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Developing Neuroimaging Phenotypes of the Default Mode Network in PTSD: Integrating the Resting State, Working Memory, and Structural Connectivity
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White matter microstructural alterations in episodic cluster headache outside attacks: a tract-based spatial

Francesca Caramia1, Antonio Di Renzo2, Giada Giuliani3

  • 1Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy. francesca.caramia@uniroma1.it.

The Journal of Headache and Pain
|June 4, 2026
PubMed
Summary
This summary is machine-generated.

Cluster headache involves widespread white matter changes in brain networks, not just trigeminal pathways. These microstructural abnormalities may underlie the persistent network dysfunction seen in episodic cluster headache.

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Diffusion Tensor Magnetic Resonance Imaging in the Analysis of Neurodegenerative Diseases
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Area of Science:

  • Neuroscience
  • Neurology
  • Radiology

Background:

  • Cluster headache (CH) is a severe neurological disorder.
  • CH is increasingly viewed as a disorder of brain networks.
  • Persistent brain alterations in CH suggest underlying network dysfunction.

Purpose of the Study:

  • Investigate white matter microstructural changes in episodic cluster headache (CH).
  • Examine differences in diffusion metrics between CH patients and healthy controls.
  • Explore associations between white matter abnormalities and clinical variables in CH.

Main Methods:

  • Diffusion tensor imaging (DTI) and tract-based spatial statistics (TBSS) were used.
  • 27 episodic CH patients and 20 healthy controls were analyzed.
  • Fractional anisotropy (FA), axial diffusivity (AD), mean diffusivity (MD), and radial diffusivity (RD) were quantified.

Main Results:

  • Episodic CH patients showed widespread white matter alterations compared to controls.
  • Reduced FA and AD, with increased MD, were observed in key brain pathways.
  • No significant associations were found between diffusion metrics and clinical variables.

Conclusions:

  • White matter alterations affect pathways supporting large-scale pain and cognitive-affective networks.
  • Findings support a network-based model of cluster headache.
  • Persistent white matter abnormalities may be a substrate for enduring network dysfunction in CH.