title: Migraine attacks the Basal Ganglia.
abstract: BACKGROUND
  With time, episodes of migraine headache afflict patients with increased frequency, longer duration and more intense pain. While episodic migraine may be defined as 1-14 attacks per month, there are no clear-cut phases defined, and those patients with low frequency may progress to high frequency episodic migraine and the latter may progress into chronic daily headache (> 15 attacks per month). The pathophysiology of this progression is completely unknown. Attempting to unravel this phenomenon, we used high field (human) brain imaging to compare functional responses, functional connectivity and brain morphology in patients whose migraine episodes did not progress (LF) to a matched (gender, age, age of onset and type of medication) group of patients whose migraine episodes progressed (HF).
  
  
  RESULTS
  In comparison to LF patients, responses to pain in HF patients were significantly lower in the caudate, putamen and pallidum. Paradoxically, associated with these lower responses in HF patients, gray matter volume of the right and left caudate nuclei were significantly larger than in the LF patients. Functional connectivity analysis revealed additional differences between the two groups in regard to response to pain.
  
  
  CONCLUSIONS
  Supported by current understanding of basal ganglia role in pain processing, the findings suggest a significant role of the basal ganglia in the pathophysiology of the episodic migraine.
authors.affiliation: Department of Radiology, Children’s Hospital Boston, Harvard Medical School, Boston, MA 02115, USA.
authors.forename: Nasim
authors.initials: N
authors.lastname: Maleki
authors.forename: Lino
authors.initials: L
authors.lastname: Becerra
authors.forename: Lauren
authors.initials: L
authors.lastname: Nutile
authors.forename: Gautam
authors.initials: G
authors.lastname: Pendse
authors.forename: Jennifer
authors.initials: J
authors.lastname: Brawn
authors.forename: Marcelo
authors.initials: M
authors.lastname: Bigal
authors.forename: Rami
authors.initials: R
authors.lastname: Burstein
authors.forename: David
authors.initials: D
authors.lastname: Borsook
mesh_terms: D000328:Adult; D001479:Basal Ganglia / Q000473:pathology / Q000503:physiopathology*; D016022:Case-Control Studies; D002421:Caudate Nucleus / Q000473:pathology / Q000503:physiopathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D008881:Migraine Disorders / Q000473:pathology / Q000503:physiopathology*; D011699:Putamen / Q000473:pathology / Q000503:physiopathology