title: Increased Functional Activation of Limbic Brain Regions during Negative Emotional Processing in Migraine.
abstract: Pain is both an unpleasant sensory and emotional experience. This is highly relevant in migraine where cortical hyperexcitability in response to sensory stimuli (including pain, light, and sound) has been extensively reported. However, migraine may feature a more general enhanced response to aversive stimuli rather than being sensory-specific. To this end we used functional magnetic resonance imaging to assess neural activation in migraineurs interictaly in response to emotional visual stimuli from the International Affective Picture System. Migraineurs, compared to healthy controls, demonstrated increased neural activity in response to negative emotional stimuli. Most notably in regions overlapping in their involvement in both nociceptive and emotional processing including the posterior cingulate, caudate, amygdala, and thalamus (cluster corrected, p < 0.01). In contrast, migraineurs and healthy controls displayed no and minimal differences in response to positive and neutral emotional stimuli, respectively. These findings support the notion that migraine may feature more generalized altered cerebral processing of aversive/negative stimuli, rather than exclusively to sensory stimuli. A generalized hypersensitivity to aversive stimuli may be an inherent feature of migraine, or a consequential alteration developed over the duration of the disease. This proposed cortical-limbic hypersensitivity may form an important part of the migraine pathophysiology, including psychological comorbidity, and may represent an innate sensitivity to aversive stimuli that underpins attack triggers, attack persistence and (potentially) gradual headache chronification.
authors: Center for Pain and the Brain (PAIN Research Group), Boston Children's Hospital, Harvard Medical School, BostonMA, USA; Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, BostonMA, USA.
authors: Sophie L
authors: SL
authors: Wilcox
authors: Center for Pain and the Brain (PAIN Research Group), Boston Children's Hospital, Harvard Medical School, BostonMA, USA; Department of Psychiatry, PAIN Research Group, Brain Imaging Center, McLean Hospital, Harvard Medical School, BelmontMA, USA.
authors: Rosanna
authors: R
authors: Veggeberg
authors: Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston MA, USA.
authors: Jordan
authors: J
authors: Lemme
authors: Center for Pain and the Brain (PAIN Research Group), Boston Children's Hospital, Harvard Medical School, BostonMA, USA; Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, BostonMA, USA.
authors: Duncan J
authors: DJ
authors: Hodkinson
authors: Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston MA, USA.
authors: Steven
authors: S
authors: Scrivani
authors: Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston MA, USA.
authors: Rami
authors: R
authors: Burstein
authors: Center for Pain and the Brain (PAIN Research Group), Boston Children's Hospital, Harvard Medical School, BostonMA, USA; Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, BostonMA, USA; Department of Psychiatry, PAIN Research Group, Brain Imaging Center, McLean Hospital, Harvard Medical School, BelmontMA, USA.
authors: Lino
authors: L
authors: Becerra
authors: Center for Pain and the Brain (PAIN Research Group), Boston Children's Hospital, Harvard Medical School, BostonMA, USA; Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Harvard Medical School, BostonMA, USA; Department of Psychiatry, PAIN Research Group, Brain Imaging Center, McLean Hospital, Harvard Medical School, BelmontMA, USA.
authors: David
authors: D
authors: Borsook
keywords: IAPS; emotion; fMRI; headache; limbic; migraine