Phase dependent hypothalamic activation following trigeminal input in cluster headache

TY - JOUR

T1 - Phase dependent hypothalamic activation following trigeminal input in cluster headache

AU - Schulte, Laura H

AU - Haji, Ame Abdu

AU - May, Arne

PY - 2020/3/30

Y1 - 2020/3/30

N2 - 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.

AB - 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.

KW - Adult

KW - Brain Stem/physiopathology

KW - Cluster Headache/physiopathology

KW - Female

KW - Humans

KW - Hypothalamus/physiopathology

KW - Magnetic Resonance Imaging

KW - Male

KW - Middle Aged

KW - Nociception/physiology

KW - Pain/physiopathology

U2 - 10.1186/s10194-020-01098-2

DO - 10.1186/s10194-020-01098-2

M3 - SCORING: Journal article

C2 - 32228453

VL - 21

SP - 30

JO - J HEADACHE PAIN

JF - J HEADACHE PAIN

SN - 1129-2369

IS - 1

ER -