Abstract
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 language | English |
|---|---|
| Pages (from-to) | 543-550 |
| Number of pages | 8 |
| Journal | Brain |
| Volume | 129 |
| Issue number | 2 |
| DOIs | |
| Publication status | Published - Feb 2006 |
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Keywords
- Addiction
- Medication overuse headache
- Migraine
- Orbitofrontal cortex
- PET
ASJC Scopus subject areas
- Neuroscience(all)
Cite this
Orbitofrontal cortex involvement in chronic analgesic-overuse headache evolving from episodic migraine. / Fumal, Arnaud; Laureys, Steven; Di Clemente, Laura; Boly, Mélanie; Bohotin, Valentin; Vandenheede, Michel; Coppola, Gianluca; Salmon, Eric; Kupers, Ron; Schoenen, Jean.
In: Brain, Vol. 129, No. 2, 02.2006, p. 543-550.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Orbitofrontal cortex involvement in chronic analgesic-overuse headache evolving from episodic migraine
AU - Fumal, Arnaud
AU - Laureys, Steven
AU - Di Clemente, Laura
AU - Boly, Mélanie
AU - Bohotin, Valentin
AU - Vandenheede, Michel
AU - Coppola, Gianluca
AU - Salmon, Eric
AU - Kupers, Ron
AU - Schoenen, Jean
PY - 2006/2
Y1 - 2006/2
N2 - 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.
AB - 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.
KW - Addiction
KW - Medication overuse headache
KW - Migraine
KW - Orbitofrontal cortex
KW - PET
UR - http://www.scopus.com/inward/record.url?scp=31544480659&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=31544480659&partnerID=8YFLogxK
U2 - 10.1093/brain/awh691
DO - 10.1093/brain/awh691
M3 - Article
C2 - 16330505
AN - SCOPUS:31544480659
VL - 129
SP - 543
EP - 550
JO - Brain
JF - Brain
SN - 0006-8950
IS - 2
ER -