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Ou Y, Ni X, Gao X, Yu Y, Zhang Y, Wang Y, Liu J, Yin Z, Rong J, Sun M, Chen J, Tang Z, Xiao W, Zhao L. Structural and functional changes of anterior cingulate cortex subregions in migraine without aura: relationships with pain sensation and pain emotion. Cereb Cortex 2024; 34:bhae040. [PMID: 38342690 PMCID: PMC10859245 DOI: 10.1093/cercor/bhae040] [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: 11/27/2023] [Revised: 01/19/2024] [Accepted: 01/20/2024] [Indexed: 02/13/2024] Open
Abstract
Migraine without aura is a multidimensional neurological disorder characterized by sensory, emotional, and cognitive symptoms linked to structural and functional abnormalities in the anterior cingulate cortex. Anterior cingulate cortex subregions play differential roles in the clinical symptoms of migraine without aura; however, the specific patterns and mechanisms remain unclear. In this study, voxel-based morphometry and seed-based functional connectivity were used to investigate structural and functional alterations in the anterior cingulate cortex subdivisions in 50 patients with migraine without aura and 50 matched healthy controls. Compared with healthy controls, patients exhibited (1) decreased gray matter volume in the subgenual anterior cingulate cortex, (2) increased functional connectivity between the bilateral subgenual anterior cingulate cortex and right middle frontal gyrus, and between the posterior part of anterior cingulate cortex and right middle frontal gyrus, orbital part, and (3) decreased functional connectivity between the anterior cingulate cortex and left anterior cingulate and paracingulate gyri. Notably, left subgenual anterior cingulate cortex was correlated with the duration of each attack, whereas the right subgenual anterior cingulate cortex was associated with migraine-specific quality-of-life questionnaire (emotion) and self-rating anxiety scale scores. Our findings provide new evidence supporting the hypothesis of abnormal anterior cingulate cortex subcircuitry, revealing structural and functional abnormalities in its subregions and emphasizing the potential involvement of the left subgenual anterior cingulate cortex-related pain sensation subcircuit and right subgenual anterior cingulate cortex -related pain emotion subcircuit in migraine.
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Affiliation(s)
- Yangxu Ou
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 1166, Liutai Avenue, Wenjiang District, Chengdu, Sichuan 611137, China
| | - Xixiu Ni
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 1166, Liutai Avenue, Wenjiang District, Chengdu, Sichuan 611137, China
| | - Xiaoyu Gao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 1166, Liutai Avenue, Wenjiang District, Chengdu, Sichuan 611137, China
| | - Yang Yu
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 1166, Liutai Avenue, Wenjiang District, Chengdu, Sichuan 611137, China
| | - Yutong Zhang
- Department of Scientific Research and Education and Training Management, the Third People’s Hospital of Chengdu, Chengdu, Sichuan 610000, China
| | - Yanan Wang
- Department of Pain Treatment, Chongqing Hospital of Traditional Chinese Medicine, Chongqing 400021, China
| | - Jie Liu
- Department of Neurology, Sichuan Provincial People’s Hospital, Chengdu, Sichuan 610072, China
| | - Zihan Yin
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 1166, Liutai Avenue, Wenjiang District, Chengdu, Sichuan 611137, China
| | - Jing Rong
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 1166, Liutai Avenue, Wenjiang District, Chengdu, Sichuan 611137, China
| | - Mingsheng Sun
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 1166, Liutai Avenue, Wenjiang District, Chengdu, Sichuan 611137, China
- Sichuan Clinical Medical Research Center for Acupuncture and Moxibustion, Chengdu, Sichuan 611137, China
| | - Jiao Chen
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 1166, Liutai Avenue, Wenjiang District, Chengdu, Sichuan 611137, China
- Sichuan Clinical Medical Research Center for Acupuncture and Moxibustion, Chengdu, Sichuan 611137, China
| | - Zili Tang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 1166, Liutai Avenue, Wenjiang District, Chengdu, Sichuan 611137, China
| | - Wang Xiao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 1166, Liutai Avenue, Wenjiang District, Chengdu, Sichuan 611137, China
| | - Ling Zhao
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, No. 1166, Liutai Avenue, Wenjiang District, Chengdu, Sichuan 611137, China
- Sichuan Clinical Medical Research Center for Acupuncture and Moxibustion, Chengdu, Sichuan 611137, China
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Zhong J, Xu J, Wang Z, Yang H, Li J, Yu H, Huang W, Wan C, Ma H, Zhang N. Changes in brain functional networks in remitted major depressive disorder: a six-month follow-up study. BMC Psychiatry 2023; 23:628. [PMID: 37641013 PMCID: PMC10464087 DOI: 10.1186/s12888-023-05082-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 08/06/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND Patients with remitted major depressive disorder (rMDD) show abnormal functional connectivity of the central executive network (CEN), salience networks (SN) and default mode network (DMN). It is unclear how these change during remission, or whether changes are related to function. METHODS Three spatial networks in 17 patients with rMDD were compared between baseline and the six-month follow-up, and to 22 healthy controls. Correlations between these changes and psychosocial functioning were also assessed. RESULTS In the CEN, patients at baseline had abnormal functional connectivity in the right anterior cingulate, right dorsolateral prefrontal cortex (DLPFC) and inferior parietal lobule (IPL) compare with HCs. There were functional connection differences in the right DLPFC and left IPL at baseline during follow-up. Abnormal connectivity in the right DLPFC and medial prefrontal cortex (mPFC) were found at follow-up. In the SN, patients at baseline had abnormal functional connectivity in the insula, left anterior cingulate, left IPL, and right precuneus; compared with baseline, patients had higher connectivity in the right DLPFC at follow-up. In the DMN, patients at baseline had abnormal functional connectivity in the right mPFC. Resting-state functional connectivity of the IPL and DLPFC in the CEN correlated with psychosocial functioning. CONCLUSIONS At six-month follow-up, the CEN still showed abnormal functional connectivity in those with rMDD, while anomalies in the SN and DMN has disappeared. Resting-state functional connectivity of the CEN during early rMDD is associated with psychosocial function. CLINICAL TRIALS REGISTRATION Pharmacotherapy and Psychotherapy for MDD after Remission on Psychology and Neuroimaging. https://www. CLINICALTRIALS gov/ , registration number: NCT01831440 (15/4/2013).
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Affiliation(s)
- Jiaqi Zhong
- Affiliated Nanjing Brain Hospital of Nanjing Medical University, No.264 Guangzhou Street, Gulou District, Nanjing, 210029, Jiangsu, China
- Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Jingren Xu
- Affiliated Nanjing Brain Hospital of Nanjing Medical University, No.264 Guangzhou Street, Gulou District, Nanjing, 210029, Jiangsu, China
| | - Zhenzhen Wang
- Affiliated Nanjing Brain Hospital of Nanjing Medical University, No.264 Guangzhou Street, Gulou District, Nanjing, 210029, Jiangsu, China
- School of psychological and cognitive sciences, Peking University, Beijing, 100871, China
| | - Hao Yang
- Affiliated Nanjing Brain Hospital of Nanjing Medical University, No.264 Guangzhou Street, Gulou District, Nanjing, 210029, Jiangsu, China
| | - Jiawei Li
- Affiliated Nanjing Brain Hospital of Nanjing Medical University, No.264 Guangzhou Street, Gulou District, Nanjing, 210029, Jiangsu, China
| | - Haoran Yu
- Affiliated Nanjing Brain Hospital of Nanjing Medical University, No.264 Guangzhou Street, Gulou District, Nanjing, 210029, Jiangsu, China
| | - Wenyan Huang
- Affiliated Nanjing Brain Hospital of Nanjing Medical University, No.264 Guangzhou Street, Gulou District, Nanjing, 210029, Jiangsu, China
| | - Cheng Wan
- Department of Medical Informatic, School of Biomedical Engineering and Informatics, Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Hui Ma
- Affiliated Nanjing Brain Hospital of Nanjing Medical University, No.264 Guangzhou Street, Gulou District, Nanjing, 210029, Jiangsu, China.
| | - Ning Zhang
- Affiliated Nanjing Brain Hospital of Nanjing Medical University, No.264 Guangzhou Street, Gulou District, Nanjing, 210029, Jiangsu, China.
- Functional Brain Imaging Institute of Nanjing Medical University, Nanjing, 210029, Jiangsu, China.
- Cognitive Behavioral Therapy Institute of Nanjing Medical University, Nanjing, 210029, Jiangsu, China.
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Wen J, Gao Y, Li M, Hu S, Zhao M, Su C, Wang Q, Xi H, Zhan L, Lv Y, Antwi CO, Ren J, Jia X. Regional abnormalities of spontaneous brain activity in migraine: A coordinate‐based meta‐analysis. J Neurosci Res 2023. [DOI: 10.1002/jnr.25191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/17/2023] [Accepted: 03/13/2023] [Indexed: 04/03/2023]
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Schramm S, Börner C, Reichert M, Baum T, Zimmer C, Heinen F, Bonfert MV, Sollmann N. Functional magnetic resonance imaging in migraine: A systematic review. Cephalalgia 2023; 43:3331024221128278. [PMID: 36751858 DOI: 10.1177/03331024221128278] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Migraine is a highly prevalent primary headache disorder. Despite a high burden of disease, key disease mechanisms are not entirely understood. Functional magnetic resonance imaging is an imaging method using the blood-oxygen-level-dependent signal, which has been increasingly used in migraine research over recent years. This systematic review summarizes recent findings employing functional magnetic resonance imaging for the investigation of migraine. METHODS We conducted a systematic search and selection of functional magnetic resonance imaging applications in migraine from April 2014 to December 2021 (PubMed and references of identified articles according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines). Methodological details and main findings were extracted and synthesized. RESULTS Out of 224 articles identified, 114 were included after selection. Repeatedly emerging structures of interest included the insula, brainstem, limbic system, hypothalamus, thalamus, and functional networks. Assessment of functional brain changes in response to treatment is emerging, and machine learning has been used to investigate potential functional magnetic resonance imaging-based markers of migraine. CONCLUSIONS A wide variety of functional magnetic resonance imaging-based metrics were found altered across the brain for heterogeneous migraine cohorts, partially correlating with clinical parameters and supporting the concept to conceive migraine as a brain state. However, a majority of findings from previous studies have not been replicated, and studies varied considerably regarding image acquisition and analyses techniques. Thus, while functional magnetic resonance imaging appears to have the potential to advance our understanding of migraine pathophysiology, replication of findings in large representative datasets and precise, standardized reporting of clinical data would likely benefit the field and further increase the value of observations.
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Affiliation(s)
- Severin Schramm
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Corinna Börner
- LMU Hospital, Dr. von Hauner Children's Hospital, Department of Pediatric Neurology and Developmental Medicine, Munich, Germany.,LMU Center for Children with Medical Complexity, iSPZ Hauner, Ludwig Maximilian University, Munich, Germany
| | - Miriam Reichert
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Florian Heinen
- LMU Hospital, Dr. von Hauner Children's Hospital, Department of Pediatric Neurology and Developmental Medicine, Munich, Germany
| | - Michaela V Bonfert
- LMU Hospital, Dr. von Hauner Children's Hospital, Department of Pediatric Neurology and Developmental Medicine, Munich, Germany.,LMU Center for Children with Medical Complexity, iSPZ Hauner, Ludwig Maximilian University, Munich, Germany
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany.,Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
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5
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Markin K, Trufanov A, Frunza D, Litvinenko I, Tarumov D, Krasichkov A, Polyakova V, Efimtsev A, Medvedev D. fMRI Findings in Cortical Brain Networks Interactions in Migraine Following Repetitive Transcranial Magnetic Stimulation. Front Neurol 2022; 13:915346. [PMID: 35800086 PMCID: PMC9253380 DOI: 10.3389/fneur.2022.915346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/12/2022] [Indexed: 11/21/2022] Open
Abstract
Background Repetitive transcranial magnetic stimulation (rTMS) is one of the high-potential non-pharmacological methods for migraine treatment. The purpose of this study is to define the neuroimaging markers associated with rTMS therapy in patients with migraine based on data from functional MRI (fMRI). Materials and Methods A total of 19 patients with episodic migraine without aura underwent a 5-day course of rTMS of the fronto-temporo-parietal junction bilaterally, at 10 Hz frequency and 60% of motor threshold response of 900 pulses. Resting-state functional MRI (1.5 T) and a battery of tests were carried out for each patient to clarify their diagnosis, qualitative and quantitative characteristics of pain, and associated affective symptoms. Changes in functional connectivity (FC) in the brain's neural networks before and after the treatment were identified through independent components analysis. Results Over the course of therapy, we observed an increase in FC of the default mode network within it, with pain system components and with structures of the visual network. We also noted a decrease in FC of the salience network with sensorimotor and visual networks, as well as an increase in FC of the visual network. Besides, we identified 5 patients who did not have a positive response to one rTMS course after the first week of treatment according to the clinical scales results, presumably because of an increasing trend of depressive symptoms and neuroimaging criteria for depressive disorder. Conclusions Our results show that a 5-day course of rTMS significantly alters the connectivity of brain networks associated with pain and antinociceptive brain systems in about 70% of cases, which may shed light on the neural mechanisms underlying migraine treatment with rTMS.
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Affiliation(s)
- Kirill Markin
- Psychiatry Department, Kirov Military Medical Academy, Saint Petersburg, Russia
- *Correspondence: Kirill Markin ; orcid.org/0000-0002-6242-1279
| | - Artem Trufanov
- Neurology Department, Kirov Military Medical Academy, Saint Petersburg, Russia
- Department of Software Engineering and Computer Applications, Saint Petersburg Electrotechnical University “LETI”, Saint Petersburg, Russia
| | - Daria Frunza
- Neurology Department, Kirov Military Medical Academy, Saint Petersburg, Russia
| | - Igor Litvinenko
- Neurology Department, Kirov Military Medical Academy, Saint Petersburg, Russia
| | - Dmitriy Tarumov
- Psychiatry Department, Kirov Military Medical Academy, Saint Petersburg, Russia
| | - Alexander Krasichkov
- Radio Engineering Systems Department, Saint Petersburg Electrotechnical University “LETI”, Saint Petersburg, Russia
| | - Victoria Polyakova
- Department of Pathology, Saint-Petersburg State Pediatric Medical University, Saint Petersburg, Russia
| | - Alexander Efimtsev
- Department of Software Engineering and Computer Applications, Saint Petersburg Electrotechnical University “LETI”, Saint Petersburg, Russia
- Department of Radiology, Almazov National Medical Research Centre, Saint Petersburg, Russia
| | - Dmitriy Medvedev
- Federal State Unitary Enterprise, Federal Medical Biological Agency, Saint Petersburg, Russia
- Department of Physical Therapy and Sports Medicine, North-Western State Medical University Named After I.I. Mechnikov, Saint Petersburg, Russia
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Mayr A, Jahn P, Stankewitz A, Deak B, Winkler A, Witkovsky V, Eren O, Straube A, Schulz E. Patients with chronic pain exhibit individually unique cortical signatures of pain encoding. Hum Brain Mapp 2021; 43:1676-1693. [PMID: 34921467 PMCID: PMC8886665 DOI: 10.1002/hbm.25750] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 11/22/2021] [Accepted: 12/01/2021] [Indexed: 12/30/2022] Open
Abstract
Chronic pain is characterised by an ongoing and fluctuating intensity over time. Here, we investigated how the trajectory of the patients' endogenous pain is encoded in the brain. In repeated functional MRI (fMRI) sessions, 20 patients with chronic back pain and 20 patients with chronic migraine were asked to continuously rate the intensity of their endogenous pain. Linear mixed effects models were used to disentangle cortical processes related to pain intensity and to pain intensity changes. At group level, we found that the intensity of pain in patients with chronic back pain is encoded in the anterior insular cortex, the frontal operculum, and the pons; the change of pain in chronic back pain and chronic migraine patients is mainly encoded in the anterior insular cortex. At the individual level, we identified a more complex picture where each patient exhibited their own signature of endogenous pain encoding. The diversity of the individual cortical signatures of chronic pain encoding results bridge between clinical observations and neuroimaging; they add to the understanding of chronic pain as a complex and multifaceted disease.
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Affiliation(s)
- Astrid Mayr
- Department of Radiology, University Hospital LMU, Ludwig-Maximilians-Universität München, Munich, Germany.,Department of Neurology, University Hospital LMU, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Pauline Jahn
- Department of Neurology, University Hospital LMU, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Anne Stankewitz
- Department of Neurology, University Hospital LMU, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Bettina Deak
- Department of Neurology, University Hospital LMU, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Anderson Winkler
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Viktor Witkovsky
- Department of Theoretical Methods, Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovak Republic
| | - Ozan Eren
- Department of Neurology, University Hospital LMU, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Andreas Straube
- Department of Neurology, University Hospital LMU, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Enrico Schulz
- Department of Neurology, University Hospital LMU, Ludwig-Maximilians-Universität München, Munich, Germany.,Department of Medical Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
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7
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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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8
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Karsan N, Goadsby PJ. Migraine Is More Than Just Headache: Is the Link to Chronic Fatigue and Mood Disorders Simply Due to Shared Biological Systems? Front Hum Neurosci 2021; 15:646692. [PMID: 34149377 PMCID: PMC8209296 DOI: 10.3389/fnhum.2021.646692] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/26/2021] [Indexed: 12/12/2022] Open
Abstract
Migraine is a symptomatically heterogeneous condition, of which headache is just one manifestation. Migraine is a disorder of altered sensory thresholding, with hypersensitivity among sufferers to sensory input. Advances in functional neuroimaging have highlighted that several brain areas are involved even prior to pain onset. Clinically, patients can experience symptoms hours to days prior to migraine pain, which can warn of impending headache. These symptoms can include mood and cognitive change, fatigue, and neck discomfort. Some epidemiological studies have suggested that migraine is associated in a bidirectional fashion with other disorders, such as mood disorders and chronic fatigue, as well as with other pain conditions such as fibromyalgia. This review will focus on the literature surrounding alterations in fatigue, mood, and cognition in particular, in association with migraine, and the suggested links to disorders such as chronic fatigue syndrome and depression. We hypothesize that migraine should be considered a neural disorder of brain function, in which alterations in aminergic networks integrating the limbic system with the sensory and homeostatic systems occur early and persist after headache resolution and perhaps interictally. The associations with some of these other disorders may allude to the inherent sensory sensitivity of the migraine brain and shared neurobiology and neurotransmitter systems rather than true co-morbidity.
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Affiliation(s)
- Nazia Karsan
- Headache Group, Wolfson Centre for Age-Related Diseases, Division of Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,NIHR-Wellcome Trust King's Clinical Research Facility, SLaM Biomedical Research Centre, King's College Hospital, London, United Kingdom
| | - Peter J Goadsby
- Headache Group, Wolfson Centre for Age-Related Diseases, Division of Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,NIHR-Wellcome Trust King's Clinical Research Facility, SLaM Biomedical Research Centre, King's College Hospital, London, United Kingdom.,Department of Neurology, University of California, Los Angeles, Los Angeles, CA, United States
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9
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The Evolution of Medication Overuse Headache: History, Pathophysiology and Clinical Update. CNS Drugs 2021; 35:545-565. [PMID: 34002347 DOI: 10.1007/s40263-021-00818-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
Medication overuse headache (MOH), the development or worsening of chronic headache resulting from frequent and excessive intake of medications used for acute treatment of headache, is a common secondary headache disorder and is associated with significant personal and societal burdens. The plausible physiologic mechanism is that chronic exposure to acute care migraine treatment leads to suppression of endogenous antinociceptive systems, consequently facilitating the trigeminal nociceptive process via up-regulation of the calcitonin gene-related peptide (CGRP) system. Recognizing and preventing its development is an integral aspect of migraine management, as medication overuse is a modifiable risk factor in the progression from episodic to chronic migraine. Over the years, MOH has been difficult to treat and has generated much controversy. Ongoing debates exist over the diagnostic criteria and treatment strategies, particularly regarding the roles of formal detoxification and preventive treatment. The arrival of the anti-CGRP monoclonal antibodies has also challenged our views of MOH and its treatment. This review outlines the evolution of MOH diagnostic criteria, presents the current understanding of MOH pathogenesis and discusses the debates over its development and treatment. Data on the efficacy of anti-CGRP monoclonal antibodies in the setting of medication overuse is also presented. These results indicate that patients with medication overuse, who are treated with these new medications, may not need to be detoxified in order to treat MOH. In light of these developments, it is likely that in the future MOH will be more readily diagnosed and treatment will result in better outcomes.
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10
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Huang X, Zhang D, Wang P, Mao C, Miao Z, Liu C, Xu C, Yin X, Wu X. Altered amygdala effective connectivity in migraine without aura: evidence from resting-state fMRI with Granger causality analysis. J Headache Pain 2021; 22:25. [PMID: 33858323 PMCID: PMC8048057 DOI: 10.1186/s10194-021-01240-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 04/05/2021] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Granger causality analysis (GCA) has been used to investigate the pathophysiology of migraine. Amygdala plays a key role in pain modulation of migraine attack. However, the detailed neuromechanism remained to be elucidated. We applied GCA to explore the amygdala-based directional effective connectivity in migraine without aura (MwoA) and to determine the relation with clinical characteristics. METHODS Forty-five MwoA patients and forty age-, sex-, and years of education-matched healthy controls(HCs) underwent resting-state functional magnetic resonance imaging (fMRI). Bilateral amygdala were used as seed regions in GCA to investigate directional effective connectivity and relation with migraine duration or attack frequency. RESULTS MwoA patients showed significantly decreased effective connectivity from right amygdala to right superior temporal gyrus, left superior temporal gyrus and right precentral gyrus compared with HCs. Furthermore, MwoA patients demonstrated significantly decreased effective connectivity from the left amygdala to the ipsilateral superior temporal gyrus. Also, MwoA patients showed enhanced effective connectivity from left inferior frontal gyrus to left amygdala. Effective connectivity outflow from right amygdala to right precentral gyrus was negatively correlated to disease duration. CONCLUSIONS Altered directional effective connectivity of amygdala demonstrated that neurolimbic pain networks contribute to multisensory integration abnormalities and deficits in pain modulation of MwoA patients.
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Affiliation(s)
- Xiaobin Huang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road Nanjing, 210006, Nanjing, Jiangsu Province, China
| | - Di Zhang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road Nanjing, 210006, Nanjing, Jiangsu Province, China
| | - Peng Wang
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road Nanjing, 210006, Nanjing, Jiangsu Province, China
| | - Cunnan Mao
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road Nanjing, 210006, Nanjing, Jiangsu Province, China
| | - Zhengfei Miao
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road Nanjing, 210006, Nanjing, Jiangsu Province, China
| | - Chunmei Liu
- Department of Neurology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, 210006, Nanjing, Jiangsu Province, China
| | - Chenjie Xu
- Department of Pain Treatment, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road, 210006, Nanjing, Jiangsu Province, China
| | - Xindao Yin
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road Nanjing, 210006, Nanjing, Jiangsu Province, China
| | - Xinying Wu
- Department of Radiology, Nanjing First Hospital, Nanjing Medical University, No.68, Changle Road Nanjing, 210006, Nanjing, Jiangsu Province, China.
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11
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Abstract
Migraine is a prevalent primary headache disorder and is usually considered as benign. However, structural and functional changes in the brain of individuals with migraine have been reported. High frequency of white matter abnormalities, silent infarct-like lesions, and volumetric changes in both gray and white matter in individuals with migraine compared to controls have been demonstrated. Functional magnetic resonance imaging (MRI) studies found altered connectivity in both the interictal and ictal phase of migraine. MR spectroscopy and positron emission tomography studies suggest abnormal energy metabolism and mitochondrial dysfunction, as well as other metabolic changes in individuals with migraine. In this review, we provide a brief overview of neuroimaging studies that have helped us to characterize some of these changes and discuss their limitations, including small sample sizes and poorly defined control groups. A better understanding of alterations in the brains of patients with migraine could help not only in the diagnosis but may potentially lead to the optimization of a targeted anti-migraine therapy.
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12
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de Tommaso M, Vecchio E, Quitadamo SG, Coppola G, Di Renzo A, Parisi V, Silvestro M, Russo A, Tedeschi G. Pain-Related Brain Connectivity Changes in Migraine: A Narrative Review and Proof of Concept about Possible Novel Treatments Interference. Brain Sci 2021; 11:brainsci11020234. [PMID: 33668449 PMCID: PMC7917911 DOI: 10.3390/brainsci11020234] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/27/2021] [Accepted: 02/08/2021] [Indexed: 01/07/2023] Open
Abstract
A neuronal dysfunction based on the imbalance between excitatory and inhibitory cortical-subcortical neurotransmission seems at the basis of migraine. Intercritical neuronal abnormal excitability can culminate in the bioelectrical phenomenon of Cortical Spreading Depression (CSD) with secondary involvement of the vascular system and release of inflammatory mediators, modulating in turn neuronal activity. Neuronal dysfunction encompasses the altered connectivity between the brain areas implicated in the genesis, maintenance and chronic evolution of migraine. Advanced neuroimaging techniques allow to identify changes in functional connectivity (FC) between brain areas involved in pain processes. Through a narrative review, we re-searched case-control studies on FC in migraine, between 2015 and 2020, by inserting the words migraine, fMRI, EEG, MEG, connectivity, pain in Pubmed. Studies on FC have shown that cortical processes, in the neurolimbic pain network, are likely to be prevalent for triggering attacks, in response to predisposing factors, and that these lead to a demodulation of the subcortical areas, at the basis of migraine maintenance. The link between brain dysfunction and peripheral interactions through the inhibition of CGRP, the main mediator of sterile migraine inflammation needs to be further investigated. Preliminary evidence could suggest that peripheral nerves inference at somatic and trigeminal levels, appears to change brain FC.
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Affiliation(s)
- Marina de Tommaso
- Applied Neurophysiology and Pain Unit, Bari Aldo Moro University, 70121 Bari, Italy; (E.V.); (S.G.Q.)
- Correspondence: ; Tel.: +39-080-5596739
| | - Eleonora Vecchio
- Applied Neurophysiology and Pain Unit, Bari Aldo Moro University, 70121 Bari, Italy; (E.V.); (S.G.Q.)
| | - Silvia Giovanna Quitadamo
- Applied Neurophysiology and Pain Unit, Bari Aldo Moro University, 70121 Bari, Italy; (E.V.); (S.G.Q.)
| | - Gianluca Coppola
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, 00185 Rome, Italy;
| | | | - Vincenzo Parisi
- IRCCS—Fondazione Bietti, 00198 Rome, Italy; (A.D.R.); (V.P.)
| | - Marcello Silvestro
- Clinica Neurologica e Neurofisiopatologia Università della Campania ‘Luigi Vanvitelli’, 81100 Napoli, Italy; (M.S.); (A.R.); (G.T.)
| | - Antonio Russo
- Clinica Neurologica e Neurofisiopatologia Università della Campania ‘Luigi Vanvitelli’, 81100 Napoli, Italy; (M.S.); (A.R.); (G.T.)
| | - Gioacchino Tedeschi
- Clinica Neurologica e Neurofisiopatologia Università della Campania ‘Luigi Vanvitelli’, 81100 Napoli, Italy; (M.S.); (A.R.); (G.T.)
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13
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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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14
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Abstract
Migraine is a debilitating condition; however, the pharmacological effects on central nervous system networks after successful therapy are poorly understood. Defining this neurocircuitry is critical to our understanding of the disorder and for the development of antimigraine drugs. Using an established inflammatory soup model of migraine-like pathophysiology (N = 12) compared with sham synthetic interstitial fluid migraine induction (N = 12), our aim was to evaluate changes in network-level functional connectivity after sumatriptan-naproxen infusion in awake, conscious rodents (Sprague-Dawley rats). Sumatriptan-naproxen infusion functional magnetic resonance imaging data were analyzed using an independent component analysis approach. Whole-brain analysis yielded significant between-group (inflammatory soup vs synthetic interstitial fluid) alterations in functional connectivity across the cerebellar, default mode, basal ganglia, autonomic, and salience networks. These results demonstrate the large-scale antimigraine effects of sumatriptan-naproxen co-administration after dural sensitization.
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15
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Coppola G, Di Renzo A, Tinelli E, Petolicchio B, Di Lorenzo C, Parisi V, Serrao M, Calistri V, Tardioli S, Cartocci G, Caramia F, Di Piero V, Pierelli F. Patients with chronic migraine without history of medication overuse are characterized by a peculiar white matter fiber bundle profile. J Headache Pain 2020; 21:92. [PMID: 32682393 PMCID: PMC7368770 DOI: 10.1186/s10194-020-01159-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/13/2020] [Indexed: 12/13/2022] Open
Abstract
Background We investigated intracerebral fiber bundles using a tract-based spatial statistics (TBSS) analysis of diffusion tensor imaging (DTI) data to verify microstructural integrity in patients with episodic (MO) and chronic migraine (CM). Methods We performed DTI in 19 patients with MO within interictal periods, 18 patients with CM without any history of drug abuse, and 18 healthy controls (HCs) using a 3 T magnetic resonance imaging scanner. We calculated diffusion metrics, including fractional anisotropy (FA), axial diffusion (AD), radial diffusion (RD), and mean diffusion (MD). Results TBSS revealed no significant differences in the FA, MD, RD, and AD maps between the MO and HC groups. In comparison to the HC group, the CM group exhibited widespread increased RD (bilateral superior [SCR] and posterior corona radiata [PCR], bilateral genu of the corpus callosum [CC], bilateral posterior limb of internal capsule [IC], bilateral superior longitudinal fasciculus [LF]) and MD values (tracts of the right SCR and PCR, right superior LF, and right splenium of the CC). In comparison to the MO group, the CM group showed decreased FA (bilateral SCR and PCR, bilateral body of CC, right superior LF, right forceps minor) and increased MD values (bilateral SCR and right PCR, right body of CC, right superior LF, right splenium of CC, and right posterior limb of IC). Conclusion Our results suggest that chronic migraine can be associated with the widespread disruption of normal white matter integrity in the brain.
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Affiliation(s)
- Gianluca Coppola
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy
| | - Antonio Di Renzo
- IRCCS - Fondazione Bietti, Research Unit of Neurophysiology of Vision and Neuro-Ophthalmology, Via Livenza 3, 00198, Rome, Italy
| | - Emanuele Tinelli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Cherubino Di Lorenzo
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy
| | - Vincenzo Parisi
- IRCCS - Fondazione Bietti, Research Unit of Neurophysiology of Vision and Neuro-Ophthalmology, Via Livenza 3, 00198, Rome, Italy.
| | - Mariano Serrao
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy
| | - Valentina Calistri
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Stefano Tardioli
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Gaia Cartocci
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Francesca Caramia
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Vittorio Di Piero
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | - Francesco Pierelli
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy.,IRCCS - Neuromed, Pozzilli, IS, Italy
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16
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Qin Z, Su J, He XW, Ban S, Zhu Q, Cui Y, Zhang J, Hu Y, Liu YS, Zhao R, Qiao Y, Li J, Liu JR, Du X. Disrupted functional connectivity between sub-regions in the sensorimotor areas and cortex in migraine without aura. J Headache Pain 2020; 21:47. [PMID: 32375638 PMCID: PMC7203097 DOI: 10.1186/s10194-020-01118-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 04/28/2020] [Indexed: 01/29/2023] Open
Abstract
Background Migraine is a severe and disabling brain disorder, and the exact neurological mechanisms remain unclear. Migraineurs have altered pain perception, and headache attacks disrupt their sensory information processing and sensorimotor integration. The altered functional connectivity of sub-regions of sensorimotor brain areas with other brain cortex associated with migraine needs further investigation. Methods Forty-eight migraineurs without aura during the interictal phase and 48 age- and sex-matched healthy controls underwent resting-state functional magnetic resonance imaging scans. We utilized seed-based functional connectivity analysis to investigate whether patients exhibited abnormal functional connectivity between sub-regions of sensorimotor brain areas and cortex regions. Results We found that patients with migraineurs without aura exhibited disrupted functional connectivities between the sensorimotor areas and the visual cortex, temporal cortex, posterior parietal lobule, prefrontal areas, precuneus, cingulate gyrus, sensorimotor areas proper and cerebellum areas compared with healthy controls. In addition, the clinical data of the patients, such as disease duration, pain intensity and HIT-6 score, were negatively correlated with these impaired functional connectivities. Conclusion In patients with migraineurs without aura, the functional connectivities between the sensorimotor brain areas and other brain regions was reduced. These disrupted functional connectivities might contribute to abnormalities in visual processing, multisensory integration, nociception processing, spatial attention and intention and dysfunction in cognitive evaluation and modulation of pain. Recurrent headache attacks might lead to the disrupted network between primary motor cortex and temporal regions and between primary somatosensory cortex and temporal regions. Pain sensitivity and patient quality of life are closely tied to the abnormal functional connectivity between sensorimotor regions and other brain areas.
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Affiliation(s)
- Zhaoxia Qin
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Electronic Science, East China Normal University, 3663 North Zhong-Shan Road, 200062, Shanghai, People's Republic of China
| | - Jingjing Su
- Department of Neurology and Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, 200011, Shanghai, People's Republic of China
| | - Xin-Wei He
- Department of Neurology and Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, 200011, Shanghai, People's Republic of China.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Shiyu Ban
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Electronic Science, East China Normal University, 3663 North Zhong-Shan Road, 200062, Shanghai, People's Republic of China
| | - Qian Zhu
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Electronic Science, East China Normal University, 3663 North Zhong-Shan Road, 200062, Shanghai, People's Republic of China
| | - Yangyang Cui
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Electronic Science, East China Normal University, 3663 North Zhong-Shan Road, 200062, Shanghai, People's Republic of China
| | - Jilei Zhang
- Clinical Science, Philips Healthcare, Shanghai, 200040, P. R. China
| | - Yue Hu
- Department of Neurology and Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, 200011, Shanghai, People's Republic of China.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Yi-Sheng Liu
- Department of Neurology and Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, 200011, Shanghai, People's Republic of China
| | - Rong Zhao
- Department of Neurology and Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, 200011, Shanghai, People's Republic of China.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Yuan Qiao
- Department of Neurology and Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, 200011, Shanghai, People's Republic of China.,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China
| | - Jianqi Li
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Electronic Science, East China Normal University, 3663 North Zhong-Shan Road, 200062, Shanghai, People's Republic of China
| | - Jian-Ren Liu
- Department of Neurology and Jiuyuan Municipal Stroke Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, 200011, Shanghai, People's Republic of China. .,Clinical Research Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200011, China.
| | - Xiaoxia Du
- Shanghai Key Laboratory of Magnetic Resonance and Department of Physics, School of Physics and Electronic Science, East China Normal University, 3663 North Zhong-Shan Road, 200062, Shanghai, People's Republic of China.
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17
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Vandenbussche N, Paemeleire K, Katsarava Z. The Many Faces of Medication-Overuse Headache in Clinical Practice. Headache 2020; 60:1021-1036. [PMID: 32232847 DOI: 10.1111/head.13785] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 02/28/2020] [Indexed: 12/24/2022]
Abstract
The management of medication-overuse headache (MOH) is multifaceted and headache experts have different views on the optimal strategy to tackle this type of secondary headache. The purpose of this review is to provide an overview of the literature on the management of MOH, and to highlight important considerations in the clinical evaluation of the MOH patient. Managing MOH in clinical practice starts by evaluating the headache patient with medication overuse, determining the overused drug(s), assessing the impact of headaches on the patient and assessing comorbid conditions and disorders. Withdrawal of the overused medication is the cornerstone of treatment. An inpatient or outpatient setting is chosen based on the clinical profile of the patient. There is evidence for abrupt withdrawal combined with headache preventive treatment. Bridging therapy to bring relief to withdrawal headaches and/or symptoms should be offered. Education and motivational work through multidisciplinary assessment show benefits in sustaining withdrawal and preventing relapse. Although the reversal of chronic headache after cessation of overused acute medication has been noticed worldwide, different aspects of the management of MOH, such as complete or gradual withdrawal, or preventive treatment with or without withdrawal are still debated.
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Affiliation(s)
| | - Koen Paemeleire
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
| | - Zaza Katsarava
- Department of Neurology, University of Duisburg-Essen, Essen, Germany.,Department of Neurology, Evangelical Hospital Unna, Unna, Germany.,EVEX Medical Corporation, Tbilisi, GA, USA.,Sechenov University Moscow, Moscow, Russian Federation
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18
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Serafini RA, Pryce KD, Zachariou V. The Mesolimbic Dopamine System in Chronic Pain and Associated Affective Comorbidities. Biol Psychiatry 2020; 87:64-73. [PMID: 31806085 PMCID: PMC6954000 DOI: 10.1016/j.biopsych.2019.10.018] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Revised: 10/24/2019] [Accepted: 10/25/2019] [Indexed: 12/18/2022]
Abstract
Chronic pain is a complex neuropsychiatric disorder characterized by sensory, cognitive, and affective symptoms. Over the past 2 decades, researchers have made significant progress toward understanding the impact of mesolimbic dopamine circuitry in acute and chronic pain. These efforts have provided insights into the circuits and intracellular pathways in the brain reward center that are implicated in sensory and affective manifestations of chronic pain. Studies have also identified novel therapeutic targets as well as factors that affect treatment responsiveness. Dysregulation of dopamine function in the brain reward center may further promote comorbid mood disorders and vulnerability to addiction. This review discusses recent clinical and preclinical findings on the neuroanatomical and neurochemical adaptations triggered by prolonged pain states in the brain reward pathway. Furthermore, this discussion highlights evidence of mechanisms underlying comorbidities among pain, depression, and addiction.
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Affiliation(s)
- Randal A Serafini
- Nash Family Department of Neuroscience, Department of Pharmacological Sciences, and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kerri D Pryce
- Nash Family Department of Neuroscience, Department of Pharmacological Sciences, and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Venetia Zachariou
- Nash Family Department of Neuroscience, Department of Pharmacological Sciences, and Friedman Brain Institute, Icahn School of Medicine at Mount Sinai, New York, New York.
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19
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Coppola G, Parisi V, Di Renzo A, Pierelli F. Cortical pain processing in migraine. J Neural Transm (Vienna) 2019; 127:551-566. [DOI: 10.1007/s00702-019-02089-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 09/28/2019] [Indexed: 12/17/2022]
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20
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Maleki N, Androulakis XM. Is There Any MRI Pattern That Discriminates Female From Male Migraine Patients? Front Neurol 2019; 10:961. [PMID: 31551917 PMCID: PMC6747047 DOI: 10.3389/fneur.2019.00961] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/21/2019] [Indexed: 12/27/2022] Open
Abstract
There has been accumulating evidence on sex disparity in incidence, prevalence, symptomology, and burden of migraine. Several neuroimaging studies on migraine patients attempted to unravel the mechanisms of the disease, yet very few of them examined the sex-related differences. Here, we will first discuss some of the reported neuroimaging patterns that discriminate females from males in migraine. We will then re-examine the salient neuroimaging findings in migraine and discuss them in relation to sex-related influences. Finally, we will discuss some of the intriguing recent data suggesting the presence of sex-specific traits in migraineurs. These findings may have potential implications for future neuroimaging studies to identify underlying correlating patterns in the brain to (1) explain the neural basis for higher prevalence of migraine in women, and (2) better understand migraine-specific changes during different stages of life in both men and women.
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Affiliation(s)
- Nasim Maleki
- Psychiatric Neuroimaging Division, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Xiao Michelle Androulakis
- Columbia VA Health Care System, Columbia, SC, United States.,Department of Neurology, School of Public Health, University of South Carolina, Columbia, SC, United States
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21
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Coppola G, Di Renzo A, Petolicchio B, Tinelli E, Di Lorenzo C, Parisi V, Serrao M, Calistri V, Tardioli S, Cartocci G, Schoenen J, Caramia F, Di Piero V, Pierelli F. Aberrant interactions of cortical networks in chronic migraine. Neurology 2019; 92:e2550-e2558. [DOI: 10.1212/wnl.0000000000007577] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/29/2019] [Indexed: 01/01/2023] Open
Abstract
ObjectiveWe investigated resting-state (RS)-fMRI using independent component analysis (ICA) to determine the functional connectivity (FC) between networks in chronic migraine (CM) patients and their correlation with clinical features.MethodsTwenty CM patients without preventive therapy or acute medication overuse underwent 3T MRI scans and were compared to a group of 20 healthy controls (HC). We used MRI to collect RS data in 3 selected networks, identified using group ICA: the default mode network (DMN), the executive control network (ECN), and the dorsal attention system (DAS).ResultsCompared to HC, CM patients had significantly reduced functional connectivity between the DMN and the ECN. Moreover, in patients, the DAS showed significantly stronger FC with the DMN and weaker FC with the ECN. The higher the severity of headache, the increased the strength of DAS connectivity, and the lower the strength of ECN connectivity.ConclusionThese results provide evidence for large-scale reorganization of functional cortical networks in chronic migraine. They suggest that the severity of headache is associated with opposite connectivity patterns in frontal executive and dorsal attentional networks.
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22
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Androulakis XM, Krebs KA, Jenkins C, Maleki N, Finkel AG, Rorden C, Newman R. Central Executive and Default Mode Network Intranet work Functional Connectivity Patterns in Chronic Migraine. ACTA ACUST UNITED AC 2018; 6. [PMID: 30574520 PMCID: PMC6298435 DOI: 10.4172/2329-6895.1000393] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: The neural mechanisms of chronic migraine remain largely unknown but linked to the decreased connectivity to intrinsic brain networks. Objective: To characterize the intranetwork functional connectivity within the Central Executive Network (CEN) and Default Mode Network (DMN) in chronic migraine (CM), with and without medication overuse headache (MOH). Methods: Using functional magnetic resonance imaging, we performed post-hoc analysis of a total of 136 pairs of nodes to node functional connectivity (NTNC) within the CEN and 6 pairs of NTNC within the DMN in CM (n=13) and CMMOH (n=16) as compared to controls, and between these two subgroups. Results: Connectivity between right ventrolateral prefrontal cortex (PFC) to contralateral anterior thalamus and connectivity between left dorsal PFC/frontal eye field (FEF) to dorsomedial PFC were decreased within the CEN in both CM and CMMOH subgroups. In the CEN, there was more widespread disruption in the CMMOH (n=16) versus CM (n=13), when compared to healthy controls. Within the subgroups, connectivity between right inferior frontal gyrus to left dorsolateral PFC was decreased in CMMOH compared to CM. In the DMN, only one NTNC (left lateral parietal to precuneus/PCC) was disrupted in the CMMOH group when compared to controls. Conclusion: There are similar patterns of NTNC dysfunction within CEN in CM regardless of MOH status. We observed more extensive intranetwork disruption in CMMOH than CM. The decreased coherence between the right inferior frontal gyrus and the left dorsolateral PFC in CMMOH is likely associated with a significant disruption in the inhibitory control and a maladaptive response in risk aversion and reward; whereas the decreased coherence between right dorsolateral and ventrolateral PFC to contralateral dorsal PFC/FEF may be related to lack of cognitive control and top-down regulation of pain in both CM and CMMOH.
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Affiliation(s)
- X Michelle Androulakis
- Division of Neurology, WJB Dorn VA Medical Center, Columbia, SC, USA.,Department of Neurology, University of South Carolina, Columbia, SC, USA
| | - Kaitlin A Krebs
- Division of Neurology, WJB Dorn VA Medical Center, Columbia, SC, USA
| | - Charmaine Jenkins
- Division of Neurology, WJB Dorn VA Medical Center, Columbia, SC, USA
| | | | | | - Chris Rorden
- Department of Psychology, University of South Carolina, Columbia, SC, USA
| | - Roger Newman
- Department of Psychology, University of South Carolina, Columbia, SC, USA
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23
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Vecchio E, Bassez I, Ricci K, Tassorelli C, Liebler E, de Tommaso M. Effect of Non-invasive Vagus Nerve Stimulation on Resting-State Electroencephalography and Laser-Evoked Potentials in Migraine Patients: Mechanistic Insights. Front Hum Neurosci 2018; 12:366. [PMID: 30271335 PMCID: PMC6146235 DOI: 10.3389/fnhum.2018.00366] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 08/28/2018] [Indexed: 12/24/2022] Open
Abstract
A recent multicenter trial provided Class I evidence that for patients with an episodic migraine, non-invasive vagus nerve stimulation (nVNS) significantly increases the probability of having mild pain or being pain-free 2 h post-stimulation. Here we aimed to investigate the potential effect of nVNS in the modulation of spontaneous and pain related bioelectrical activity in a subgroup of migraine patients enrolled in the PRESTO trial by using resting-state electroencephalography and trigeminal laser-evoked potentials (LEPs). LEPs were recorded for 27 migraine patients who received active or sham nVNS over the cervical vagus nerve. We measured power values for frequencies between 1–100 Hz in a resting-state condition and the latency and amplitude of N1, N2, and P2 components of LEPs in a basal condition during and after active or sham vagus nerve stimulation (T0, T1, T2). The P2 evoked by the right and the left trigeminal branch was smaller during active nVNS. The sham device also attenuated the P2 amplitude evoked by the left trigeminal branch at T1 and T2, but this attenuation did not reach significance. No changes were observed for N1 amplitude, N1, N2, P2 latency, or pain rating. nVNS induced an increase of EEG power in both slow and fast rhythms, but this effect was not significant as compared to the sham device. These findings suggest that nVNS acts on the cortical areas that are responsible for trigeminal pain control and pave the ground for future studies aimed at confirming the possible correlations with clinical outcomes, including the effect on symptoms that are directly correlated with trigeminal pain processing and modulation.
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Affiliation(s)
- Eleonora Vecchio
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Polyclinic General Hospital, Bari Aldo Moro University, Bari, Italy
| | - Iege Bassez
- Department of Data Analysis, Ghent University, Ghent, Belgium
| | - Katia Ricci
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Polyclinic General Hospital, Bari Aldo Moro University, Bari, Italy
| | - Cristina Tassorelli
- Headache Science Center, C. Mondino Foundation, Pavia, Italy.,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Eric Liebler
- electroCore LLC, Basking Ridge, NJ, United States
| | - Marina de Tommaso
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Polyclinic General Hospital, Bari Aldo Moro University, Bari, Italy
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24
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Wu T, Fan J, Chen Y, Xiang J, Zhu D, Zhang J, Shi J, Jiang T. Interictal Abnormalities of Neuromagnetic Gamma Oscillations in Migraine Following Negative Emotional Stimulation. Front Behav Neurosci 2018; 12:169. [PMID: 30174594 PMCID: PMC6108251 DOI: 10.3389/fnbeh.2018.00169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Accepted: 07/16/2018] [Indexed: 01/03/2023] Open
Abstract
Here, we aimed to investigate brain activity in migraineurs in response to emotional stimulation. Magnetoencephalography (MEG) was used to examine 20 patients with episodic migraine (EM group), 15 patients with chronic migraine (CM group), and 35 healthy participants (control group). Neuromagnetic brain activity was elicited by emotional stimulation using photographs of facial expressions. We analyzed the latency and amplitude of M100 and M170 components and used Morlet wavelet and beamformers to analyze the spectral and spatial signatures of MEG signals in gamma band (30–100 Hz). We found that the timing and frequency of MEG activity differed across the three groups in response negative emotional stimuli. First, peak M170 amplitude was significantly lower in the CM group than in the control group. Second, compared with the control group, the average spectral power was significantly lower in the EM group and CM group at M100 and M170. Third, the average spectral powers of the M100 and M170 in the CM group were negatively correlated with either HAM-D scores or migraine attack frequency. No significant differences across groups was found for positive or neutral emotional stimuli. Furthermore, after negative emotional stimuli, the MEG source analysis demonstrated that the CM group showed a significantly higher percentage of amygdala activation than the control group for M100 and M170. Thus, during headache free phases, migraineurs have abnormal brain activity in the gamma band in response to negative emotional stimuli. Trial Registration:ChiCTR-RNC-17012599. Registered 7 September, 2017.
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Affiliation(s)
- Ting Wu
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Jie Fan
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Yueqiu Chen
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Jing Xiang
- Department of Neurology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, United States
| | - Donglin Zhu
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
| | - Junpeng Zhang
- Department of Medical Information and Engineering, School of Electrical Engineering and Information, Sichuan University, Chengdu, China
| | - Jingping Shi
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Nanjing, China
- Department of Neurology, School of Medicine, Nanjing University, Nanjing, China
- *Correspondence: Jingping Shi,
| | - Tianzi Jiang
- Key Laboratory for NeuroInformation of the Ministry of Education, School of Life Sciences and Technology, University of Electronic Science and Technology of China, Chengdu, China
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25
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Schoenen J, Coppola G. Efficacy and mode of action of external trigeminal neurostimulation in migraine. Expert Rev Neurother 2018; 18:545-555. [PMID: 29897267 DOI: 10.1080/14737175.2018.1488588] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
INTRODUCTION Available preventive drug treatments for migraine lack complete efficacy and often have unpleasant adverse effects. Hence, their clinical utility and therapeutic adherence are limited. Noninvasive neurostimulation methods applied over various peripheral sites (forehead, mastoid, upper arm, cervical vagus nerve) have raised great interest because of their excellent efficacy/tolerance profile. Among them external trigeminal nerve stimulation (eTNS) was first to obtain FDA approval for migraine therapy. Areas covered: All clinical trials of eTNS as preventive or acute migraine treatment published in extenso or presented at congresses are reviewed. The paper analyzes neuroimaging and neurophysiological studies on mechanisms of action of eTNS. As many of these studies point toward the anterior cingulate cortex (ACC) as a likely eTNS target, the paper scrutinizes the available literature on the ACC implication in migraine pathophysiology. Expert commentary: eTNS is a viable alternative to standard pharmacological antimigraine strategies both for prevention and abortive therapy. eTNS could chiefly exert its action by modulating the perigenual ACC, which might also be of interest for treating other disorders like fibromyalgia or depression. It remains to be determined if this might be a common mechanism to other peripheral noninvasive neurostimulation methods.
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Affiliation(s)
- Jean Schoenen
- a Headache Research Unit , University Department of Neurology CHR Citadelle Hospital , Liège , Belgium
| | - Gianluca Coppola
- b Research Unit of Neurophysiology of Vision and Neuro-Ophthalmology , G. B. Bietti Foundation IRCCS , Rome , Italy
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26
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Krebs K, Rorden C, Androulakis XM. Resting State Functional Connectivity After Sphenopalatine Ganglion Blocks in Chronic Migraine With Medication Overuse Headache: A Pilot Longitudinal fMRI Study. Headache 2018; 58:732-743. [DOI: 10.1111/head.13318] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 02/15/2018] [Accepted: 03/11/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Kaitlin Krebs
- School of Medicine, Department of Neurology; University of South Carolina; Columbia SC USA
| | - Chris Rorden
- School of Medicine, Department of Neurology; University of South Carolina; Columbia SC USA
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