Department of Neurology, University Hospital Zurich, CH-8091 Zurich, Switzerland, Institute for Biomedical Engineering, Swiss Federal Institute of Technology and the University of Zurich, CH-8091 Zurich, Switzerland, Institute of Neuroradiology, University Hospital Zurich, CH-8091 Zurich, Switzerland, and Rehaclinic Bad Zurzach, CH-5330 Bad Zurzach, Switzerland.
J Neurosci. 2013 Sep 25;33(39):15343-9. doi: 10.1523/JNEUROSCI.3804-12.2013.
Patients with chronic daily headache and overuse of analgesics, triptans, or other acute headache compounds, are considered to suffer from medication-overuse headache (MOH). This implies that medication overuse is the cause of headache chronification. It remains a key question why only two-thirds of patients with chronic migraine-like headache and overuse of pain medication improve after detoxification, whereas the remainder continue to have chronic headache. In the present longitudinal MRI study, we used voxel-based morphometry to investigate gray matter changes related to medication withdrawal in a group of humans with MOH. As a main result, we found that only patients with significant clinical improvement showed a significant decrease of previously increased gray matter in the midbrain including periaqueductal gray matter and nucleus cuneiformis, whereas patients without improvement did not. Patients without treatment response had less gray matter in the orbitofrontal cortex. Another striking result is the correlation of treatment response with the amount of orbitofrontal gray matter. Thus, we demonstrate adaptive gray matter changes within the pain modulatory system in patients with MOH who responded to detoxification, probably reflecting neuronal plasticity. Decreased gray matter in the orbitofrontal cortex at baseline may be predictive of poor response to treatment.
患有慢性每日头痛和过度使用镇痛药、曲普坦类或其他急性头痛化合物的患者被认为患有药物过度使用性头痛（MOH）。这意味着药物过度使用是头痛慢性化的原因。一个关键问题仍然是，为什么只有三分之二的慢性偏头痛样头痛和过度使用止痛药的患者在解毒后改善，而其余患者仍持续患有慢性头痛。在本项纵向 MRI 研究中，我们使用基于体素的形态计量学来研究一组 MOH 患者与药物戒断相关的灰质变化。作为主要结果，我们发现只有临床显著改善的患者在前脑包括导水管周围灰质和楔形核中先前增加的灰质有显著减少，而没有改善的患者则没有。没有治疗反应的患者眶额皮质中的灰质较少。另一个惊人的结果是治疗反应与眶额皮质灰质的数量相关。因此，我们在对解毒有反应的 MOH 患者中证明了疼痛调节系统内适应性灰质变化，可能反映了神经元可塑性。基线时眶额皮质中的灰质减少可能预示着对治疗的反应不佳。
