Chronic migraine with medication overuse pre-post withdrawal of symptomatic medication: clinical results and FMRI correlations.
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.
Grazzi
Licia
L
National Neurological Institute C. Besta: Headache Centre, Milan, Italy.
Chiapparini
Luisa
L
Ferraro
Stefania
S
Usai
Susanna
S
Andrasik
Frank
F
Mandelli
Maria Luisa
ML
Bruzzone
Maria Grazia
MG
Bussone
Gennaro
G
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
D000700:Analgesics