Functional Neuroimaging in Trigeminal Autonomic Cephalalgias

[Trigeminal Autonomic Cephalgias]

Compared with migraine and tension-type headache, trigeminal autonomic cephalgias (TAC) are rare, but the resulting significant impairment and the not irrelevant prevalence (e. g., cluster headache 0.1%) make TACs important diagnoses. Unfortunately, the correct diagnosis is often delayed. This article provides an overview of the diagnostic approach and therapeutic options in TACs.

No structural brain alterations in new daily persistent headache - a cross sectional VBM/SBM study

OBJECTIVE

To identify grey matter alterations in patients suffering new daily persistent headache to enrich the pathophysiological concept of this rare headache disorder characterised by a distinct, clearly remembered onset and its instant chronification.

METHOD

Magnetic resonance-based voxel-based and surface-based morphometry was used to investigate 23 patients suffering from new daily persistent headache and 23 age- and gender-matched healthy controls with 1.5 Tesla MRI.Independent statistical analysis was performed at three sites using statistical parametric mapping, as well as FSL(FMRIB Software Library)-based approaches.

RESULTS

No grey matter changes were detected using this sophisticated and cross-checked method.

CONCLUSION

The absence of structural brain changes in patients with new daily persistent headache contribute to the recent discussion regarding structural alterations in primary headache disorders in general and does not provide evidence for grey matter changes being associated with the pathophysiology of new daily persistent headache. Future research will have to determine the underlying pathophysiological mechanisms of this disorder.

Paroxysmal hemicrania associated to carotid artery dissection: a case report

There are numerous case reports relating trigeminal autonomic cephalalgias to structural injuries. However there is no description of the association between paroxysmal hemicrania and carotid artery dissection.  We describe a previously healthy 63-year-old male presented with the onset of severe, throbbing pain in the right frontal region, lasting between 10 and 30 minutes, with a frequency of approximately two to three attacks per day, which began two days before seeking medical care. Pain was associated with ipsilateral tearing, semiptosis and nasal congestion. A cervical arterial magnetic resonance angiography demonstrated left carotid artery dissection in the C1/C2 segment of the left internal carotid artery. The patient became asymptomatic after indomethacin use. We conclude that the possibility of investigating carotid dissection should be considered in patients with paroxysmal hemicrania.  

Role of Functional Neuroimaging in Primary Headache Disorders

Background

Key structures for the pathophysiology of primary headache disorders such as migraine, cluster headache, and other trigeminal autonomic cephalalgias were identified by imaging in the past years.

Objective

Available data on functional imaging in primary headache disorders are summarized in this review.

Material and Methods

We performed a MEDLINE search on December 27^th, 2020 using the search terms "primary headache" AND "imaging" that returned 453 results in English, out of which 137 were labeled reviews. All articles were evaluated for content and relevance for this narrative review.

Results

The structure depicted most consistently using functional imaging in different states of primary headaches (without and with pain) was the posterior hypothalamus. Whole-brain imaging techniques such as resting-state functional resonance imaging showed a wide-ranging association of cortical and subcortical areas with human nociceptive processing in the pathophysiological mechanisms underlying the different TACs. Similarities of distinct groups of primary headache disorders, as well as their differences in brain activation across these disorders, were highlighted.

Conclusion

The importance of neuroimaging research from clinical practice point of view remains the reliable and objective distinction of each individual pain syndrome from one another. This will help to make the correct clinical diagnosis and pave the way for better and effective treatment in the future. More research will be necessary to fulfill this unmet need.