Elsevier

The Lancet Neurology

Volume 3, Issue 11, November 2004, Pages 645-651
The Lancet Neurology

Review
Functional neuroimaging of headaches

https://doi.org/10.1016/S1474-4422(04)00904-4Get rights and content

Summary

Functional neuroimaging, mainly PET and functional MRI, is the main tool that allows the capturing of neurovascular events during a headache attack. In migraine, functional imaging has clarified the underlying pathophysiology of the visual aura, whereas in migraine without aura, brainstem findings suggest a dysfunctional pain system. In cluster headache, the activation and morphological changes seen in a region posterior and inferior to the hypothalamus has provided a useful therapeutic target using deep-brain stimulation. We will discuss the main neuroimaging findings pertaining to the pathophysiology of these two common headache disorders, migraine and cluster headache.

Section snippets

Migraine with aura

The visual aura is one of the most spectacular and feared symptoms reported during a migraine attack. This has prompted researchers to study the underlying pathogenetic mechanisms. Previous limitations to studying acute migraine attacks have included the difficulty in the triggering of typical attacks under controlled conditions, and studying the actual event with appropriate techniques. Since Milner associated the migraine visual aura with cortical spreading depression (CSD) in 1958,2 no study

Cluster headache

Cluster headache is a unique primary pain syndrome characterised by strictly unilateral severe periorbital pain with ipsilateral autonomic phenomena. Some of the most striking features of this syndrome are the circadian and circannual rhythmicity of attacks, the relapsing-remitting course, and abnormal rhythms of hormones such as cortisol, testosterone, growth hormone, or endorphins.39 All these alterations have pointed to the involvement of the hypothalamus as the primum movens structure in

Conclusion

Neuroimaging of different headache disorders is beginning to provide important information about the pathogenesis of cephalic pain. We are still far away from discovering the primum movens structure, most probably because headache is a complex disorder in which no single factor or structure plays a key role. The variability in the activation patterns may be the result of this situation. Further studies with larger sample sizes may reduce the inherent variability of functional studies, and

Search strategy and selection criteria

References for this review were identified by searches of MEDLINE from Jan 1997 to May 2004, references from relevant articles, and the authors' own files. The search terms “migraine with aura”, “migraine without aura”, “cluster headache”, “functional imaging”, “PET”, and “fMRI” were used. Abstracts and reports from meetings were included only if they related directly to the previously published work. Only original papers published in English, as well as data from three presentations (one

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