Journal Article

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 and Jean Schoenen

in Brain

Published on behalf of The Guarantors of Brain

Volume 129, issue 2, pages 543-550
Published in print February 2006 | ISSN: 0006-8950
Published online December 2005 | e-ISSN: 1460-2156 | DOI: http://dx.doi.org/10.1093/brain/awh691
Orbitofrontal cortex involvement in chronic analgesic-overuse headache evolving from episodic migraine

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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.

Keywords: PET; orbitofrontal cortex; migraine; addiction; medication overuse headache; FDG = [18F]fluorodeoxyglucose; FDG-PET = 18F-fluoro-deoxyglucose positron emission tomography; MOH = medication overuse headache; MRI = magnetic resonance imaging; OFC = orbitofrontal cortex; PET = positron emission tomography; rCBF = regional cerebral blood flow; VAS = visual analogue scale

Journal Article.  5479 words.  Illustrated.

Subjects: Neurology ; Neuroscience

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