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Right-lateralised central processing for pain of nitroglycerin-induced cluster headache
Jen-Chuen Hsieh1, Jan Hannerz, Martin Ingvar
1Section of Clinical Neurophysiology, Department of Clinical Neuroscience, Karolinska Hospital/Karolinska Institute,Stockholm, Sweden Section of Neurology, Department of Clinical Neuroscience, Karolinska Hospital/Karolinska Institute,Stockholm, Sweden Institute of Neuroscience, School of Life Science and Dept. of Medicine, School of Medical Science, National Yang-Ming University, Taipai Taiwan, ROC Neuroanesthesia and Pain Unit, Dept. of Anesthesiology, Veterans General Hospital-Taipei,11217 Taipei Taiwan, ROC.
This study reveals the right hemisphere, particularly the anterior cingulate cortex (ACC), plays a key role in the emotional aspects of cluster headache (CH) pain. Findings suggest right-hemispheric specialization for negative emotions and attention in pain.
Area of Science:
- Neuroscience
- Pain Research
- Brain Imaging
Background:
- Functional brain imaging (PET) suggests right hemisphere involvement in affective pain processing.
- Clinical pain syndromes often show right-sided brain activation, especially in the anterior cingulate cortex (ACC).
Purpose of the Study:
- To investigate the central processing of cluster headache (CH) attacks.
- To explore the role of the right hemisphere in the affective and attentional aspects of CH pain.
Main Methods:
- Provoked cluster headache attacks using sublingual nitroglycerin (NTG).
- Functional brain imaging (Positron Emission Tomography - PET) to observe brain activity.
Main Results:
- Provoked CH attacks activated the ACC (Brodmann areas 24 and 32) and the right temporopolar region.
- Activated ACC regions are associated with affective/cognitive pain processing and attention.
- The right hemisphere showed preferential activation in attributing emotional valence and attention to pain.
Conclusions:
- The right hemisphere is preferentially involved in the emotional processing and attention allocation during cluster headache attacks.
- Findings support the theory of right hemispheric specialization for processing withdrawal-related negative affect.
- Central processing differences between provoked CH and experimental pain suggest distinct underlying mechanisms.