Pain processing in medication overuse headache: a functional magnetic resonance imaging (fMRI) study

S. Ferraro, L. Grazzi, M.L. Mandelli, D. Aquino, D. Di Fiore, S. Usai, M.G. Bruzzone, F. Di Salle, G. Bussone, L. Chiapparini

Research output: Contribution to journalArticleAcademicpeer-review

22 Citations (Scopus)

Abstract

Objective. The primary aim was to investigate functional differences between medication overuse headache (MOH) patients and controls with the purpose of evaluating the presence of a global alteration in the processing of noxious stimuli throughout the pain matrix. The secondary aim was to investigate whether activations in MOH patients normalize after medication withdrawal, which would suggest a possible role of the pain matrix in headache chronification. Design. Functional magnetic resonance imaging was performed during painful mechanical stimulation in nine female patients with MOH immediately and at 6 months after beginning medication withdrawal, and in nine control participants. Results. Compared with controls, immediately after beginning withdrawal, the MOH patients showed reduced pain-related activity across the primary somatosensory cortex, inferior parietal lobule, and supramarginal gyrus, as well as in regions of the lateral pathway of the pain matrix. At 6 months, these differences were no longer detectable. Conclusion. Our findings suggest that significant functional changes occur in the lateral pain pathway in MOH patients. These could result from different processes: 1) cortical down-regulation aimed at reducing painful input to the cortex; 2) activity-dependent plasticity induced by excessive painful input during migraine attacks; and 3) direct effect of medication overuse. At 6 months after withdrawal, activity in these regions normalized, suggesting that no irreversible changes occur due to medication overuse.
Original languageEnglish
Pages (from-to)255-262
Number of pages8
JournalPain Medicine
Volume13
Issue number2
DOIs
Publication statusPublished - Feb 2012

Keywords

  • Medication Overuse Headache
  • Pain Processing
  • Drug Withdrawal
  • fMRI
  • POSITRON EMISSION TOMOGRAPHY
  • BRAIN-STEM ACTIVATION
  • SOMATOSENSORY CORTEX
  • PERIPHERAL MONONEUROPATHY
  • CENTRAL SENSITIZATION
  • NEUROPATHIC PAIN
  • MIGRAINE
  • RAT
  • REPRESENTATION
  • MECHANISMS

Cite this

Ferraro, S., Grazzi, L., Mandelli, M. L., Aquino, D., Di Fiore, D., Usai, S., Bruzzone, M. G., Di Salle, F., Bussone, G., & Chiapparini, L. (2012). Pain processing in medication overuse headache: a functional magnetic resonance imaging (fMRI) study. Pain Medicine, 13(2), 255-262. https://doi.org/10.1111/j.1526-4637.2011.01183.x