Migraine attacks as a result of hypothalamic loss of control

Stankewitz, Anne; Keidel, Leonie; Rehm, Mathias; Irving, Stephanie; Kaczmarz, Stephan; Preibisch, Christine; Witkovský, Viktor; Zimmer, Claus; Schulz, Enrico; Toelle, Thomas R

doi:10.1016/j.nicl.2021.102784

Cited by 32 publications

(36 citation statements)

References 59 publications

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“…Hypothalamic function is also involved in addiction, anxiety disorders, and weight maintenance. Some investigators assume the hypothalamus regulates the limbic system (Stankewitz et al, 2021). Major visceral afferent connections to the hypothalamus arrive from the nucleus tractus solitarius, which also receives a convergence of inputs from cranial nerves VII, IX and X and relays information to the limbic system.…”

Section: Neuroanatomy Of Migraine and Cluster Headachesmentioning

confidence: 99%

“…The networks through which the hypothalamus serves this role in migraine are both influenced by, as well as sub-serve, multiple functions that include setting brainstem oscillatory functions, sensory thresholds, and pain modulation at all levels of the neuroaxis. In longitudinal data obtained by functional magnetic resonance imaging (fMRI) from 12 migraineurs, perfusion changes over the migraine cycle occurred mainly in limbic structures with lower hypothalamic connectivity noted during the headache phase, leading these investigators to propose that an increasing loss of hypothalamic control over the limbic structures increases the susceptibility of limbic neurons to migraine triggers (Stankewitz et al, 2021).…”

Section: Modern Migraine Theorymentioning

confidence: 99%

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Remediating Intractable Headache: An Effective Nonpharmacological Approach Employing Infralow Frequency Neuromodulation

Legarda¹,

Michas-Martin²,

McDermott³

2022

Front. Hum. Neurosci.

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Section: Neuroanatomy Of Migraine and Cluster Headachesmentioning

confidence: 99%

Section: Modern Migraine Theorymentioning

confidence: 99%

Remediating Intractable Headache: An Effective Nonpharmacological Approach Employing Infralow Frequency Neuromodulation

Legarda¹,

Michas-Martin²,

McDermott³

2022

Front. Hum. Neurosci.

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“…Other correlations concern the possible involvement of the suprachiasmatic nucleus, situated in the anterior part of the hypothalamus dorsal and above the optic chiasma, which is correlated with the dorsal medullary reticular substance and through sympathetic projections to the parasympathetic pterygopalatine ganglion and the trigeminal sensory nuclei [49]; after all now the hyphothalamus role in the generation of headache attacks is demonstrated by known relevance to the trigeminal reflex and increased connection with the limbic area [50,51].…”

Section: Anatomy and Physiopatologymentioning

confidence: 99%

Cranial Autonomic Symptoms and Migraine: What Relationship and What Meaning? A Review

Cascio¹,

Correnti²,

D’Agostino³

et al. 2022

J. Integr. Neurosci.

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Cranial autonomic symptoms (CAS) have been usually associated with trigeminal autonomic cephalalgias (TAC's), however in the last few years several reports in adult and pediatric population have reported important presence of the CAS in migraine. Also several evidences experimentally show that the increased parasympathetic outflow can enhance the sensitization of nociceptive receptors involved in migraine. The presence of CAS suggests an activation of the trigeminal-autonomic reflex, probably related to an over-activation of the trigeminal afferent arm. For these reasons identifing and understanding of these symptoms in migraine may be important to help in the diagnosis and effective management. The purpose of this review is, analyzing the literature data, to discuss the prevalence of these CAS in migraine, the pathophysiological meaning in the pathogenesis of migraine and whether their presence influences the prognosis and therapy of migraine in adult and pediatric age.

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“…The latest report using longitudinal fMRI, showed that cyclic changes of brain perfusion in hypothalamic and limbic regions (insula, accumbens, hippocampus), with the highest perfusion during the headache attack, may be linked to specific neural dynamics throughout the migraine cycle ( 35 ). Interestingly, there was a progressive increase of functional connectivity among these structures, reaching a peak before collapsing at or the near headache onset, in a sort of sudden meltdown between the hypothalamus and the limbic brain ( 36 ). Similarly, a progressive increase before headache and a sudden drop of functional connectivity of the hypothalamus at the headache onset was found for sensory and frontal cortices, basal ganglia, and cerebellum ( 36 ).…”

Section: Introductionmentioning

confidence: 99%

“…Interestingly, there was a progressive increase of functional connectivity among these structures, reaching a peak before collapsing at or the near headache onset, in a sort of sudden meltdown between the hypothalamus and the limbic brain ( 36 ). Similarly, a progressive increase before headache and a sudden drop of functional connectivity of the hypothalamus at the headache onset was found for sensory and frontal cortices, basal ganglia, and cerebellum ( 36 ). In another recent study, interictal assessment of episodic migraineurs has found alterations in dynamic functional coupling between the hypothalamus and brain regions, processing pain and vision, as well as high-order sensations, representing clinical features, such as disease duration and disability in the orbitofrontal gyrus of the prefrontal cortex ( 37 ).…”

Section: Introductionmentioning

confidence: 99%

Cerebro-Cerebellar Networks in Migraine Symptoms and Headache

Noseda

2022

Front. Pain Res.

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The cerebellum is associated with the biology of migraine in a variety of ways. Clinically, symptoms such as fatigue, motor weakness, vertigo, dizziness, difficulty concentrating and finding words, nausea, and visual disturbances are common in different types of migraine. The neural basis of these symptoms is complex, not completely known, and likely involve activation of both specific and shared circuits throughout the brain. Posterior circulation stroke, or neurosurgical removal of posterior fossa tumors, as well as anatomical tract tracing in animals, provided the first insights to theorize about cerebellar functions. Nowadays, with the addition of functional imaging, much progress has been done on cerebellar structure and function in health and disease, and, as a consequence, the theories refined. Accordingly, the cerebellum may be useful but not necessary for the execution of motor, sensory or cognitive tasks, but, rather, would participate as an efficiency facilitator of neurologic functions by improving speed and skill in performance of tasks produced by the cerebral area to which it is reciprocally connected. At the subcortical level, critical regions in these processes are the basal ganglia and thalamic nuclei. Altogether, a modulatory role of the cerebellum over multiple brain regions appears compelling, mainly by considering the complexity of its reciprocal connections to common neural networks involved in motor, vestibular, cognitive, affective, sensory, and autonomic processing—all functions affected at different phases and degrees across the migraine spectrum. Despite the many associations between cerebellum and migraine, it is not known whether this structure contributes to migraine initiation, symptoms generation or headache. Specific cerebellar dysfunction via genetically driven excitatory/inhibitory imbalances, oligemia and/or increased risk to white matter lesions has been proposed as a critical contributor to migraine pathogenesis. Therefore, given that neural projections and functions of many brainstem, midbrain and forebrain areas are shared between the cerebellum and migraine trigeminovascular pathways, this review will provide a synopsis on cerebellar structure and function, its role in trigeminal pain, and an updated overview of relevant clinical and preclinical literature on the potential role of cerebellar networks in migraine pathophysiology.

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Migraine attacks as a result of hypothalamic loss of control

Cited by 32 publications

References 59 publications

Remediating Intractable Headache: An Effective Nonpharmacological Approach Employing Infralow Frequency Neuromodulation

Remediating Intractable Headache: An Effective Nonpharmacological Approach Employing Infralow Frequency Neuromodulation

Cranial Autonomic Symptoms and Migraine: What Relationship and What Meaning? A Review

Cerebro-Cerebellar Networks in Migraine Symptoms and Headache

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