CI = 1.60-10.22; depressive symptoms: OR = 2.02, 95% CI = 1.26-3.24) were more likely to be EM than HS. Those presenting higher levels of mental pain were more likely to be CM than EM (OR = 1.45, 95% CI = 1.02-2.07). CONCLUSION Migraine is an unpleasant sensory and emotional experience associated with psychosocial manifestations that might contribute to the level of suffering of the individuals. Mental pain resulted to be the variable that most differentiated patients with CM from EM.
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11
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Bauer PR, Tolner EA, Keezer MR, Ferrari MD, Sander JW. Headache in people with epilepsy. Nat Rev Neurol 2021; 17:529-544. [PMID: 34312533 DOI: 10.1038/s41582-021-00516-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 02/06/2023]
Abstract
Epidemiological estimates indicate that individuals with epilepsy are more likely to experience headaches, including migraine, than individuals without epilepsy. Headaches can be temporally unrelated to seizures, or can occur before, during or after an episode; seizures and migraine attacks are mostly not temporally linked. The pathophysiological links between headaches (including migraine) and epilepsy are complex and have not yet been fully elucidated. Correct diagnoses and appropriate treatment of headaches in individuals with epilepsy is essential, as headaches can contribute substantially to disease burden. Here, we review the insights that have been made into the associations between headache and epilepsy over the past 5 years, including information on the pathophysiological mechanisms and genetic variants that link the two disorders. We also discuss the current best practice for the management of headaches co-occurring with epilepsy and highlight future challenges for this area of research.
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Affiliation(s)
- Prisca R Bauer
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Freiburg, Freiburg, Germany.
| | - Else A Tolner
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands.,Department of Human Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Mark R Keezer
- Research Centre of the Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,School of Public Health, Université de Montréal, Montreal, Quebec, Canada.,Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands
| | - Michel D Ferrari
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Josemir W Sander
- Stichting Epilepsie Instellingen Nederland, Heemstede, The Netherlands.,NIHR University College London Hospitals Biomedical Research Centre, UCL Queen Square Institute of Neurology, London, UK.,Chalfont Centre for Epilepsy, Chalfont St Peter, UK
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12
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Freitag FG. Headache Medicine Grand Challenge: Headache: A New Frontier, A New Challenge. FRONTIERS IN PAIN RESEARCH 2021; 2:690683. [PMID: 35295521 PMCID: PMC8915632 DOI: 10.3389/fpain.2021.690683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 06/04/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Frederick G. Freitag
- Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, United States
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13
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Wang L, Cai XT, Zu MD, Zhang J, Deng ZR, Wang Y. Decreased Resting-State Functional Connectivity of Periaqueductal Gray in Temporal Lobe Epilepsy Comorbid With Migraine. Front Neurol 2021; 12:636202. [PMID: 34122295 PMCID: PMC8189422 DOI: 10.3389/fneur.2021.636202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Accepted: 04/15/2021] [Indexed: 11/29/2022] Open
Abstract
Objective: Patients with temporal lobe epilepsy (TLE) are at high risk for having a comorbid condition of migraine, and these two common diseases are proposed to have some shared pathophysiological mechanisms. Our recent study indicated the dysfunction of periaqueductal gray (PAG), a key pain-modulating structure, contributes to the development of pain hypersensitivity and epileptogenesis in epilepsy. This study is to investigate the functional connectivity of PAG network in epilepsy comorbid with migraine. Methods: Thirty-two patients with TLE, including 16 epilepsy patients without migraine (EwoM) and 16 epilepsy patients with comorbid migraine (EwM), and 14 matched healthy controls (HCs) were recruited and underwent resting functional magnetic resonance imaging (fMRI) scans to measure the resting-state functional connectivity (RsFC) of PAG network. The frequency and severity of migraine attacks were assessed using the Migraine Disability Assessment Questionnaire (MIDAS) and Visual Analog Scale/Score (VAS). In animal experiments, FluoroGold (FG), a retrograde tracing agent, was injected into PPN and its fluorescence detected in vlPAG to trace the neuronal projection from vlPAG to PPN. FG traced neuron number was used to evaluate the neural transmission activity of vlPAG-PPN pathway. The data were processed and analyzed using DPARSF and SPSS17.0 software. Based on the RsFC finding, the excitatory transmission of PAG and the associated brain structure was studied via retrograde tracing in combination with immunohistochemical labeling of excitatory neurons. Results: Compared to HCs group, the RsFC between PAG and the left pedunculopontine nucleus (PPN), between PAG and the corpus callosum (CC), was decreased both in EwoM and EwM group, while the RsFC between PAG and the right PPN was increased only in EwoM group but not in EwM group. Compared to EwoM group, the RsFC between PAG and the right PPN was decreased in EwM group. Furthermore, the RsFC between PAG and PPN was negatively correlated with the frequency and severity of migraine attacks. In animal study, a seizure stimulation induced excitatory transmission from PAG to PPN was decreased in rats with chronic epilepsy as compared to that in normal control rats. Conclusion: The comorbidity of epilepsy and migraine is associated with the decreased RsFC between PAG and PPN.
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Affiliation(s)
- Long Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.,Department of Neurology, The Second People Hospital of Hefei, Hefei, China
| | - Xin-Ting Cai
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Mei-Dan Zu
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Juan Zhang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Zi-Ru Deng
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yu Wang
- Department of Neurology, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Martinelli D, Castellazzi G, De Icco R, Bacila A, Allena M, Faggioli A, Sances G, Pichiecchio A, Borsook D, Gandini Wheeler-Kingshott CAM, Tassorelli C. Thalamocortical Connectivity in Experimentally-Induced Migraine Attacks: A Pilot Study. Brain Sci 2021; 11:165. [PMID: 33514029 PMCID: PMC7911420 DOI: 10.3390/brainsci11020165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/19/2021] [Accepted: 01/20/2021] [Indexed: 11/17/2022] Open
Abstract
In this study we used nitroglycerin (NTG)-induced migraine attacks as a translational human disease model. Static and dynamic functional connectivity (FC) analyses were applied to study the associated functional brain changes. A spontaneous migraine-like attack was induced in five episodic migraine (EM) patients using a NTG challenge. Four task-free functional magnetic resonance imaging (fMRI) scans were acquired over the study: baseline, prodromal, full-blown, and recovery. Seed-based correlation analysis (SCA) was applied to fMRI data to assess static FC changes between the thalamus and the rest of the brain. Wavelet coherence analysis (WCA) was applied to test time-varying phase-coherence changes between the thalamus and salience networks (SNs). SCA results showed significantly FC changes between the right thalamus and areas involved in the pain circuits (insula, pons, cerebellum) during the prodromal phase, reaching its maximal alteration during the full-blown phase. WCA showed instead a loss of synchronisation between thalami and SN, mainly occurring during the prodrome and full-blown phases. These findings further support the idea that a temporal change in thalamic function occurs over the experimentally induced phases of NTG-induced headache in migraine patients. Correlation of FC changes with true clinical phases in spontaneous migraine would validate the utility of this model.
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Affiliation(s)
- Daniele Martinelli
- Headache Science Center, IRCCS Mondino Foundation, 27100 Pavia, Italy; (R.D.I.); (M.A.); (G.S.); (C.T.)
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (A.P.); (C.A.M.G.W.-K.)
| | - Gloria Castellazzi
- NMR Research Unit Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, London WC1N3BG, UK;
- Department of Electrical Computer and Biomedical Engineering, University of Pavia, 27100 Pavia, Italy
- IRCCS Mondino Foundation, 27100 Pavia, Italy
| | - Roberto De Icco
- Headache Science Center, IRCCS Mondino Foundation, 27100 Pavia, Italy; (R.D.I.); (M.A.); (G.S.); (C.T.)
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (A.P.); (C.A.M.G.W.-K.)
| | - Ana Bacila
- Center of Advance Imaging and Radiomics, IRCCS Mondino Foundation, 27100 Pavia, Italy; (A.B.); (A.F.)
| | - Marta Allena
- Headache Science Center, IRCCS Mondino Foundation, 27100 Pavia, Italy; (R.D.I.); (M.A.); (G.S.); (C.T.)
| | - Arianna Faggioli
- Center of Advance Imaging and Radiomics, IRCCS Mondino Foundation, 27100 Pavia, Italy; (A.B.); (A.F.)
| | - Grazia Sances
- Headache Science Center, IRCCS Mondino Foundation, 27100 Pavia, Italy; (R.D.I.); (M.A.); (G.S.); (C.T.)
| | - Anna Pichiecchio
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (A.P.); (C.A.M.G.W.-K.)
- Center of Advance Imaging and Radiomics, IRCCS Mondino Foundation, 27100 Pavia, Italy; (A.B.); (A.F.)
| | - David Borsook
- Centre for Pain and The Brain Boston Children’s Hospital and Massachussetts General Hospital (MGH) Harvard Medical School, Boston, MA 02115, USA;
| | - Claudia A. M. Gandini Wheeler-Kingshott
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (A.P.); (C.A.M.G.W.-K.)
- NMR Research Unit Queen Square MS Centre, Department of Neuroinflammation, UCL Institute of Neurology, Faculty of Brain Sciences, London WC1N3BG, UK;
| | - Cristina Tassorelli
- Headache Science Center, IRCCS Mondino Foundation, 27100 Pavia, Italy; (R.D.I.); (M.A.); (G.S.); (C.T.)
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (A.P.); (C.A.M.G.W.-K.)
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González-Hernández A, Condés-Lara M, García-Boll E, Villalón CM. An outlook on the trigeminovascular mechanisms of action and side effects concerns of some potential neuropeptidergic antimigraine therapies. Expert Opin Drug Metab Toxicol 2021; 17:179-199. [DOI: 10.1080/17425255.2021.1856366] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | - Miguel Condés-Lara
- Instituto de Neurobiología, Universidad Nacional Autónoma de México, Querétaro, México
| | - Enrique García-Boll
- Instituto de Neurobiología, Universidad Nacional Autónoma de México, Querétaro, México
| | - Carlos M. Villalón
- Departamento de Farmacobiología, Cinvestav-Coapa, Ciudad de México, México
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16
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Ziegeler C, Mehnert J, Asmussen K, May A. Central effects of erenumab in migraine patients. Neurology 2020; 95:e2794-e2802. [DOI: 10.1212/wnl.0000000000010740] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 06/22/2020] [Indexed: 12/26/2022] Open
Abstract
ObjectiveTo determine whether erenumab, a new monoclonal antibody to the calcitonin gene-related peptide (CGRP) receptor, exerts functional central effects in migraineurs by performing functional imaging scans on patients treated with erenumab.MethodsWe conducted an fMRI study on 27 patients with migraine using a well-established trigeminal nociceptive paradigm, examining patients before and 2 weeks after administration of the CGRP receptor antibody erenumab 70 mg.ResultsComparing both visit days in all patients (n = 27) revealed that erenumab leads to a decrease in activation in the right thalamus (i.e., contralateral to the stimulated side), right middle temporal gyrus, right lingual gyrus, left operculum, and several clusters on both sides of the cerebellum. Furthermore, when responders (n = 9) and nonresponders (n = 8) of the respective same headache state were compared, we found a significant reduction of hypothalamic activation after the administration of erenumab in responders only (t = 4.78; contrast estimate 29.79 [90% confidence interval 19.53–40.05]). This finding of reduced hypothalamic activation was confirmed when absolute headache days was used as a regressor.InterpretationThese findings suggest that erenumab may not be an exclusively peripheral migraine treatment but has additional central effects. Whether this is due to secondary changes after peripheral modulation of sensory input or indeed represents a direct central mode of action is discussed.
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17
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von Deneen KM, Zhao L, Liu J. Individual differences of maladaptive brain changes in migraine and their relationship with differential effectiveness of treatments. BRAIN SCIENCE ADVANCES 2020. [DOI: 10.26599/bsa.2019.9050021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Migraine is a difficult disorder to identify with regard to its pathophysiological mechanisms, and its treatment has been primarily difficult owing to interindividual differences. Substantial rates of nonresponsiveness to medications are common, making migraine treatment complicated. In this review, we systematically analyzed recent studies concerning neuroimaging findings regarding the neurophysiology of migraine. We linked the current imaging research with anecdotal evidence from interindividual factors such as duration and pain intensity of migraine, age, gender, hormonal interplay, and genetics. These factors suggested the use of nonpharmacological therapies such as transcranial magnetic stimulation, transcranial direct current stimulation, and placebo therapy for the treatment of migraine. Finally, we discussed how interindividual differences are related to such nondrug treatments.
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Affiliation(s)
- Karen M. von Deneen
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi’an 710126, Shaanxi, China
- Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi’an 710126, Shaanxi, China
| | - Ling Zhao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu 610075, Sichuan, China
| | - Jixin Liu
- Center for Brain Imaging, School of Life Science and Technology, Xidian University, Xi’an 710126, Shaanxi, China
- Engineering Research Center of Molecular and Neuro Imaging, Ministry of Education, Xi’an 710126, Shaanxi, China
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18
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Altered structural brain network topology in chronic migraine. Brain Struct Funct 2019; 225:161-172. [DOI: 10.1007/s00429-019-01994-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 11/23/2019] [Indexed: 02/05/2023]
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19
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Dysregulation of multisensory processing stands out from an early stage of migraine: a study in pediatric patients. J Neurol 2019; 267:760-769. [DOI: 10.1007/s00415-019-09639-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 11/13/2019] [Accepted: 11/14/2019] [Indexed: 12/18/2022]
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20
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Chiarugi A. A Popperian View on Anti‐CGRP Biologics in Migraine. Headache 2019; 59:1855-1860. [DOI: 10.1111/head.13695] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2019] [Indexed: 12/23/2022]
Affiliation(s)
- Alberto Chiarugi
- Headache Center Careggi University Hospital University of Florence Florence Italy
- Department of Health Sciences Section of Clinical Pharmacology and Oncology University of Florence Florence Italy
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21
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Tolner EA, Chen SP, Eikermann-Haerter K. Current understanding of cortical structure and function in migraine. Cephalalgia 2019; 39:1683-1699. [PMID: 30922081 PMCID: PMC6859601 DOI: 10.1177/0333102419840643] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 02/28/2019] [Accepted: 03/04/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To review and discuss the literature on the role of cortical structure and function in migraine. DISCUSSION Structural and functional findings suggest that changes in cortical morphology and function contribute to migraine susceptibility by modulating dynamic interactions across cortical and subcortical networks. The involvement of the cortex in migraine is well established for the aura phase with the underlying phenomenon of cortical spreading depolarization, while increasing evidence suggests an important role for the cortex in perception of head pain and associated sensations. As part of trigeminovascular pain and sensory processing networks, cortical dysfunction is likely to also affect initiation of attacks. CONCLUSION Morphological and functional changes identified across cortical regions are likely to contribute to initiation, cyclic recurrence and chronification of migraine. Future studies are needed to address underlying mechanisms, including interactions between cortical and subcortical regions and effects of internal (e.g. genetics, gender) and external (e.g. sensory inputs, stress) modifying factors, as well as possible clinical and therapeutic implications.
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Affiliation(s)
- Else A Tolner
- Departments of Neurology and Human Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Shih-Pin Chen
- Insitute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei
- Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei
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22
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Altered Spontaneous Activity and Functional Connectivity in the Posterior Pons of Patients With Migraine Without Aura. THE JOURNAL OF PAIN 2019; 21:347-354. [PMID: 31400473 DOI: 10.1016/j.jpain.2019.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 06/03/2019] [Accepted: 08/02/2019] [Indexed: 01/20/2023]
Abstract
The brainstem has been discussed as the main player in the pathogenesis of migraine. Dysfunctional brainstem nuclei and their abnormal connections to other key brain centers may contribute to headache and other symptoms of migraine. In the present study, 32 patients with migraine without aura (MWoA) and 32 age- and sex-matched healthy controls (HCs) underwent resting-state fMRI scans. We used masked independent analysis (mICA) to investigate whether patients with MWoA exhibited abnormal brainstem nuclei-cortical functional connectivity (FC). The mICA can suppress adjacent physiological noise and prevent results from being driven by the much stronger signals of the surrounding structures. Regional homogeneity (ReHo) was used to investigate whether the brainstem regions with abnormal FC to other brain areas exhibited abnormal regional neuronal activity. Patients with MWoA showed significantly weaker FC between the posterior pons and the left superior parietal lobule, the left middle temporal gyrus, and the left middle frontal gyrus. Furthermore, patients with MWoA exhibited significantly decreased ReHo values in the posterior pons compared with HCs, and the posterior pons ReHo value was significantly negatively correlated with HIT-6 scores in the MWoA group. Patients with MWoA exhibited functional abnormalities in the posterior pons and weakened connections between the posterior pons and several key cortical brain areas involved in pain processing during the resting state. PERSPECTIVE: This study provided increased evidence that the pons is involved in the pathophysiological mechanism of migraine, and weakened connections suggest that the touch and pain sensation of migraine sufferers may not be properly relayed to cortical processing areas, which may be associated with the pathogenesis of MWoA.
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23
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Balkaya M, Seidel JL, Sadeghian H, Qin T, Chung DY, Eikermann-Haerter K, van den Maagdenberg AMJM, Ferrari MD, Ayata C. Relief Following Chronic Stress Augments Spreading Depolarization Susceptibility in Familial Hemiplegic Migraine Mice. Neuroscience 2019; 415:1-9. [PMID: 31299346 DOI: 10.1016/j.neuroscience.2019.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 06/29/2019] [Accepted: 07/01/2019] [Indexed: 11/25/2022]
Abstract
Cortical spreading depolarization (CSD) is the electrophysiological substrate of migraine aura, and a putative trigger of trigeminovascular activation and migraine headache. Many migraineurs report stress or relief after a stress triggers an attack. We tested whether various stress conditions might modulate CSD susceptibility and whether this is dependent on genetic factors. Male and female wild type and familial hemiplegic migraine type1 (FHM1) knock-in mice heterozygous for the S218L missense mutation were subjected to acute or chronic stress, or chronic stress followed by relief (36 h). Acute stress was induced by restraint and exposure to bright light and white noise (3 h). Chronic stress was induced for 28 days by two cycles of repeated exposure of mice to a rat (7 days), physical restraint (3 days), and forced swimming (3 days). Electrical CSD threshold and KCl-induced (300 mM) CSD frequency were determined in occipital cortex in vivo at the end of each protocol. Relief after chronic stress reduced the electrical CSD threshold and increased the frequency of KCl-induced CSDs in FHM1 mutants only. Acute or chronic stress without relief did not affect CSD susceptibility in either strain. Stress status did not affect CSD propagation speed, duration or amplitude. In summary, relief after chronic stress, but not acute or chronic stress alone, augments CSD in genetically susceptible mice. Therefore, enhanced CSD susceptibility may explain why, in certain patients, migraine attacks typically occur during a period of stress relief such as weekends or holidays.
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Affiliation(s)
- Mustafa Balkaya
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Jessica L Seidel
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Homa Sadeghian
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Tao Qin
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - David Y Chung
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Katharina Eikermann-Haerter
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA
| | - Arn M J M van den Maagdenberg
- Department of Neurology Leiden University Medical Center, Leiden 2300, RC, the Netherlands; Human Genetics, Leiden University Medical Center, Leiden 2300, RC, the Netherlands
| | - Michel D Ferrari
- Department of Neurology Leiden University Medical Center, Leiden 2300, RC, the Netherlands
| | - Cenk Ayata
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Charlestown, MA 02129, USA; Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02129, USA.
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Wang L, Shen J, Cai XT, Tao WW, Wan YD, Li DL, Tan XX, Wang Y. Ventrolateral Periaqueductal Gray Matter Neurochemical Lesion Facilitates Epileptogenesis and Enhances Pain Sensitivity in Epileptic Rats. Neuroscience 2019; 411:105-118. [PMID: 31158436 DOI: 10.1016/j.neuroscience.2019.05.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/13/2019] [Accepted: 05/15/2019] [Indexed: 12/31/2022]
Abstract
The ventrolateral periaqueductal gray matter (vlPAG) plays a critical role in the pathogenesis of migraine and few studies have shown that vlPAG might be involved in the pathophysiology of epilepsy. But its roles in epileptogenesis and comorbid relationship between migraine and epilepsy have never been reported. In this study, the impairments of vlPAG neuronal network during spontaneous recurrent seizure (SRS) development after status epilepticus (SE) were investigated, and the pain sensitivity as well as the SRS investigated after neurochemical lesion to vlPAG to determine the role of vlPAG in epileptogenesis and in migraine comorbidity with epilepsy. Neuronal loss and alterations of excitatory and inhibitory neural transmission within vlPAG accompanied the development of epileptogenesis induced by SE. On the other hand, neurochemical lesion to vlPAG enhanced frequency and duration of spontaneous seizure event and frequency of epileptiform inter-ictal spike discharges in electroencephalography (EEG), but decreased pain threshold in epileptic rats. This indicates an involvement of the pain regulating structure, vlPAG, in the pathogenesis of epilepsy. This may imply that vlPAG network alterations could be a possible underlying mechanism of the interactive comorbid relationship between epilepsy and migraine.
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Affiliation(s)
- Lei Wang
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Jie Shen
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Xin-Ting Cai
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Wei-Wei Tao
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Ya-Di Wan
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Dong-Lin Li
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Xiu-Xiu Tan
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China
| | - Yu Wang
- Department of Neurology, Epilepsy and Headache Group, the First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Hefei 230022, China; Department of Neurology, the Fourth Affiliated Hospital of Anhui Medical University, Huaihai Avenue 100, Hefei 230000, China.
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25
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Abstract
OBJECTIVE The goal of this narrative review is to provide an overview of migraine pathophysiology, with an emphasis on the role of calcitonin gene-related peptide (CGRP) within the context of the trigeminovascular system. BACKGROUND Migraine is a prevalent and disabling neurological disease that is characterized in part by intense, throbbing, and unilateral headaches. Despite recent advances in understanding its pathophysiology, migraine still represents an unmet medical need, as it is often underrecognized and undertreated. Although CGRP has been known to play a pivotal role in migraine for the last 2 decades, this has now received more interest spurred by the early clinical successes of drugs that block CGRP signaling in the trigeminovascular system. DESIGN This narrative review presents an update on the role of CGRP within the trigeminovascular system. PubMed searches were used to find recent (ie, 2016 to November 2018) published articles presenting new study results. Review articles are also included not as primary references but to bring these to the attention of the reader. Original research is referenced in describing the core of the narrative, and review articles are used to support ancillary points. RESULTS The trigeminal ganglion neurons provide the connection between the periphery, stemming from the interface between the primary afferent fibers of the trigeminal ganglion and the meningeal vasculature and the central terminals in the trigeminal nucleus caudalis. The neuropeptide CGRP is abundant in trigeminal ganglion neurons, and is released from the peripheral nerve and central nerve terminals as well as being secreted within the trigeminal ganglion. Release of CGRP from the peripheral terminals initiates a cascade of events that include increased synthesis of nitric oxide and sensitization of the trigeminal nerves. Secreted CGRP in the trigeminal ganglion interacts with adjacent neurons and satellite glial cells to perpetuate peripheral sensitization, and can drive central sensitization of the second-order neurons. A shift in central sensitization from activity-dependent to activity-independent central sensitization may indicate a mechanism driving the progression of episodic migraine to chronic migraine. The pathophysiology of cluster headache is much more obscure than that of migraine, but emerging evidence suggests that it may also involve hypersensitivity of the trigeminovascular system. Ongoing clinical studies with therapies targeted at CGRP will provide additional, valuable insights into the pathophysiology of this disorder. CONCLUSIONS CGRP plays an essential role in the pathophysiology of migraine. Treatments that interfere with the functioning of CGRP in the peripheral trigeminal system are effective against migraine. Blocking sensitization of the trigeminal nerve by attenuating CGRP activity in the periphery may be sufficient to block a migraine attack. Additionally, the potential exists that this therapeutic strategy may also alleviate cluster headache as well.
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Affiliation(s)
- Smriti Iyengar
- Eli Lilly and CompanyIndianapolisINUSA
- Present address:
Indiana University School of MedicineIndianapolisINUSA
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26
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Mehnert J, Bader D, Nolte G, May A. Visual input drives increased occipital responsiveness and harmonized oscillations in multiple cortical areas in migraineurs. NEUROIMAGE-CLINICAL 2019; 23:101815. [PMID: 30974326 PMCID: PMC6458451 DOI: 10.1016/j.nicl.2019.101815] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 03/29/2019] [Accepted: 04/02/2019] [Indexed: 12/12/2022]
Abstract
Migraineurs are hypersensitive for most sensory domains like visual, auditory or somatosensory processing even outside of attacks. This behavioral peculiarity is mirrored by findings of cortical hyper-responsivity already in the interictal state. Using repetitive visual stimulation to elicit steady state visually evoked potentials (SSVEP) in 30 interictal episodic migraineurs and 30 controls we show hyper-responsivity of the visual cortex in the migraineurs. Additionally, the occipital regions were remarkably stronger coupled to the temporal, premotor and the anterior cingulate cortex than in headache free controls. These data suggest harmonized oscillations of different cortical areas as a response to visual input which might be driven by the cuneus. Furthermore, the increased coupling is modulated by the current state of the migraine cycle as the coupling was significantly stronger in patients with longer interictal periods. Migraineurs visual cortex compared to controls is hyper-responsiveness in response to repetitive visual stimulation. The hyper-responsiveness is stronger coupled to temporal, premotor and anterior cingulate cortex than in controls. This increased coupling is modulated by the current state of the migraine cycle. Our data suggest that visual input in migraineurs leads to harmonized oscillations of multiple cortical areas.
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Affiliation(s)
- Jan Mehnert
- Department of Systems Neuroscience, University Medical Center Eppendorf, Hamburg, Germany
| | - Daniel Bader
- Department of Systems Neuroscience, University Medical Center Eppendorf, Hamburg, Germany
| | - Guido Nolte
- Department of Neurophysiology and Pathophysiology, University Medical Center Eppendorf, Hamburg, Germany
| | - Arne May
- Department of Systems Neuroscience, University Medical Center Eppendorf, Hamburg, Germany.
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27
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Abstract
The cerebellum plays an important role in pain processing but its function in headache and specifically in migraine is not known. We therefore compared 54 migraineurs with pairwise matched healthy controls in a magnetic resonance imaging study on neuronal cerebellar activity in response to nociceptive trigeminal sensation and also investigated possible structural alterations. Headache frequency, disease duration, and the proximity to a migraine attack were used as co-factors. Migraine patients showed functional and structural alterations in the posterior part of the cerebellum, namely crus I and crus II. Gray matter volume changes were seen on the right side whereas functional changes were ipsilateral to the stimulation, on the left side. Neuronal activity in the crus in response to trigeminal pain was modulated by migraine severity and the migraine phase. As the crus is strongly interconnected to higher cognitive areas in the temporal, frontal, and parietal part of the cortex our results suggest an specific cerebellar involvement in migraine. This is further supported by our finding of decreased connectivity from the crus to the thalamus and higher cortical areas in the patients. We therefore suggest an abnormally decreased inhibitory involvement of the migraine cerebellum on gating and nociceptive evaluation.
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Affiliation(s)
- Jan Mehnert
- 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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28
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Cuvellier JC. Pediatric vs. Adult Prodrome and Postdrome: A Window on Migraine Pathophysiology? Front Neurol 2019; 10:199. [PMID: 30930831 PMCID: PMC6423905 DOI: 10.3389/fneur.2019.00199] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 02/15/2019] [Indexed: 01/03/2023] Open
Abstract
Few studies have been conducted on the prodromal and postdromal phases of the migraine attack in children and adolescents. Using a questionnaire, we found that 67% of 103 children and adolescents with migraine reported at least one prodromal symptom, with a mean number per subject of 1.8 (median 2.2). The most frequently reported prodromal symptoms were face changes, fatigue and irritability. In pediatric patients selected as having prodrome, fatigue, mood change and neck stiffness were the most frequently reported prodromal symptoms. Using a different design, Laurell et al. found that 71% of 137 pediatric patients reported at least one prodromal symptom with a mean number per subject of 1.9 ± 2.0. Studying postdrome was fraught with unexpected difficulties as our preliminary research showed. Patients reported 2 groups of symptoms occurring during the resolution phase of the headache: symptoms whose onset was before headache cessation and were persisting after it, and symptoms whose onset was after headache cessation. We referred to the former as persistent symptoms and to the latter as true postdromes. Ninety-one per cent of patients reported persistent symptoms, with a mean of 6.0 and a median of 2, asthenia, pallor, cognitive difficulties, anorexia, somnolence, and nausea being the more frequently reported. True postdromes were reported by 82% of patients, with a mean of 2.6 and a median of 2, thirst, somnolence, visual disturbances, food craving, paraesthesias, and ocular pain being the most frequent reported. Interestingly, several prodromal and postdromal symptoms are also encountered during the aura classic and/or accompany the headache phase. Functional imaging in migraine has showed that the activations in areas such as hypothalamus or brainstem may begin before headache onset and/or persist after headache relief. Thus, one may wonder whether prodromal and postdromal symptoms may indicate the involvement of the limbic system, dopaminergic pathways, the hypothalamus and the brainstem. Differences between children, adolescents and adults might contribute to the understanding of migraine neurobiology.
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Affiliation(s)
- Jean-Christophe Cuvellier
- Division of Pediatric Neurology, Department of Pediatrics, Lille Faculty of Medicine and Children's Hospital, Lille, France
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29
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Burish MJ, Chen Z, Yoo SH. Emerging relevance of circadian rhythms in headaches and neuropathic pain. Acta Physiol (Oxf) 2019; 225:e13161. [PMID: 29969187 DOI: 10.1111/apha.13161] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Accepted: 06/29/2018] [Indexed: 12/13/2022]
Abstract
Circadian rhythms of physiology are the keys to health and fitness, as dysregulation, by genetic mutations or environmental factors, increases disease risk and aggravates progression. Molecular and physiological studies have shed important light on an intrinsic clock that drives circadian rhythms and serves essential roles in metabolic homoeostasis, organ physiology and brain functions. One exciting new area in circadian research is pain, including headache and neuropathic pain for which new mechanistic insights have recently emerged. For example, cluster headache is an intermittent pain disorder with an exceedingly precise circadian timing, and preliminary evidence is emerging linking several circadian components (eg, Clock and Nr1d1) with the disease. In this review, we first discuss the broad metabolic and physiological relevance of the circadian timing system. We then provide a detailed review of the circadian relevance in pain disease and physiology, including cluster headache, migraine, hypnic headache and neuropathic pain. Finally, we describe potential therapeutic implications, including existing pain medicines and novel clock-modulating compounds. The physiological basis for the circadian rhythms in pain is an exciting new area of research with profound basic and translational impact.
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Affiliation(s)
- Mark J. Burish
- Department of Neurosurgery; University of Texas Health Science Center at Houston; Houston Texas
| | - Zheng Chen
- Department of Biochemistry and Molecular Biology; University of Texas Health Science Center at Houston; Houston Texas
| | - Seung-Hee Yoo
- Department of Biochemistry and Molecular Biology; University of Texas Health Science Center at Houston; Houston Texas
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30
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Lambru G, Andreou AP, Guglielmetti M, Martelletti P. Emerging drugs for migraine treatment: an update. Expert Opin Emerg Drugs 2018; 23:301-318. [PMID: 30484333 DOI: 10.1080/14728214.2018.1552939] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Introduction: Migraine is a very frequent and disabling neurological disorder. The current treatment options are old, generally poorly tolerated and not migraine-specific, reflecting the low priority of migraine research and highlighting the vast unmet need in its management. Areas covered: Advancement in the understanding of migraine pathophysiological mechanisms and identification of novel potentially meaningful targets have resulted in a multitude of emerging acute and preventive treatments. Here we review the known putative migraine pathophysiological mechanisms in order to understand the rationale of the most promising novel treatments targeting the Calcitonin-Gene-Related Peptide receptor and ligand and the 5 hydroxytryptamine (5-HT)1F receptor. Key findings on the phase II and phase III clinical trials on these treatments will be summarized. Furthermore, a critical analysis on failed trials of potentially meaningful targets such the nitric oxide and the orexinergic pathways will be conducted. Future perspective will be outlined. Expert opinion: The recent approval of Erenumab and Fremanezumab is a major milestone in the therapy of migraine since the approval of triptans. Several more studies are needed to fully understand the clinical potential, long-term safety and cost-effectiveness of these therapies. This paramount achievement should stimulate the development of further research in the migraine field.
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Affiliation(s)
- Giorgio Lambru
- a The Headache Centre, Pain Management and Neuromodulation , Guy's and St Thomas NHS Foundation Trust , London , UK.,b The Wolfson CARD, Institute of Psychology, Psychiatry and Neuroscience , King's College London , London , UK
| | - Anna P Andreou
- a The Headache Centre, Pain Management and Neuromodulation , Guy's and St Thomas NHS Foundation Trust , London , UK.,b The Wolfson CARD, Institute of Psychology, Psychiatry and Neuroscience , King's College London , London , UK
| | - Martina Guglielmetti
- c Department of Clinical and Molecular Medicine , Sapienza" University, "Sant'Andrea" Hospital, Regional Referral Headache Centre , Rome , Italy
| | - Paolo Martelletti
- c Department of Clinical and Molecular Medicine , Sapienza" University, "Sant'Andrea" Hospital, Regional Referral Headache Centre , Rome , Italy
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31
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Changes in Brainstem Pain Modulation Circuitry Function over the Migraine Cycle. J Neurosci 2018; 38:10479-10488. [PMID: 30341182 DOI: 10.1523/jneurosci.1088-18.2018] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 09/23/2018] [Accepted: 09/25/2018] [Indexed: 02/06/2023] Open
Abstract
The neural mechanism responsible for migraine remains unclear. While an external trigger has been proposed to initiate a migraine, it has also been proposed that changes in brainstem function are critical for migraine headache initiation and maintenance. Although the idea of altered brainstem function has some indirect support, no study has directly measured brainstem pain modulation circuitry function in migraineurs particularly immediately before a migraine. In male and female humans, we performed fMRI in 31 controls and 31 migraineurs at various times in their migraine cycle. We measured brainstem function during noxious orofacial stimulation and assessed resting-state functional connectivity. First, we found that, in individual migraineurs, pain sensitivity increased over the interictal period but then dramatically decreased immediately before a migraine. Second, despite overall similar pain intensity ratings between groups, in the period immediately before a migraine, compared with controls and other migraine phases, migraineurs displayed greater activation in the spinal trigeminal nucleus during noxious orofacial stimulation and reduced functional connectivity of this region with the rostral ventromedial medulla. Additionally, during the interictal phase, migraineurs displayed reduced activation of the midbrain periaqueductal gray matter and enhanced periaqueductal gray connectivity with the rostral ventromedial medulla. These data support the hypothesis that brainstem sensitivity fluctuates throughout the migraine cycle. However, in contrast to the prevailing hypothesis, our data suggest that, immediately before a migraine attack, endogenous analgesic mechanisms are enhanced and incoming noxious inputs are less likely to reach higher brain centers.SIGNIFICANCE STATEMENT It has been hypothesized that alterations in brainstem function are critical for the generation of migraine. In particular, modulation of orofacial pain pathways by brainstem circuits alters the propensity of external triggers or ongoing spontaneous activity to evoke a migraine attack. We sought to obtain empirical evidence to support this theory. Contrary to our hypothesis, we found that pain sensitivity decreased immediately before a migraine, and this was coupled with increased sensitivity of the spinal trigeminal nucleus to noxious stimuli. We also found that resting connectivity within endogenous pain modulation circuitry alters across the migraine cycle. These changes may reflect enhanced and diminished neural tone states proposed to be critical for the generation of a migraine and underlie cyclic fluctuations in migraine brainstem sensitivity.
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Amin FM, Hougaard A, Magon S, Sprenger T, Wolfram F, Rostrup E, Ashina M. Altered thalamic connectivity during spontaneous attacks of migraine without aura: A resting-state fMRI study. Cephalalgia 2017; 38:1237-1244. [DOI: 10.1177/0333102417729113] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Functional connectivity of brain networks may be altered in migraine without aura patients. Functional magnetic resonance imaging (fMRI) studies have demonstrated changed activity in the thalamus, pons and cerebellum in migraineurs. Here, we investigated the thalamic, pontine and cerebellar network connectivity during spontaneous migraine attacks. Methods Seventeen patients with episodic migraine without aura underwent resting-state fMRI scan during and outside of a spontaneous migraine attack. Primary endpoint was a difference in functional connectivity between the attack and the headache-free days. Functional connectivity was assessed in four different networks using seed-based analysis. The chosen seeds were in the thalamus (MNI coordinates x,y,z: right, 22,–24,0 and left, –22,–28,6), pons (right, 8,–24,–32 and left, –8,–24,–32), cerebellum crus I (right, 46,–58,–30 and left, –46,–58,–30) and cerebellum lobule VI (right, 34,–42,–36 and left, –32,–42,–36). Results We found increased functional connectivity between the right thalamus and several contralateral brain regions (superior parietal lobule, insular cortex, primary motor cortex, supplementary motor area and orbitofrontal cortex). There was decreased functional connectivity between the right thalamus and three ipsilateral brain areas (primary somatosensory cortex and premotor cortex). We found no change in functional connectivity in the pontine or the cerebellar networks. Conclusions The study indicates that network connectivity between thalamus and pain modulating as well as pain encoding cortical areas are affected during spontaneous migraine attacks.
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Affiliation(s)
- Faisal Mohammad Amin
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anders Hougaard
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stefano Magon
- Department of Neurology and Medical Image Analysis Center, University Hospital, University of Basel, Basel, Switzerland
| | - Till Sprenger
- Department of Neurology, DKD Helios Klinik Wiesbaden, Wiesbaden, Germany
| | - Frauke Wolfram
- Department of Radiology, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Egill Rostrup
- Functional Imaging Unit, Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Messoud Ashina
- Danish Headache Center, Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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