Neuroimaging in cluster headache and other trigeminal autonomic cephalalgias

Elisa Iacovelli, Gianluca Coppola, Emanuele Tinelli, Francesco Pierelli, Federico Bianco

Research output: Contribution to journalArticlepeer-review


The central nervous system mechanisms involved in trigeminal autonomic cephalalgias, a group of primary headaches characterized by strictly unilateral head pain that occurs in association with ipsilateral craniofacial autonomic features, are still not comprehensively understood. However, functional imaging methods have revolutionized our understanding of mechanisms involved in these primary headache syndromes. The present review provides a brief overview of the major modern functional neuroimaging techniques used to examine brain structure, biochemistry, metabolic state, and functional capacity. The available functional neuroimaging data in cluster headache and other TACs will thus be summarized. Although the precise brain structures responsible for these primary headache syndromes still remain to be determined, neuroimaging data suggest a major role for posterior hypothalamus activation in initiating and maintaining attacks. Furthermore, pathophysiological involvement of the pain neuromatrix and of the central descending opiatergic pain control system was observed. Given the rapid advances in functional and structural neuroimaging methodologies, it can be expected that these non-invasive techniques will continue to improve our understanding into the nature of the brain dysfunction in cluster headache and other trigeminal autonomic cephalalgias.

Original languageEnglish
Pages (from-to)11-20
Number of pages10
JournalJournal of Headache and Pain
Issue number1
Publication statusPublished - Jan 2012


  • Functional MRI
  • Hypothalamus
  • Magnetic resonance spectroscopy
  • Pain neuromatrix
  • Positron emission tomography
  • Single photon emission computed tomography
  • Trigeminal autonomic cephalalgias
  • Voxel-based morphometry

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Clinical Neurology


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