From neuroimaging to patients’ bench: what we have learnt from trigemino-autonomic pain syndromes
- 206 Downloads
Trigeminal autonomic cephalalgias (TACs) are primary headaches including cluster headache, paroxysmal hemicrania, and short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT). A number of neuroimaging studies have been conducted in last decade showing involvement of brain areas included in the pain matrix. Apart from pain matrix involvement, other neuroimaging findings data deserve special attention. The hypothalamic activation reported in the course of TAC attacks coupled with the efficacy of hypothalamic neurostimulation to treat drug-resistant TAC forms clearly indicate the posterior hypothalamus as a crucial area in TAC pathophysiology. In animal models this brain area has been shown to modulate craniofacial pain; moreover, hypothalamic activation occurs in other pain conditions, suggesting that posterior hypothalamus has a more complex role in TAC pathophysiology rather than simply being considered as a trigger. In contrast, hypothalamic activation may serve as a crucial area in terminating rather than triggering attacks. It also could lead to a central condition facilitating initiation of TAC attacks.
KeywordsNeuroimaging Trigeminal autonomic cephalalgias Pathophysiology Trigeminal system Hypothalamus
Conflict of interest
We declare that we have no conflict of interest.
- 1.Headache Classification Committee of the International Headache Society (2004) The International Classification of Headache Disorders: 2nd edition. Cephalalgia 24(Suppl 1):1–160Google Scholar
- 5.Leone M, Proietti Cecchini A, Franzini A, Broggi G, Cortelli P, Montagna P, May A, Juergens T, Cordella R, Carella F, Bussone G (2008) Lessons from 8 years’ experience of hypothalamic stimulation in cluster headache. Cephalalgia 28:789–797Google Scholar
- 6.Kudrow L (1980) Cluster headache, mechanism and management, 1st edn. Oxford University Press, New YorkGoogle Scholar
- 19.Sánchez del Río M, Hernández JA, Caminero AB, Pareja JA, Alvarez Linera J (2003) Activacion subcortical en SUNCT y V-1 con Resonancia Funcional. Neurologia 18(9):517Google Scholar
- 31.Fontaine D, Lazorthes Y, Mertens P, Blond S, Géraud G, Fabre N, Navez M, Lucas C, Dubois F, Gonfrier S, Paquis P, Lantéri-Minet M (2010) Safety and efficacy of deep brain stimulation in refractory cluster headache: a randomized placebo-controlled double-blind trial followed by a 1-year open extension. J Headache Pain 11(1):23–31PubMedCrossRefGoogle Scholar
- 32.Seijo F, Saiz A, Lozano B, Santamarta E, Alvarez-Vega M, Seijo E, Fernández de León R, Fernández-González F, Pascual J (2011) Neuromodulation of the posterolateral hypothalamus for the treatment of chronic refractory cluster headache: experience in five patients with a modified anatomical target. Cephalalgia Nov 24 (Epub ahead of print)Google Scholar
- 35.Lyons MK, Dodick DW, Evidente VG (2008) Responsiveness of short-lasting unilateral neuralgiform headache with conjunctival injection and tearing to hypothalamic deep brain stimulation. J Neurosurg 26:1–3Google Scholar
- 36.Bartsch T, Falk D, Knudsen K, Reese R, Raethjen J, Mehdorn HM, Volkmann J, Deuschl G (2011) Deep brain stimulation of the posterior hypothalamic area in intractable short-lasting unilateral neuralgiform headache with conjunctival injection and tearing (SUNCT). Cephalalgia 31(13):1405–1408PubMedCrossRefGoogle Scholar