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Cluster headache pathophysiology: What we have learned from advanced neuroimaging
Marcello Silvestro1, Alessandro Tessitore1, Ilaria Orologio1
1Headache Centre, Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy.
Headache
|March 22, 2022
Summary
Advanced neuroimaging reveals cluster headache (CH) involves complex cortical-hypothalamic-brainstem interactions, not just a single generator. This supports a neurolimbic pain network model for CH, moving beyond older hypotheses.
Area of Science:
- Neuroscience
- Neurology
- Medical Imaging
Background:
- Cluster headache (CH) pathophysiology understanding has gaps in subcortical and cortical brain structure interactions.
- Advanced neuroimaging is crucial for elucidating these complex brain mechanisms.
Purpose of the Study:
- To review significant findings from structural, microstructural, and functional neuroimaging in CH.
- To summarize progress in understanding CH pathophysiology for a unifying model.
Main Methods:
- Narrative review of advanced neuroimaging studies (structural, microstructural, functional).
- Synthesis of preclinical, neurophysiological, and biochemical experimental data.
Main Results:
- Neuroimaging shifted CH understanding from peripheral/vascular hypotheses to a trigeminovascular model.
- Highlighted the critical role of the hypothalamus and its connections in CH genesis.
Conclusions:
- CH pathophysiology involves a complex "neurolimbic pain network," extending beyond the "pain matrix."
- Cortical-hypothalamic-brainstem functional interconnections likely drive CH attacks via top-down mechanisms igniting the trigeminovascular system.
