title: Chronic migraine with medication overuse pre-post withdrawal of symptomatic medication: clinical results and FMRI correlations.
abstract: BACKGROUND
  Chronic migraine with symptomatic medication overuse (CMwMO) is a common and often debilitating clinical condition. Withdrawal of the offending drug(s) is considered the first step in management. Functional magnetic resonance imaging (fMRI) may be a useful technique for obtaining information on particular neuronal changes in the pain network involved in this condition.
  
  
  OBJECTIVE
  To identify specific fMRI patterns in patients suffering from CMwMO before and after withdrawal intervention.
  
  
  METHODS
  We collected fMRI data from a group of patients suffering from CMwMO, evaluating those patients prior to and 6 months following withdrawal. We applied stimuli at sites far removed from where the headaches were experienced. Moreover, pre-intervention fMRI data from the headache patients were compared with those obtained from headache-free and otherwise healthy controls.
  
  
  RESULTS
  Before withdrawal, the right supramarginal gyrus, the right inferior and superior parietal cortex were hypoactive. Activity recovered to almost normal 6 months after withdrawal of the offending medications.
  
  
  CONCLUSIONS
  The hypoactivation we detected in the lateral pain system indicate that there exists a modification of the pain network in CMwMO and that these changes are reversible with therapy.
authors.affiliation: National Neurological Institute C. Besta: Headache Centre, Milan, Italy.
authors.forename: Licia
authors.initials: L
authors.lastname: Grazzi
authors.forename: Luisa
authors.initials: L
authors.lastname: Chiapparini
authors.forename: Stefania
authors.initials: S
authors.lastname: Ferraro
authors.forename: Susanna
authors.initials: S
authors.lastname: Usai
authors.forename: Frank
authors.initials: F
authors.lastname: Andrasik
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Mandelli
authors.forename: Maria Grazia
authors.initials: MG
authors.lastname: Bruzzone
authors.forename: Gennaro
authors.initials: G
authors.lastname: Bussone
mesh_terms: D000328:Adult; D000700:Analgesics / Q000009:adverse effects*; D001921:Brain / Q000503:physiopathology*; D001931:Brain Mapping; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D008881:Migraine Disorders / Q000139:chemically induced / Q000503:physiopathology* / Q000628:therapy*; D009415:Nerve Net / Q000503:physiopathology*; D016896:Treatment Outcome
chemical_list: D000700:Analgesics