Cortical and Subcortical Alterations in Medication Overuse Headache.
Jan Mehnert1, Julia Hebestreit1, Arne May1
1Department of Systems Neuroscience, University Medical Center Eppendorf, Hamburg, Germany.
Frontiers in Neurology
|July 11, 2018
Summary
Medication-overuse headache patients show altered brain structure and function, particularly in the orbitofrontal cortex. Drug withdrawal improved brain activity and connectivity, suggesting the orbitofrontal cortex is key to headache processing.
Area of Science:
- Neurology
- Neuroimaging
- Pain Medicine
Background:
- Medication-overuse headache (MOH) is a growing clinical challenge.
- Therapeutic strategies for MOH primarily involve drug withdrawal.
- Previous studies indicate structural changes in the orbitofrontal cortex (OFC) in MOH patients, but its functional role remains unclear.
Purpose of the Study:
- To investigate the structural and functional changes in the brain associated with medication withdrawal in patients with MOH.
- To explore the role of the orbitofrontal cortex in the processing of nociceptive input during MOH withdrawal.
Main Methods:
- Compared structural and functional magnetic resonance imaging (fMRI) data of 18 MOH patients before and after drug withdrawal.
- Utilized a trigeminal nociceptive fMRI paradigm.
- Compared patient data with age- and gender-matched controls.
Main Results:
- Structural changes in the orbitofrontal cortex of MOH patients were confirmed and correlated with clinical outcomes post-withdrawal.
- Neuronal activity in pain-related regions (operculum, insula, spinal trigeminal nucleus) increased after drug withdrawal.
- Reduced functional connectivity between the orbitofrontal cortex and nociceptive input regions (spinal trigeminal nucleus, cerebellum) was observed before withdrawal and recovered afterward.
Conclusions:
- The orbitofrontal cortex plays a crucial role in mediating between bottom-up and top-down processing in headache.
- Drug withdrawal in medication-overuse headache leads to normalization of brain activity and functional connectivity.
- These findings highlight the importance of the orbitofrontal cortex in the pathophysiology and treatment of MOH.
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