Headache disorders: functional neuroimaging

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By Manjit S Matharu PhD MRCP and Norazah Abu Bakar MD

Until recently, primary headache disorders were considered to be due to peripheral mechanisms, such as vascular changes or neurogenic inflammation. Developments in neuroimaging are providing evidence that these headaches are primarily driven from the brain. In this clinical article, Dr. Manjit Matharu and Dr. Norazah Abu Bakar of the National Hospital for Neurology and Neurosurgery in Queen Square, London reviews functional neuroimaging studies in migraine, cluster headache, rarer headaches, and experimental head pain. Dr. Matharu highlights the neural structures that have been implicated by functional neuroimaging studies as having a crucial role in the pathophysiology of primary headache disorders.

Key points

  • Functional neuroimaging has substantially advanced our understanding of the mechanisms underpinning primary headache syndromes.
  • Functional imaging has been instrumental in establishing that primary headache syndromes are central nervous system disorders with neurovascular manifestations rather than vascular disorders.
  • These studies have established that cortical spreading depression is the pathophysiological mechanism of migraine aura.
  • Several functional imaging studies have outlined the crucial role of the brainstem in episodic and chronic migraine and of the hypothalamus/midbrain tegmentum in the trigeminal autonomic cephalalgias.