Imaging in the Evaluation of Headache

Wang

et al. 2017

Human Brain Mapping

This study aims to characterize the psychological wellbeing of chronic headache (CH) patients, to identify cortical structural abnormalities and any associations of those abnormalities with resting state functional connectivity (rsFC), and to determine whether such rsFC abnormality is specific to CH patients. Compared with healthy controls (CON ), CH patients suffered from mild depression, sleep disturbances, and relatively poor quality of life. CH patients also exhibited widespread cortical thickness (CT) abnormalities in left premotor (BA6), right primary somatosensory (S1) and right prefrontal (BA10) cortices, as well as in regions of default mode and executive control networks. Using cortical regions with thickness abnormality as seeds, we found cortical region pairs showed strengthened rsFC in CH patients. Using the same seeds, rsFC analysis from chronic low back pain (CLBP) patients and their controls (CON ) identified abnormalities in non-overlapping cortical region pairs. Direct comparison of rsFC between CH and CLBP patients revealed significantly differences in thirteen cortical region pairs, including the four identified in CH and CON comparison. Across all three groups (CH, CLBP and CON), the rsFC between left multisensory association area (BA39) and left posterior cingulate cortex (BA23) differed significantly. Eight regions showed CT abnormality in CLBP patients, two of which overlapped with those of CH patients. Our observations support the notion that CH and CLBP pain are pathological conditions, under which the brain develops distinct widespread structural and functional abnormalities. CH and CLBP groups share some similar structural abnormalities, but rsFC abnormalities in several cortical region pairs appear to be pathology-specific. Hum Brain Mapp 38:1815-1832, 2017. © 2017 Wiley Periodicals, Inc.

Section: Table II Cortical Regions Showed Significantly Differencesmentioning

confidence: 87%

Cortical thickness and functional connectivity abnormality in chronic headache and low back pain patients

Wang

et al. 2017

Human Brain Mapping

“…They are a compact mass of sinusoidal-type vessels without normal intervening brain. They appear hyperdense on CT, and on MRI as well-circumscribed masses with a rim of T2 hypointensity and marked gradient susceptibility signal on MRI [13] (Figs. 1, 2, and 3).…”

Section: Cavernous Malformationsmentioning

confidence: 99%

Neuroimaging in Secondary Headache Disorders

Chaudhry

Friedman

2015

Curr Pain Headache Rep

A secondary headache may develop de novo or in patients with a history of primary headaches, and a thorough history and neurological exam often helps to suspect a secondary etiology. The causes of secondary headaches include tumors, vascular etiologies, structural brain disorders, infection, inflammation, and alterations of cerebrospinal fluid pressure dynamics. Computed tomography (CT) is very sensitive for detecting acute hemorrhage but magnetic resonance imaging (MRI) is preferred over a head CT in subacute and non-emergent cases. Obtaining the correct diagnosis may include incorporation of intravenous contrast agents, special imaging sequences, and functional imaging techniques.

“…The increasing popularity of CT scans is likely due to a combination of reliability, accessibility, and the ability to quickly exclude life-threatening intracranial hemorrhage or bone abnormalities. Common indications for CT imaging in the ED include head trauma, disorientation, seizure, focal weakness, syncope, loss of consciousness, vertigo, and headache [15,21].…”

Section: Computed Tomographymentioning

confidence: 99%

“…Although primary headache disorders make up the majority of headaches presenting to clinicians, it can be difficult to effectively identify a primary headache disorder from a secondary headache disorder without the presence of Bred flags^in the history or an abnormal neurologic exam. Examples of red flags are as follows [9][10][11][12][13][14][15][16][17][18][19] Although imaging studies can cause harm by exposing patients to potentially harmful radiation and increasing the cost of care, they can also exclude or identify high-risk pathology and help alleviate patient anxiety. From a research standpoint, emerging techniques such as functional magnetic resonance imaging (MRI), positron emission tomography (PET) scans, and voxel-based morphometry (VBM) can help us understand the pathophysiology behind certain headache disorders.…”

Section: Introductionmentioning

confidence: 99%

Appropriate Use of Neuroimaging in Headache

Kuruvilla

Lipton

2015

Curr Pain Headache Rep

Headache may be caused by primary disorders, such as migraines, or secondary disorders, such as intracranial neoplasm or hemorrhage. Imaging plays an important role in differentiating between primary and secondary headache disorders. This article reviews the effectiveness of computed tomography (CT) and magnetic resonance imaging (MRI) in the evaluation of a patient with a headache. It also discusses the utility and cost-effectiveness of performing imaging studies in patients with a headache and a normal neurological exam. Emerging imaging techniques such as functional MRI, positron emission tomography (PET) scans, and voxel-based morphometry (VBM) are also discussed.