Russo Antonio, Esposito Fabrizio, Conte Francesca, Fratello Michele, Caiazzo Giuseppina, Marcuccio Laura, Giordano Alfonso, Tedeschi Gioacchino, Tessitore Alessandro
1 Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences, Second University of Naples, Italy.
2 MRI Research Center SUN-FISM, Second University of Naples, Italy.
Cephalalgia. 2017 Apr;37(4):305-314. doi: 10.1177/0333102416644969. Epub 2016 Apr 15.
Objective A prospective clinical imaging study has been conducted to investigate pain processing functional pathways during trigeminal heat stimulation (THS) in patients with migraine without aura experiencing ictal cutaneous allodynia (CA) (MwoA CA+). Methods Using whole-brain BOLD-fMRI, functional response to THS at three different intensities (41°, 51° and 53℃) was investigated interictally in 20 adult MwoA CA+ patients compared with 20 MwoA patients without ictal CA (MwoA CA-) and 20 healthy controls (HCs). Secondary analyses evaluated associations between BOLD signal change and clinical features of migraine. Results During moderate-noxious THS (51℃), we observed a significantly greater activation in (a) the anterior cingulate cortex in MwoA CA+ patients compared to HCs and (b) the middle frontal gyrus in MwoA CA+ patients compared to both MwoA CA- patients and HCs. Furthermore, during high-noxious THS (53℃) a significantly decreased activation in the secondary somatosensory cortices was observed in (a) MwoA CA- patients compared to both MwoA CA+ patients and HCs and (b) MwoA CA+ patients compared to HCs. CA severity was positively correlated with the secondary somatosensory cortices activation. Conclusions Our findings suggest that CA may be subtended by both a dysfunctional analgesic compensatory mechanism and an abnormal internal representation of pain in migraine patients.
开展一项前瞻性临床影像学研究，以调查无先兆偏头痛且发作期存在发作性皮肤痛觉过敏（CA）（MwoA CA+）患者在三叉神经热刺激（THS）期间的疼痛处理功能通路。方法：采用全脑BOLD-fMRI，在发作间期对20例成年MwoA CA+患者、20例无发作期CA的MwoA患者（MwoA CA-）和20例健康对照者（HCs）进行研究，调查其对三种不同强度（41°、51°和53℃）THS的功能反应。二级分析评估BOLD信号变化与偏头痛临床特征之间的关联。结果：在中度有害性THS（51℃）期间，我们观察到（a）与HCs相比，MwoA CA+患者的前扣带回皮质激活明显增强，以及（b）与MwoA CA-患者和HCs相比，MwoA CA+患者的额中回激活明显增强。此外，在高度有害性THS（53℃）期间，观察到（a）与MwoA CA+患者和HCs相比，MwoA CA-患者的二级体感皮层激活明显降低，以及（b）与HCs相比，MwoA CA+患者的二级体感皮层激活明显降低。CA严重程度与二级体感皮层激活呈正相关。结论：我们的研究结果表明，CA可能由偏头痛患者功能失调的镇痛补偿机制和异常的疼痛内部表征共同支撑。
