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 journalArticle

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 languageEnglish
Pages (from-to)543-550
Number of pages8
JournalBrain
Volume129
Issue number2
DOIs
Publication statusPublished - Feb 2006

Fingerprint

Secondary Headache Disorders
Prefrontal Cortex
Migraine Disorders
Analgesics
Glucose
Parietal Lobe
Headache Disorders
Somatoform Disorders
Gyrus Cinguli
Thalamus
Chronic Pain
Substance-Related Disorders
Pain
Brain
Population

Keywords

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

ASJC Scopus subject areas

  • Neuroscience(all)

Cite this

Fumal, A., Laureys, S., Di Clemente, L., Boly, M., Bohotin, V., Vandenheede, M., ... Schoenen, J. (2006). Orbitofrontal cortex involvement in chronic analgesic-overuse headache evolving from episodic migraine. Brain, 129(2), 543-550. https://doi.org/10.1093/brain/awh691

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 journalArticle

Fumal, A, Laureys, S, Di Clemente, L, Boly, M, Bohotin, V, Vandenheede, M, Coppola, G, Salmon, E, Kupers, R & Schoenen, J 2006, 'Orbitofrontal cortex involvement in chronic analgesic-overuse headache evolving from episodic migraine', Brain, vol. 129, no. 2, pp. 543-550. https://doi.org/10.1093/brain/awh691
Fumal A, Laureys S, Di Clemente L, Boly M, Bohotin V, Vandenheede M et al. Orbitofrontal cortex involvement in chronic analgesic-overuse headache evolving from episodic migraine. Brain. 2006 Feb;129(2):543-550. https://doi.org/10.1093/brain/awh691
Fumal, Arnaud ; Laureys, Steven ; Di Clemente, Laura ; Boly, Mélanie ; Bohotin, Valentin ; Vandenheede, Michel ; Coppola, Gianluca ; Salmon, Eric ; Kupers, Ron ; Schoenen, Jean. / Orbitofrontal cortex involvement in chronic analgesic-overuse headache evolving from episodic migraine. In: Brain. 2006 ; Vol. 129, No. 2. pp. 543-550.
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