Pain modulation in primary headache syndromes
Final Report Abstract
The aim of the project was to study abnormalities of intrinsic spontaneous brain connectivity networks in patients with episodic migraine using resting state fMRI. Migraine is typically considered to be an episodic disorder with discrete attacks of headache. In contrast there is now evidence that the processing and perception of sensory stimuli is abnormal even outside of attacks. Recently, several large-scale networks of coherent spontaneous activity fluctuations have been described in the human brain. These intrinsic connectivity networks mirror functional activations associated with sensory (visual, auditory, somatosensory), motor and cognitive tasks. The subjective perception of sensory information may depend on the preexisting activity of such intrinsic connectivity networks and an alteration in such networks may produce sensory facilitation as observed in migraine. We investigated resting state brain activity during a task-free (rest) fMRI session at 3 Tesla using Independent Component Analysis (ICA) in 21 interictal and 21 age and gender-matched healthy control subjects. Preprocessing, ICA and the voxel-wise statistical analysis were performed with Brainvoyager QX applying the fast-ICA algorithm and self-organized group ICA plugin. Categorical random-effects group analysis was performed with the Brainvoyager ANCOVA module for the visual, auditory, sensorimotor and ‘default mode’ network. We also studied the ‘salience network’ as this network largely overlaps with the ‘pain network’. Results were thresholded at p<0.05 using cluster-size thresholding for correction of multiple comparisons. We found increased network activity (stronger functional connectivity) bilaterally in the visual, auditory and sensorimotor network in migraineurs. Increased functional connectivity was also found in parts of the salience network. In contrast, reduced network activity was observed in the posterior part of the default mode network (precuneus). Our findings underline that abnormal brain activity in migraineurs is not restricted to attacks. We evidence an extensive alteration of functional connectivity in multiple networks reflecting the migrainous phenotype and this emphasizes that migraine is a disorder of the brain. We suggest the observed interictal abnormalities of spontaneous brain activity reflect the predisposition of migraineurs for their symptoms.
Publications
- Tension Type Headache in Adolescence and Childhood: Where Are We Now? Curr Pain Headache Rep (epub ahead of print)
Monteith TS, Sprenger T
- Migraine pathogenesis and state of pharmacological treatment options. BMC Med. 2009;7:71
Sprenger T, Goadsby PJ
- Patients with somatoform pain disorder show gray-matter loss in pain processing structures - a voxel-based morphometric study. Psychosom Med 2009;71:49-56
Valet M, Gündel H, Sprenger T, Sorg C, Mühlau M, Zimmer C, Tölle TR
- Schmerzforschung mit PET. Nervenheilkunde 2009;28:733-738
Sprenger T, Tölle TR, Boecker H, Bartenstein P
- Trigemino-autonome Cephalgien. Bei Erstdiagnose immer auf sekundäre Formen achten! Nervenarzt 2009;80:1417-23
Rosenberg-Nordmann M, Berthele A, Tölle TR, Sprenger T
- Current practice and future directions in the prevention and acute management of Migraine. Lancet Neurol 2010;9:285–98
Goadsby PJ, Sprenger T
- GABAergic Dysfunction in Essential Tremor: An 11C-Flumazenil PET Study. J Nucl Med 2010;51:1030-1035
Boecker H, Weindl A, Brooks DJ, Ceballos-Baumann A, Liedtke C, Miederer M, Sprenger T, Wagner KJ, Miederer I
- Neurometabolic correlates of depression and disability in patients with severe episodic pain. J Neurol 2010 (epub ahead of print)
Seifert CL, Valet M, Pfaffenrath V, Boecker H, Rüther KV, Tölle TR, Sprenger T
- Temperature modulated histamine-itch in lesional and non-lesional skin in atopic eczema - a combined psychophysical and neuroimaging study. Allergy 2010;65:84-94
Pfab F, Valet M, Sprenger T, Huss-Marp TJ, Athanasiadis GI, Baurecht HJ, Zimmer C, Behrendt H, Ring J, T.R. Tölle, Darsow U
- The mu opioid receptor agonist remifentanil induces acute dysphoria irrespective of its analgesic properties. J Psychopharmacol 2010;24:355-361
Wagner KJ, Valet M, Kochs EF, Kriner M, Tölle TR, Sprenger T
- Untersuchungen zur zerebralen Verarbeitung von Schmerzen mit funktioneller Bildgebung. Somatosensorische, affektive, kognitive, vegetative und motororische Aspekte. Der Schmerz 2010;24:114-121
Valet M, Sprenger T, Tölle TR
- What has Functional Neuroimaging done for Primary Headache and for the Clinical Neurologist? J Clin Neurosci 2010;17:547-53
Sprenger T, Goadsby PJ
