Cortical plasticity in episodic and chronic cluster headache.
Cluster headache (CH) is characterized by recurrent episodes of excruciatingly painful, unilateral headache attacks typically accompanied by trigeminal autonomic symptoms. Due to its rhythm with alternating episodes of pain and no-pain, it is an excellent model to investigate whether structural brain changes detected by magnetic resonance based voxel-based-morphometry (VBM) reflect the cause of the disease, may be a consequence of the underlying disease other than pain, or may simply be caused by the sensation of pain itself. We investigated 91 patients with CH in different stages of their disease using VBM and compared them to 78 age- and gender-matched healthy controls. We detected distinct regional gray matter (GM) changes in different brain regions including the temporal lobe, the hippocampus, the insular cortex and the cerebellum. The extent, location and direction of observed GM alterations depended on the state of disease and appeared dynamic in relation to pain state (i.e., pain vs. no-pain). No hypothalamic changes were detected in CH patients compared to healthy controls. The GM changes observed in this study are highly dynamic and thereby reflect the cortical plasticity of the brain in regard to pain. This observed dynamic may provide an explanation of the diverse results of previous VBM studies in pain. Regarding CH the results suggest that the disease is more likely to be caused by a network dysfunction rather than by a single malfunctioning structure.
Department of Neurology, University of Duisburg Essen, Hufelandstr. 55, Essen 45122, Germany.
Steffen
S
Naegel
Department of Neurology, University of Duisburg Essen, Hufelandstr. 55, Essen 45122, Germany.
Dagny
D
Holle
Department of Neurology, University of Duisburg Essen, Hufelandstr. 55, Essen 45122, Germany.
Nathalie
N
Desmarattes
Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Hufelandstr. 55, Essen 45122, Germany.
Nina
N
Theysohn
Department of Neurology, University of Duisburg Essen, Hufelandstr. 55, Essen 45122, Germany.
Hans-Christoph
HC
Diener
Department of Neurology, University of Duisburg Essen, Hufelandstr. 55, Essen 45122, Germany.
Zaza
Z
Katsarava
Department of Neurology, University of Duisburg Essen, Hufelandstr. 55, Essen 45122, Germany.
Mark
M
Obermann
D000293:Adolescent; D000328:Adult; D001921:Brain / Q000473:pathology*; D003027:Cluster Headache / Q000473:pathology*; D005260:Female; D066128:Gray Matter / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009473:Neuronal Plasticity; D012720:Severity of Illness Index; D055815:Young Adult
Chronic pain; Cluster headache; Neuronal plasticity; Voxel-based morphometry