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Decrease of gray matter volume in the midbrain is associated with treatment response in medication-overuse headache:

Franz Riederer1, Andreas R Gantenbein, Marvin Marti

  • 1Department of Neurology, University Hospital Zurich, CH-8091 Zurich, Switzerland, Institute for Biomedical Engineering, Swiss Federal Institute of Technology and the University of Zurich, CH-8091 Zurich, Switzerland, Institute of Neuroradiology, University Hospital Zurich, CH-8091 Zurich, Switzerland, and Rehaclinic Bad Zurzach, CH-5330 Bad Zurzach, Switzerland.

The Journal of Neuroscience : the Official Journal of the Society for Neuroscience
|September 27, 2013
PubMed
Summary

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Medication-overuse headache patients who improved after detoxification showed decreased midbrain gray matter. Poor responders had less orbitofrontal gray matter, suggesting it predicts treatment outcomes.

Area of Science:

  • Neurology
  • Neuroimaging
  • Pain Medicine

Background:

  • Medication-overuse headache (MOH) affects patients with chronic daily headache due to acute medication overuse.
  • Only two-thirds of MOH patients improve after detoxification, indicating factors influencing treatment response.
  • The underlying neurobiological mechanisms for varying treatment outcomes in MOH remain unclear.

Purpose of the Study:

  • To investigate gray matter changes associated with medication withdrawal in patients with MOH.
  • To identify neuroimaging predictors of clinical improvement following detoxification in MOH patients.

Main Methods:

  • Longitudinal magnetic resonance imaging (MRI) study.
  • Voxel-based morphometry (VBM) used to analyze gray matter differences.

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  • Comparison of gray matter changes between patients with and without clinical improvement after detoxification.

    • Main Results:

    • Patients with significant clinical improvement after detoxification showed a decrease in previously increased midbrain gray matter (including periaqueductal gray matter and nucleus cuneiformis).
    • Patients without clinical improvement had less gray matter in the orbitofrontal cortex at baseline.
    • A correlation was found between treatment response and the amount of orbitofrontal gray matter.

    Conclusions:

    • Adaptive gray matter changes within the pain modulatory system occur in MOH patients who respond to detoxification, suggesting neuronal plasticity.
    • Reduced orbitofrontal gray matter at baseline may predict a poor response to treatment in medication-overuse headache.