Matharu Manjit S, Cohen Anna S, McGonigle David J, Ward Nick, Frackowiak Richard S, Goadsby Peter J
Institute of Neurology, Headache Group, London, United Kingdom.
Headache. 2004 Sep;44(8):747-61. doi: 10.1111/j.1526-4610.2004.04141.x.
To determine the brain structures involved in mediating the pain of hemicrania continua using positron emission tomography.
Hemicrania continua is a strictly unilateral, continuous headache of moderate intensity, with superimposed exacerbations of severe intensity that are accompanied by trigeminal autonomic features and migrainous symptoms. The syndrome is exquisitely responsive to indomethacin. Its clinical phenotype overlaps with that of the trigeminal autonomic headaches and migraine in which the hypothalamus and the brainstem, respectively, have been postulated to play central pathophysiologic roles. We hypothesized, based on the clinical phenotype, that hemicrania continua may involve activations in the hypothalamus, or dorsal rostral pons, or both.
Seven patients with hemicrania continua were studied in two sessions each. In one session, the patients were scanned during baseline pain and when rendered completely pain free after being administered indomethacin 100 mg intramuscularly. In the other session, the patients were scanned during baseline pain and when still in pain after being administered placebo intramuscularly. Seven age- and sex-matched nonheadache subjects acted as the control group. The scan images were processed and analyzed using SPM99.
There was a significant activation of the contralateral posterior hypothalamus and ipsilateral dorsal rostral pons in association with the headache of hemicrania continua. In addition, there was activation of the ipsilateral ventrolateral midbrain, which extended over the red nucleus and the substantia nigra, and bilateral pontomedullary junction. No intracranial vessel dilatation was obvious.
This study demonstrated activations of various subcortical structures, in particular the posterior hypothalamus and the dorsal rostral pons. If posterior hypothalamic and brainstem activation are considered as markers of trigeminal autonomic headaches and migrainous syndromes, respectively, then the activation pattern demonstrated in hemicrania continua mirrors the clinical phenotype, with its overlap with trigeminal autonomic headaches and migraine.
使用正电子发射断层扫描确定参与介导持续性偏侧头痛疼痛的脑结构。
持续性偏侧头痛是一种严格单侧的、中度强度的持续性头痛，伴有严重强度的叠加性加重，伴有三叉神经自主性特征和偏头痛症状。该综合征对吲哚美辛反应极为敏感。其临床表型与三叉神经自主性头痛和偏头痛的表型重叠，其中分别假定下丘脑和脑干在中枢病理生理中起作用。基于临床表型，我们假设持续性偏侧头痛可能涉及下丘脑或延髓背侧嘴部或两者的激活。
对7例持续性偏侧头痛患者进行了两次研究。在一次研究中，在基线疼痛期间以及肌肉注射100mg吲哚美辛后疼痛完全缓解时对患者进行扫描。在另一次研究中，在基线疼痛期间以及肌肉注射安慰剂后仍疼痛时对患者进行扫描。7名年龄和性别匹配的无头痛受试者作为对照组。使用SPM99对扫描图像进行处理和分析。
与持续性偏侧头痛相关的对侧下丘脑后部和同侧延髓背侧嘴部有明显激活。此外，同侧腹外侧中脑有激活，延伸至红核和黑质，以及双侧脑桥延髓交界处激活。颅内血管无明显扩张。
本研究证明了各种皮质下结构的激活，特别是下丘脑后部和延髓背侧嘴部。如果将下丘脑后部和脑干激活分别视为三叉神经自主性头痛和偏头痛综合征的标志物，那么持续性偏侧头痛中显示的激活模式反映了临床表型，其与三叉神经自主性头痛和偏头痛有重叠。
