Posterior hypothalamic and brainstem activation in hemicrania continua.
Details
Serval ID
serval:BIB_78F9F71FB6C8
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Posterior hypothalamic and brainstem activation in hemicrania continua.
Journal
Headache
ISSN
0017-8748 (Print)
ISSN-L
0017-8748
Publication state
Published
Issued date
2004
Volume
44
Number
8
Pages
747-761
Language
english
Notes
Publication types: Clinical Trial ; Journal Article ; Randomized Controlled TrialPublication Status: ppublish
Abstract
Objective.-To determine the brain structures involved in mediating the pain of hemicrania continua using positron emission tomography.
Background.-Hemicrania continua is a strictly unilateral, continuous headache of moderate intensity, with superimposed exacerbations of severe intensity that are accompanied by trigeminal autonomic features and migrainous symptoms. The syndrome is exquisitely responsive to indomethacin. Its clinical phenotype overlaps with that of the trigeminal autonomic headaches and migraine in which the hypothalamus and the brainstem, respectively, have been postulated to play central pathophysiologic roles. We hypothesized, based on the clinical phenotype, that hemicrania continua may involve activations in the hypothalamus, or dorsal rostral pons, or both.
Methods.-Seven patients with hemicrania continua were studied in two sessions each. In one session, the patients were scanned during baseline pain and when rendered completely pain free after being administered indomethacin 100 mg intramuscularly. In the other session, the patients were scanned during baseline pain and when still in pain after being administered placebo intramuscularly. Seven age- and sex-matched nonheadache subjects acted as the control group. The scan images were processed and analyzed using SPM99.
Results.-There was a significant activation of the contralateral posterior hypothalamus and ipsilateral dorsal rostral pons in association with the headache of hemicrania continua. In addition, there was activation of the ipsilateral ventrolateral midbrain, which extended over the red nucleus and the substantia nigra, and bilateral pontomedullary junction. No intracranial vessel dilatation was obvious.
Conclusions.-This study demonstrated activations of various subcortical structures, in particular the posterior hypothalamus and the dorsal rostral pons. If posterior hypothalamic and brainstem activation are considered as markers of trigeminal autonomic headaches and migrainous syndromes, respectively, then the activation pattern demonstrated in hemicrania continua mirrors the clinical phenotype, with its overlap with trigeminal autonomic headaches and migraine.
Background.-Hemicrania continua is a strictly unilateral, continuous headache of moderate intensity, with superimposed exacerbations of severe intensity that are accompanied by trigeminal autonomic features and migrainous symptoms. The syndrome is exquisitely responsive to indomethacin. Its clinical phenotype overlaps with that of the trigeminal autonomic headaches and migraine in which the hypothalamus and the brainstem, respectively, have been postulated to play central pathophysiologic roles. We hypothesized, based on the clinical phenotype, that hemicrania continua may involve activations in the hypothalamus, or dorsal rostral pons, or both.
Methods.-Seven patients with hemicrania continua were studied in two sessions each. In one session, the patients were scanned during baseline pain and when rendered completely pain free after being administered indomethacin 100 mg intramuscularly. In the other session, the patients were scanned during baseline pain and when still in pain after being administered placebo intramuscularly. Seven age- and sex-matched nonheadache subjects acted as the control group. The scan images were processed and analyzed using SPM99.
Results.-There was a significant activation of the contralateral posterior hypothalamus and ipsilateral dorsal rostral pons in association with the headache of hemicrania continua. In addition, there was activation of the ipsilateral ventrolateral midbrain, which extended over the red nucleus and the substantia nigra, and bilateral pontomedullary junction. No intracranial vessel dilatation was obvious.
Conclusions.-This study demonstrated activations of various subcortical structures, in particular the posterior hypothalamus and the dorsal rostral pons. If posterior hypothalamic and brainstem activation are considered as markers of trigeminal autonomic headaches and migrainous syndromes, respectively, then the activation pattern demonstrated in hemicrania continua mirrors the clinical phenotype, with its overlap with trigeminal autonomic headaches and migraine.
Keywords
Adult, Anti-Inflammatory Agents, Non-Steroidal/therapeutic use, Cerebrovascular Circulation, Double-Blind Method, Female, Humans, Hypothalamus/pathology, Hypothalamus/physiopathology, Indomethacin/therapeutic use, Male, Middle Aged, Migraine Disorders/drug therapy, Migraine Disorders/physiopathology, Pons/pathology, Pons/physiopathology, Positron-Emission Tomography, Red Nucleus/pathology, Red Nucleus/physiopathology, Substantia Nigra/pathology, Substantia Nigra/physiopathology
Pubmed
Web of science
Create date
11/09/2011 18:27
Last modification date
20/08/2019 14:35