Gray matter changes related to chronic posttraumatic headache.
BACKGROUND
Although up to 15% of patients with whiplash injury develop chronic headache, the basis and mechanisms of this posttraumatic headache are not well understood.


METHODS
Thirty-two patients with posttraumatic headache following whiplash injury were investigated within 14 days after the accident and again after 3 months using magnetic resonance-based voxel-based morphometry. Twelve patients developed chronic headache lasting longer than 3 months and were studied a third time after 1 year.


RESULTS
Patients who developed chronic headache revealed decreases in gray matter in the anterior cingulate and dorsolateral prefrontal cortex after 3 months. These changes resolved after 1 year, in parallel to the cessation of headache. The same patients who developed chronic headache showed an increase of gray matter in antinociceptive brainstem centers, thalamus, and cerebellum 1 year after the accident.


CONCLUSIONS
We demonstrate adaptive gray matter changes of pain processing structures in patients with chronic posttraumatic headache in regard to neuronal plasticity, thus providing a biologically plausible basis for this common, disabling problem.
Obermann
Mark
M
Department of Neurology, University of Duisburg-Essen, 45122 Essen, Germany. mark.obermann@uni-due.de
Nebel
K
K
Schumann
C
C
Holle
D
D
Gizewski
E R
ER
Maschke
M
M
Goadsby
P J
PJ
Diener
H-C
HC
Katsarava
Z
Z
D000328:Adult; D000368:Aged; D001284:Atrophy / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D001921:Brain / Q000473:pathology* / Q000503:physiopathology; D001933:Brain Stem / Q000473:pathology / Q000503:physiopathology; D002531:Cerebellum / Q000473:pathology / Q000503:physiopathology; D002908:Chronic Disease; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006179:Gyrus Cinguli / Q000473:pathology / Q000503:physiopathology; D020773:Headache Disorders / Q000209:etiology* / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D006984:Hypertrophy / Q000209:etiology / Q000473:pathology / Q000503:physiopathology; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009434:Neural Pathways / Q000473:pathology / Q000503:physiopathology; D009473:Neuronal Plasticity / Q000502:physiology; D017397:Prefrontal Cortex / Q000473:pathology / Q000503:physiopathology; D013788:Thalamus / Q000473:pathology / Q000503:physiopathology; D013995:Time; D014911:Whiplash Injuries / Q000150:complications*; D055815:Young Adult