Neurology Unit, Guglielmo da Saliceto Hospital, Piacenza, Italy.
Cephalalgia. 2013 Apr;33(6):416-20. doi: 10.1177/0333102412474505. Epub 2013 Jan 28.
The functional neuroimaging of headache patients has revolutionized our understanding of the pathophysiology of primary headaches, providing unique insights into these syndromes. Indeed, functional neuroimaging studies have shown the activation of specific brain structures, the brainstem in migraine and posterior hypothalamus in cluster headache (CH), as well as in other trigeminal autonomic cephalalgias. We describe the functional neuroimaging findings in a patient suffering from CH headache, investigated with functional magnetic resonance imaging (fMRI) during typical pain attacks.
Two typical, consecutive CH attacks were investigated by two fMRI imaging sessions on the same day. Both fMRI scans were performed at rest, during the CH attacks and the pain-free state induced by subcutaneous administration of sumatriptan.
Significant activation of the bilateral red nucleus, ventral pons and trigeminal root entry zone ipsilaterally to the pain side was detected during the pain state, in addition to the hypothalamic region ipsilaterally to the pain side.
Being that such structures are mainly involved in motor function and reactive behaviour, their activation, in our hypothesis, may be linked to pain avoidance and may well represent a defence reaction in cluster headache, which is characterised by a "fight-or-flight" type behavioural pattern during pain attacks.
头痛患者的功能神经影像学研究极大地改变了我们对原发性头痛病理生理学的理解，为这些综合征提供了独特的见解。事实上，功能神经影像学研究表明，特定脑结构（偏头痛中的脑干和丛集性头痛中的下丘脑后部）以及其他三叉神经自主头痛的激活。我们描述了一位丛集性头痛患者的功能神经影像学发现，该患者在典型疼痛发作期间接受了功能磁共振成像（fMRI）检查。
在同一天进行了两次 fMRI 成像检查，以研究两次典型的连续丛集性头痛发作。两次 fMRI 扫描均在休息时、CH 发作时以及皮下给予舒马曲坦引起的无痛状态下进行。
在疼痛状态下，除了疼痛侧下丘脑区域外，还检测到双侧红核、腹侧脑桥和三叉神经根进入区同侧的显著激活。
由于这些结构主要涉及运动功能和反应性行为，我们假设它们的激活可能与疼痛回避有关，并且可能代表丛集性头痛中的防御反应，在疼痛发作期间表现出“战斗或逃跑”类型的行为模式。
