1
|
Basedau H, May A, Mehnert J. Cerebellar somatotopy of the trigemino-cervical complex during nociception. Eur J Pain 2024; 28:719-728. [PMID: 38013614 DOI: 10.1002/ejp.2212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023]
Abstract
INTRODUCTION The somatotopic organization of the human cerebellum processes somato-motoric input. Its role during pain perception for nociceptive input remains ambiguous. A standardized experimental trigeminal nociceptive input in functional imaging might clarify the role of the cerebellum in trigeminal nociception. Also of interest is the greater occipital nerve, which innervates the back of the head, and can influence the trigeminal perception due to functional coupling within the brainstem, forming the so-called trigemino-cervical complex. METHODS In our preregistered study (clinicaltrials.gov: NTC03999060), we stimulated the greater occipital as well as the three main branches of the trigeminal nerve during functional magnetic resonance imaging in two independent cohorts of young healthy volunteers without psychiatric, neurological or pain-related disorders to disentangle overlapping somatotopic cerebellar organization of the nerves innervating the human head. RESULTS We found a dominant effect of the first trigeminal branch in the cerebellum, underpinning its particular role for headache diseases, and somatotopic representations in bilateral cerebellar lobules I-IV, V, VIIb, VIIIa and Crus I as well as in the brainstem. SIGNIFICANCE The study expands the current knowledge on facial and head pain processing by the cerebellum and provides an initial somatotopic map of the trigemino-cervical complex in the human cerebellum with a predominant representation of the first trigeminal branch.
Collapse
Affiliation(s)
- Hauke Basedau
- Department of Systems Neuroscience, University Medical Center Eppendorf, Hamburg, Germany
| | - Arne May
- Department of Systems Neuroscience, University Medical Center Eppendorf, Hamburg, Germany
| | - Jan Mehnert
- Department of Systems Neuroscience, University Medical Center Eppendorf, Hamburg, Germany
| |
Collapse
|
2
|
Fila M, Przyslo L, Derwich M, Pawlowska E, Blasiak J. Potential of focal cortical dysplasia in migraine pathogenesis. Cereb Cortex 2024; 34:bhae158. [PMID: 38615241 DOI: 10.1093/cercor/bhae158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/21/2024] [Accepted: 03/23/2024] [Indexed: 04/15/2024] Open
Abstract
Focal cortical dysplasias are abnormalities of the cerebral cortex associated with an elevated risk of neurological disturbances. Cortical spreading depolarization/depression is a correlate of migraine aura/headache and a trigger of migraine pain mechanisms. However, cortical spreading depolarization/depression is associated with cortical structural changes, which can be classified as transient focal cortical dysplasias. Migraine is reported to be associated with changes in various brain structures, including malformations and lesions in the cortex. Such malformations may be related to focal cortical dysplasias, which may play a role in migraine pathogenesis. Results obtained so far suggest that focal cortical dysplasias may belong to the causes and consequences of migraine. Certain focal cortical dysplasias may lower the threshold of cortical excitability and facilitate the action of migraine triggers. Migraine prevalence in epileptic patients is higher than in the general population, and focal cortical dysplasias are an established element of epilepsy pathogenesis. In this narrative/hypothesis review, we present mainly information on cortical structural changes in migraine, but studies on structural alterations in deep white matter and other brain regions are also presented. We develop the hypothesis that focal cortical dysplasias may be causally associated with migraine and link pathogeneses of migraine and epilepsy.
Collapse
Affiliation(s)
- Michal Fila
- Department of Developmental Neurology and Epileptology, Polish Mother's Memorial Hospital Research Institute, Rzgowska 281/289, 93-338 Lodz, Łódzkie, Poland
| | - Lukasz Przyslo
- Department of Developmental Neurology and Epileptology, Polish Mother's Memorial Hospital Research Institute, Rzgowska 281/289, 93-338 Lodz, Łódzkie, Poland
| | - Marcin Derwich
- Department of Developmental Dentistry, Medical University of Lodz, Pomorska 251, 90-647 Lodz, Łódzkie, Poland
| | - Ezbieta Pawlowska
- Department of Developmental Dentistry, Medical University of Lodz, Pomorska 251, 90-647 Lodz, Łódzkie, Poland
| | - Janusz Blasiak
- Faculty of Medicine, Collegium Medicum, Mazovian Academy in Plock, Plac Generała Dabrowskiego 2, 09-420 Plock, Mazowieckie, Poland
| |
Collapse
|
3
|
Affatato O, Rukh G, Schiöth HB, Mwinyi J. Volumetric Differences in Cerebellum and Brainstem in Patients with Migraine: A UK Biobank Study. Biomedicines 2023; 11:2528. [PMID: 37760969 PMCID: PMC10526353 DOI: 10.3390/biomedicines11092528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/16/2023] [Accepted: 09/06/2023] [Indexed: 09/29/2023] Open
Abstract
Background: The cerebellum and the brainstem are two brain structures involved in pain processing and modulation that have also been associated with migraine pathophysiology. The aim of this study was to investigate possible associations between the morphology of the cerebellum and brainstem and migraine, focusing on gray matter differences in these brain areas. Methods: The analyses were based on data from 712 individuals with migraine and 45,681 healthy controls from the UK Biobank study. Generalized linear models were used to estimate the mean gray matter volumetric differences in the brainstem and the cerebellum. The models were adjusted for important biological covariates such as BMI, age, sex, total brain volume, diastolic blood pressure, alcohol intake frequency, current tobacco smoking, assessment center, material deprivation, ethnic background, and a wide variety of health conditions. Secondary analyses investigated volumetric correlation between cerebellar sub-regions. Results: We found larger gray matter volumes in the cerebellar sub-regions V (mean difference: 72 mm3, 95% CI [13, 132]), crus I (mean difference: 259 mm3, 95% CI [9, 510]), VIIIa (mean difference: 120 mm3, 95% CI [0.9, 238]), and X (mean difference: 14 mm3, 95% CI [1, 27]). Conclusions: Individuals with migraine show larger gray matter volumes in several cerebellar sub-regions than controls. These findings support the hypothesis that the cerebellum plays a role in the pathophysiology of migraine.
Collapse
Affiliation(s)
- Oreste Affatato
- Functional Pharmacology and Neuroscience Unit, Department of Surgical Science, Uppsala University, 752 36 Uppsala, Sweden
- Uppsala University’s Centre for Women’s Mental Health during the Reproductive Lifespan—WoMHeR, Uppsala University, 752 36 Uppsala, Sweden
| | - Gull Rukh
- Functional Pharmacology and Neuroscience Unit, Department of Surgical Science, Uppsala University, 752 36 Uppsala, Sweden
| | - Helgi Birgir Schiöth
- Functional Pharmacology and Neuroscience Unit, Department of Surgical Science, Uppsala University, 752 36 Uppsala, Sweden
| | - Jessica Mwinyi
- Functional Pharmacology and Neuroscience Unit, Department of Surgical Science, Uppsala University, 752 36 Uppsala, Sweden
- Uppsala University’s Centre for Women’s Mental Health during the Reproductive Lifespan—WoMHeR, Uppsala University, 752 36 Uppsala, Sweden
| |
Collapse
|
4
|
Altamura C, Viticchi G, Rizzo AC, Maggio P, Brunelli N, Marcosano M, Lazzaro VD, Fiacco F, Agostoni EC, Silvestrini M, Vernieri F. Stroke territory and atherosclerosis in ischemic stroke patients with a history of migraine with aura. Front Neurol 2023; 14:1142424. [PMID: 36923493 PMCID: PMC10008946 DOI: 10.3389/fneur.2023.1142424] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/02/2023] [Indexed: 03/01/2023] Open
Abstract
Introduction The mechanisms subtending the increased stroke risk in migraine with aura (MA) are not fully understood. Our study aims to evaluate if the clinical profile in stroke patients with MA differentiates from those without MA. Methods We retrieved the prospective registered electronic clinical dossiers of adult patients younger than 60 years with acute ischemic stroke admitted in four hospitals between January 2016 and June 2022. Patients were classified by the history of MA (MA+ and MA-). Results We identified 851 stroke patients (59 MA+, 6.9%). Compared to MA-, MA+ patients were characterized by younger age (44.0 ± 10.6 vs 50.1 ± 8.2 years), female sex (59.3% vs 29.0%), and affected by cryptogenic (OR 2.594 95% CI 1.483-4.537), and cerebellar stroke (OR 3.218 95% CI 1.657-6.250; p ≤ 0.001 for all comparisons). After adjusting for age and sex, MA+ patients presented less frequently hypertension (OR 0.349 95% CI 0.167-0.470; p=0.005) and dyslipidemia (OR 0.523 95% CI 0.280-0.974; p = 0.041). After adjusting also for risk factors, the MA+ group had less frequently symptomatic large vessel stenosis (OR 0.126 95% CI 0.017-0,924; p = 0.042) and clinical atherosclerosis (OR 0.103 95% CI 0.014-0.761; p = 0.026), while intima-media thickness did not differ (p = 0.395). Discussion Cryptogenic and cerebellar stroke and fewer vascular risk factors and clinical atherosclerosis seem to characterize stroke patients with MA.
Collapse
Affiliation(s)
- Claudia Altamura
- Department of Medicine and Surgery, Unit of Headache and Neurosonology, Università Campus Bio-Medico di Roma, Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- *Correspondence: Claudia Altamura ✉
| | | | - Angelo Cascio Rizzo
- Neurology and Stroke Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Paola Maggio
- Neurology Unit, ASST Bergamo Est, Seriate, Italy
| | - Nicoletta Brunelli
- Department of Medicine and Surgery, Unit of Headache and Neurosonology, Università Campus Bio-Medico di Roma, Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Marilena Marcosano
- Department of Medicine and Surgery, Unit of Headache and Neurosonology, Università Campus Bio-Medico di Roma, Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| | - Vincenzo Di Lazzaro
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
- Department of Medicine and Surgery, Unit of Neurology, Neurophysiology, Neurobiology, and Psychiatry, Università Campus Bio-Medico di Roma, Roma, Italy
| | | | | | | | - Fabrizio Vernieri
- Department of Medicine and Surgery, Unit of Headache and Neurosonology, Università Campus Bio-Medico di Roma, Roma, Italy
- Fondazione Policlinico Universitario Campus Bio-Medico, Roma, Italy
| |
Collapse
|
5
|
Haehner A, Gossrau G, Bock F, Hummel T, Iannilli E. Migraine Type-Dependent Patterns of Brain Activation After Facial and Intranasal Trigeminal Stimulation. Brain Topogr 2023; 36:52-71. [PMID: 36370239 PMCID: PMC9834371 DOI: 10.1007/s10548-022-00924-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 10/24/2022] [Indexed: 11/15/2022]
Abstract
In migraine, the trigeminal nerve is intimately involved in the pathophysiology of the disease. We hypothesized that alterations in the sensory trigeminal activation in migraine would be reflected by EEG-derived event-related potentials (ERP). We aimed to investigate differences in the temporal and spatial processing of trigeminal stimuli between interictal migraine patients and healthy subjects. ERP to trigeminal stimuli were recorded at 128-channels to allow localization of their cortical sources with high temporal resolution. Seventeen patients with episodic migraine without aura, 17 subjects with episodic migraine with aura, and 17 healthy subjects participated in the study. The first branch of the trigeminal nerve was stimulated using intranasal chemical (CO2), cutaneous electrical, and cutaneous mechanical (air puff) stimuli. Analyses were performed with regard to micro-state segmentation, ERP source localization, and correlation with the patients' clinical characteristics. Topographical assessments of EEG configurations were associated with the pathological condition. The source analysis revealed altered trigeminal-sensory response patterns in the precuneus, temporal pole, and cerebellum for both migraine groups during the interictal phase. The estimated current source density was positively correlated with migraine disease duration, indicating brain functional and structural changes as a consequence of the disease. Hyperactivity of the cerebellar posterior lobe was observed as a specific trigeminal response of migraine patients with aura. In conclusion, our results suggest the presence of brain changes accompanying the advancement of migraine as an expression of dysfunctional central pain processing. Hence, we identified EEG patterns in response to mechano-/chemosensory stimuli that can serve as biomarkers of migraine.
Collapse
Affiliation(s)
- Antje Haehner
- Smell & Taste Center, Deptartment of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - Gudrun Gossrau
- Headache Outpatient Clinic, University Pain Center, University Hospital, TU Dresden, Dresden, Germany
| | - Franziska Bock
- Smell & Taste Center, Deptartment of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - Thomas Hummel
- Smell & Taste Center, Deptartment of Otorhinolaryngology, TU Dresden, Dresden, Germany
| | - Emilia Iannilli
- Smell & Taste Center, Deptartment of Otorhinolaryngology, TU Dresden, Dresden, Germany. .,Deptartment of Biomed Sci, State Univ of New York at Albany, Albany, NY, USA. .,Deptartment of Psychology, K-F University of Graz, Graz, Austria.
| |
Collapse
|
6
|
Wang M, Tutt JO, Dorricott NO, Parker KL, Russo AF, Sowers LP. Involvement of the cerebellum in migraine. Front Syst Neurosci 2022; 16:984406. [PMID: 36313527 PMCID: PMC9608746 DOI: 10.3389/fnsys.2022.984406] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 09/27/2022] [Indexed: 11/14/2022] Open
Abstract
Migraine is a disabling neurological disease characterized by moderate or severe headaches and accompanied by sensory abnormalities, e.g., photophobia, allodynia, and vertigo. It affects approximately 15% of people worldwide. Despite advancements in current migraine therapeutics, mechanisms underlying migraine remain elusive. Within the central nervous system, studies have hinted that the cerebellum may play an important sensory integrative role in migraine. More specifically, the cerebellum has been proposed to modulate pain processing, and imaging studies have revealed cerebellar alterations in migraine patients. This review aims to summarize the clinical and preclinical studies that link the cerebellum to migraine. We will first discuss cerebellar roles in pain modulation, including cerebellar neuronal connections with pain-related brain regions. Next, we will review cerebellar symptoms and cerebellar imaging data in migraine patients. Lastly, we will highlight the possible roles of the neuropeptide calcitonin gene-related peptide (CGRP) in migraine symptoms, including preclinical cerebellar studies in animal models of migraine.
Collapse
Affiliation(s)
- Mengya Wang
- Department of Neuroscience and Pharmacology, University of Iowa, Iowa City, IA, United States
| | - Joseph O. Tutt
- Department of Biology and Biochemistry, University of Bath, Bath, United Kingdom
| | | | - Krystal L. Parker
- Department of Psychiatry, University of Iowa, Iowa City, IA, United States
| | - Andrew F. Russo
- Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, IA, United States,Department of Neurology, University of Iowa, Iowa City, IA, United States,Center for the Prevention and Treatment of Visual Loss, Veterans Administration Health Center, Iowa City, IA, United States
| | - Levi P. Sowers
- Center for the Prevention and Treatment of Visual Loss, Veterans Administration Health Center, Iowa City, IA, United States,Department of Pediatrics, University of Iowa, Iowa City, IA, United States,*Correspondence: Levi P. Sowers
| |
Collapse
|
7
|
Wang M, Castonguay WC, Duong TL, Huebner MW, Flinn HC, Greenway AM, Russo AF, Sowers LP. Stimulation of CGRP-expressing neurons in the medial cerebellar nucleus induces light and touch sensitivity in mice. NEUROBIOLOGY OF PAIN (CAMBRIDGE, MASS.) 2022; 12:100098. [PMID: 35782531 PMCID: PMC9240374 DOI: 10.1016/j.ynpai.2022.100098] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/17/2022] [Accepted: 06/20/2022] [Indexed: 04/30/2023]
Abstract
Calcitonin gene-related peptide (CGRP) is considered a major player in migraine pathophysiology. However, the location and mechanisms of CGRP actions in migraine are not clearly elucidated. One important question yet to be answered is: Does central CGRP signaling play a role in migraine? One candidate site is the cerebellum, which serves as a sensory and motor integration center and is activated in migraine patients. The cerebellum has the most CGRP binding sites in the central nervous system and a deep cerebellar nucleus, the medial nucleus (MN), expresses CGRP (MNCGRP). A previous study demonstrated that CGRP delivery into the cerebellum induced migraine-like behaviors. We hypothesized that stimulation of MNCGRP neurons might induce migraine-like behaviors. To test the hypothesis, we used an optogenetic strategy using CalcaCre/+ mice to drive Cre-dependent expression of channelrhodopsin-2 selectively in CGRP neurons in the cerebellar MN. A battery of behavioral tests was done to assess preclinical behaviors that are surrogates of migraine symptoms, including light aversion, cutaneous allodynia, and spontaneous pain when MNCGRP neurons were optically stimulated. Motor functions were also assessed. Optical stimulation of MNCGRP neurons decreased the time spent in the light, which was coupled to increased time spent resting in the dark, but not the light. These changes were only significant in female mice. Plantar tactile sensitivity was increased in the ipsilateral paws of both sexes, but contralateral paw data were less clear. There was no significant increase in anxiety-like behavior, spontaneous pain (squint), or changes in gait. These discoveries reveal that MNCGRP neurons may contribute to migraine-like sensory hypersensitivity to light and touch.
Collapse
Affiliation(s)
- Mengya Wang
- Department of Neuroscience and Pharmacology, University of Iowa, Iowa City, IA 52242, USA
| | - William C. Castonguay
- Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, IA 52242, USA
| | - Thomas L. Duong
- Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, IA 52242, USA
| | - Michael W. Huebner
- Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, IA 52242, USA
| | - Harold C. Flinn
- Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, IA 52242, USA
| | - Agatha M. Greenway
- Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, IA 52242, USA
| | - Andrew F. Russo
- Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, IA 52242, USA
- Center for the Prevention and Treatment of Visual Loss, Veterans Administration Health Center, Iowa City, IA 52246, USA
- Department of Neurology, University of Iowa, Iowa City, IA 52242, USA
| | - Levi P. Sowers
- Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, IA 52242, USA
- Center for the Prevention and Treatment of Visual Loss, Veterans Administration Health Center, Iowa City, IA 52246, USA
- Corresponding author at: Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, IA 52242, USA.
| |
Collapse
|
8
|
Wang W, Zhang X, Bai X, Zhang Y, Yuan Z, Tang H, Li Z, Hu Z, Zhang Y, Yu X, Sui B, Wang Y. Gamma-aminobutyric acid and glutamate/glutamine levels in the dentate nucleus and periaqueductal gray with episodic and chronic migraine: a proton magnetic resonance spectroscopy study. J Headache Pain 2022; 23:83. [PMID: 35840907 PMCID: PMC9287958 DOI: 10.1186/s10194-022-01452-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/04/2022] [Indexed: 11/19/2022] Open
Abstract
Background The pathogenesis of migraine chronification remains unclear. Functional and structural magnetic resonance imaging studies have shown impaired functional and structural alterations in the brains of patients with chronic migraine. The cerebellum and periaqueductal gray (PAG) play pivotal roles in the neural circuits of pain conduction and analgesia in migraine. However, few neurotransmitter metabolism studies of these migraine-associated regions have been performed. To explore the pathogenesis of migraine chronification, we measured gamma-aminobutyric acid (GABA) and glutamate/glutamine (Glx) levels in the dentate nucleus (DN) and PAG of patients with episodic and chronic migraine and healthy subjects. Methods Using the MEGA-PRESS sequence and a 3-Tesla magnetic resonance scanner (Signa Premier; GE Healthcare, Chicago, IL, USA), we obtained DN and PAG metabolite concentrations from patients with episodic migraine (n = 25), those with chronic migraine (n = 24), and age-matched and sex-matched healthy subjects (n = 16). Patients with chronic migraine were further divided into those with (n = 12) and without (n = 12) medication overuse headache. All scans were performed at the Beijing Tiantan Hospital, Capital Medical University. Results We found that patients with chronic migraine had significantly lower levels of GABA/water (p = 0.011) and GABA/creatine (Cr) (p = 0.026) in the DN and higher levels of Glx/water (p = 0.049) in the PAG than healthy controls. In all patients with migraine, higher GABA levels in the PAG were significantly associated with poorer sleep quality (GABA/water: r = 0.515, p = 0.017, n = 21; GABA/Cr: r = 0.522, p = 0.015, n = 21). Additionally, a lower Glx/Cr ratio in the DN may be associated with more severe migraine disability (r = -0.425, p = 0.055, n = 20), and lower GABA/water (r = -0.424, p = 0.062, n = 20) and Glx/Water (r = -0.452, p = 0.045, n = 20) may be associated with poorer sleep quality. Conclusions Neurochemical levels in the DN and PAG may provide evidence of the pathological mechanisms of migraine chronification. Correlations between migraine characteristics and neurochemical levels revealed the pathological mechanisms of the relevant characteristics. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-022-01452-6.
Collapse
Affiliation(s)
- Wei Wang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Xueyan Zhang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, No.1, Jianshe East Road, Zhengzhou, Henan Province, 450000, China
| | - Xiaoyan Bai
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China.,Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Yingkui Zhang
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Ziyu Yuan
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Hefei Tang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Zhiye Li
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China.,Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Zhangxuan Hu
- GE Healthcare, No.1 Tongji Nan Road, Beijing Economic Technological Development Area, Beijing, 100070, China
| | - Yaqing Zhang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Xueying Yu
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Binbin Sui
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China.
| | - Yonggang Wang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China.
| |
Collapse
|
9
|
Noseda R. Cerebro-Cerebellar Networks in Migraine Symptoms and Headache. FRONTIERS IN PAIN RESEARCH 2022; 3:940923. [PMID: 35910262 PMCID: PMC9326053 DOI: 10.3389/fpain.2022.940923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 06/13/2022] [Indexed: 11/13/2022] Open
Abstract
The cerebellum is associated with the biology of migraine in a variety of ways. Clinically, symptoms such as fatigue, motor weakness, vertigo, dizziness, difficulty concentrating and finding words, nausea, and visual disturbances are common in different types of migraine. The neural basis of these symptoms is complex, not completely known, and likely involve activation of both specific and shared circuits throughout the brain. Posterior circulation stroke, or neurosurgical removal of posterior fossa tumors, as well as anatomical tract tracing in animals, provided the first insights to theorize about cerebellar functions. Nowadays, with the addition of functional imaging, much progress has been done on cerebellar structure and function in health and disease, and, as a consequence, the theories refined. Accordingly, the cerebellum may be useful but not necessary for the execution of motor, sensory or cognitive tasks, but, rather, would participate as an efficiency facilitator of neurologic functions by improving speed and skill in performance of tasks produced by the cerebral area to which it is reciprocally connected. At the subcortical level, critical regions in these processes are the basal ganglia and thalamic nuclei. Altogether, a modulatory role of the cerebellum over multiple brain regions appears compelling, mainly by considering the complexity of its reciprocal connections to common neural networks involved in motor, vestibular, cognitive, affective, sensory, and autonomic processing—all functions affected at different phases and degrees across the migraine spectrum. Despite the many associations between cerebellum and migraine, it is not known whether this structure contributes to migraine initiation, symptoms generation or headache. Specific cerebellar dysfunction via genetically driven excitatory/inhibitory imbalances, oligemia and/or increased risk to white matter lesions has been proposed as a critical contributor to migraine pathogenesis. Therefore, given that neural projections and functions of many brainstem, midbrain and forebrain areas are shared between the cerebellum and migraine trigeminovascular pathways, this review will provide a synopsis on cerebellar structure and function, its role in trigeminal pain, and an updated overview of relevant clinical and preclinical literature on the potential role of cerebellar networks in migraine pathophysiology.
Collapse
Affiliation(s)
- Rodrigo Noseda
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
- Harvard Medical School, Boston, MA, United States
- *Correspondence: Rodrigo Noseda
| |
Collapse
|
10
|
Wang M, Duong TL, Rea BJ, Waite JS, Huebner MW, Flinn HC, Russo AF, Sowers LP. CGRP Administration Into the Cerebellum Evokes Light Aversion, Tactile Hypersensitivity, and Nociceptive Squint in Mice. FRONTIERS IN PAIN RESEARCH 2022; 3:861598. [PMID: 35547239 PMCID: PMC9082264 DOI: 10.3389/fpain.2022.861598] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/17/2022] [Indexed: 12/16/2022] Open
Abstract
The neuropeptide calcitonin gene-related peptide (CGRP) is a major player in migraine pathophysiology. Previous preclinical studies demonstrated that intracerebroventricular administration of CGRP caused migraine-like behaviors in mice, but the sites of action in the brain remain unidentified. The cerebellum has the most CGRP binding sites in the central nervous system and is increasingly recognized as both a sensory and motor integration center. The objective of this study was to test whether the cerebellum, particularly the medial cerebellar nuclei (MN), might be a site of CGRP action. In this study, CGRP was directly injected into the right MN of C57BL/6J mice via a cannula. A battery of tests was done to assess preclinical behaviors that are surrogates of migraine-like symptoms. CGRP caused light aversion measured as decreased time in the light zone even with dim light. The mice also spent more time resting in the dark zone, but not the light, along with decreased rearing and transitions between zones. These behaviors were similar for both sexes. Moreover, significant responses to CGRP were seen in the open field assay, von Frey test, and automated squint assay, indicating anxiety, tactile hypersensitivity, and spontaneous pain, respectively. Interestingly, CGRP injection caused significant anxiety and spontaneous pain responses only in female mice, and a more robust tactile hypersensitivity in female mice. No detectable effect of CGRP on gait was observed in either sex. These results suggest that CGRP injection in the MN causes light aversion accompanied by increased anxiety, tactile hypersensitivity, and spontaneous pain. A caveat is that we cannot exclude contributions from other cerebellar regions in addition to the MN due to diffusion of the injected peptide. These results reveal the cerebellum as a new site of CGRP actions that may contribute to migraine-like hypersensitivity.
Collapse
Affiliation(s)
- Mengya Wang
- Department of Neuroscience and Pharmacology, University of Iowa, Iowa City, IA, United States
| | - Thomas L. Duong
- Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, IA, United States
| | - Brandon J. Rea
- Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, IA, United States
- Center for the Prevention and Treatment of Visual Loss, Veterans Administration Health Center, Iowa City, IA, United States
| | - Jayme S. Waite
- Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, IA, United States
| | - Michael W. Huebner
- Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, IA, United States
| | - Harold C. Flinn
- Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, IA, United States
| | - Andrew F. Russo
- Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, IA, United States
- Center for the Prevention and Treatment of Visual Loss, Veterans Administration Health Center, Iowa City, IA, United States
- Department of Neurology, University of Iowa, Iowa City, IA, United States
| | - Levi P. Sowers
- Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, IA, United States
- Center for the Prevention and Treatment of Visual Loss, Veterans Administration Health Center, Iowa City, IA, United States
- *Correspondence: Levi P. Sowers
| |
Collapse
|
11
|
Association of plasma tryptophan concentration with periaqueductal gray matter functional connectivity in migraine patients. Sci Rep 2022; 12:739. [PMID: 35031640 PMCID: PMC8760301 DOI: 10.1038/s41598-021-04647-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 12/14/2021] [Indexed: 01/16/2023] Open
Abstract
Altered periaqueductal gray matter (PAG) functional connectivity contributes to brain hyperexcitability in migraine. Although tryptophan modulates neurotransmission in PAG projections through its metabolic pathways, the effect of plasma tryptophan on PAG functional connectivity (PAG-FC) in migraine has not been investigated yet. In this study, using a matched case-control design PAG-FC was measured during a resting-state functional magnetic resonance imaging session in migraine without aura patients (n = 27) and healthy controls (n = 27), and its relationship with plasma tryptophan concentration (TRP) was assessed. In addition, correlations of PAG-FC with age at migraine onset, migraine frequency, trait-anxiety and depressive symptoms were tested and the effect of TRP on these correlations was explored. Our results demonstrated that migraineurs had higher TRP compared to controls. In addition, altered PAG-FC in regions responsible for fear-cascade and pain modulation correlated with TRP only in migraineurs. There was no significant correlation in controls. It suggests increased sensitivity to TRP in migraine patients compared to controls. Trait-anxiety and depressive symptoms correlated with PAG-FC in migraine patients, and these correlations were modulated by TRP in regions responsible for emotional aspects of pain processing, but TRP did not interfere with processes that contribute to migraine attack generation or attack frequency.
Collapse
|
12
|
Chen C, Mao Y, Falahpour M, MacNiven KH, Heit G, Sharma V, Alataris K, Liu TT. Effects of sub-threshold transcutaneous auricular vagus nerve stimulation on cerebral blood flow. Sci Rep 2021; 11:24018. [PMID: 34912017 PMCID: PMC8674256 DOI: 10.1038/s41598-021-03401-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/01/2021] [Indexed: 11/08/2022] Open
Abstract
Transcutaneous auricular vagus nerve stimulation (taVNS) has shown promise as a non-invasive alternative to vagus nerve stimulation (VNS) with implantable devices, which has been used to treat drug-resistant epilepsy and treatment-resistant depression. Prior work has used functional MRI to investigate the brain response to taVNS, and more recent work has also demonstrated potential therapeutic effects of high-frequency sub-threshold taVNS in rheumatoid arthritis. However, no studies to date have measured the effects of high-frequency sub-threshold taVNS on cerebral blood flow (CBF). The objective of this study was to determine whether high-frequency (20 kHz) sub-threshold taVNS induces significant changes in CBF, a promising metric for the assessment of the sustained effects of taVNS. Arterial spin labeling (ASL) MRI scans were performed on 20 healthy subjects in a single-blind placebo-controlled repeated measures experimental design. The ASL scans were performed before and after 15 min of either sub-threshold taVNS treatment or a sham control. taVNS induced significant changes in CBF in the superior posterior cerebellum that were largely localized to bilateral Crus I and Crus II. Post hoc analyses showed that the changes were driven by a treatment-related decrease in CBF. Fifteen minutes of high-frequency sub-threshold taVNS can induce sustained CBF decreases in the bilateral posterior cerebellum in a cohort of healthy subjects. This study lays the foundation for future studies in clinical populations, and also supports the use of ASL measures of CBF for the assessment of the sustained effects of taVNS.
Collapse
Affiliation(s)
- Conan Chen
- Center for Functional MRI, Department of Radiology, University of California San Diego, 9500 Gilman Drive #0677, La Jolla, CA, 92093, USA.
| | - Yixiang Mao
- Center for Functional MRI, Department of Radiology, University of California San Diego, 9500 Gilman Drive #0677, La Jolla, CA, 92093, USA
| | - Maryam Falahpour
- Center for Functional MRI, Department of Radiology, University of California San Diego, 9500 Gilman Drive #0677, La Jolla, CA, 92093, USA
| | - Kelly H MacNiven
- Department of Psychology, Stanford University, Stanford, CA, USA
- Nēsos Corporation, Redwood City, CA, USA
| | - Gary Heit
- Nēsos Corporation, Redwood City, CA, USA
- Department of Neurosurgery, Hue University of Medicine and Pharmacy, Hue, Vietnam
| | | | | | - Thomas T Liu
- Center for Functional MRI, Department of Radiology, University of California San Diego, 9500 Gilman Drive #0677, La Jolla, CA, 92093, USA.
| |
Collapse
|
13
|
Dai W, Liu RH, Qiu E, Liu Y, Chen Z, Chen X, Ao R, Zhuo M, Yu S. Cortical mechanisms in migraine. Mol Pain 2021; 17:17448069211050246. [PMID: 34806494 PMCID: PMC8606910 DOI: 10.1177/17448069211050246] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Migraine is the second most prevalent disorder in the world; yet, its underlying mechanisms are still poorly understood. Cumulative studies have revealed pivotal roles of cerebral cortex in the initiation, propagation, and termination of migraine attacks as well as the interictal phase. Investigation of basic mechanisms of the cortex in migraine not only brings insight into the underlying pathophysiology but also provides the basis for designing novel treatments. We aim to summarize the current research literatures and give a brief overview of the cortex and its role in migraine, including the basic structure and function; structural, functional, and biochemical neuroimaging; migraine-related genes; and theories related to cortex in migraine pathophysiology. We propose that long-term plasticity of synaptic transmission in the cortex encodes migraine.
Collapse
Affiliation(s)
- Wei Dai
- Department of Neurology, Chinese PLA General Hospital, Beijing, China.,Chinese PLA Medical School, Beijing, China
| | - Ren-Hao Liu
- Center for Neuron and Disease, Frontier Institutes of Science and Technology, 12480Xi'an Jiaotong University, Xi'an, China
| | - Enchao Qiu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Yinglu Liu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Zhiye Chen
- Department of Neurology, Chinese PLA General Hospital, Beijing, China.,Department of Radiology, Chinese PLA General Hospital, Beijing, China
| | - Xiaoyan Chen
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Ran Ao
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| | - Min Zhuo
- Center for Neuron and Disease, Frontier Institutes of Science and Technology, 12480Xi'an Jiaotong University, Xi'an, China.,International Institute for Brain Research, Qingdao International Academician Park, Qingdao, China.,Department of Physiology, 1 King's College Circle, University of Toronto, Toronto, ON, Canada
| | - Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, Beijing, China
| |
Collapse
|
14
|
Naguib LE, Abdel Azim GS, Abdellatif MA. A volumetric magnetic resonance imaging study in migraine. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00372-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Abstract
Background
Although migraine phenotype has been widely described, the explanation of migraine pathophysiology still has a gap that might be partly bridged by neuroimaging investigations. The aim of the study is to assess volumetric brain changes in migraineurs compared with controls, and in episodic migraine in comparison to chronic type. Structural brain changes in migraineurs (with and without aura) were assessed by an automated segmentation method (Free Surfer). T1-weighted MRIs of 25 migraineurs (14 diagnosed as episodic type and 11 diagnosed as chronic migraine) and 25 headache-free controls were evaluated and processed.
Results
Migraine patients had significant reduction of the volume of total brain, grey matter, brain stem, cerebellum, basal ganglia, thalamus, hippocampus and amygdala in comparison to control subjects. Patients with chronic migraine had significant reduction in volume of total brain, grey matter, cerebellum and frontal lobe thickness in comparison to those with episodic migraine.
Conclusion
Migraineurs showed volumetric brain changes mainly in areas related to central processing of pain and in areas specific for migraine (such as brain stem) when compared to healthy controls. Chronic migraineurs showed significant reduction in grey matter, in areas involved in processing of pain, cognition and multisensory integration versus patients with episodic migraine, which adds insight into the pathophysiology of migraine as a progressive disorder that may have long-term impacts on the brain as regards structure and function.
Collapse
|
15
|
Stankewitz A, Keidel L, Rehm M, Irving S, Kaczmarz S, Preibisch C, Witkovsky V, Zimmer C, Schulz E, Toelle TR. Migraine attacks as a result of hypothalamic loss of control. NEUROIMAGE-CLINICAL 2021; 32:102784. [PMID: 34425551 PMCID: PMC8379646 DOI: 10.1016/j.nicl.2021.102784] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/06/2021] [Accepted: 08/06/2021] [Indexed: 12/27/2022]
Abstract
Hypothalamo-limbic connectivity reflects the cyclic nature of migraine. Hypothalamo-limbic connectivity is largest just before the attack. Hypothalamo-limbic connectivity is collapsing during the attack. Limbic perfusion is increasing and has a maximum during the attack. The disrupted connectivity allows high limbic perfusion, resulting in migraine attack.
Migraine is a complex neurological disorder affecting approximately 12% of the population. The pathophysiology is not yet fully understood, however the clinical features of the disease, such as the cyclic behaviour of attacks and vegetative symptoms, suggest a prominent role of the hypothalamus. Previous research has observed neuronal alterations at different time points during the migraine interval, specifically just before the headache is initiated. We therefore aimed to assess the trajectory of migraineurs’ brain activity over an entire migraine cycle. Using functional magnetic resonance imaging (fMRI) with pseudo-continuous arterial spin labelling (ASL), we designed a longitudinal intra-individual study to detect the rhythmicity of (1) the cerebral perfusion and (2) the hypothalamic connectivity over an entire migraine cycle. Twelve episodic migraine patients were examined in 82 sessions during spontaneous headache attacks with follow-up recordings towards the next attack. We detected cyclic changes of brain perfusion in the limbic circuit (insula and nucleus accumbens), with the highest perfusion during the headache attack. In addition, we found an increase of hypothalamic connectivity to the limbic system over the interictal interval towards the attack, then collapsing during the headache phase. The present data provide strong evidence for the predominant role of the hypothalamus in generating migraine attacks. Due to a genetically-determined cortical hyperexcitability, migraineurs are most likely characterised by an increased susceptibility of limbic neurons to the known migraine trigger. The hypothalamus as a metronome of internal processes is suggested to control these limbic circuits: migraine attacks may occur as a result of the hypothalamus losing control over the limbic system. Repetitive psychosocial stress, one of the leading trigger factors reported by patients, might make the limbic system even more vulnerable and lead to a premature triggering of a migraine attack. Potential therapeutic interventions are therefore suggested to strengthen limbic circuits with dedicated medication or psychological approaches.
Collapse
Affiliation(s)
- Anne Stankewitz
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany; Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Leonie Keidel
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Department of Ophthalmology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Mathias Rehm
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Stephanie Irving
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Stephan Kaczmarz
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Christine Preibisch
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Viktor Witkovsky
- Department of Theoretical Methods, Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovak Republic
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Enrico Schulz
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany; Department of Medical Psychology, Ludwig-Maximilians-Universität München, Munich, Germany.
| | - Thomas R Toelle
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| |
Collapse
|
16
|
Liu S, Luo S, Yan T, Ma W, Wei X, Chen Y, Zhan S, Wang B. Differential Modulating Effect of Acupuncture in Patients With Migraine Without Aura: A Resting Functional Magnetic Resonance Study. Front Neurol 2021; 12:680896. [PMID: 34122321 PMCID: PMC8193984 DOI: 10.3389/fneur.2021.680896] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 05/04/2021] [Indexed: 02/05/2023] Open
Abstract
Introduction: Migraine is a recurrent neurological disorder, the symptoms of which can be significantly relieved by acupuncture. However, the central mechanism via which acupuncture exerts its therapeutic effect in migraine is unclear. The aim of this study was to compare the differences in regional homogeneity (ReHo) between patients with migraine without aura (MwoA) and healthy controls (HCs) and to explore the immediate and cumulative therapeutic effect of acupuncture in patients with MwoA using resting-state functional magnetic resonance imaging (fMRI). Methods: The study subjects were 40 patients with MwoA and 16 matched HCs. The patients with MwoA received acupuncture on 2 days per week for 6 weeks for a total of 12 sessions followed by 24 weeks of follow-up. The primary clinical efficacy outcomes were the number of days with migraine and the average severity of headache. Secondary outcomes were the Migraine-Specific Quality of Life Questionnaire, Self-Rating Anxiety Scale, and Self-Rating Depression Scale scores. In the migraine group, resting-state blood-oxygen-level-dependent fMRI scans were obtained at baseline and after the first and 12th acupuncture sessions to measure the ReHo value. In the HCs, only a baseline resting-state blood-oxygen-level-dependent fMRI scan was obtained. Results: Compared with the control group, the migraine group had a significantly lower ReHo value in the cerebellum, which increased after the first acupuncture session. Long-term acupuncture significantly improved migraine symptoms and mood with a therapeutic effect that lasted for at least 6 months. After 12 acupuncture sessions, there were significant increase of cerebellum and angular gyrus in the migraine group. Conclusion: These findings suggest that migraine is related to cerebellar dysfunction. Acupuncture can relieve the symptoms of migraine, improve dysfunction of cerebellum, and activate brain regions involved in modulation of pain and emotion The cumulative therapeutic effect of acupuncture is more extensive and significant than its immediate effect.
Collapse
Affiliation(s)
- Shanshan Liu
- Department of Acupuncture and Moxibustion, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shilei Luo
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Tianwei Yan
- Department of Acupuncture and Moxibustion, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wen Ma
- Department of Acupuncture and Moxibustion, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Xiangyu Wei
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yilei Chen
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Songhua Zhan
- Department of Radiology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Bo Wang
- Department of Acupuncture and Moxibustion, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| |
Collapse
|
17
|
Hosp JA, Reisert M, von Kageneck C, Rijntjes M, Weiller C. Approximation to pain-signaling network in humans by means of migraine. Hum Brain Mapp 2021; 42:766-779. [PMID: 33112461 PMCID: PMC7814755 DOI: 10.1002/hbm.25261] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/06/2020] [Accepted: 10/14/2020] [Indexed: 12/23/2022] Open
Abstract
Nociceptive signals are processed within a pain-related network of the brain. Migraine is a rather specific model to gain insight into this system. Brain networks may be described by white matter tracts interconnecting functionally defined gray matter regions. Here, we present an overview of the migraine-related pain network revealed by this strategy. Based on diffusion tensor imaging data from subjects in the Human Connectome Project (HCP) database, we used a global tractography approach to reconstruct white matter tracts connecting brain regions that are known to be involved in migraine-related pain signaling. This network includes an ascending nociceptive pathway, a descending modulatory pathway, a cortical processing system, and a connection between pain-processing and modulatory areas. The insular cortex emerged as the central interface of this network. Direct connections to visual and auditory cortical association fields suggest a potential neural basis of phono- or photophobia and aura phenomena. The intra-axonal volume (Vintra ) as a measure of fiber integrity based on diffusion microstructure was extracted using an innovative supervised machine learning approach in form of a Bayesian estimator. Self-reported pain levels of HCP subjects were positively correlated with tract integrity in subcortical tracts. No correlation with pain was found for the cortical processing systems.
Collapse
Affiliation(s)
- Jonas Aurel Hosp
- Faculty of Medicine, Department of Neurology and NeuroscienceMedical Center – University of FreiburgFreiburgGermany
| | - Marco Reisert
- Faculty of Medicine, Department of Stereotactic and Functional NeurosurgeryUniversity of FreiburgFreiburgGermany
- Department of Medical PhysicsFreiburg University Medical CenterFreiburgGermany
| | - Charlotte von Kageneck
- Faculty of Medicine, Department of Neurology and NeuroscienceMedical Center – University of FreiburgFreiburgGermany
| | - Michel Rijntjes
- Faculty of Medicine, Department of Neurology and NeuroscienceMedical Center – University of FreiburgFreiburgGermany
| | - Cornelius Weiller
- Faculty of Medicine, Department of Neurology and NeuroscienceMedical Center – University of FreiburgFreiburgGermany
| |
Collapse
|
18
|
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.
Collapse
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.)
| |
Collapse
|
19
|
Lemme J, Holmes S, Sibai D, Mari J, Simons LE, Burstein R, Zurakowski D, Lebel A, O'Brien M, Upadhyay J, Borsook D. Altered Brain Network Connectivity Underlies Persistent Post-Traumatic Headache following Mild Traumatic Brain Injury in Youth. J Neurotrauma 2021; 38:1632-1641. [PMID: 33183144 DOI: 10.1089/neu.2020.7189] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Post-traumatic headaches (PTHs) are associated with mild traumatic brain injuries (mTBI) and may predict the persistence of concussion symptoms. Altered brain networks implicated in brain injury and the affective components of headache-related pain may underlie the resolution of PTH. This is a hypothesis-generating investigation to evaluate the extent to which pain symptom reporting and functional brain changes are different in a cohort of young mTBI patients with resolved (PTH-R) and persistent (PTH-P) post-traumatic headache symptoms relative to healthy controls. This was a cross-sectional investigation involving 59 participants between the ages of 12-24 (PTH-P, n = 21; PTH-R, n = 18; healthy control, n = 20). Participants had no significant history of pre-existing headaches, chronic pain, or psychiatric neurological conditions. The primary outcome was resting-state functional connectivity (RS-Fc) alterations between cohorts. Secondary outcomes were self-reported pain-related symptoms. Elevated scores were reported for fear of pain in both PTH cohorts. Using a false discovery rate of p = 0.05, the PTH-P cohort showed altered connectivity relative to healthy controls in brain regions such as the frontal, temporal, and cerebellar regions, as well as sub-cortical regions including the amygdala and accumbens. The PTH-R cohort showed altered RS-Fc between cerebellar and temporal lobe sub-regions. Our results indicate that a core network of brain regions implicated in the affective pain response are functionally altered in PTH cohorts. Results should be interpreted given limitations on sample size and multiple comparisons. Despite the resolution of symptoms, persons who experience PTH may experience ongoing functional brain abnormalities, which may underlie symptom chronification.
Collapse
Affiliation(s)
- Jordan Lemme
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital-Harvard Medical School, Boston, Massachusetts, USA
| | - Scott Holmes
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital-Harvard Medical School, Boston, Massachusetts, USA
| | - Diana Sibai
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital-Harvard Medical School, Boston, Massachusetts, USA
| | - Joud Mari
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital-Harvard Medical School, Boston, Massachusetts, USA
| | - Laura E Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Rami Burstein
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - David Zurakowski
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital-Harvard Medical School, Boston, Massachusetts, USA
| | - Alyssa Lebel
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital-Harvard Medical School, Boston, Massachusetts, USA
| | - Michael O'Brien
- Department of Orthopedic Surgery, Boston Children's Hospital-Harvard Medical School, Boston, Massachusetts, USA
| | - Jaymin Upadhyay
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital-Harvard Medical School, Boston, Massachusetts, USA
| | - David Borsook
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital-Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
20
|
Episodic Vestibular Syndrome with Hyperventilation-Induced Downbeat Nystagmus. THE CEREBELLUM 2020; 20:796-803. [PMID: 33083962 DOI: 10.1007/s12311-020-01204-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/13/2020] [Indexed: 10/23/2022]
Abstract
Hyperventilation-induced downbeat nystagmus (HV-DBN) has been reported in cerebellar disorders and explained by a loss of the inhibitory cerebellar output via a metabolic effect on cerebellar Ca2+ channels. The aim of this study was to determine the clinical characteristics and underlying pathogenesis of episodic vestibular syndrome (EVS) with HV-DBN. Of 667 patients with EVS, we recruited 22 with HV-DBN and assessed their clinical characteristics, video-oculographic findings, and the results of molecular genetic analyses. The age at symptom onset was 47.5 ± 13.0 years (mean ± SD), and there was a female preponderance (n = 15, 68%). The duration of vertigo/dizziness attacks ranged from minutes to a few days, and 11 patients (50%) fulfilled the diagnostic criteria for vestibular migraine. HV-induced new-onset DBN in 8 patients, while the remaining 14 showed augmentation of spontaneous DBN by HV. The maximum slow-phase velocity of HV-DBN ranged from 2.2 to 11.9°/s, which showed a statistical difference with that of spontaneous DBN (median = 4.95, IQR = 3.68-6.55 vs. median = 1.25, IQR = 0.20-2.15, p < 0.001). HV-DBN was either purely downbeat (n = 11) or accompanied with small horizontal components (n = 11). Other neuro-otologic findings included perverted head-shaking nystagmus (n = 11), central positional nystagmus (n = 7), saccadic pursuit (n = 3), and horizontal gaze-evoked nystagmus (n = 1). Gene expression profiling with a bioinformatics analysis identified 43 upregulated and 49 downregulated differentially expressed genes (DEGs) in patients with EVS and HV-DBN and revealed that the downregulated DEGs were significantly enriched in terms related to the ribosome pathway. Our results suggest that the underlying cerebellar dysfunction would be responsible for paroxysmal attacks of vertigo in patients with EVS and HV-DBN.
Collapse
|
21
|
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.
Collapse
|
22
|
Karsan N, Bose PR, O’Daly O, Zelaya FO, Goadsby PJ. Alterations in Functional Connectivity During Different Phases of the Triggered Migraine Attack. Headache 2020; 60:1244-1258. [DOI: 10.1111/head.13865] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 05/12/2020] [Indexed: 01/03/2023]
Affiliation(s)
- Nazia Karsan
- Headache Group Department of Basic and Clinical Neuroscience Institute of Psychiatry, Psychology and Neuroscience King’s College London London UK
- NIHR‐Wellcome Trust King’s Clinical Research Facility SLaM Biomedical Research Centre King’s College Hospital London UK
| | - Pyari R. Bose
- Headache Group Department of Basic and Clinical Neuroscience Institute of Psychiatry, Psychology and Neuroscience King’s College London London UK
- NIHR‐Wellcome Trust King’s Clinical Research Facility SLaM Biomedical Research Centre King’s College Hospital London UK
| | - Owen O’Daly
- Department of Neuroimaging Centre for Neuroimaging Sciences Institute of Psychiatry, Psychology and Neuroscience King’s College London London UK
| | - Fernando O. Zelaya
- Department of Neuroimaging Centre for Neuroimaging Sciences Institute of Psychiatry, Psychology and Neuroscience King’s College London London UK
| | - Peter J. Goadsby
- Headache Group Department of Basic and Clinical Neuroscience Institute of Psychiatry, Psychology and Neuroscience King’s College London London UK
- NIHR‐Wellcome Trust King’s Clinical Research Facility SLaM Biomedical Research Centre King’s College Hospital London UK
| |
Collapse
|
23
|
Liu HY, Lee PL, Chou KH, Lai KL, Wang YF, Chen SP, Chen WT, Wang SJ. The cerebellum is associated with 2-year prognosis in patients with high-frequency migraine. J Headache Pain 2020; 21:29. [PMID: 32188423 PMCID: PMC7081533 DOI: 10.1186/s10194-020-01096-4] [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: 01/25/2020] [Accepted: 03/09/2020] [Indexed: 11/15/2022] Open
Abstract
Background The increase of headache frequency is associated with higher headache related disability and lower quality of life in patients with migraine. However, the pathophysiology of migraine progression, persistence, or remission is elusive. The purpose of this study is to identify the brain signatures that are predictive of the long-term outcomes among patients with high-frequency migraine (HFM: 10–30 headache days/month). Methods We prospectively enrolled patients with HFM and healthy controls and collected their baseline clinical profiles and brain-MRI data at first visit. We longitudinally followed the patients and determined their outcomes at 2-year follow-up. Good outcome was defined as ≥50% reduction of baseline headache days and poor outcome was defined as reduction < 50% or frequency increase. Voxel-based morphometry was used to study gray matter volume (GMV), and structural covariance was used to investigate structural connectivity. Results Among 56 patients with HFM, 37 had good outcome and 19 poor outcome. Compared to the healthy controls (n = 37), patients with poor outcome had decreased GMV over the left posterior cingulate gyrus, and increased GMV over the bilateral cerebellum and the right precentral gyrus. Further, patients with poor outcome had greater GMV over the right and the left cerebella compared to patients with good outcome, and the GMVs of the cerebella were correlated to 2-year headache frequencies (right: r = 0.38, P = 0.005; left: r = 0.35, P = 0.009). Structural connectivity were increased between the cerebellum and the cuneus, the calcarine cortex, and the temporal lobe, respectively, in patients with poor outcome, and was decreased between the cerebellum and the prefrontal cortex in patients with poor outcome. The structural covariance integrities between the right cerebellum and the right cuneus were correlated to 2-year headache frequencies (r = 0.36, P = 0.008). Conclusions Structural volume and connectivity changes of the cerebellum may underlie headache persistence in patients with HFM.
Collapse
Affiliation(s)
- Hung-Yu Liu
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, No. 201, Sec. 2 Shih-Pai Rd, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Pei-Lin Lee
- Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan
| | - Kun-Hsien Chou
- Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan
| | - Kuan-Lin Lai
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, No. 201, Sec. 2 Shih-Pai Rd, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yen-Feng Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, No. 201, Sec. 2 Shih-Pai Rd, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Shih-Pin Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, No. 201, Sec. 2 Shih-Pai Rd, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan.,Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Ta Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, No. 201, Sec. 2 Shih-Pai Rd, Taipei, Taiwan. .,School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Brain Research Center, National Yang-Ming University, Taipei, Taiwan.
| | - Shuu-Jiun Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, No. 201, Sec. 2 Shih-Pai Rd, Taipei, Taiwan. .,School of Medicine, National Yang-Ming University, Taipei, Taiwan. .,Brain Research Center, National Yang-Ming University, Taipei, Taiwan.
| |
Collapse
|
24
|
Edvinsson L, Haanes KA. Views on migraine pathophysiology: Where does it start? ACTA ACUST UNITED AC 2019. [DOI: 10.1111/ncn3.12356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- Lars Edvinsson
- Department of Clinical Sciences Division of Experimental Vascular Research Lund University Lund Sweden
- Department of Clinical Experimental Research Glostrup Research Institute Rigshospitalet Glostrup Denmark
| | - Kristian Agmund Haanes
- Department of Clinical Experimental Research Glostrup Research Institute Rigshospitalet Glostrup Denmark
| |
Collapse
|
25
|
Qin Z, He XW, Zhang J, Xu S, Li GF, Su J, Shi YH, Ban S, Hu Y, Liu YS, Zhuang MT, Zhao R, Shen XL, Li J, Liu JR, Du X. Structural changes of cerebellum and brainstem in migraine without aura. J Headache Pain 2019; 20:93. [PMID: 31477012 PMCID: PMC6734280 DOI: 10.1186/s10194-019-1045-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 08/26/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Increasing evidence has suggested that the cerebellum is associated with pain and migraine. In addition, the descending pain system of the brainstem is the major site of trigeminal pain processing and modulation and has been discussed as a main player in the pathophysiology of migraine. Cerebellar and brainstem structural changes associated with migraineurs remain to be further investigated. METHODS Voxel-based morphometry (VBM) (50 controls, 50 migraineurs without aura (MWoAs)) and diffusion tensor imaging (DTI) (46 controls, 46 MWoAs) were used to assess cerebellum and brainstem anatomical alterations associated with MWoAs. We utilized a spatially unbiased infratentorial template toolbox (SUIT) to perform cerebellum and brainstem optimized VBM and DTI analysis. We extracted the average diffusion values from a probabilistic cerebellar white matter atlas to investigate whether MWoAs exhibited microstructure alterations in the cerebellar peduncle tracts. RESULTS MWoAs showed decreased fractional anisotropy (FA) in the vermis VI extending to the bilateral lobules V and VI of the cerebellum. We also found higher axial diffusivity (AD), mean diffusivity (MD), and radial diffusivity (RD) in the right inferior cerebellum peduncle tract in MWoAs. MWoAs exhibited both reduced gray matter volume and increased AD, MD and RD in the spinal trigeminal nucleus (SpV). CONCLUSION MWoAs exhibited microstructural changes in the cerebellum and the local brainstem. These structural differences might contribute to dysfunction of the transmission and modulation of noxious information, trigeminal nociception, and conduction and integration of multimodal information in MWoAs. These findings further suggest involvement of the cerebellum and the brainstem in the pathology of migraine without aura.
Collapse
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
| | - 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
| | - Jilei Zhang
- 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
| | - Shuai Xu
- 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
| | - Ge-Fei Li
- 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
| | - 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
| | - Yan-Hui Shi
- 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
| | - 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
| | - Mei-Ting Zhuang
- 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
| | - Xiao-Lei Shen
- 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
| | - 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.
| |
Collapse
|
26
|
Russo A, Tessitore A, Silvestro M, Di Nardo F, Trojsi F, Del Santo T, De Micco R, Esposito F, Tedeschi G. Advanced visual network and cerebellar hyperresponsiveness to trigeminal nociception in migraine with aura. J Headache Pain 2019; 20:46. [PMID: 31053057 PMCID: PMC6734311 DOI: 10.1186/s10194-019-1002-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 04/18/2019] [Indexed: 01/03/2023] Open
Abstract
Background Despite the growing body of advanced studies investigating the neuronal correlates of pain processing in patients with migraine without aura (MwoA), only few similar studies have been conducted in patients with migraine with aura (MwA). Therefore, we aimed to explore the functional brain response to trigeminal noxious heat stimulation in patients with MwA. Methods Seventeen patients with MwA and 15 age- and sex-matched healthy controls (HC) underwent whole-brain blood oxygen level–dependent (BOLD) fMRI during trigeminal noxious heat stimulation. To examine the specificity of any observed differences between patients with MwA and HC, the functional response of neural pathways to trigeminal noxious heat stimulation in patients with MwA was compared with 18 patients with MwoA. Secondary analyses investigated the correlations between BOLD signal changes and clinical parameters of migraine severity. Results We observed a robust cortical and subcortical pattern of BOLD response to trigeminal noxious heat stimulation across all participants. Patients with MwA showed a significantly increased activity in higher cortical areas known to be part of a distributed network involved in advanced visual processing, including lingual gyrus, inferior parietal lobule, inferior frontal gyrus and medial frontal gyrus. Moreover, a significantly greater cerebellar activation was observed in patients with MwA when compared with both patients with MwA and HC. Interestingly, no correlations were found between migraine severity parameters and magnitude of BOLD response in patients with MwA. Conclusion Our findings, characterized by abnormal visual pathway response to trigeminal noxious heat stimulation, support the role of a functional integration between visual and trigeminal pain networks in the pathophysiological mechanisms underlying migraine with aura. Moreover, they expand the concept of “neurolimbic-pain network” as a model of MwoA including both limbic dysfunction and cortical dys-excitability. Indeed, we suggest a model of “neurolimbic-visual-pain network” in MwA patients, characterized by dysfunctional correlations between pain-modulating circuits not only with the cortical limbic areas but with advanced visual areas as well. Furthermore, the abnormal cerebellar response to trigeminal noxious heat stimulation may suggest a dysfunctional cerebellar inhibitory control on thalamic sensory gating, impinging on the advanced visual processing cortical areas in patients with MwA. Electronic supplementary material The online version of this article (10.1186/s10194-019-1002-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Antonio Russo
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, I-80138, Naples, Italy.,MRI Research Centre SUN-FISM, University of Campania, "Luigi Vanvitelli", Caserta, Italy
| | - Alessandro Tessitore
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, I-80138, Naples, Italy
| | - Marcello Silvestro
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, I-80138, Naples, Italy.,MRI Research Centre SUN-FISM, University of Campania, "Luigi Vanvitelli", Caserta, Italy
| | - Federica Di Nardo
- MRI Research Centre SUN-FISM, University of Campania, "Luigi Vanvitelli", Caserta, Italy
| | - Francesca Trojsi
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, I-80138, Naples, Italy.,MRI Research Centre SUN-FISM, University of Campania, "Luigi Vanvitelli", Caserta, Italy
| | - Teresa Del Santo
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, I-80138, Naples, Italy
| | - Rosa De Micco
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, I-80138, Naples, Italy.,MRI Research Centre SUN-FISM, University of Campania, "Luigi Vanvitelli", Caserta, Italy
| | - Fabrizio Esposito
- Department of Medicine, Surgery and Dentistry, Scuola Medica Salernitana, University of Salerno, Fisciano, Italy
| | - Gioacchino Tedeschi
- Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, University of Campania "Luigi Vanvitelli", Piazza Miraglia 2, I-80138, Naples, Italy. .,MRI Research Centre SUN-FISM, University of Campania, "Luigi Vanvitelli", Caserta, Italy. .,Institute for Diagnosis and Care 'Hermitage-Capodimonte', Naples, Italy.
| |
Collapse
|
27
|
Silva KE, Rosner J, Ullrich NJ, Chordas C, Manley PE, Moulton EA. Pain affect disrupted in children with posterior cerebellar tumor resection. Ann Clin Transl Neurol 2019; 6:344-354. [PMID: 30847366 PMCID: PMC6389840 DOI: 10.1002/acn3.709] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/26/2018] [Accepted: 11/26/2018] [Indexed: 12/26/2022] Open
Abstract
Objectives Damage to the posterior cerebellum can cause affective deficits in patients. In adults, cerebellar infarcts result in thermal hyperalgesia and affect descending modulation of pain. This study evaluated the effect of resection of low-grade cerebellar tumors on pain processing in human children. Methods Twelve pediatric patients treated with surgery only for low-grade gliomas (8 females, 4 males; mean age = 13.8 ± 5.6) and twelve matched controls (8 females, 4 males; mean age = 13.8 ± 5.7) were evaluated using quantitative sensory testing and fMRI. Five patients had tumors localized to posterior cerebellar hemispheres, henceforth identified as Crus Patients. Results Crus Patients had significantly lower pain tolerance to a cold pressor test than controls. No significant differences were detected between subject groups for heat and cold detection thresholds (HDT, CDT), and heat and cold pain thresholds (HPT, CPT). Crus Patients also showed significantly decreased fMRI responses to painful heat in anterior insula, which has been associated with pain affect. Interpretation Damage to posterior cerebellar hemispheres disrupted affective pain processing and endogenous pain modulation, resulting in decreased pain tolerance to suprathreshold noxious stimuli. This suggests that surgical resection of this region in children may increase the risk of developing pain disorders.
Collapse
Affiliation(s)
- Katie E Silva
- Center for Pain and the Brain Department of Anesthesiology, Critical Care and Pain Medicine Boston Children's Hospital Harvard Medical School Boston Massachusetts 02215
| | - Julie Rosner
- Center for Pain and the Brain Department of Anesthesiology, Critical Care and Pain Medicine Boston Children's Hospital Harvard Medical School Boston Massachusetts 02215
| | - Nicole J Ullrich
- Department of Neurology Boston Children's Hospital Harvard Medical School Boston Massachusetts 02115.,Department of Hematology/Oncology Boston Children's Hospital Harvard Medical School Boston Massachusetts 02115.,Dana-Farber/Boston Children's Cancer and Blood Disorders Center Boston Massachusetts 02115
| | - Christine Chordas
- Department of Hematology/Oncology Boston Children's Hospital Harvard Medical School Boston Massachusetts 02115
| | - Peter E Manley
- Department of Hematology/Oncology Boston Children's Hospital Harvard Medical School Boston Massachusetts 02115.,Dana-Farber/Boston Children's Cancer and Blood Disorders Center Boston Massachusetts 02115
| | - Eric A Moulton
- Center for Pain and the Brain Department of Anesthesiology, Critical Care and Pain Medicine Boston Children's Hospital Harvard Medical School Boston Massachusetts 02215
| |
Collapse
|
28
|
Anagnostou E, Gerakoulis S, Voskou P, Kararizou E. Postural instability during attacks of migraine without aura. Eur J Neurol 2018; 26:319-e21. [PMID: 30295375 DOI: 10.1111/ene.13815] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2018] [Accepted: 10/03/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE Migraine has long been associated with unsteadiness and dizziness but postural control has not been studied in the ictal state. Here, the stability of upright stance during migraine attacks was measured. METHODS Static balance was assessed prospectively in migraine patients (n = 30) during quiet stance for 40 s on a posturographic force platform. Recordings were performed both ictally and in the pain-free interval. Subjects were assessed under four different conditions yielding different visual and proprioceptive feedback environments. Both ictal and interictal data were compared with age-matched healthy controls (n = 30). RESULTS Postural instability increased significantly under all experimental conditions during migraine attacks. Whilst standing on a foam pad with eyes closed, median sway area was 353 mm2 in control subjects, 318 mm2 in migraineurs in the pain-free period and 618 mm2 in the ictal state. However, Romberg and vestibular Romberg quotients were not altered during migraine attacks. Spectral analyses of postural sway also showed similar profiles in migraineurs and controls. The severity of headache was inversely correlated to Romberg quotients. CONCLUSIONS The demonstrated pattern of balance disorder during migraine attacks suggests a transient cerebellar dysfunction. Our findings also indicate that intense headache induces a re-weighting of sensory processing toward less dependence on visual and proprioceptive information.
Collapse
Affiliation(s)
- E Anagnostou
- Department of Neurology, Eginition Hospital, University of Athens, Athens, Greece
| | - S Gerakoulis
- Department of Neurology, Eginition Hospital, University of Athens, Athens, Greece
| | - P Voskou
- Department of Neurology, Eginition Hospital, University of Athens, Athens, Greece
| | - E Kararizou
- Department of Neurology, Eginition Hospital, University of Athens, Athens, Greece
| |
Collapse
|