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Functional brain imaging in hemicrania continua: Implications for nosology and pathophysiology

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Abstract

Hemicrania continua is a strictly unilateral, continuous headache of mild to moderate intensity, with superimposed exacerbations of moderate to 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 cephalalgias and migraine, in which the hypothalamus and the brain stem, respectively, have been postulated to play central pathophysiologic roles. A recent positron-emission tomography study of a cohort of patients with hemicrania continua demonstrated 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.

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References and Recommended Reading

  1. Headache Classification Committee of The International Headache Society: The International Classification of Headache Disorders, edn 2. Cephalalgia 2004, 24(suppl 1):1–160.

    Google Scholar 

  2. Matharu MS, Boes CJ, Goadsby PJ: Management of trigeminal autonomic cephalalgias and hemicrania continua. Drugs 2003, 63:1637–1677.

    Article  PubMed  CAS  Google Scholar 

  3. Medina JL, Diamond S: Cluster headache variant: spectrum of a new headache syndrome. Arch Neurol 1981, 38:705–709.

    PubMed  CAS  Google Scholar 

  4. Boghen D, Desaulniers N: Background vascular headache: relief with indomethacin. Can J Neurol Sci 1983, 10:270–271.

    PubMed  CAS  Google Scholar 

  5. Sjaastad O, Spierings EL: Hemicrania continua: another headache absolutely responsive to indomethacin. Cephalalgia 1984, 4:65–70.

    Article  PubMed  CAS  Google Scholar 

  6. Peres MFP, Silberstein SD, Nahmias S, et al.: Hemicrania continua is not that rare. Neurology 2001, 57:948–951.

    PubMed  CAS  Google Scholar 

  7. Wheeler SD, Allen KF, Pusey T: Is hemicrania continua a migraine variant? Cephalalgia 2001, 21:508.

    Google Scholar 

  8. Goadsby PJ, Lipton RB: A review of paroxysmal hemicranias, SUNCT syndrome, and other short-lasting headaches with autonomic features, including new cases. Brain 1997, 120:193–209.

    Article  PubMed  Google Scholar 

  9. Goadsby PJ: Pathophysiology of cluster headache: a trigeminal autonomic cephalgia. Lancet Neurol 2002, 1:37–43.

    Google Scholar 

  10. Raskin NH: Headache. New York: Churchill-Livingstone; 1988.

    Google Scholar 

  11. Weiller C, May A, Limmroth V, et al.: Brain stem activation in spontaneous human migraine attacks. Nat Med 1995, 1:658–660.

    Article  PubMed  CAS  Google Scholar 

  12. Matharu MS, Bartsch T, Ward N, et al.: Central neuromodulation in chronic migraine patients with suboccipital stimulators: a PET study. Brain 2004, 127:220–230.

    Article  PubMed  Google Scholar 

  13. May A, Bahra A, Buchel C, et al.: Hypothalamic activation in cluster headache attacks. Lancet 1998, 352:275–278. First observations of posterior hypothalamic grey activation in cluster headache.

    Article  PubMed  CAS  Google Scholar 

  14. May A, Bahra A, Buchel C, et al.: PET and MRA findings in cluster headache and MRA in experimental pain. Neurology 2000, 55:1328–1335.

    PubMed  CAS  Google Scholar 

  15. Sprenger T, Boecker H, Tolle TR, et al.: Specific hypothalamic activation during a spontaneous cluster headache attack. Neurology 2004, 62:516–517.

    PubMed  CAS  Google Scholar 

  16. May A, Bahra A, Buchel C, et al.: Functional MRI in spontaneous attacks of SUNCT: short-lasting neuralgiform headache with conjunctival injection and tearing. Ann Neurol 1999, 46:791–793.

    Article  PubMed  CAS  Google Scholar 

  17. Sprenger T, Valet M, Platzer S, et al.: SUNCT: bilateral hypothalamic activation during headache attacks and resolving of symptoms after trigeminal decompression. Pain 2005, 113:422–426.

    Article  PubMed  Google Scholar 

  18. Cohen AS, Matharu MS, Kalisch R, et al.: Functional MRI in SUNCT shows differential hypothalamic activation with increasing pain. Cephalalgia 2004, 24:1098–1099.

    Article  Google Scholar 

  19. May A, Kaube H, Buechel C, et al.: Experimental cranial pain elicited by capsaicin: a PET study. Pain 1998, 74:61–66.

    Article  PubMed  CAS  Google Scholar 

  20. Afridi S, Matharu MS, Lee L, et al.: A PET study exploring the laterality of brain stem activation in migraine using glyceryl trinitrate. Brain 2005, 128:932–939. Important clinical paper aimed at studying laterality in migraine.

    Article  PubMed  CAS  Google Scholar 

  21. Bahra A, Matharu MS, Buchel C, et al.: Brain stem activation specific to migraine headache. Lancet 2001, 357:1016–1017.

    Article  PubMed  CAS  Google Scholar 

  22. Afridi S, Giffin NJ, Kaube H, et al.: A PET study in spontaneous migraine. Arch Neurol 2005, in press.

  23. Goadsby PJ: Neuroimaging in headache. Microsc Res Tech 2001, 53:179–187.

    Article  PubMed  CAS  Google Scholar 

  24. Matharu MS, Cohen AS, McGonigle DJ, et al.: Posterior hypothalamic and brain stem activation in hemicrania continua. Headache 2004, 44:747–761. First observations of brain changes in hemicrania continua.

    Article  PubMed  Google Scholar 

  25. Moore-Ede MC: The circadian timing system in mammals: two pacemakers preside over many secondary oscillators. Fed Proc 1983, 42:2802–2808.

    PubMed  CAS  Google Scholar 

  26. Kudrow L: Plasma testosterone levels in cluster headache preliminary results. Headache 1976, 16:228–231.

    Google Scholar 

  27. Leone M, Bussone G: A review of hormonal findings in cluster headache: evidence for hypothalamic involvement. Cephalalgia 1993, 13:309–317.

    Article  PubMed  CAS  Google Scholar 

  28. Derbyshire SW, Jones AK, Devani P, et al.: Cerebral responses to pain in patients with atypical facial pain measured by positron emission tomography. J Neurol Neurosurg Psychiatry 1994, 57:1166–1172.

    PubMed  CAS  Google Scholar 

  29. Denuelle M, Fabre N, Payoux P, Chollet FG: Brain stem and hypothalamic activation in spontaneous migraine attacks. Cephalalgia 2004, 24:775–814.

    Article  Google Scholar 

  30. May A, Ashburner J, Buchel C, et al.: Correlation between structural and functional changes in brain in an idiopathic headache syndrome. Nat Med 1999, 5:836–838.

    Article  PubMed  CAS  Google Scholar 

  31. Matharu MS, Good CD, May A, et al.: No change in the structure of the brain in migraine: a voxel-based morphometric study. Eur J Neurol 2003, 10:53–58.

    Article  PubMed  CAS  Google Scholar 

  32. Leone M, Franzini A, Bussone G: Stereotactic stimulation of the posterior hypothalamic gray matter in a patient with intractable cluster headache. N Engl J Med 2001, 345:1428–1429.

    Article  PubMed  CAS  Google Scholar 

  33. Franzini A, Ferroli P, Leone M, Broggi G: Stimulation of the posterior hypothalamus for treatment of chronic intractable cluster headaches: the first reported series. Neurosurgery 2003, 52:1095–1101. First series of patients with deep brain stimulation for cluster headache.

    Article  PubMed  Google Scholar 

  34. Leone M, Franzini A, Broggi G, et al.: Long-term follow-up of bilateral hypothalamic stimulation for intractable cluster headache. Brain 2004, 127:2259–2264.

    Article  PubMed  CAS  Google Scholar 

  35. Leone M, Franzini A, D’Amico D, et al.: Hypothalamic deep brain stimulation to relieve intractable chronic SUNCT: the first case. Neurology 2004, 62(suppl 5):A356.

    Google Scholar 

  36. Sano K, Mayanagi Y, Sekino H, et al.: Results of stimulation and destruction of the posterior hypothalamus in man. J Neurosurg 1970, 33:689–707.

    Article  PubMed  CAS  Google Scholar 

  37. Bejjani BP, Houeto JL, Hariz M, et al.: Aggressive behavior induced by intraoperative stimulation in the triangle of Sano. Neurology 2002, 59:1425–1427.

    PubMed  CAS  Google Scholar 

  38. Ingvar M: Pain and functional imaging. Philos Trans R Soc Lond B Biol Sci 1999, 354:1347–1358.

    Article  PubMed  CAS  Google Scholar 

  39. Kupers R: Facial pain: from animal models to functional neuroimaging studies. Acta Neurol Belg 2001, 101:32–38.

    PubMed  CAS  Google Scholar 

  40. Jones AK, Kulkarni B, Derbyshire SW: Pain mechanisms and their disorders. Br Med Bull 2003, 65:83–93.

    Article  PubMed  CAS  Google Scholar 

  41. Hsieh JC, Stahle-Backdahl M, Hagermark O, et al.: Traumatic nociceptive pain activates the hypothalamus and the periaqueductal gray: a positron-emission tomography study. Pain 1996, 64:303–314.

    Article  PubMed  CAS  Google Scholar 

  42. Rosen SD, Paulesu E, Frith CD, et al.: Central nervous system pathways mediating angina. Lancet 1994, 344:147–150.

    Article  PubMed  CAS  Google Scholar 

  43. Rosen SD, Paulesu E, Nihoyannopoulos P, et al.: Silent ischemia as a central problem: regional brain activation compared in silent and painful myocardial ischemia. Ann Intern Med 1996, 124:939–949.

    PubMed  CAS  Google Scholar 

  44. Kupers RC, Gybels JM, Gjedde A: Positron-emission tomography study of a chronic pain patient successfully treated with somatosensory thalamic stimulation. Pain 2000, 87:295–302.

    Article  PubMed  CAS  Google Scholar 

  45. Wu MT, Sheen JM, Chuang KH, et al.: Neuronal specificity of acupuncture response: a fMRI study with electroacupuncture. Neuroimage 2002, 16:1028–1037.

    Article  PubMed  Google Scholar 

  46. Hui KK, Liu J, Makris N, et al.: Acupuncture modulates the limbic system and subcortical gray structures of the human brain: evidence from fMRI studies in normal subjects. Hum Brain Mapp 2000, 9:13–25.

    Article  PubMed  CAS  Google Scholar 

  47. Wu MT, Hsieh JC, Xiong J, et al.: Central nervous pathway for acupuncture stimulation: localization of processing with functional MR imaging of the brain--preliminary experience. Radiology 1999, 212:133–141.

    PubMed  CAS  Google Scholar 

  48. Wang Q, Mao LM, Han JS: Naloxone-reversible analgesia produced by microstimulation of the arcuate nucleus of the hypothalamus in pentobarbital-anesthetized rats. Exp Brain Res 1990, 80:201–204.

    Article  PubMed  CAS  Google Scholar 

  49. Dafny N, Dong WQ, Prieto-Gomez C, et al.: Lateral hypothalamus: site involved in pain modulation. Neuroscience 1996, 70:449–460.

    Article  PubMed  CAS  Google Scholar 

  50. Lumb BM, Lovick TA: The rostral hypothalamus: an area for the integration of autonomic and sensory responsiveness. J Neurophysiol 1993, 70:1570–1577.

    PubMed  CAS  Google Scholar 

  51. May A, Goadsby PJ: The trigeminovascular system in humans: pathophysiological implications for primary headache syndromes of the neural influences on the cerebral circulation. J Cereb Blood Flow Metab 1999, 19:115–127. Good review of TAC physiology.

    Article  PubMed  CAS  Google Scholar 

  52. May A, Buchel C, Turner R, Goadsby PJ: MR-angiography in facial and other pain: neurovascular mechanisms of trigeminal sensation. J Cereb Blood Flow Metab 2001, 21:1171–1176.

    Article  PubMed  CAS  Google Scholar 

  53. Frese A, Evers S, May A: Autonomic activation in experimental trigeminal pain. Cephalalgia 2003, 23:67–68. Important observation of cranial autonomic activation with pain.

    Article  PubMed  CAS  Google Scholar 

  54. Barbanti P, Fabbrini G, Pesare M, et al.: Unilateral cranial autonomic symptoms in migraine. Cephalalgia 2002, 22:256–259.

    Article  PubMed  CAS  Google Scholar 

  55. Avnon Y, Nitzan M, Sprecher E, et al.: Different patterns of parasympathetic activation in uni-and bilateral migraineurs. Brain 2003, 126:1660–1670.

    Article  PubMed  Google Scholar 

  56. Benoliel R, Sharav Y: Trigeminal neuralgia with lacrimation or SUNCT syndrome? Cephalalgia 1998, 18:85–90.

    Article  PubMed  CAS  Google Scholar 

  57. Goadsby PJ, Matharu MS, Boes CJ: SUNCT syndrome or trigeminal neuralgia with lacrimation. Cephalalgia 2001, 21:82–83.

    Article  PubMed  CAS  Google Scholar 

  58. Malick A, Burstein R: Cells of origin of the trigeminohypothalamic tract in the rat. J Comp Neurol 1998, 400:125–144.

    Article  PubMed  CAS  Google Scholar 

  59. Goadsby PJ, Lambert GA, Lance JW: Differential effects on the internal and external carotid circulation of the monkey evoked by locus coeruleus stimulation. Brain Res 1982, 249:247–254.

    Article  PubMed  CAS  Google Scholar 

  60. Goadsby PJ, Zagami AS, Lambert GA: Neural processing of craniovascular pain: a synthesis of the central structures involved in migraine. Headache 1991, 31:365–371.

    Article  PubMed  CAS  Google Scholar 

  61. Welch KM, Nagesh V, Aurora S, Gelman N: Periaqueductal grey matter dysfunction in migraine: Cause or the burden of illness? Headache 2001, 41:629–637. Challenging paper suggesting that frequent migrane leads to iron deposition in the brain.

    Article  PubMed  CAS  Google Scholar 

  62. Raskin NH, Hosobuchi Y, Lamb S: Headache may arise from perturbation of brain. Headache 1987, 27:416–420.

    Article  PubMed  CAS  Google Scholar 

  63. Veloso F, Kumar K, Toth C: Headache secondary to deep brain implantation. Headache 1998, 38:507–515.

    Article  PubMed  CAS  Google Scholar 

  64. Haas DC, Kent PF, Friedman DI: Headache caused by a single lesion of multiple sclerosis in the periaqueductal gray area. Headache 1993, 33:452–455.

    Article  PubMed  CAS  Google Scholar 

  65. Goadsby PJ: Neurovascular headache and a midbrain vascular malformation: evidence for a role of the brain stem in chronic migraine. Cephalalgia 2002, 22:107–111.

    Article  PubMed  CAS  Google Scholar 

  66. Afridi S, Goadsby PJ: New onset migraine with a brain stem cavernous angioma. J Neurol Neurosurg Psychiatry 2003, 74:680–682.

    Article  PubMed  CAS  Google Scholar 

  67. Iadarola MJ, Berman KF, Zeffiro TA, et al.: Neural activation during acute capsaicin-evoked pain and allodynia assessed with PET. Brain 1998, 121:931–947.

    Article  PubMed  Google Scholar 

  68. Bingel U, Quante M, Knab R, et al.: Subcortical structures involved in pain processing: evidence from single-trial fMRI. Pain 2002, 99:313–321.

    Article  PubMed  CAS  Google Scholar 

  69. Cao Y, Welch KM, Aurora S, Vikingstad EM: Functional MRI-BOLD of visually triggered headache in patients with migraine. Arch Neurol 1999, 56:548–554. Important paper showing changes in brain activation with triggered migrane.

    Article  PubMed  CAS  Google Scholar 

  70. Matsumoto RR, Walker JM: Inhibition of rubral neurons by noxious and non-noxious pressure. Brain Res 1991, 556:78–84.

    Article  PubMed  CAS  Google Scholar 

  71. Bernays RL, Heeb L, Cuenod M, Streit P: Afferents to the rat red nucleus studied by means of D-[3H]aspartate, [3H]choline and non-selective tracers. Neuroscience 1988, 26:601–619.

    Article  PubMed  CAS  Google Scholar 

  72. Flumerfelt BA, Hrycyshyn AW: Precerebellar nuclei and red nucleus. In The Rat in Central Nervous System. Edited by Paxinos G. New York: Academic Press; 1985:221–250.

    Google Scholar 

  73. Basbaum AI, Fields HL: Endogenous pain control systems: brain stem spinal pathways and endorphin circuitry. Annu Rev Neurosci 1984, 7:307–338.

    Article  Google Scholar 

  74. Nishioka S, Nakahama H: Peripheral somatic activation of neurons in the cat red nucleus. J Neurophysiol 1973, 36:296–307.

    PubMed  CAS  Google Scholar 

  75. Prado WA, Roberts MH: An assessment of the antinociceptive and aversive effects of stimulating identified sites in the rat brain. Brain Res 1985, 340:219–228.

    Article  PubMed  CAS  Google Scholar 

  76. Kumar A, Raghubir R, Dhawan BN: Possible involvement of nitric oxide in red nucleus stimulation-induced analgesia in the rat. Eur J Pharmacol 1995, 279:1–5.

    Article  PubMed  CAS  Google Scholar 

  77. Chudler EH, Dong WK: The role of the basal ganglia in nociception and pain. Pain 1995, 60:33–38.

    Article  Google Scholar 

  78. Barasi S: Responses of substantia nigra neurones to noxious stimulation. Brain Res 1979, 171:121–130.

    Article  PubMed  CAS  Google Scholar 

  79. Feger J, Jacquemin J, Ohye C: Peripheral excitatory input to substantia nigra. Exp Neurol 1978, 59:351–360.

    Article  PubMed  CAS  Google Scholar 

  80. Jurna I, Heinz G, Blinn G, Nell T: The effect of substantia nigra stimulation and morphine on alpha-motoneurones and the tail-flick response. Eur J Pharmacol 1978, 51:239–250.

    Article  PubMed  CAS  Google Scholar 

  81. Segal M, Sandberg D: Analgesia produced electrical stimulation of catecholamine nuclei in the rat brain. Brain Res 1977, 123:369–372.

    Article  PubMed  CAS  Google Scholar 

  82. Li J, Ji YP, Qiao JT, Dafny N: Suppression of nociceptive responses in parafascicular neurons by stimulation of substantia nigra: an analysis of related inhibitory pathways. Brain Res 1992, 591:109–115.

    Article  PubMed  CAS  Google Scholar 

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  1. Institute of Neurology, 1N 3BG, London, WC, UK

    Peter J. Goadsby MD

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Matharu, M.S., Goadsby, P.J. Functional brain imaging in hemicrania continua: Implications for nosology and pathophysiology. Current Science Inc 9, 281–288 (2005). https://doi.org/10.1007/s11916-005-0038-z

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