Laura H Schulte1,2, Ame Abdu Haji1, Arne May3. 1. Department of Systems Neuroscience, University Medical Center Eppendorf, University of Hamburg, Hamburg, Germany. 2. Clinic for Psychiatry, University Medical Center Eppendorf, University of Hamburg, Hamburg, Germany. 3. Department of Systems Neuroscience, University Medical Center Eppendorf, University of Hamburg, Hamburg, Germany. a.may@uke.de.
Abstract
BACKGROUND: Task-free imaging approaches using PET have shown the posterior hypothalamus to be specifically activated during but not outside cluster headache attacks. Evidence from task related functional imaging approaches however is scarce. METHODS: Twenty-one inactive cluster headache patients (episodic cluster headache out of bout), 16 active cluster headache patients (10 episodic cluster headache in bout, 6 chronic cluster headache) and 18 control participants underwent high resolution brainstem functional magnetic resonance imaging of trigeminal nociception using gaseous ammonia as a painful stimulus. RESULTS: Following trigeminonociceptive stimulation with ammonia there was a significantly stronger activation within the posterior hypothalamus in episodic cluster headache patients out of bout when compared to controls. When contrasting estimates of the pain contrast, active cluster headache patients where in between the two other groups but did not differ significantly from either. CONCLUSION: The posterior hypothalamus might thus be hyperexcitable in cluster headache patients outside the bout while excitability to external nociceptive stimuli decreases during in bout periods, probably due to frequent hypothalamic activation and possible neurotransmitter exhaustion during cluster attacks.
BACKGROUND: Task-free imaging approaches using PET have shown the posterior hypothalamus to be specifically activated during but not outside cluster headache attacks. Evidence from task related functional imaging approaches however is scarce. METHODS: Twenty-one inactive cluster headachepatients (episodic cluster headache out of bout), 16 active cluster headachepatients (10 episodic cluster headache in bout, 6 chronic cluster headache) and 18 control participants underwent high resolution brainstem functional magnetic resonance imaging of trigeminal nociception using gaseous ammonia as a painful stimulus. RESULTS: Following trigeminonociceptive stimulation with ammonia there was a significantly stronger activation within the posterior hypothalamus in episodic cluster headachepatients out of bout when compared to controls. When contrasting estimates of the pain contrast, active cluster headachepatients where in between the two other groups but did not differ significantly from either. CONCLUSION: The posterior hypothalamus might thus be hyperexcitable in cluster headachepatients outside the bout while excitability to external nociceptive stimuli decreases during in bout periods, probably due to frequent hypothalamic activation and possible neurotransmitter exhaustion during cluster attacks.
Authors: Carmen Fourier; Caroline Ran; Christina Sjöstrand; Elisabet Waldenlind; Anna Steinberg; Andrea Carmine Belin Journal: Cephalalgia Date: 2021-07-13 Impact factor: 6.292