Withdrawal from acute medication normalises short-term cortical synaptic potentiation in medication overuse headache

Francesca Cortese, Francesco Pierelli, Flavia Pauri, Cherubino Di Lorenzo, Chiara Lepre, Giulia Malavolta, Chiara Merluzzo, Vincenzo Parisi, Anna Ambrosini, Mariano Serrao, Gianluca Coppola

Research output: Contribution to journalArticle

Abstract

Objectives: To study the effects of a standard acute medication withdrawal program on short-term cortical plasticity mechanisms in patients with medication overuse headache (MOH). Methods: Thirteen patients with MOH and 16 healthy volunteers underwent repetitive transcranial magnetic stimulation (rTMS) over the left motor cortex; in patients with MOH, recordings were performed before and after a 3-week medication withdrawal program. Ten trains of 10 stimuli each (120% resting motor threshold) were delivered at 1 Hz or 5 Hz in two separate sessions in a randomised order. Motor evoked potential (MEP) amplitudes were measured from the right first dorsal interosseous muscle and the slope of the linear regression line from the first to the tenth stimuli was calculated for each participant. Results: All subjects exhibited MEP amplitude inhibition in response to 1 Hz rTMS. Alternatively, the 5-Hz trains of rTMS inhibited rather than potentiated MEP amplitudes in patients with MOH. The physiological potentiating effect of 5 Hz rTMS on MEP amplitudes was restored after drug withdrawal and in proportion with the percentage reduction in monthly headache days in patients with MOH. Conclusions: The results suggest that acute medication withdrawal normalises brain responses in patients with MOH. Clinical improvements after medication withdrawal may reflect the reversal of neurophysiological dysfunction. Accordingly, medication withdrawal should be offered to patients with MOH as early as possible in order to prevent the development of more pronounced alterations in brain plasticity.

Original languageEnglish
JournalNeurological Sciences
DOIs
Publication statusPublished - Jan 1 2019

Fingerprint

Secondary Headache Disorders
Motor Evoked Potentials
Transcranial Magnetic Stimulation
Motor Cortex
Brain
Headache
Linear Models
Healthy Volunteers
Muscles

Keywords

  • Chronic migraine
  • Repetitive transcranial magnetic stimulation
  • Short-term depression
  • Short-term potentiation
  • Synaptic plasticity

ASJC Scopus subject areas

  • Dermatology
  • Clinical Neurology
  • Psychiatry and Mental health

Cite this

Withdrawal from acute medication normalises short-term cortical synaptic potentiation in medication overuse headache. / Cortese, Francesca; Pierelli, Francesco; Pauri, Flavia; Di Lorenzo, Cherubino; Lepre, Chiara; Malavolta, Giulia; Merluzzo, Chiara; Parisi, Vincenzo; Ambrosini, Anna; Serrao, Mariano; Coppola, Gianluca.

In: Neurological Sciences, 01.01.2019.

Research output: Contribution to journalArticle

@article{5edeff9f869a4fbab39bc6f477239443,
title = "Withdrawal from acute medication normalises short-term cortical synaptic potentiation in medication overuse headache",
abstract = "Objectives: To study the effects of a standard acute medication withdrawal program on short-term cortical plasticity mechanisms in patients with medication overuse headache (MOH). Methods: Thirteen patients with MOH and 16 healthy volunteers underwent repetitive transcranial magnetic stimulation (rTMS) over the left motor cortex; in patients with MOH, recordings were performed before and after a 3-week medication withdrawal program. Ten trains of 10 stimuli each (120{\%} resting motor threshold) were delivered at 1 Hz or 5 Hz in two separate sessions in a randomised order. Motor evoked potential (MEP) amplitudes were measured from the right first dorsal interosseous muscle and the slope of the linear regression line from the first to the tenth stimuli was calculated for each participant. Results: All subjects exhibited MEP amplitude inhibition in response to 1 Hz rTMS. Alternatively, the 5-Hz trains of rTMS inhibited rather than potentiated MEP amplitudes in patients with MOH. The physiological potentiating effect of 5 Hz rTMS on MEP amplitudes was restored after drug withdrawal and in proportion with the percentage reduction in monthly headache days in patients with MOH. Conclusions: The results suggest that acute medication withdrawal normalises brain responses in patients with MOH. Clinical improvements after medication withdrawal may reflect the reversal of neurophysiological dysfunction. Accordingly, medication withdrawal should be offered to patients with MOH as early as possible in order to prevent the development of more pronounced alterations in brain plasticity.",
keywords = "Chronic migraine, Repetitive transcranial magnetic stimulation, Short-term depression, Short-term potentiation, Synaptic plasticity",
author = "Francesca Cortese and Francesco Pierelli and Flavia Pauri and {Di Lorenzo}, Cherubino and Chiara Lepre and Giulia Malavolta and Chiara Merluzzo and Vincenzo Parisi and Anna Ambrosini and Mariano Serrao and Gianluca Coppola",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s10072-019-03735-4",
language = "English",
journal = "Neurological Sciences",
issn = "1590-1874",
publisher = "Springer-Verlag Italia s.r.l.",

}

TY - JOUR

T1 - Withdrawal from acute medication normalises short-term cortical synaptic potentiation in medication overuse headache

AU - Cortese, Francesca

AU - Pierelli, Francesco

AU - Pauri, Flavia

AU - Di Lorenzo, Cherubino

AU - Lepre, Chiara

AU - Malavolta, Giulia

AU - Merluzzo, Chiara

AU - Parisi, Vincenzo

AU - Ambrosini, Anna

AU - Serrao, Mariano

AU - Coppola, Gianluca

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Objectives: To study the effects of a standard acute medication withdrawal program on short-term cortical plasticity mechanisms in patients with medication overuse headache (MOH). Methods: Thirteen patients with MOH and 16 healthy volunteers underwent repetitive transcranial magnetic stimulation (rTMS) over the left motor cortex; in patients with MOH, recordings were performed before and after a 3-week medication withdrawal program. Ten trains of 10 stimuli each (120% resting motor threshold) were delivered at 1 Hz or 5 Hz in two separate sessions in a randomised order. Motor evoked potential (MEP) amplitudes were measured from the right first dorsal interosseous muscle and the slope of the linear regression line from the first to the tenth stimuli was calculated for each participant. Results: All subjects exhibited MEP amplitude inhibition in response to 1 Hz rTMS. Alternatively, the 5-Hz trains of rTMS inhibited rather than potentiated MEP amplitudes in patients with MOH. The physiological potentiating effect of 5 Hz rTMS on MEP amplitudes was restored after drug withdrawal and in proportion with the percentage reduction in monthly headache days in patients with MOH. Conclusions: The results suggest that acute medication withdrawal normalises brain responses in patients with MOH. Clinical improvements after medication withdrawal may reflect the reversal of neurophysiological dysfunction. Accordingly, medication withdrawal should be offered to patients with MOH as early as possible in order to prevent the development of more pronounced alterations in brain plasticity.

AB - Objectives: To study the effects of a standard acute medication withdrawal program on short-term cortical plasticity mechanisms in patients with medication overuse headache (MOH). Methods: Thirteen patients with MOH and 16 healthy volunteers underwent repetitive transcranial magnetic stimulation (rTMS) over the left motor cortex; in patients with MOH, recordings were performed before and after a 3-week medication withdrawal program. Ten trains of 10 stimuli each (120% resting motor threshold) were delivered at 1 Hz or 5 Hz in two separate sessions in a randomised order. Motor evoked potential (MEP) amplitudes were measured from the right first dorsal interosseous muscle and the slope of the linear regression line from the first to the tenth stimuli was calculated for each participant. Results: All subjects exhibited MEP amplitude inhibition in response to 1 Hz rTMS. Alternatively, the 5-Hz trains of rTMS inhibited rather than potentiated MEP amplitudes in patients with MOH. The physiological potentiating effect of 5 Hz rTMS on MEP amplitudes was restored after drug withdrawal and in proportion with the percentage reduction in monthly headache days in patients with MOH. Conclusions: The results suggest that acute medication withdrawal normalises brain responses in patients with MOH. Clinical improvements after medication withdrawal may reflect the reversal of neurophysiological dysfunction. Accordingly, medication withdrawal should be offered to patients with MOH as early as possible in order to prevent the development of more pronounced alterations in brain plasticity.

KW - Chronic migraine

KW - Repetitive transcranial magnetic stimulation

KW - Short-term depression

KW - Short-term potentiation

KW - Synaptic plasticity

UR - http://www.scopus.com/inward/record.url?scp=85061013260&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85061013260&partnerID=8YFLogxK

U2 - 10.1007/s10072-019-03735-4

DO - 10.1007/s10072-019-03735-4

M3 - Article

AN - SCOPUS:85061013260

JO - Neurological Sciences

JF - Neurological Sciences

SN - 1590-1874

ER -