TY - JOUR
T1 - The pathophysiology of episodic cluster headache
T2 - Insights from recent neuroimaging research
AU - Yang, Fu Chi
AU - Chou, Kun Hsien
AU - Kuo, Chen Yuan
AU - Lin, Yung Yang
AU - Lin, Ching Po
AU - Wang, Shuu Jiun
N1 - Publisher Copyright:
© 2017, © International Headache Society 2017.
PY - 2018/4/1
Y1 - 2018/4/1
N2 - Background: Cluster headache is a disorder characterized by intermittent, severe unilateral head pain accompanied by cranial autonomic symptoms. Most cases of CH are episodic, manifesting as “in-bout” periods of frequent headache separated by month-to-year-long “out-of-bout” periods of remission. Previous imaging studies have implicated the hypothalamus and pain matrix in the pathogenesis of episodic CH. However, the pathophysiology driving the transition between in- and out-of-bout periods remains unclear. Methods: The present study provides a narrative review of previous neuroimaging studies on the pathophysiology of episodic CH, addressing alterations in brain structures, metabolism, and structural and functional connectivity occurring between bout periods. Results: Although the precise brain structures responsible for episodic CH are unknown, major roles are indicated for the posterior hypothalamus (especially in acute attacks), the pain neuromatrix with an emphasis on central descending pain modulation, and non-traditional pain processing networks including the occipital, cerebellar, and salience networks. These areas are potentially related to dynamic transitioning between in- and out-of-bout periods. Conclusion: Recent progress in magnetic resonance imaging of episodic CH has provided additional insights into dynamic bout-associated structural and functional connectivity changes in the brain, especially in non-traditional pain processing network areas. These areas warrant future investigations as targets for neuromodulation in patients with CH.
AB - Background: Cluster headache is a disorder characterized by intermittent, severe unilateral head pain accompanied by cranial autonomic symptoms. Most cases of CH are episodic, manifesting as “in-bout” periods of frequent headache separated by month-to-year-long “out-of-bout” periods of remission. Previous imaging studies have implicated the hypothalamus and pain matrix in the pathogenesis of episodic CH. However, the pathophysiology driving the transition between in- and out-of-bout periods remains unclear. Methods: The present study provides a narrative review of previous neuroimaging studies on the pathophysiology of episodic CH, addressing alterations in brain structures, metabolism, and structural and functional connectivity occurring between bout periods. Results: Although the precise brain structures responsible for episodic CH are unknown, major roles are indicated for the posterior hypothalamus (especially in acute attacks), the pain neuromatrix with an emphasis on central descending pain modulation, and non-traditional pain processing networks including the occipital, cerebellar, and salience networks. These areas are potentially related to dynamic transitioning between in- and out-of-bout periods. Conclusion: Recent progress in magnetic resonance imaging of episodic CH has provided additional insights into dynamic bout-associated structural and functional connectivity changes in the brain, especially in non-traditional pain processing network areas. These areas warrant future investigations as targets for neuromodulation in patients with CH.
KW - Bout periods
KW - diffusion tensor imaging
KW - functional connectivity
KW - magnetic resonance imaging
KW - pain matrix
KW - voxel-based morphometry
UR - http://www.scopus.com/inward/record.url?scp=85042691901&partnerID=8YFLogxK
U2 - 10.1177/0333102417716932
DO - 10.1177/0333102417716932
M3 - Review article
C2 - 28677993
AN - SCOPUS:85042691901
SN - 0333-1024
VL - 38
SP - 970
EP - 983
JO - Cephalalgia
JF - Cephalalgia
IS - 5
ER -