Phase dependent hypothalamic activation following trigeminal input in cluster headache

Laura H Schulte,Arne May,Ame Abdu Haji

doi:10.1186/s10194-020-01098-2

Laura H Schulte, Arne May + Show 1 more

Open Access

https://doi.org/10.1186/s10194-020-01098-2

Copy DOI

Abstract

BackgroundTask-free imaging approaches using PET have shown the posterior hypothalamus to be specifically activated during but not outside cluster headache attacks. Evidence from task related functional imaging approaches however is scarce.MethodsTwenty-one inactive cluster headache patients (episodic cluster headache out of bout), 16 active cluster headache patients (10 episodic cluster headache in bout, 6 chronic cluster headache) and 18 control participants underwent high resolution brainstem functional magnetic resonance imaging of trigeminal nociception using gaseous ammonia as a painful stimulus.ResultsFollowing trigeminonociceptive stimulation with ammonia there was a significantly stronger activation within the posterior hypothalamus in episodic cluster headache patients out of bout when compared to controls. When contrasting estimates of the pain contrast, active cluster headache patients where in between the two other groups but did not differ significantly from either.ConclusionThe posterior hypothalamus might thus be hyperexcitable in cluster headache patients outside the bout while excitability to external nociceptive stimuli decreases during in bout periods, probably due to frequent hypothalamic activation and possible neurotransmitter exhaustion during cluster attacks.

Highlights

In most Task-free imaging approaches like H2O-PET and restingstate fMRI, the posterior hypothalamus has been shown to be activated during but not outside cluster headache attacks with activity levels normalising after pain relieve due to sumatriptan administration [1,2,3]
We investigate active and non-active cluster headache patients using a wellestablished paradigm for functional magnetic resonance imaging of trigeminal nociception
Fifty-five participants where included in the final analysis (21 episodic cluster headache patients out of bout, 16 active cluster headache patients (10 eCH in bout, 6 CCH) and 18 control participants)

Summary

Introduction

In most Task-free imaging approaches like H2O-PET and restingstate fMRI, the posterior hypothalamus has been shown to be activated during but not outside cluster headache attacks with activity levels normalising after pain relieve due to sumatriptan administration [1,2,3]. Hypothalamic restingstate connectivity is altered in cluster headache patients as compared to healthy controls [4, 5] suggesting a crucial role of this brain area in the pathophysiology of Schulte et al The Journal of Headache and Pain (2020) 21:30 that hypothalamic processing of trigeminal nociceptive stimuli might be altered in cluster headache patients as compared to healthy controls. We investigate active and non-active cluster headache patients using a wellestablished paradigm for functional magnetic resonance imaging of trigeminal nociception. Task-free imaging approaches using PET have shown the posterior hypothalamus to be activated during but not outside cluster headache attacks. Evidence from task related functional imaging approaches is scarce

Methods

Results

Conclusion