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Phase dependent hypothalamic activation following trigeminal input in cluster headache.

Laura H Schulte1,2, Ame Abdu Haji1, Arne May3

  • 1Department of Systems Neuroscience, University Medical Center Eppendorf, University of Hamburg, Hamburg, Germany.

The Journal of Headache and Pain
|April 2, 2020
PubMed
Summary

Cluster headache patients show increased posterior hypothalamus activity outside attacks. This suggests hyperexcitability, potentially decreasing during attacks due to frequent activation and neurotransmitter exhaustion.

Keywords:
Brainstem fMRICluster headacheHypothalamusNociceptive stimulation

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Area of Science:

  • Neuroscience
  • Neurology
  • Medical Imaging

Background:

  • Previous PET studies indicated posterior hypothalamus activation during cluster headache attacks.
  • Evidence from task-related functional imaging regarding this area is limited.

Purpose of the Study:

  • To investigate functional magnetic resonance imaging (fMRI) responses in the posterior hypothalamus during trigeminal nociception in cluster headache patients.
  • To compare hypothalamic activity between cluster headache patients (in and out of bout) and controls.

Main Methods:

  • High-resolution brainstem fMRI was used to assess trigeminal nociception.
  • Gaseous ammonia served as a painful stimulus.
  • Participants included inactive episodic cluster headache patients, active cluster headache patients (episodic and chronic), and controls.

Main Results:

  • Episodic cluster headache patients (out of bout) exhibited significantly greater posterior hypothalamus activation compared to controls following nociceptive stimulation.
  • Active cluster headache patients showed intermediate activation levels, not significantly different from either group.

Conclusions:

  • The posterior hypothalamus may be hyperexcitable in cluster headache patients when they are not experiencing an attack.
  • Hyperexcitability might decrease during attacks, possibly due to frequent activation and neurotransmitter depletion.