What has functional neuroimaging done for primary headache … and for the clinical neurologist?

Journal of Clinical Neuroscience
Volume 17, Issue 5 , May 2010, Pages 547-553 

Till Sprenger^a and Peter J. Goadsby^{, a,}

^a UCSF Headache Centre, Department of Neurology, University of California, 1701 Divisadero St, Suite 480, San Francisco, CA 94115, USA

Received 30 July 2009; 

accepted 23 September 2009. 

Available online 12 March 2010.

Abstract

Our understanding of mechanisms involved in primary headache syndromes has been substantially advanced using functional neuroimaging. The data have helped establish the now-prevailing view of primary headache syndromes, such as migraine and cluster headache, as brain disorders with neurovascular manifestations, not as disorders of blood vessels.

This review focuses on the results of studies applying positron emission tomography, functional MRI, and voxel-based morphometry, and attempts to synthesize the growing body of literature to provide pathophysiological concepts. We will further outline future research directions and the clinical applicability of functional imaging in headache patients.

Article Outline

1. Introduction

2. Methods of functional neuroimaging

2.1. Positron emission tomography

2.2. Functional MRI

3. What are the data?

3.1. Experimental pain

3.2. Trigeminal autonomic cephalalgias

3.2.1. Cluster headache

3.2.2. Paroxysmal hemicrania and SUNCT

3.3. Migraine without aura

3.4. Migrane with aura

3.5. Tension-type headache

4. What do the data mean?

4.1. Peripheral versus central pathogenesis and pain control mechanisms

4.1.1. Trigeminal autonomic cephalgias

4.1.2. Migraine

4.1.3. Migraine aura

4.2. Specificity of results

5. What are the consequences for the clinical neurologist

5.1. Patient education

5.2. Clinical application of imaging findings, neuroimaging as a diagnostic tool?

6. What can be expected?

Acknowledgements

References

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Fig. 2. Statistical comparison of [¹¹C]diprenorphine positron emission tomography (PET) impulse response function at 60 minutes (IRF60) in the pineal gland between patients with cluster headache and healthy volunteers. Decreases in opioidergic receptor availability are superimposed in color on an anatomic reference MRI (single-subject sagittal T1-weighted MRI provided by the statistical parametric mapping software) (p < 0.001 uncorrected). (From Sprenger T, Willoch F, Miederer M, Schindler F, Valet M, Berthele A, Spilker ME, Förderreuther S, Straube A, Stangier I, Wester HJ, Tölle TR. Opioidergic changes in the pineal gland and hypothalamus in cluster headache: a ligand PET study. Neurology 2006;66:1108–10.⁶)

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