Pain Processing in Medication Overuse Headache: A Functional Magnetic Resonance Imaging (fMRI) Study
Pain Processing in Medication Overuse Headache: A Functional Magnetic Resonance Imaging (fMRI) Study
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DOI：
10.1111/j.1526-4637.2011.01183.x
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发表时间：
2012-02-01
期刊：
影响因子：
3.1
通讯作者：
Chiapparini, Luisa
中科院分区：
文献类型：
--
作者：
Ferraro, Stefania;Grazzi, Licia;Chiapparini, Luisa
目标。主要目的是调查药物过度使用头痛(MOH)患者和对照组之间的功能差异，目的是评估疼痛基质中伤害性刺激处理过程中是否存在整体变化。第二个目的是调查停药后MOH患者的活动是否恢复正常，这将提示疼痛矩阵在头痛时序化中可能发挥的作用。对9例女性MOH患者在疼痛机械刺激时、停药后6个月和9例对照组进行功能磁共振成像检查。与对照组相比，戒断后即刻，MOH患者的初级躯体感觉皮质、顶下小叶和缘上回以及疼痛矩阵外侧通路的区域的疼痛相关活动减少。在6个月时，这些差异不再被检测到。我们的研究结果表明，MOH患者的外侧痛通路发生了显著的功能变化。这可能是由不同的过程引起的：1)旨在减少对皮质的痛苦输入的皮质下调；2)偏头痛发作期间过度痛苦输入所诱导的依赖活动的可塑性；以及3)药物过度使用的直接影响。在停药6个月后，这些区域的活动恢复正常，表明不会因为药物过度使用而发生不可逆转的变化。
Objective. The primary aim was to investigate functional differences between medication overuse headache (MOH) patients and controls with the purpose of evaluating the presence of a global alteration in the processing of noxious stimuli throughout the pain matrix. The secondary aim was to investigate whether activations in MOH patients normalize after medication withdrawal, which would suggest a possible role of the pain matrix in headache chronification.Design. Functional magnetic resonance imaging was performed during painful mechanical stimulation in nine female patients with MOH immediately and at 6 months after beginning medication withdrawal, and in nine control participants.Results. Compared with controls, immediately after beginning withdrawal, the MOH patients showed reduced pain- related activity across the primary somatosensory cortex, inferior parietal lobule, and supramarginal gyrus, as well as in regions of the lateral pathway of the pain matrix. At 6 months, these differences were no longer detectable.Conclusion. Our findings suggest that significant functional changes occur in the lateral pain pathway in MOH patients. These could result from different processes: 1) cortical down-regulation aimed at reducing painful input to the cortex; 2) activitydependent plasticity induced by excessive painful input during migraine attacks; and 3) direct effect of medication overuse. At 6 months after withdrawal, activity in these regions normalized, suggesting that no irreversible changes occur due to medication overuse.