Brain Metabolism and Structure in Chronic Migraine
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CHRONIC DAILY HEADACHE (SJ WANG, SECTION EDITOR)
Brain Metabolism and Structure in Chronic Migraine Kuan-Lin Lai 1,2,3 & David M. Niddam 3,4 Accepted: 10 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose of Review The purpose of this paper is to review and synthesize current literature in which neurochemical and structural brain imaging were used to investigate chronic migraine (CM) pathophysiology and to further discuss the clinical implications. Recent Findings Spectroscopic and structural MRI studies have shown the presence of both impaired metabolism and structural alterations in the brain of CM patients. Metabolic changes in key brain regions support the notion of altered energetics and homeostasis as part of CM pathophysiology. Furthermore, CM, like other chronic pain disorders, may undergo structural reorganization in pain-related brain regions following near persistent endogenous painful input. Finally, both imaging techniques may provide potential biomarkers of disease state and progression and may help guide novel therapeutic interventions or strategies. Summary Spectroscopic and structural MRI have revealed novel aspects of CM pathophysiology. Findings from the former support the metabolic theory of migraine pathogenesis. Keywords Creatine . Energy deficiency . Magnetic resonance spectroscopy . Voxel-based morphometry . Surface-based morphometry . Medication overuse headache
Introduction Migraine is one of the most prevalent neurological disorders worldwide, with a prevalence as high as 10–15% [1]. Although the majority of patients with migraine suffer from the episodic form (i.e., episodic migraine, EM), the headache frequency increases gradually in a subset of patients to an almost daily occurrence [2]. Chronic migraine (CM), as characterized by the high headache frequency, is inherently defined as headache occurring on ≥ 15 days/month, of which ≥ 8 have to fulfill the criteria of migraine, for a period of more than 3 months [3]. One This article is part of the Topical Collection on Chronic Daily Headache * David M. Niddam [email protected] 1
Department of Neurology, The Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
2
Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
3
Brain Research Center, National Yang-Ming University, Taipei, Taiwan
4
Institute of Brain Science, School of Medicine, National Yang-Ming University, No. 155, Section 2, Linong Street, Taipei 112, Taiwan
of the major risk factors for progression from EM to CM is the overuse of acute abortive medication [4]. Excessive intake of acute medications may lead to worsening of migraine headaches and result in what is termed medication overuse headache (MOH), a condition further complicating the clinical course and response to treatment in CM. Approximately half of all CM patients are also comorbid with MOH [5]. Hence, it is of great importance to understand not only how acute medications interact with central headache gener
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