title: Grey matter changes associated with medication-overuse headache: correlations with disease related disability and anxiety.
abstract: OBJECTIVE
  Medication-overuse headache (MOH) is associated with psychiatric comorbidities. Neurobiological similarities to substance dependence have been suggested. This study investigated grey matter changes, focussing on pain and reward systems.
  
  
  METHODS
  Using voxel-based morphometry, structural MRIs were compared between 29 patients with both, MOH and migraine, according to International Headache Society criteria, and healthy controls. The Migraine Disability Assessment (MIDAS) score was used. Anxiety and depression were screened for with the Hospital Anxiety and Depression Scale (HADS) and confirmed by a psychiatrist, using the Mini International Neuropsychiatric Interview.
  
  
  RESULTS
  Nineteen patients (66%) had a present or past psychiatric disorder, mainly affective (N = 11) and anxiety disorders (N = 8). In all patients a significant increase of grey matter volume (GMV) was found in the periaqueductal grey matter of the midbrain, which correlated positively with the MIDAS and the HADS-anxiety subscale. A GMV increase was found bilaterally in the thalamus, and the ventral striatum. A significant GMV decrease was detected in frontal regions including orbitofrontal cortex, anterior cingulate cortex, the left and right insula, and the precuneus.
  
  
  CONCLUSIONS
  These findings are consistent with dysfunction of antinociceptive systems in MOH, which is influenced by anxiety. Dysfunction of the reward system may be a neurobiological basis for dependence in a subgroup of MOH patients.
authors: Department of Neurology, Headache Unit, University Hospital Zurich, Zurich, Switzerland.
authors: Franz
authors: F
authors: Riederer
authors: Marvin
authors: M
authors: Marti
authors: Roger
authors: R
authors: Luechinger
authors: Rupert
authors: R
authors: Lanzenberger
authors: Jan
authors: J
authors: von Meyenburg
authors: Andreas R
authors: AR
authors: Gantenbein
authors: Roberto
authors: R
authors: Pirrotta
authors: Charly
authors: C
authors: Gaul
authors: Spyridon
authors: S
authors: Kollias
authors: Peter S
authors: PS
authors: Sándor
mesh_terms: D000328:Adult; D000700:Analgesics / Q000506:poisoning; D000701:Analgesics, Opioid / Q000506:poisoning; D001008:Anxiety Disorders / Q000139:chemically induced* / Q000473:pathology* / Q000523:psychology; D001921:Brain / Q000187:drug effects / Q000473:pathology*; D001931:Brain Mapping / Q000379:methods; D002540:Cerebral Cortex / Q000187:drug effects / Q000473:pathology; D005260:Female; D005625:Frontal Lobe / Q000187:drug effects / Q000473:pathology; D006179:Gyrus Cinguli / Q000187:drug effects / Q000473:pathology; D051271:Headache Disorders, Secondary / Q000139:chemically induced* / Q000473:pathology*; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000379:methods; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D028642:Persons with Psychiatric Disorders / Q000523:psychology; D008881:Migraine Disorders / Q000139:chemically induced / Q000473:pathology; D010296:Parietal Lobe / Q000187:drug effects / Q000473:pathology; D063487:Prescription Drug Misuse; D011569:Psychiatric Status Rating Scales; D019966:Substance-Related Disorders / Q000150:complications* / Q000473:pathology* / Q000523:psychology; D013788:Thalamus / Q000187:drug effects / Q000473:pathology
chemical_list: D000700:Analgesics; D000701:Analgesics, Opioid