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May 23, 2017; 88 (21) Article

Hypothalamus as a mediator of chronic migraine

Evidence from high-resolution fMRI

Laura H. Schulte, Angie Allers, Arne May
First published April 26, 2017, DOI: https://doi.org/10.1212/WNL.0000000000003963
Laura H. Schulte
From the Department of Systems Neuroscience, University Medical Center Eppendorf, Hamburg, Germany.
MD
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Angie Allers
From the Department of Systems Neuroscience, University Medical Center Eppendorf, Hamburg, Germany.
MD
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Arne May
From the Department of Systems Neuroscience, University Medical Center Eppendorf, Hamburg, Germany.
MD, PHD
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Citation
Hypothalamus as a mediator of chronic migraine
Evidence from high-resolution fMRI
Laura H. Schulte, Angie Allers, Arne May
Neurology May 2017, 88 (21) 2011-2016; DOI: 10.1212/WNL.0000000000003963

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Abstract

Objective: To identify pathophysiologic mechanisms of migraine chronification using a recently standardized protocol for high-resolution brainstem imaging of trigeminal nociceptive stimulation.

Methods: Eighteen episodic migraineurs (EMs), 17 chronic migraineurs (CMs), and 19 healthy controls (HCs) underwent painful ammonia stimulation of the left nostril in a 3T MRI scanner. Functional images were acquired with a brainstem-optimized protocol for high-resolution echo-planar imaging.

Results: We detected a significantly stronger activation of the anterior right hypothalamus in CMs compared to HCs. To exclude the headache as a prime mediator of the hypothalamic activations, we compared all migraineurs with headaches (EMs and CMs) with all migraineurs without headaches (EMs and CMs) and HCs in a second analysis and found a more posterior region of the hypothalamus to be more activated bilaterally during headaches.

Conclusions: Our data corroborate the fact that the hypothalamus plays a crucial role in the pathophysiology of migraine chronification and acute pain stage of migraineurs. While the more posterior part of the hypothalamus seems to be important for the acute pain stage, the more anterior part seems to play an important role in attack generation and migraine chronification.

GLOSSARY

CM=
chronic migraineur;
EM=
episodic migraineur;
HC=
healthy control

Footnotes

  • Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Received November 30, 2016.
  • Accepted in final form March 1, 2017.
  • © 2017 American Academy of Neurology
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Letters: Rapid online correspondence

  • Migraine: A cycling disorder driven by the brain
    • Arne May, University Clinic Hamburg[email protected]
    • Laura Schulte
    Submitted September 27, 2017
  • Migraine: A lateralizing disorder with onset before aura/headache?
    • Vinod K. Gupta, Physician / Director, Migraine-Headache Institute, New Delhi, India[email protected]
    Submitted September 19, 2017
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