Neuroimaging in chronic migraine

In chronic migraine, many neuroimaging studies with advanced techniques showed abnormalities in several brain areas involved in pain processing. The structural and functional dysfunctions are reported in cerebral areas localized in the brainstem and in the lateral and medial pain pathways. Using the advanced technique of volumetric MRI (voxel-based morphometry), reduction in the grey and white matter in brain areas of the pain network and increased density of the structures of the brainstem were observed in patients with episodic or chronic migraine. Most of the studies of functional anatomy in chronic migraine uses positron emission tomography (PET) and functional RM. These techniques could detect cerebral areas with regional cerebral blood flow and blood level oxygenation-dependent (BOLD) signal changes. Several PET and functional MRI experiments in patients with chronic migraine and drugs overuse before and after the withdrawal showed hypometabolism and hypoactivation in cortical areas involved in pain processing. These areas normalize their activity after detoxification, indicating reversible metabolic changes and BOLD signal changes as observed in other chronic pain. Functional and structural alterations observed in the cerebral areas of the pain network could be a result of a selective dysfunction of these regions due to cortical overstimulation associated with chronic pain. Advanced neuroimaging techniques have revolutionized the knowledge on chronic migraine, determining specific cortical substrate that could explain different forms of chronic migraine and perhaps the predisposition of patients to different therapeutic responses and to possible relapse in drug abuse.