Functional anatomy of headache.
Functional neuroimaging in headache patients has revolutionised our understanding of these syndromes and provided unique insights into some of the commonest maladies in man, suggesting that at least migraine and cluster headache are primarily driven from the brain. Repeated and independent findings reinforce the crucial role for the brain stem in acute and probably also in chronic migraine, and the hypothalamic grey in several trigemino- autonomic headaches. If further studies confirm these findings, a better understanding will be gained of where and how acute and preventative therapy can be targeted. Given the rapid advances in functional neuroimaging, in particular newer techniques, such as voxel-based morphometry and magnetic resonance spectrometry, functional imaging continues to play a significant role and opens new avenues in targeting the neural substrates in individual primary headache syndromes.
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Department of Systems Neuroscience, University of Hamburg, Martinistrasse 52, D-20246, Hamburg, Germany. a.may@uke.uni-hamburg.de