Department of Medical Neuroscience, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea.
Department of Neurosurgery, Chungbuk National University Hospital, Cheongju, Republic of Korea.
J Headache Pain. 2024 Nov 25;25(1):205. doi: 10.1186/s10194-024-01914-z.
Trigeminal neuropathic pain (TNP), migraine, and cluster headache (CH) profoundly impact the quality of life and present significant clinical challenges due to their complex neurobiological underpinnings. This review delves into the pivotal role of the hypothalamus in the pathophysiology of these facial pain syndromes, highlighting its distinctive functions and potential as a primary target for research, diagnosis, and therapy. While the involvement of the hypothalamus in migraine and CH has been increasingly supported by imaging and clinical studies, the precise mechanisms of its role remain under active investigation. The role of the hypothalamus in TNP, in contrast, is less explored and represents a critical gap in our understanding. The hypothalamus's involvement varies significantly across these conditions, orchestrating a unique interplay of neural circuits and neurotransmitter systems that underlie the distinct characteristics of each pain type. We have explored advanced neuromodulation techniques, such as deep brain stimulation (DBS) and optogenetics, which show promise in targeting hypothalamic dysfunction to alleviate pain symptoms. Furthermore, we discuss the neuroplastic changes within the hypothalamus that contribute to the chronicity of these pains and the implications of these findings for developing targeted therapies. By offering a comprehensive examination of the hypothalamus's roles, this paper aims to bridge existing knowledge gaps and propel forward the understanding and management of facial neuralgias, underscoring the hypothalamus's critical position in future neurological research.
三叉神经病理性疼痛（TNP）、偏头痛和丛集性头痛（CH）严重影响生活质量，由于其复杂的神经生物学基础，给临床带来了重大挑战。本篇综述深入探讨了下丘脑在这些面痛综合征的病理生理学中的关键作用，强调了其独特的功能和作为研究、诊断和治疗的主要靶点的潜力。虽然影像学和临床研究越来越支持下丘脑在偏头痛和 CH 中的作用，但下丘脑作用的确切机制仍在积极研究中。相比之下，下丘脑在 TNP 中的作用则较少被探索，这是我们理解中的一个关键空白。下丘脑在这些疾病中的作用差异显著，协调着不同神经回路和神经递质系统的独特相互作用，这些系统构成了每种疼痛类型的独特特征。我们已经探索了高级神经调节技术，如深部脑刺激（DBS）和光遗传学，这些技术显示出靶向下丘脑功能障碍以缓解疼痛症状的潜力。此外，我们还讨论了下丘脑内的神经可塑性变化，这些变化导致了这些疼痛的慢性化，以及这些发现对开发靶向治疗的意义。通过对下丘脑作用的全面检查，本文旨在弥合现有知识差距，推动对面神经痛的理解和管理，强调下丘脑在未来神经科学研究中的关键地位。
