A review of diagnostic and functional imaging in headache.
A review of diagnostic and functional imaging in headache.
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DOI：
10.1007/s10194-006-0307-1
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发表时间：
2006-09
影响因子：
7.4
通讯作者：
May, Arne
中科院分区：
文献类型：
--
作者：
May, Arne
头痛患者的神经成像使我们对原发性头痛的病理生理学的理解发生了革命性的变化，并为这些综合征提供了独特的见解。现代影像研究指出，与临床图像一起，指向一个主要的触发原因。使用正电子发射断层扫描的早期功能成像工作揭示了一些综合征的起源，最近得到改进，这意味着在偏头痛(脑干)和几个三叉神经-自主神经头痛(下丘脑灰质)中观察到的激活以允许或触发的方式参与疼痛过程，而不仅仅是对第一分区伤害性感觉本身的反应。使用先进的基于体素的形态计量学方法，有人提出，在急性丛集性头痛中专门激活的大脑区域-下丘脑后灰质-与同一区域灰质的增加之间存在相关性。没有发现偏头痛和药物过度使用头痛的结构变化，而慢性紧张型头痛患者在已知的涉及疼痛处理的区域显示出显著的灰质减少。因此，现代神经成像清楚地表明，大多数原发头痛综合征主要是由大脑驱动的，激活了三叉神经血管反射，需要在两侧：中枢和外周发挥作用的治疗方法。
The neuroimaging of headache patients has revolutionised our understanding of the pathophysiology of primary headaches and provided unique insights into these syndromes. Modern imaging studies point, together with the clinical picture, towards a central triggering cause. The early functional imaging work using positron emission tomography shed light on the genesis of some syndromes, and has recently been refined, implying that the observed activation in migraine (brainstem) and in several trigeminal-autonomic headaches (hypothalamic grey) is involved in the pain process in either a permissive or triggering manner rather than simply as a response to first-division nociception per se. Using the advanced method of voxel-based morphometry, it has been suggested that there is a correlation between the brain area activated specifically in acute cluster headache — the posterior hypothalamic grey matter — and an increase in grey matter in the same region. No structural changes have been found for migraine and medication overuse headache, whereas patients with chronic tension-type headache demonstrated a significant grey matter decrease in regions known to be involved in pain processing. Modern neuroimaging thus clearly suggests that most primary headache syndromes are predominantly driven from the brain, activating the trigeminovascular reflex and needing therapeutics that act on both sides: centrally and peripherally.