Skip to main content

Advertisement

Log in

Functional Imaging in Chronic Migraine

  • Chronic Daily Headache (S-J Wang, Section Editor)
  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Chronic migraine is a relatively common disorder in neurological terms that causes very significant disability at a high cost. The precise mechanisms behind the progression of episodic migraine to chronic migraine are not well understood. Functional neuro-imaging works on the basis that neuronal activations are associated with changes in regional cerebral blood flow, and it can help us answer some of these questions. In this review, we discuss important recent studies in chronic migraine or studies relating to increasing frequency of migraine attacks. The findings show that increasing frequency of migraine attacks is associated with changes in key brainstem areas, basal ganglia and various cortical areas involved in pain.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Natoli JL, Manack A, Dean B, et al. Global prevalence of chronic migraine: a systematic review. Cephalalgia. 2010;30:599–609.

    PubMed  CAS  Google Scholar 

  2. Headache disorders. Fact sheet N°277. http://www.who.int/mediacentre/factsheets/fs277/en/. Accessed Jan 2013.

  3. Bloudek LM, Stokes M, Buse DC, et al. Cost of healthcare for patients with migraine in five European countries: results from the International Burden of Migraine Study (IBMS). J Headache Pain. 2012;13:361–78.

    Article  PubMed  CAS  Google Scholar 

  4. Headache Classification Committee of The International Headache Society. International Classification of Headache Disorders: 2nd edition. Cephalalgia. 2004, 24: 1–160.

    Google Scholar 

  5. Stovner LJ, Andree C. Prevalence of headache in Europe: a review for the Eurolight project. J Headache Pain. 2010;11:289–99.

    Article  PubMed  Google Scholar 

  6. Bigal ME, Serrano D, Buse D, et al. Acute migraine medications and evolution from episodic to chronic migraine: a longitudinal population-based study. Headache. 2008;48:1157–68.

    Article  PubMed  Google Scholar 

  7. Manack A, Buse DC, Serrano D, Turkel CC, Lipton RB. Rates, predictors, and consequences of remission from chronic migraine to episodic migraine. Neurology. 2011;76:711–8.

    Article  PubMed  CAS  Google Scholar 

  8. Bigal ME, Lipton RB. Obesity is a risk factor for transformed migraine but not chronic tension-type headache. Neurology. 2006;67(2):252–7.

    Article  PubMed  Google Scholar 

  9. Ashina S, Serrano D, Lipton RB, et al. Depression and risk of transformation of episodic to chronic migraine. J Headache Pain. 2012;13:615–24.

    Article  PubMed  Google Scholar 

  10. Katsarava Z, Schneeweiss S, Kurth T, et al. Incidence and predictors for chronicity of headache in patients with episodic migraine. Neurology. 2004;62:788–90.

    Article  PubMed  CAS  Google Scholar 

  11. Frackowiak RSJ, Friston KJ. Functional neuroanatomy of the human brain: positron emission tomography—a new neuroanatomical technique. J Anat. 1994;184:211–25.

    PubMed  Google Scholar 

  12. Weiller C, May A, Limmroth V, et al. Brain stem activation in spontaneous human migraine attacks. Nat Med. 1995;1:658–60.

    Article  PubMed  CAS  Google Scholar 

  13. Matharu MS, Bartsch T, Ward N, et al. Central neuromodulation in chronic migraine patients with suboccipital stimulators: a PET study. Brain. 2004;127(Pt 1):220–30.

    Article  PubMed  Google Scholar 

  14. Obermann M, Gizewski ER, Limmroth V, Diener HC, Katsarava Z. Symptomatic migraine and pontine vascular malformation: evidence for a key role of the brainstem in the pathophysiology of chronic migraine. Cephalalgia. 2006;26:763–6.

    Article  PubMed  CAS  Google Scholar 

  15. Goadsby PJ. Neurovascular headache and a midbrain vascular malformation: evidence for a role of the brainstem in chronic migraine. Cephalalgia. 2002;22:107–11.

    Article  PubMed  CAS  Google Scholar 

  16. • Grazzi L, Chiapparini L, Ferraro S, et al. Chronic migraine with medication overuse pre-post withdrawal of symptomatic medication: clinical results and FMRI correlations. Headache. 2010;50:998–1004. This study shows that MOH is associated with reversible changes in the lateral pain system involved in the localization, intensity and quality of pain.

    Article  PubMed  Google Scholar 

  17. Fumal A, Laureys S, Di Clemente L, et al. Orbitofrontal cortex involvement in chronic analgesic-overuse headache evolving from episodic migraine. Brain. 2006;129(Pt 2):543–50.

    PubMed  Google Scholar 

  18. London ED, Cascella NG, Wong DF, et al. Cocaine-induced reduction of glucose utilization in human brain. A study using positron emission tomography and [fluorine 18]-fluorodeoxyglucose. Arch Gen Psychiatry. 1990;47:567–74.

    Article  PubMed  CAS  Google Scholar 

  19. Volkow ND, Fowler JS, Wolf AP, et al. Changes in brain glucose metabolism in cocaine dependence and withdrawal. Am J Psychiatry. 1991;148:621–6.

    PubMed  CAS  Google Scholar 

  20. London ED, Ernst M, Grant S, Bonson K, Weinstein A. Orbitofrontal cortex and human drug abuse: functional imaging. Cereb Cortex. 2000;10:334–42.

    Article  PubMed  CAS  Google Scholar 

  21. Volkow ND, Fowler JS, Wang GJ. The addicted human brain viewed in the light of imaging studies: brain circuits and treatment strategies. Neuropharmacology. 2004;47 Suppl 1:3–13.

    Article  PubMed  CAS  Google Scholar 

  22. Katsarava Z, Muessig M, Dzagnizde A, et al. Medication overuse headache: rates and predictors for relapse in a 4-year prospective study. Cephalalgia. 2004;25:12–5.

    Article  Google Scholar 

  23. Fritsche G, Eberl A, Katsarava Z, Limmoroth V, Diener HC. Drug-induced headache: long-term follow up of withdrawal therapy and persistence of drug misuse. Eur Neurol. 2001;45:229–35.

    Article  PubMed  CAS  Google Scholar 

  24. Grazzi L, Andrasik F, D’Amico D, et al. Behavioral and pharmacologic treatment of transformed migraine with analgesic overuse: outcome at 3 years. Headache. 2002;59:1011–114.

    Google Scholar 

  25. • Maleki N, Becerra L, Brawn J, et al.: Common hippocampal structural and functional changes in migraine. Brain Struct Funct. 2012, Jul 4. doi: 10.1007/s00429‐012‐0437‐y. PMID: 22760159. This study associates hippocampal changes of reduced volume, greater activation in response to pain and reduced functional connectivity to pain-related cortical areas with increasing frequency of migraine attacks, probably relating to the involvement of the hippocampus in the stress response.

  26. McEwen BS. Stress and hippocampal plasticity. Annu Rev Neurosci. 1999;22:105–22.

    Article  PubMed  CAS  Google Scholar 

  27. McEwen BS. Plasticity of the hippocampus: adaptation to chronic stress and allostatic load. Ann N Y Acad Sci. 2001;933:265–77.

    Article  PubMed  CAS  Google Scholar 

  28. McEwen BS, Gianaros PJ. Central role of the brain in stress and adaptation: links to socioeconomic status, health, and disease. Ann N Y Acad Sci. 2010;1186:190–222.

    Article  PubMed  Google Scholar 

  29. Rodrigues SM, LeDoux JE, Sapolsky RM. The influence of stress hormones on fear circuitry. Annu Rev Neurosci. 2009;32:289–313.

    Article  PubMed  CAS  Google Scholar 

  30. Cui Z, Gerfen CR, Young WS 3rd. Hypothalamic and other connections with the dorsal CA2 area of the mouse hippocampus. J Comp Neurol. 2012 Nov 21. doi: 10.1002/cne.23263. PMID:23172108

  31. •• Maleki N, Becerra L, Nutile L, et al. Migraine attacks the Basal Ganglia. Mol Pain. 2011;7:71. This study associates the basal ganglia findings of increased volume and reduced activations in response to pain with increasing frequency of migraine attacks.

    Article  PubMed  Google Scholar 

  32. •• Starr CJ, Sawaki L, Wittenberg GF, et al. The contribution of the putamen to sensory aspects of pain: insights from structural connectivity and brain lesions. Brain. 2011;134(Pt 7):1987–2004. The findings of this study suggest that the putamen and the basal ganglia are involved in the sensory experience of pain beyond the well-known role in pain-related motor responses via the cortico-basal ganglia-thalamo-cortical loops.

    Article  PubMed  Google Scholar 

  33. Afridi SK, Matharu MS, Lee L, et al. A PET study exploring the laterality of brainstem activation in migraine using glyceryl trinitrate. Brain. 2005;128(Pt 4):932–9.

    Article  PubMed  CAS  Google Scholar 

  34. May A, Bahra A, Büchel C, Frackowiak RS, Goadsby PJ. Hypothalamic activation in cluster headache attacks. Lancet. 1998;352:275–8.

    Article  PubMed  CAS  Google Scholar 

  35. Kruit MC, Launer LJ, Overbosch J, van Buchem MA, Ferrari MD. Iron accumulation in deep brain nuclei in migraine: a population-based magnetic resonance imaging study. Cephalalgia. 2009;29:351–9.

    Article  PubMed  CAS  Google Scholar 

  36. Tepper SJ, Lowe MJ, Beall E, etal.: Iron deposition in pain-regulatory nuclei in episodic migraine and chronic daily headache by MRI. 2012;52:236–43.

  37. Hallgren B, Sourander P. The effect of age on the non-haemin iron in the human brain. J Neurochem. 1958;3:41–51.

    Article  PubMed  CAS  Google Scholar 

  38. Valfrè W, Rainero I, Bergui M, Pinessi L. Voxel-based morphometry reveals gray matter abnormalities in migraine. Headache. 2008;48:109–17.

    Article  PubMed  Google Scholar 

  39. Price DD. Psychological and neural mechanisms of the affective dimension of pain. Science. 2000;288:1769–72.

    Article  PubMed  CAS  Google Scholar 

  40. Lai TH, Fuh JL, Lirng JF, Lin CP, Wang SJ. Brainstem 1H-MR spectroscopy in episodic and chronic migraine. J Headache Pain. 2012;13(8):645–51.

    Article  PubMed  CAS  Google Scholar 

  41. Kong J, Tu PC, Zyloney C, Su TP. Intrinsic functional connectivity of the periaqueductal gray, a resting fMRI study. Behav Brain Res. 2010;211:215–9.

    Article  PubMed  Google Scholar 

  42. • Mainero C, Boshyan J, Hadjikhani N. Altered functional magnetic resonance imaging resting-state connectivity in periaqueductal gray networks in migraine. Ann Neurol. 2011;70:838–45. This study shows reduced functional connectivity of the PAG with prefrontal cortex, ACC and amygdala correlating with increasing frequency of migraine attacks.

    Article  PubMed  Google Scholar 

  43. Knight YE, Goadsby PJ. The periaqueductal grey matter modulates trigeminovascular input: a role in migraine? Neuroscience. 2001;106:793–800.

    Article  PubMed  CAS  Google Scholar 

  44. Kato Y, Araki N, Matsuda H, Ito Y, Suzuki C. Arterial spin-labeled MRI study of migraine attacks treated with rizatriptan. J Headache Pain. 2010;11:255–8.

    Article  PubMed  Google Scholar 

Download references

Conflict of Interest

Dr. Farooq Maniyar declares that he has no conflict of interest.

Dr. Peter J. Goadsby declares that he has no conflict of interest.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Peter J. Goadsby.

Additional information

This article is part of the Topical Collection on Chronic Daily Headache

Rights and permissions

Reprints and permissions

About this article

Cite this article

Maniyar, F.H., Goadsby, P.J. Functional Imaging in Chronic Migraine. Curr Pain Headache Rep 17, 333 (2013). https://doi.org/10.1007/s11916-013-0333-z

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11916-013-0333-z

Keywords

Navigation