Neuroimaging Findings in Patients with Medication Overuse Headache
- 288 Downloads
Medication overuse headache (MOH) is a secondary headache syndrome defined as the deterioration of the headache associated with the overuse of analgesics. The prevalence of MOH is 1–2% in the general population and even up to 50% in special clinics. Overuse of abortive medications is highly associated with chronic daily headaches and also a known risk factor for headache evolution. Possible mechanisms include neural plasticity changes such as sensitization and defective endogenous pain inhibition. Psychological studies have suggested dependence, even addiction, in patients with MOH. Neuroimaging studies have provided valuable information concerning MOH pathophysiology. Magnetic resonance imaging analyzed by voxel-based morphometry showed gray matter volume changes in brain areas participating the pain modulations. Changes of brain function at similar areas have been revealed by positron emission tomography and functional magnetic resonance imaging studies. Many of these changes were correlated with either headache and/or analgesics parameters such as frequency and duration. These changes are typically reversible after successful treatment. Though the cause or consequence debate remains unsettled, we are more in favor of these findings as maladaptive changes to the frequent headaches or medication overuse. Of these brain areas involved in MOH, orbitofrontal cortex is of interest in several ways. In an early positron emission tomography study, the hypometabolism persists after successful treatment which implied a causal role. The following morphological studies showed the orbitofrontal cortex volume could predict treatment responses. Functional magnetic resonance imaging studies, task positive and also resting-state ones, also reported changes within the mesocorticolimbic dopamine system, also known as reward system. Important brain areas of this system include ventral tegmental area, striatum, and orbitofrontal cortex. The system plays an important role in decision-making, dependence, and addiction, as implicated in psychological studies of MOH. Further studies on neuromodulation of this system may be considered in the treatment of MOH.
KeywordsMagnetic resonance imaging Medication overuse headache Positron emission tomography
This study was supported in part by grants from the Taipei Veterans General Hospital (V106C-106, VGHUST105-G7-1-1, V105C-127, V105D9-001-MY2-2, V105E9-001-MY2-1, VTA105-V1-1-1), Ministry of Science and Technology of Taiwan (MOST 106-2321-B-010-009-, MOST 10-2314-B-010-015-MY2, and MOST 103-2321-B-010-017-), Academia Sinica (Grant No. IBMS-BM10601010026, IBMS-CRC103-P04), Brain Research Center, National Yang-Ming University, Ministry of Health and Welfare, Taiwan (MOHW 103-TDU-B-211-113-003, MOHW 104-TDU-B-211-113-003, MOHW 105-TDU-B-211-113-003), National Yang-Ming University–Far Eastern Memorial Hospital Joint Research Program (NYMU-FEMH 105FN10, NYMU-FEMH 106DN10), Far Eastern Memorial Hospital (FEMH-2016-C-023, FEMH-2017-D-004), and a grant from the Ministry of Education, Aim for the Top University Plan.
Compliance with Ethical Standards
Conflict of Interest
Tzu-Hsien Lai declares no conflict of interest. Dr. Wang reports personal fees from Eli-Lilly, personal fees from Daiichi-Sankyo, personal fees from Pfizer, Taiwan, personal fees from Bayer, and personal fees from Eisai, all outside of the submitted work.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
- 5.Siberstein SD, Lipton RB, Solomon S, Mathew NT. Classification of daily and near-daily headaches: proposed revisions to the HIS criteria. Headache. 1994;34(1):1–7. https://doi.org/10.1111/j.1526-4610.1994.hed3401001.x.CrossRefPubMedGoogle Scholar
- 10.Wang SJ, Fuh JL, Lu S, Juang K. Chronic daily headache in adolescents: prevalence, impact, and medication overuse. Neurology. 2006;66(2):193–7. https://doi.org/10.1212/01.wnl.0000183555.54305.fd.CrossRefPubMedGoogle Scholar
- 12.• Lai TH, Protsenko E, Cheng YC, Loggia ML, Coppola G, Chen WT. Neural plasticity in common forms of chronic headaches. Neural Plast. 2015;2015:205985. This article thoroughly discussed neural plasticity changes related to various types of important headaches, including medication overuse headache. CrossRefPubMedPubMedCentralGoogle Scholar
- 17.Riederer F, Marti M, Luechinger R, Lanzenberger R, von Meyenburg J, Gantenbein AR, et al. Grey matter changes associated with medication-overuse headache: correlations with disease related disability and anxiety. World J Biol Psychiatry. 2012;13(7):517–25. https://doi.org/10.3109/15622975.2012.665175.CrossRefPubMedGoogle Scholar
- 18.• Riederer F, Gantenbein AR, Marti M, Luechinger R, Kollias S, Sándor PS. Decrease of gray matter volume in the midbrain is associated with treatment response in medication-overuse headache: possible influence of orbitofrontal cortex. J Neurosci. 2013;33:15343–9. The study confirmed the reversibility of gray matter volumes after treatment of medication overuse headache and pointed out the orbitofrontal cortex volume in predicting the treatment response. CrossRefPubMedGoogle Scholar
- 22.Michels L, Christidi F, Steiger VR, et al. Pain modulation is affected differently in medication-overuse headache and chronic myofascial pain—a multimodal MRI study. Cephalalgia. 2017;37(8):764–79.Google Scholar
- 23.• Fumal A, Laureys SD, Clemente L, et al. Orbitofrontal cortex involvement in chronic analgesic-overuse headache evolving from episodic migraine. Brain. 2006;129:543–50. The study first showed the persistent hypometabolism of orbitofrontal cortex indicating the causal role of this brain area in medication overuse headache. CrossRefPubMedGoogle Scholar