Neurovascular Headache and A Midbrain Vascular Malformation: Evidence for A Role of the Brainstem in Chronic Migraine

Goadsby, PJ

doi:10.1046/j.1468-2982.2002.00323.x

Cited by 148 publications

(92 citation statements)

References 46 publications

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“…2,3) Therefore, involvement of the dorsal lateral pons is thought to initiate migraine or migraine-like headache. 1,8,10,11) Interestingly, one case involved a lesion located in almost the same region as in the present case. Although our case could not be distinguished from cavernous hemangioma or AVM and only showed one episode of headache, the present case together with these other migraine cases indicate that dorsal pontine lesion can produce painful sensations restricted to the trigeminal nerve territory.…”

Section: Discussionsupporting

confidence: 59%

“…15,16) Migraine or migraine-like headache may develop following brainstem hemorrhage caused by cavernous hemangioma 1,10) and arteriovenous malformation (AVM). 8,11) Positron emission tomography studies have revealed that significant activation is seen in the brainstem, especially in the dorsal lateral pons, in patients with migraine without aura 13) and migraine triggered by 1,2-glyceryl trinitrate. 2,3) Therefore, involvement of the dorsal lateral pons is thought to initiate migraine or migraine-like headache.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Transient Burning Pain in the Ipsilateral Orbit as an Initial Manifestation of Dorsal Pontine Hemorrhage -Case Report-

Doi

Hashimoto

Kira

2009

Neurol. Med. Chir.(Tokyo)

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A 45-year-old man with a past history of hypertension and hyperlipidemia presented with right dorsal pontine hemorrhage manifesting as transient burning pain in the right orbital region, followed by numbness and mild weakness of the left side of the body. Magnetic resonance imaging showed a hyperintense lesion in the right dorsal pons on T 1 -weighted and T 2 -weighted images, but no other abnormalities suggesting vascular lesions in the midbrain, medulla, cerebellum, or cerebrum. These findings were consistent with the subacute stage of small pontine hemorrhage. He was treated to decrease his blood pressure. The symptoms gradually improved and he has suffered neither recurrence of the orbital pain nor migraine for several months after the first episode of headache. The trigeminal nociceptive system in the dorsal lateral pons may be linked to this characteristic pain, as suggested by reports of secondary migraine caused by cavernous hemangioma and arteriovenous malformation, and activation of the dorsal lateral pons during migraine attacks on positron emission tomography.

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Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Transient Burning Pain in the Ipsilateral Orbit as an Initial Manifestation of Dorsal Pontine Hemorrhage -Case Report-

Doi

Hashimoto

Kira

2009

Neurol. Med. Chir.(Tokyo)

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“…Recently a brainstem lesion in the area of PAG in a patient with CDH has been described [12]. The patient was found to have had a left-sided cavernoma in the dorsal midbrain region adjacent to the PAG.…”

Section: Midbrain Vascular Malformationmentioning

confidence: 95%

Chronic daily headache: recent insights from functional imaging

Aurora

2004

J Headache Pain

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New imaging technology allows us to study neurologic disorders that have had no previous structural basis. There have been recent reports on the involvement of nociceptive pathways in daily headache. A systematic review was performed using key words "chronic daily headache" and "imaging". This paper reviews the literature on imaging studies performed on daily headache with emphasis on the new imaging technology.

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“…In a single case report a discrete sclerotic lesion in the region of the PAG in a patient with multiple sclerosis caused severe headache [5]. Recently, a brainstem lesion in the area of periaqueductal grey (PAG) in a patient with CDH has been described [6]. The patient had no previous history of headache and developed new daily persistent headache and on MRI a cavernous angioma was noted in the region of the PAG.…”

Section: Abstract Daily Headache • Functional Neuroimagingmentioning

confidence: 99%

Functional imaging of subcortical nociceptive structures in response to treatment of chronic daily headache

2004

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The objective was to provide objective imaging evidence of functional changes in brainstem structures involved in chronic daily headache (CDH). Over time, episodic migraine (EM) patients may develop CDH known as transformed migraine (TM). Using analysis of transverse relaxation rates, R2, R2* and R2' (R2* values are reflective of blood oxygen level dependence; R2' is a measure of non-heme iron in tissues) we have reported activation (hyperoxia) of red nucleus (RN) and substantia nigra (SN) (decreased R2* and R2') in CDH patients studied during headache, and dysfunction of periaqueductal grey (PAG) based on increased iron levels (elevated R2') [1]. We now report a patient with CDH who, upon treatment, reverted to EM, permitting studies when headache free and an objective analysis of treatment response. SP is a female aged 48 years. She presented with daily headaches for 6 months. Episodic headaches, meeting IHS criteria for migraine without aura, began in her 20s. At the time of presentation she was taking 5 tablets of ergotamine tartarate in the form of Ercaf and 6 extra-strength acetaminophen daily. Repeated dosages of intravenous dihydroergotamine for three days during withdrawal of all medications successfully achieved clinical reversion from CDH to EM. She was studied both during CDH and when headache free after reverting to EM, using high-resolution MR techniques to map the transverse relaxation rates R2, R2* and R2' in RN, SN and PAG. For technical reasons, PAG was not imaged during the CDH phase of her illness. During the CDH phase of her illness, respective R2* values were reduced compared to normal in the RN and SN to 30.1 m/s and 31.45 m/s. Similarly, R2' in RN and SN were abnormally low at 6.62 m/s and 6.72 m/s compared to normal. Subsequent headache free studies demonstrated that R2* and R2' in the RN became 40.1 m/s and 15.47 m/s respectively, and in the SN, 40.25 m/s and 15.19 m/s respectively. These values were similar to EM patients and normal controls. The R2' in PAG during EM for this subject was increased at 6.88 m/s but elevated compared to controls. Daily headache in this patient was associated with chronic activation of pain networks that included RN and SN. Resolution of headache was associated with resolution of activation, although there was evidence for persistent PAG dysfunction, as previously reported. To the best of our knowledge, this case represents the first objective correlation of functional changes in brainstem nociceptive networks with clinical features of TM and its response to treatment.

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Neurovascular Headache and A Midbrain Vascular Malformation: Evidence for A Role of the Brainstem in Chronic Migraine

Cited by 148 publications

References 46 publications

Transient Burning Pain in the Ipsilateral Orbit as an Initial Manifestation of Dorsal Pontine Hemorrhage -Case Report-

Transient Burning Pain in the Ipsilateral Orbit as an Initial Manifestation of Dorsal Pontine Hemorrhage -Case Report-

Chronic daily headache: recent insights from functional imaging

Functional imaging of subcortical nociceptive structures in response to treatment of chronic daily headache

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