Abstract
BackgroundBeta-blockers are a first choice migraine preventive medication. So far it is unknown how they exert their therapeutic effect in migraine. To this end we examined the neural effect of metoprolol on trigeminal pain processing in 19 migraine patients and 26 healthy controls. All participants underwent functional magnetic resonance imaging (fMRI) during trigeminal pain twice: Healthy subjects took part in a placebo-controlled, randomized and double-blind study, receiving a single dose of metoprolol and placebo. Patients were examined with a baseline scan before starting the preventive medication and 3 months later whilst treated with metoprolol.ResultsMean pain intensity ratings were not significantly altered under metoprolol. Functional imaging revealed no significant differences in nociceptive processing in both groups. Contrary to earlier findings from animal studies, we did not find an effect of metoprolol on the thalamus in either group. However, using a more liberal and exploratory threshold, hypothalamic activity was slightly increased under metoprolol in patients and migraineurs.ConclusionsNo significant effect of metoprolol on trigeminal pain processing was observed, suggesting a peripheral effect of metoprolol. Exploratory analyses revealed slightly enhanced hypothalamic activity under metoprolol in both groups. Given the emerging role of the hypothalamus in migraine attack generation, these data need further examination.
Highlights
Beta-blockers are a first choice migraine preventive medication
Several studies found that beta-blockers normalize the contingent negative variation (CNV) [10] and further that normalization of high CNV was positively correlated with treatment response [10,11,12]
The aim of this study is to assess the effects of metoprolol on brain activation patterns during trigeminal pain in migraine patients, as well as healthy human subjects, determined by functional magnetic resonance imaging (fMRI)
Summary
Beta-blockers are a first choice migraine preventive medication It is unknown how they exert their therapeutic effect in migraine. To this end we examined the neural effect of metoprolol on trigeminal pain processing in 19 migraine patients and 26 healthy controls. Beta-blockers such as metoprolol and propranolol are first choice migraine preventive medication. Beta-blockers attenuate the Hebestreit and May The Journal of Headache and Pain (2017) 18:116 migraine attack frequency. Another neurophysiological approach to observe cortical information processing is the analysis of contingent negative variation (CNV), an event-related, slow cerebral potential following activation in the striato-thalamo-cortical loop. Shields and Goadsby (2005) reported that thalamocortical activity evoked by superior sagittal sinus stimulation was inhibited after locally applied propranolol [16]
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