Cortical and Subcortical Alterations in Medication Overuse Headache
Cortical and Subcortical Alterations in Medication Overuse Headache
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DOI：
10.3389/fneur.2018.00499
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发表时间：
2018-06-25
影响因子：
3.4
通讯作者：
May, Arne
中科院分区：
文献类型：
--
作者：
Mehnert, Jan;Hebestreit, Julia;May, Arne
药物过度使用头痛在头痛诊所中是一个日益严重的问题，治疗包括停药。虽然已经证明这些患者的眼眶前额叶皮质代谢不足，灰质较少，但这一发现的功能作用仍不清楚，因为几乎没有探索停药的功能成像研究发表。我们使用公认的三叉神经伤害性功能磁共振成像范式，比较了18名患者停药前后的结构和功能磁共振图像与年龄和性别匹配的对照组。我们复制了患者眼眶前额叶皮质的结构变化，这些变化与停药的临床结果高度相关。与停药后相比，停药前疼痛相关区域(盖、岛、三叉神经脊束核)的神经元活性降低，眶前叶皮质与伤害性输入区(三叉神经脊束核)和戒断后恢复的小脑的功能连接性降低。这些数据表明，在头痛的处理过程中，眶前叶皮质作为自下而上和自上而下的中介体发挥了重要作用。
Medication-overuse headache is an increasing problem in headache clinics and therapy includes drug withdrawal. Although it has been shown that the orbitofrontal cortex is hypo-metabolic and exhibits less gray matter in these patients the functional role of this finding is still unclear as virtually no functional imaging studies exploring withdrawal of medication have been published. We compared structural and functional magnetic resonance images of 18 patients before and after drug withdrawal with age and gender matched controls using a well-established trigeminal, nociceptive fMRI paradigm. We reproduced structural changes in the orbitofrontal cortex of the patients which highly correlated with the clinical outcome of medication withdrawal. The neuronal activity before drug withdrawal in pain related regions (operculum, insula, spinal trigeminal nucleus) was reduced compared to after drug withdrawal and the orbitofrontal cortex showed a reduced functional connectivity to the nociceptive input region (spinal trigeminal nucleus) and the cerebellum which regained after withdrawal. These data suggest the seminal role of the orbitofrontal cortex as a mediator between bottom-up and top-down stream in headache processing.