Hypothalamic regulation of headache and migraine

TY - JOUR

T1 - Hypothalamic regulation of headache and migraine

AU - May, Arne

AU - Burstein, Rami

PY - 2019/11

Y1 - 2019/11

N2 - BACKGROUND: The clinical picture, but also neuroimaging findings, suggested the brainstem and midbrain structures as possible driving or generating structures in migraine.FINDINGS: This has been intensely discussed in the last decades and the advent of modern imaging studies refined the involvement of rostral parts of the pons in acute migraine attacks, but more importantly suggested a predominant role of the hypothalamus and alterations in hypothalamic functional connectivity shortly before the beginning of migraine headaches. This was shown in the NO-triggered and also in the preictal stage of native human migraine attacks. Another headache type that is clinically even more suggestive of hypothalamic involvement is cluster headache, and indeed a structure in close proximity to the hypothalamus has been identified to play a crucial role in attack generation.CONCLUSION: It is very likely that spontaneous oscillations of complex networks involving the hypothalamus, brainstem, and dopaminergic networks lead to changes in susceptibility thresholds that ultimately start but also terminate headache attacks. We will review clinical and neuroscience evidence that puts the hypothalamus in the center of scientific attention when attack generation is discussed.

AB - BACKGROUND: The clinical picture, but also neuroimaging findings, suggested the brainstem and midbrain structures as possible driving or generating structures in migraine.FINDINGS: This has been intensely discussed in the last decades and the advent of modern imaging studies refined the involvement of rostral parts of the pons in acute migraine attacks, but more importantly suggested a predominant role of the hypothalamus and alterations in hypothalamic functional connectivity shortly before the beginning of migraine headaches. This was shown in the NO-triggered and also in the preictal stage of native human migraine attacks. Another headache type that is clinically even more suggestive of hypothalamic involvement is cluster headache, and indeed a structure in close proximity to the hypothalamus has been identified to play a crucial role in attack generation.CONCLUSION: It is very likely that spontaneous oscillations of complex networks involving the hypothalamus, brainstem, and dopaminergic networks lead to changes in susceptibility thresholds that ultimately start but also terminate headache attacks. We will review clinical and neuroscience evidence that puts the hypothalamus in the center of scientific attention when attack generation is discussed.

KW - Autonomic Nervous System/physiopathology

KW - Brain Stem/physiopathology

KW - Craving/physiology

KW - Dopamine/physiology

KW - Emotions

KW - Endocrine System/physiopathology

KW - Headache/physiopathology

KW - Humans

KW - Hypothalamus/physiopathology

KW - Migraine Disorders/diagnostic imaging

KW - Nitric Oxide/physiology

KW - Nociception/physiology

KW - Pain Perception/physiology

KW - Photophobia/physiopathology

KW - Prodromal Symptoms

U2 - 10.1177/0333102419867280

DO - 10.1177/0333102419867280

M3 - SCORING: Review article

C2 - 31466456

VL - 39

SP - 1710

EP - 1719

JO - CEPHALALGIA

JF - CEPHALALGIA

SN - 0333-1024

IS - 13

ER -