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Neuroimaging in headache.

P J Goadsby1

  • 1Institute of Neurology, The National Hospital for Neurology and Neurosurgery, Queen Square, London WC1N 3BG, United Kingdom. peterg@ion.ucl.ac.uk

Microscopy Research and Technique
|April 13, 2001
PubMed
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Neuroimaging reveals that primary headaches like migraine and cluster headache originate in the brain, not just blood vessels. This suggests a neurovascular basis, highlighting the interaction between nerves and cranial circulation.

Area of Science:

  • Neuroimaging
  • Neuroscience
  • Headache Pathophysiology

Background:

  • Primary headache syndromes, including migraine and cluster headache, were traditionally viewed as vascular disorders.
  • Emerging neuroimaging and clinical data suggest these headaches are primarily brain-driven.
  • The neural innervation of cranial circulation is a key shared substrate for these conditions.

Purpose of the Study:

  • To investigate the neuroanatomical and physiological underpinnings of primary headache syndromes using neuroimaging.
  • To explore the role of central nervous system (CNS) dysfunction in the pathogenesis of migraine and cluster headache.
  • To propose a unified classification of these disorders as neurovascular headaches.

Main Methods:

  • Functional neuroimaging, specifically positron emission tomography (PET), was employed to study brain activity during headache episodes.

Related Experiment Videos

  • PET scans documented activation in specific brain regions, including the midbrain, pons, and hypothalamus.
  • Tracer accumulation in basal arteries during cluster headache attacks was observed.

    • Main Results:

    • PET studies revealed distinct brain activation patterns for migraine (midbrain, pons) and cluster headache (hypothalamus).
    • Evidence suggests these activated brain areas play a specific role in each syndrome, potentially permissive or dysfunctional.
    • Vasodilation of major basal arteries during cluster headache attacks was indicated by tracer pooling, demonstrating neural vasodilator mechanisms in humans.

    Conclusions:

    • Migraine and cluster headache are primarily neurovascular disorders, emphasizing the critical interaction between nerves and cranial vessels.
    • Understanding the neurovascular relationship is key to comprehending headache pain mechanisms.
    • Further characterization of CNS dysfunction is essential for elucidating the basic pathogenesis of these headache syndromes.