Neurosensory Assessments of Headache

头痛的神经感觉评估

• 批准号: 8970065
• 负责人: Mark A Tommerdahl
• 金额: $ 22.35万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-15 至 2017-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8970065
• 关键词: Aftercare; Anxiety; Area; Basic Science; Biological; Biopsy; Blood Tests; Brain; Brain Concussion; Cerebrum; Clinical Research; Computer Peripherals; Computers; Data; Dependence; Devices; Diagnosis; Diagnostic; Discrimination; Disease; Evaluation; Feedback; Fingers; Floor; Future; Goals; Headache; Headache Disorders; Health; Health system; Image; Individual; Intervention; Investigation; Lead; Longitudinal Studies; Measurement; Measures; Mediating; Medicine; Mental Depression; Methodology; Methods; Migraine; Monitor; Mus; Neuraxis; Neurological status; Pain; Pain Threshold; Pain-Free; Pathology; Patient Self-Report; Patients; Performance; Physicians; Probability; Process; Protocols documentation; Publishing; Recovery; Reporting; Research; Running; Sensory; Site; Skin; Subgroup; Symptoms; Syndrome; System; Tactile; Technology; Testing; Therapeutic; Time; Trauma; Treatment Efficacy; Treatment outcome; Visit; Work; base; burden of illness; clinically significant; cost; design; diaries; disability; effective therapy; experience; human subject; improved; in vivo; indexing; information processing; innovation; laptop; meetings; nerve supply; nonhuman primate; novel; patient population; response; tool; treatment planning; treatment strategy; vibration

 DESCRIPTION (provided by applicant): Headache medicine depends upon subjective reports of pain. For primary headache disorders such as migraine, no blood test, imaging, or other objective means accurately assesses either the burden of illness or its time course. This dependence on subjectivity persists from diagnosis, through evaluation of treatment efficacy, to determination of disability. Many patients with longstanding migraine underreport symptoms, explaining that they have a high pain tolerance or have simply become accustomed to their headaches. Others may exaggerate symptoms due to anxiety, pain catastrophizing, depression, or secondary gain issues. An objective, quantitative biological measurement of migraine would greatly improve diagnosis and treatment. Ideally, repeat testing would track changes in headache pain and/or chronification. This problem motivated us to develop an objective, quantitative, non-invasive method to assess changes in CNS information processing that occur with the type of systemic cortical alterations that have been suggested to occur with migraine sufferers. This system, which delivers tactile (skin) stimulation to the fingertips, takes advantag of dense innervation in the fingertips projecting to adjacent areas in the brain. Sensory percepts are highly influenced by interactions between these adjacent brain areas and effectively provide a non-invasive biopsy of brain function. The stimulation protocols were both designed and validated from our findings from in vivo studies of cerebral cortical dynamics in non-human primates. Thus, they provide cortical dynamic metrics, or cortical metrics- and while independently obtained cortical metrics are predominantly influenced by specific cortical mechanisms, combining the metrics generates an individual CNS profile that can be used to characterize an individual's neurological status.. Proof of concept, with pilot data, has been obtained for differentiating migraineurs from healthy subjects as well as individuals with concussion. This application proposes to not only fully validate that difference but to determine i there is a correlation between a subject's migraine related self-reported pain and their CNS profile. An additional innovative feature of this application is that it proposes to (1) determine subject's CNS profile before their initial physician visit, (2) track the response of the patient t the intervention prescribed by the clinician and (3) retrospectively determine the capacity of the initial CNS profile to predict treatment outcomes. RELEVANCE: The overall goal of the proposed work is to investigate the utility of novel sensory-based methodologies that are currently being used in both basic and clinical research to track recovery in headache patients post- treatment. Recently, utilizing state-of-the-art technology, we built a multi-site tactile stimulator that allows for investigation of central nervos system (CNS) health and advanced methods in sensory perceptual metrics. These metrics have been demonstrated to be sensitive to changes in centrally mediated mechanisms; and systemic alterations of cortical health (via neurodegenerational, neurodevelopmental, pharmacological or trauma induced changes) robustly change the measures. It is anticipated that clinicians will be able to utilize these measures to improve diagnostic performance and enable assessment of efficacy of treatment. The study itself will serve to validate the utility of a number of these measures in headache and eventually provide health workers with a means to detect when an individual is under-reporting or over-reporting pain symptoms, and to track the recovery of an individual from headache. Better methods for measuring the progression of headache and response to treatment could lead to better diagnostics and therapeutics. Additionally, the information from this study could aid in understanding centrally mediated mechanisms that undergo significant alterations with headache.

 描述（由申请人提供）：头痛药取决于疼痛的主观报告。对于原发性头痛疾病，如偏头痛，没有血液检查，成像或其他客观手段准确评估疾病或其时间进程的负担。这种对主观性的依赖从诊断、治疗效果的评价到残疾的确定一直存在。许多患有长期偏头痛的患者低估了症状，解释说他们有很高的疼痛耐受力，或者只是习惯了头痛。其他人可能会夸大症状，由于焦虑，疼痛灾难化，抑郁症，或继发性增益问题。偏头痛的客观、定量生物学测量将大大改善诊断和治疗。理想情况下，重复测试将跟踪头痛和/或慢性化的变化。这个问题促使我们开发一种客观的，定量的，非侵入性的方法来评估中枢神经系统信息处理的变化，发生的系统性皮质改变的类型，已被建议发生与偏头痛患者。该系统将触觉（皮肤）刺激传递到指尖，将指尖的密集神经支配投射到大脑的相邻区域。感官知觉受到这些相邻脑区之间相互作用的高度影响，并有效地提供了脑功能的非侵入性活检。刺激方案的设计和验证，从我们的研究结果，在非人类灵长类动物的大脑皮层动力学的体内研究。因此，它们提供皮质动态度量或皮质度量，并且虽然独立获得的皮质度量主要受特定皮质机制的影响，但是组合度量生成可以用于表征个体神经状态的个体CNS简档。概念的证明，与试点数据，已经获得了区分偏头痛患者从健康受试者以及个人与脑震荡。本申请提出不仅完全验证该差异，而且确定受试者的偏头痛相关的自我报告的疼痛与他们的CNS概况之间是否存在相关性。本申请的另外的创新特征在于，其提出（1）在受试者的初始医生就诊之前确定受试者的CNS概况，（2）跟踪患者对由临床医生规定的干预的响应，以及（3）回顾性地确定初始CNS概况预测治疗结果的能力。 相关性：拟议工作的总体目标是调查目前在基础和临床研究中用于跟踪头痛患者治疗后恢复的新型基于感觉的方法的效用。最近，利用国家的最先进的技术，我们建立了一个多站点触觉刺激器，允许调查中枢神经系统（CNS）的健康和先进的方法在感官知觉指标。已证明这些指标对中枢介导机制的变化敏感;皮质健康的系统性改变（通过神经退行性、神经发育、药理学或创伤诱导的变化）强烈改变了这些指标。预计临床医生将能够利用这些措施来提高诊断性能，并能够评估治疗效果。这项研究本身将有助于验证这些措施在头痛中的效用，并最终为卫生工作者提供一种检测个人何时低估或高估疼痛症状的方法，并跟踪个人从头痛中恢复的情况。更好的方法来测量头痛的进展和对治疗的反应可能会导致更好的诊断和治疗。此外，这项研究的信息有助于理解头痛发生显著变化的中枢介导机制。