Schulte Laura H, Allers Angie, May Arne
From the Department of Systems Neuroscience, University Medical Center Eppendorf, Hamburg, Germany.
Neurology. 2017 May 23;88(21):2011-2016. doi: 10.1212/WNL.0000000000003963. Epub 2017 Apr 26.
To identify pathophysiologic mechanisms of migraine chronification using a recently standardized protocol for high-resolution brainstem imaging of trigeminal nociceptive stimulation.
Eighteen episodic migraineurs (EMs), 17 chronic migraineurs (CMs), and 19 healthy controls (HCs) underwent painful ammonia stimulation of the left nostril in a 3T MRI scanner. Functional images were acquired with a brainstem-optimized protocol for high-resolution echo-planar imaging.
We detected a significantly stronger activation of the anterior right hypothalamus in CMs compared to HCs. To exclude the headache as a prime mediator of the hypothalamic activations, we compared all migraineurs with headaches (EMs and CMs) with all migraineurs without headaches (EMs and CMs) and HCs in a second analysis and found a more posterior region of the hypothalamus to be more activated bilaterally during headaches.
Our data corroborate the fact that the hypothalamus plays a crucial role in the pathophysiology of migraine chronification and acute pain stage of migraineurs. While the more posterior part of the hypothalamus seems to be important for the acute pain stage, the more anterior part seems to play an important role in attack generation and migraine chronification.
使用最近标准化的三叉神经伤害性刺激高分辨率脑干成像方案，确定偏头痛慢性化的病理生理机制。
18名发作性偏头痛患者（EMs）、17名慢性偏头痛患者（CMs）和19名健康对照者（HCs）在3T磁共振成像扫描仪中接受左侧鼻孔的氨刺激。使用针对高分辨率回波平面成像的脑干优化方案采集功能图像。
与HCs相比，我们检测到CMs中右侧下丘脑前部的激活明显更强。为了排除头痛是下丘脑激活的主要介导因素，我们在第二项分析中将所有有头痛的偏头痛患者（EMs和CMs）与所有无头痛的偏头痛患者（EMs和CMs）及HCs进行比较，发现下丘脑更靠后的区域在头痛期间双侧激活更强。
我们的数据证实了下丘脑在偏头痛慢性化和偏头痛患者急性疼痛阶段的病理生理学中起关键作用这一事实。虽然下丘脑更靠后的部分似乎对急性疼痛阶段很重要，但更靠前的部分似乎在发作产生和偏头痛慢性化中起重要作用。
