Pearls and pitfalls: neuroimaging in headache

PREMISE: One of the most exciting developments in modern neuroscience was the development of imaging techniques providing a non-invasive technique for detection of structure-function relationships characteristic of pain and headache. There is no question that neuroimaging has provided us with a better understanding of how the aura in migraine develops, and it has served as a bridge between neurophysiological studies and clinical findings, although doubtless several questions remain.

PEARLS: Neuroimaging drew attention toward central mechanisms in idiopathic headache syndromes. Outstanding functional studies have reinforced the crucial role of the brainstem in acute and chronic migraine and the hypothalamic area in trigemino-autonomic headaches. Several morphometric studies suggest a decreased gray matter in pain-transmitting areas in headache patients; however, those have to be seen in the light of a wealth of pain studies and studies on exercise-dependent plasticity.

GOAL: This review focuses on neuroimaging as a scientific tool and highlights the recent advances made in studying primary headache syndromes using functional and structural neuroimaging techniques. It will also point toward open questions and gives recommendations for future studies.