Orbitofrontal cortex involvement in chronic analgesic-overuse headache evolving from episodic migraine

Arnaud Fumal, Steven Laureys, Laura Di Clemente, Mélanie Boly, Valentin Bohotin, Michel Vandenheede, Gianluca Coppola, Eric Salmon, Ron Kupers, Jean Schoenen

Research output: Contribution to journalArticlepeer-review


The way in which medication overuse transforms episodic migraine into chronic daily headache is unknown. To search for candidate brain areas involved in this process, we measured glucose metabolism with 18-FDG PET in 16 chronic migraineurs with analgesic overuse before and 3 weeks after medication withdrawal and compared the data with those of a control population (n = 68). Before withdrawal, the bilateral thalamus, orbitofrontal cortex (OFC), anterior cingulate gyrus, insula/ventral striatum and right inferior parietal lobule were hypometabolic, while the cerebellar vermis was hypermetabolic. All dysmetabolic areas recovered to almost normal glucose uptake after withdrawal of analgesics, except the OFC where a further metabolic decrease was found. A subanalysis showed that most of the orbitofrontal hypometabolism was due to eight patients overusing combination analgesics and/or an ergotamine-caffeine preparation. Medication overuse headache is thus associated with reversible metabolic changes in pain processing structures like other chronic pain disorders, but also with persistent orbitofrontal hypofunction. The latter is known to occur in drug dependence and could predispose subgroups of migraineurs to recurrent analgesic overuse.

Original languageEnglish
Pages (from-to)543-550
Number of pages8
Issue number2
Publication statusPublished - Feb 2006


  • Addiction
  • Medication overuse headache
  • Migraine
  • Orbitofrontal cortex
  • PET

ASJC Scopus subject areas

  • Neuroscience(all)


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