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Reyes N, Huang JJ, Choudhury A, Pondelis N, Locatelli EV, Felix ER, Pattany PM, Galor A, Moulton EA. Botulinum toxin A decreases neural activity in pain-related brain regions in individuals with chronic ocular pain and photophobia. Front Neurosci 2023; 17:1202341. [PMID: 37404468 PMCID: PMC10315909 DOI: 10.3389/fnins.2023.1202341] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Accepted: 06/05/2023] [Indexed: 07/06/2023] Open
Abstract
Introduction To examine the effect of botulinum toxin A (BoNT-A) on neural mechanisms underlying pain and photophobia using functional magnetic resonance imaging (fMRI) in individuals with chronic ocular pain. Methods Twelve subjects with chronic ocular pain and light sensitivity were recruited from the Miami Veterans Affairs eye clinic. Inclusion criteria were: (1) chronic ocular pain; (2) presence of ocular pain over 1 week recall; and (3) presence of photophobia. All individuals underwent an ocular surface examination to capture tear parameters before and 4-6 weeks after BoNT-A injections. Using an event-related fMRI design, subjects were presented with light stimuli during two fMRI scans, once before and 4-6 weeks after BoNT-A injection. Light evoked unpleasantness ratings were reported by subjects after each scan. Whole brain blood oxygen level dependent (BOLD) responses to light stimuli were analyzed. Results At baseline, all subjects reported unpleasantness with light stimulation (average: 70.8 ± 32.0). Four to six weeks after BoNT-A injection, unpleasantness scores decreased (48.1 ± 33.6), but the change was not significant. On an individual level, 50% of subjects had decreased unpleasantness ratings in response to light stimulation compared to baseline ("responders," n = 6), while 50% had equivalent (n = 3) or increased (n = 3) unpleasantness ("non-responders"). At baseline, several differences were noted between responders and non-responders; responders had higher baseline unpleasantness ratings to light, higher symptoms of depression, and more frequent use of antidepressants and anxiolytics, compared to non-responders. Group analysis at baseline displayed light-evoked BOLD responses in bilateral primary somatosensory (S1), bilateral secondary somatosensory (S2), bilateral anterior insula, paracingulate gyrus, midcingulate cortex (MCC), bilateral frontal pole, bilateral cerebellar hemispheric lobule VI, vermis, bilateral cerebellar crus I and II, and visual cortices. BoNT-A injections significantly decreased light evoked BOLD responses in bilateral S1, S2 cortices, cerebellar hemispheric lobule VI, cerebellar crus I, and left cerebellar crus II. BoNT-A responders displayed activation of the spinal trigeminal nucleus at baseline where non-responders did not. Discussion BoNT-A injections modulate light-evoked activation of pain-related brain systems and photophobia symptoms in some individuals with chronic ocular pain. These effects are associated with decreased activation in areas responsible for processing the sensory-discriminative, affective, dimensions, and motor responses to pain.
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Affiliation(s)
- Nicholas Reyes
- Surgical Services, Miami Veterans Administration Medical Center, Miami, FL, United States
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States
| | - Jaxon J. Huang
- Surgical Services, Miami Veterans Administration Medical Center, Miami, FL, United States
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States
| | - Anjalee Choudhury
- Surgical Services, Miami Veterans Administration Medical Center, Miami, FL, United States
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States
| | - Nicholas Pondelis
- Brain and Eye Pain Imaging Lab, Pain and Affective Neuroscience Center, Department of Anesthesia, Critical Care and Pain Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States
| | - Elyana V. Locatelli
- Surgical Services, Miami Veterans Administration Medical Center, Miami, FL, United States
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States
| | - Elizabeth R. Felix
- Research Service, Miami Veterans Administration Medical Center, Miami, FL, United States
- Physical Medicine and Rehabilitation, University of Miami, Miami, FL, United States
| | - Pradip M. Pattany
- Department of Radiology, University of Miami, Miami, FL, United States
| | - Anat Galor
- Surgical Services, Miami Veterans Administration Medical Center, Miami, FL, United States
- Bascom Palmer Eye Institute, University of Miami, Miami, FL, United States
| | - Eric A. Moulton
- Brain and Eye Pain Imaging Lab, Pain and Affective Neuroscience Center, Department of Anesthesia, Critical Care and Pain Medicine, Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States
- Department of Ophthalmology, Boston Children’s Hospital and Harvard Medical School, Boston, MA, United States
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Islam J, KC E, So KH, Kim S, Kim HK, Park YY, Park YS. Modulation of trigeminal neuropathic pain by optogenetic inhibition of posterior hypothalamus in CCI-ION rat. Sci Rep 2023; 13:489. [PMID: 36627362 PMCID: PMC9831989 DOI: 10.1038/s41598-023-27610-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023] Open
Abstract
Posterior hypothalamus (PH), an important part of the descending pain processing pathway, has been found to be activated in trigeminal autonomic cephalalgias. However, there are very few studies conducted and information regarding its implications in trigeminal neuropathic pain (TNP). Therefore, we aimed to ascertain whether optogenetic inhibition of PH could affect the outcomes of a chronic constriction injury in the infraorbital nerve (CCI-ION) rat model. Animals were divided into the TNP animal, sham, and naive-control groups. CCI-ION surgery was performed to mimic TNP symptoms, and the optogenetic or null virus was injected into the ipsilateral PH. In vivo single-unit extracellular recordings were obtained from both the ipsilateral ventrolateral periaqueductal gray (vlPAG) and contralateral ventral posteromedial (VPM) thalamus in stimulation "OFF" and "ON" conditions. Alterations in behavioral responses during the stimulation-OFF and stimulation-ON states were examined. We observed that optogenetic inhibition of the PH considerably improved behavioral responses in TNP animals. We found increased and decreased firing activity in the vlPAG and VPM thalamus, respectively, during optogenetic inhibition of the PH. Inhibiting PH attenuates trigeminal pain signal transmission by modulating the vlPAG and trigeminal nucleus caudalis, thereby providing evidence of the therapeutic potential of PH in TNP management.
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Affiliation(s)
- Jaisan Islam
- grid.254229.a0000 0000 9611 0917Department of Medical Neuroscience, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Elina KC
- grid.254229.a0000 0000 9611 0917Department of Medical Neuroscience, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Kyoung Ha So
- grid.254229.a0000 0000 9611 0917Institute for Stem Cell and Regenerative Medicine (ISCRM), College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea ,grid.31501.360000 0004 0470 5905Bio-Max/N-Bio Institute, Institute of Bio-Engineering, Seoul National University, Seoul, Republic of Korea
| | - Soochong Kim
- grid.254229.a0000 0000 9611 0917Department of Veterinary Medicine, College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Hyong Kyu Kim
- grid.254229.a0000 0000 9611 0917Department of Medicine and Microbiology, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea
| | - Yoon Young Park
- grid.411725.40000 0004 1794 4809Department of Neurosurgery, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Young Seok Park
- Department of Medical Neuroscience, College of Medicine, Chungbuk National University, Cheongju, Republic of Korea. .,Institute for Stem Cell and Regenerative Medicine (ISCRM), College of Veterinary Medicine, Chungbuk National University, Cheongju, Republic of Korea. .,Department of Neurosurgery, Chungbuk National University Hospital, Cheongju, Republic of Korea. .,Department of Neurosurgery, Chungbuk National University Hospital, College of Medicine, Chungbuk National University, 776, 1 Sunhwanro, Seowon-gu, Cheongju-Si, Chungbuk, 28644, Republic of Korea.
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Fischer-Schulte LH, Peng KP. Migraine prodromes and migraine triggers. HANDBOOK OF CLINICAL NEUROLOGY 2023; 198:135-148. [PMID: 38043958 DOI: 10.1016/b978-0-12-823356-6.00014-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Migraine is characterized by a well-defined premonitory phase occurring hours or even days before the headache. Also, many migraineurs report typical triggers for their headaches. Triggers, however, are not consistent in their ability to precipitate migraine headaches. When looking at the clinical characteristics of both premonitory symptoms and triggers, a shared pathophysiological basis seems evident. Both seem to have their origin in basic homeostatic networks such as the feeding/fasting, the sleeping/waking, and the stress response network, all of which strongly rely on the hypothalamus as a hub of integration and are densely interconnected. They also influence the trigeminal pain processing system. Additionally, thalamic and hormonal mechanisms are involved. Activity within all those networks is influenced by various endogenous and external factors and might even cyclically change dependent on physiological internal rhythms. This might affect the threshold for the generation of migraine headaches. Premonitory symptoms thus appear as the result of an already ongoing alteration within those networks, whereas triggers might in this special situation only be able to further stress the system over the threshold for attack generation as catalysts of a process already in motion.
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Affiliation(s)
- Laura H Fischer-Schulte
- Clinic and Policlinic of Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Kuan-Po Peng
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Prasetya M, Adidharma P, Inoue T, Sulistyanto A, Fadhil, Oswari S, Keswani RR, Kusdiansah M, Aji YK, Arham A. Case report: Teflon granuloma following microvascular decompression manifesting as light-triggered trigeminal neuralgia. Front Surg 2022; 9:904434. [PMID: 36570809 PMCID: PMC9774482 DOI: 10.3389/fsurg.2022.904434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/04/2022] [Indexed: 12/13/2022] Open
Abstract
Trigeminal Neuralgia is commonly triggered by stimuli in the area of the trigeminal nerve innervation. We report an exceptionally rare case of a 61-year-old woman who complained of recurrent trigeminal neuralgia, which sole trigger was seeing a bright light. Teflon felt that was placed on the nerve root in the initial surgery was suspected of causing this rare type of trigeminal neuralgia. A reflex circuit linking luminance to trigeminal nerve activity may be implicated in activating a trigeminal nociceptive pathway by a bright light trigger.
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Affiliation(s)
- Mustaqim Prasetya
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. Dr. Mahar Mardjono Jakarta, East Jakarta, Indonesia
| | - Peter Adidharma
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. Dr. Mahar Mardjono Jakarta, East Jakarta, Indonesia,Correspondence: Peter Adidharma
| | - Takuro Inoue
- Department of Neurosurgery, Subarukai Koto Memorial Hospital, Shiga, Japan
| | - Adi Sulistyanto
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. Dr. Mahar Mardjono Jakarta, East Jakarta, Indonesia
| | - Fadhil
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. Dr. Mahar Mardjono Jakarta, East Jakarta, Indonesia
| | - Selfy Oswari
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. Dr. Mahar Mardjono Jakarta, East Jakarta, Indonesia
| | - Ryan Rhiveldi Keswani
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. Dr. Mahar Mardjono Jakarta, East Jakarta, Indonesia
| | - Muhammad Kusdiansah
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. Dr. Mahar Mardjono Jakarta, East Jakarta, Indonesia
| | - Yunus Kuntawi Aji
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. Dr. Mahar Mardjono Jakarta, East Jakarta, Indonesia
| | - Abrar Arham
- Department of Neurosurgery, National Brain Center Hospital Prof. Dr. Dr. Mahar Mardjono Jakarta, East Jakarta, Indonesia
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Theis J. Differential diagnosis and theories of pathophysiology of post-traumatic photophobia: A review. NeuroRehabilitation 2022; 50:309-319. [DOI: 10.3233/nre-228014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND: Photophobia is a common sensory symptom after traumatic brain injury (TBI) that may have a grave impact on a patient’s functional independence, neurorehabilitation, and activities of daily living. Post-TBI photophobia can be difficult to treat and the majority of patients can suffer chronically up to and beyond one year after their injury. OBJECTIVES: This review evaluates the current theories of the pathophysiology of photophobia and the most-common co-morbid etiologies of light sensitivity in TBI to help guide the differential diagnosis and individualized management of post-TBI photophobia. METHODS: Primary articles were found via PubMed and Google Scholar search of key terms including “photophobia” “light sensitivity” “photosensitivity” “photo-oculodynia” “intrinsically photosensitive retinal ganglion cells” “ipRGC” and “concussion” “brain injury” “dry eye”. Due to paucity of literature papers were reviewed from 1900 to present in English. RESULTS: Recent advances in understanding the pathophysiology of photophobia in dry eye and migraine and their connection to intrinsically photosensitive retinal ganglion cells (ipRGC) have revealed complex and multifaceted trigeminovascular and trigeminoautonomic pathways underlying photophobia. Patients who suffer a TBI often have co-morbidities like dry eye and migraine that may influence the patient’s photophobia. CONCLUSION: Post-traumatic photophobia is a complex multi-disciplinary complaint that can severely impact a patient’s quality of life. Exploration of underlying etiology may allow for improved treatment and symptomatic relief for these patients beyond tinted lenses alone.
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Affiliation(s)
- Jacqueline Theis
- Concussion Care Centre of Virginia, Richmond, VA, USA
- Virginia Neuro-Optometry, Richmond, VA, USA Tel.: +1 804 387 2902; Fax: +1 804 509 0543; E-mail:
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Wang Y, Wang S, Qiu T, Xiao Z. Photophobia in headache disorders: characteristics and potential mechanisms. J Neurol 2022; 269:4055-4067. [PMID: 35322292 DOI: 10.1007/s00415-022-11080-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/10/2022] [Accepted: 03/10/2022] [Indexed: 01/23/2023]
Abstract
Photophobia is present in multiple types of headache disorders. The coexistence of photophobia and headache suggested the potential reciprocal interactions between visual and pain pathways. In this review, we summarized the photophobic characteristics in different types of headache disorders in the context of the three diagnostic categories of headache disorders: (1) primary headaches: migraine, tension-type headache, and trigeminal autonomic cephalalgias; (2) secondary headaches: headaches attributed to traumatic brain injury, meningitis, non-traumatic subarachnoid hemorrhage and disorder of the eyes; (3) painful cranial neuropathies: trigeminal neuralgia and painful optic neuritis. We then discussed potential mechanisms for the coexistence of photophobia and headache. In conclusion, the characteristics of photophobia are different among these headache disorders. The coexistence of photophobia and headache is associated with the interactions between visual and pain pathway at retina, midbrain, thalamus, hypothalamus and visual cortex. The communication between these pathways may depend on calcitonin gene-related peptide and pituitary cyclase-activating polypeptide transmission. Moreover, cortical spreading depression, an upstream trigger of headache, also plays an important role in photophobia by increased nociceptive input to the thalamus.
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Affiliation(s)
- Yajuan Wang
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, China
| | - Shaoyang Wang
- Department of Emergency, Rizhao People's Hospital, Rizhao, 276800, Shandong, China
| | - Tao Qiu
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, China
| | - Zheman Xiao
- Department of Neurology, Renmin Hospital of Wuhan University, Wuhan, 430060, Hubei, China.
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Siddiqui R, Mungroo MR, Khan NA. SARS-CoV-2 invasion of the central nervous: a brief review. Hosp Pract (1995) 2021; 49:157-163. [PMID: 33554684 PMCID: PMC7938650 DOI: 10.1080/21548331.2021.1887677] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Accepted: 02/05/2021] [Indexed: 12/13/2022]
Abstract
There is increasing evidence of the ability of the novel coronavirus to invade the central nervous system (CNS). But how does a respiratory virus invade the highly protected CNS? Here, we reviewed available literature and case reports to determine CNS involvement in COVID-19, and to identify potential regions of the brain that may be affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its possible route of entry into the brain to identify its pathogenicity. Based on the symptoms, the parietal lobe and the cerebellum are the likely targets of SARS-CoV-2; however, further work is needed to elucidate this. The presence of ACE2, used by SARS-CoV-2 for cell entry, in the brain as well as detection of the virus in the cerebrospinal fluid, further assert that SARS-COV-2 targets the brain, and therefore, medical practitioners should take that into account when dealing with patients suffering from COVID-19.
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Affiliation(s)
- Ruqaiyyah Siddiqui
- College of Arts and Sciences, American University of Sharjah, University City, Sharjah, United Arab Emirates
| | - Mohammad Ridwane Mungroo
- Department of Clinical Sciences, College of Medicine, University of Sharjah, University City, Sharjah, United Arab Emirates
| | - Naveed Ahmed Khan
- Department of Clinical Sciences, College of Medicine, University of Sharjah, University City, Sharjah, United Arab Emirates
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Schulte LH, Peng KP. Current understanding of premonitory networks in migraine: A window to attack generation. Cephalalgia 2019; 39:1720-1727. [DOI: 10.1177/0333102419883375] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Aim To describe neuronal networks underlying commonly reported migraine premonitory symptoms and to discuss how these might precipitate migraine pain. Background Migraine headache is frequently preceded by a distinct and well characterized premonitory phase including symptoms like yawning, sleep disturbances, alterations in appetite and food intake and hypersensitivity to certain external stimuli. Recent neuroimaging studies strongly suggest the hypothalamus as the key mediator of the premonitory phase and also suggested alterations in hypothalamic networks as a mechanism of migraine attack generation. When looking at the vast evidence from basic research within the last decades, hypothalamic and thalamic networks are most likely to integrate peripheral influences with central mechanisms, facilitating the precipitation of migraine headaches. These networks include sleep, feeding and stress modulating centers within the hypothalamus, thalamic pathways and brainstem centers closely involved in trigeminal pain processing such as the spinal trigeminal nucleus and the rostral ventromedial medulla, all of which are closely interconnected. Conclusion Taken together, these networks represent the pathophysiological basis for migraine premonitory symptoms as well as a possible integration site of peripheral so-called “triggers” with central attack facilitating processes.
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Affiliation(s)
- Laura H Schulte
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Clinic and Policlinic of Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Kuan-Po Peng
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Möller M, Schroeder CF, May A. Vagus nerve stimulation modulates the cranial trigeminal autonomic reflex. Ann Neurol 2018; 84:886-892. [PMID: 30362165 DOI: 10.1002/ana.25366] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 09/25/2018] [Accepted: 10/14/2018] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The trigeminal autonomic reflex plays an important role in primary headache syndromes. Noninvasive vagal nerve stimulation (nVNS) may be an effective modulator of this reflex. METHODS Twenty-two healthy volunteers underwent kinetic oscillation stimulation (KOS) of the left nostril as a reliable trigger of the trigeminal autonomic reflex. Previous to KOS, left cervical nVNS, sham simulation, or no stimulation was applied. Lacrimation was quantified using the standardized Schirmer ll test. RESULTS Treatment with cervical nVNS significantly reduced lacrimation between no stimulation and nVNS on the ipsilateral side (minute 5: p = 0.026, ηp2 = 0.85, 95% confidence interval [CI] = 1.39-18.04; no stimulation: minute 5, 14.4 ± 9.3 mm; nVNS: minute 5, 4.7 ± 8.6 mm, mean ± standard deviation) as well as between sham stimulation and nVNS (minute 5: p = 0.030, ηp2 = 0.85, 95% CI = 1.04-17.24; sham: minute 5, 13.9 ± 6.4 mm). On the contralateral side, no significant increase between baseline and KOS was observed for nVNS (minute 5: p = 0.614, d = 0.12, 95% CI = -7.09 to 4.31; minute 5, 1.4 ± 11.5 mm) compared to both sham stimulation (minute 5: p = 0.023, d = 0.57, 95% CI = -11.46 to -0.96; minute 5, 6.2 ± 10.9 mm) and no stimulation (minute 5: p < 0.030, d = 0.62, 95% CI = -13.45 to -0.81; minute 5, 7.1 ± 11.4 mm). INTERPRETATION Cervical nVNS resulted in a robust bilateral reduction of provoked lacrimation. This effect could be mediated either by direct bilateral activation of structures such as the nucleus of the solitary tract or by a top-down modulation via the hypothalamus. Ann Neurol 2018;84:886-892.
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Affiliation(s)
- Maike Möller
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Celina F Schroeder
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Arne May
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Noseda R, Copenhagen D, Burstein R. Current understanding of photophobia, visual networks and headaches. Cephalalgia 2018; 39:1623-1634. [PMID: 29940781 DOI: 10.1177/0333102418784750] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To review clinical and pre-clinical evidence supporting the role of visual pathways, from the eye to the cortex, in the development of photophobia in headache disorders. BACKGROUND Photophobia is a poorly understood light-induced phenomenon that emerges in a variety of neurological and ophthalmological conditions. Over the years, multiple mechanisms have been proposed to explain its causes; however, scarce research and lack of systematic assessment of photophobia in patients has made the search for answers quite challenging. In the field of headaches, significant progress has been made recently on how specific visual networks contribute to photophobia features such as light-induced intensification of headache, increased perception of brightness and visual discomfort, which are frequently experienced by migraineurs. Such progress improved our understanding of the phenomenon and points to abnormal processing of light by both cone/rod-mediated image-forming and melanopsin-mediated non-image-forming visual pathways, and the consequential transfer of photic signals to multiple brain regions involved in sensory, autonomic and emotional regulation. CONCLUSION Photophobia phenotype is diverse, and the relative contribution of visual, trigeminal and autonomic systems may depend on the disease it emerges from. In migraine, photophobia could result from photic activation of retina-driven pathways involved in the regulation of homeostasis, making its association with headache more complex than previously thought.
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Affiliation(s)
- Rodrigo Noseda
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - David Copenhagen
- Department of Ophthalmology, UCSF School of Medicine, San Francisco, CA, USA
| | - Rami Burstein
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Schulte LH, Allers A, May A. Visual stimulation leads to activation of the nociceptive trigeminal nucleus in chronic migraine. Neurology 2018; 90:e1973-e1978. [DOI: 10.1212/wnl.0000000000005622] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 04/05/2018] [Indexed: 01/03/2023] Open
Abstract
ObjectiveThe visual system has often been described to be sensitized in migraineurs, with light being perceived as aversive or even painful. One possible explanation for this altered perception is crosslinks between the visual and the trigeminonociceptive system. Visual stimulation in chronic migraineurs on the level of the brainstem might lead to enhanced activity within the spinal trigeminal nucleus (sTN) as the main site of trigeminal pain processing within this area.MethodsEighteen episodic migraineurs (EM), 17 chronic migraineurs (CM), and 19 healthy controls (HC) underwent one session of high-resolution brainstem imaging during which a rotating checkerboard was presented repeatedly as a visual stimulus. Data were analyzed using SPM12 and MATLAB with the classic first-level–second-level approach of SPM. Analyses of variance were used for group comparisons.ResultsCM showed enhanced activation within the sTN as compared to HC. In addition, we observed enhanced activity within the right superior colliculus in CM as compared to HC. When comparing all migraineurs with headaches during scanning with all migraineurs without headaches during scanning and HC, we also found the sTN to be more strongly activated during headaches.ConclusionOur data provide evidence for the existence of visual–nociceptive integration on brainstem level in chronic migraineurs.
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Bekkelund SI, Müller KI, Wilhelmsen A, Alstadhaug KB. Photophobia and Seasonal Variation of Migraine in a Subarctic Population. Headache 2017. [DOI: 10.1111/head.13131] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Svein I. Bekkelund
- Department of Neurology; University Hospital of North Norway; Tromsø Norway
- Department of Clinical Medicine; UiT - The Arctic University of Norway; Tromsø Norway
| | - Kai I. Müller
- Department of Neurology; University Hospital of North Norway; Tromsø Norway
- Department of Clinical Medicine; UiT - The Arctic University of Norway; Tromsø Norway
| | - Aleksander Wilhelmsen
- Department of Clinical Medicine; UiT - The Arctic University of Norway; Tromsø Norway
| | - Karl B. Alstadhaug
- Department of Clinical Medicine; UiT - The Arctic University of Norway; Tromsø Norway
- Department of Neurology; Nordland Hospital Trust; Bodø Norway
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Lauschke JL, Plant GT, Fraser CL. Visual snow: A thalamocortical dysrhythmia of the visual pathway? J Clin Neurosci 2016; 28:123-7. [PMID: 26791474 DOI: 10.1016/j.jocn.2015.12.001] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 12/02/2015] [Indexed: 12/19/2022]
Abstract
In this paper we review the visual snow (VS) characteristics of a case cohort of 32 patients. History of symptoms and associated co-morbidities, ophthalmic examination, previous investigations and the results of intuitive colourimetry were collected and reviewed. VS symptoms follow a stereotypical description and are strongly associated with palinopsia, migraine and tinnitus, but also tremor. The condition is a chronic one and often results in misdiagnosis with psychiatric disorders or malingering. Colour filters, particularly in the yellow-blue colour spectrum, subjectively reduced symptoms of VS. There is neurobiological evidence for the syndrome of VS that links it with other disorders of visual and sensory processing such as migraine and tinnitus. Colour filters in the blue-yellow spectrum may alter the koniocellular pathway processing, which has a regulatory effect on background electroencephalographic rhythms, and may add weight to the hypothesis that VS is a thalamocortical dysrhythmia of the visual pathway.
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Affiliation(s)
- Jenny L Lauschke
- Save Sight Institute, University of Sydney, 8 Macquarie Street, Sydney, NSW 2000, Australia; Department of Ophthalmology, Prince of Wales Hospital, High Street, Randwick, NSW, Australia
| | - Gordon T Plant
- Department of Neuro-Ophthalmology, Moorfields Eye Hospital, London, United Kingdom
| | - Clare L Fraser
- Save Sight Institute, University of Sydney, 8 Macquarie Street, Sydney, NSW 2000, Australia.
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Abstract
BACKGROUND Photophobia is a debilitating feature of many headache disorders. OVERVIEW Clinical and preclinical research has identified several potential pathways involved in enhanced light sensitivity. Some of these structures include trigeminal afferents in the eye, second-order neurons in the trigeminal nucleus caudalis, third-order neurons in the posterior thalamus, modulatory neurons in the hypothalamus, and fourth-order neurons in the visual and somatosensory cortices. It is unclear to what degree each site plays a role in establishing the different temporal patterns of photophobia across different disorders. Peptides such as calcitonin gene-related peptide and pituitary adenylate cyclase-activating polypeptide may play a role in photophobia at multiple levels of the visual and trigeminal pathways. CONCLUSION While our understanding of photophobia has greatly improved in the last decade, there are still unanswered questions. These answers will help us develop new therapies to provide relief to patients with primary headache disorders.
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Affiliation(s)
- Heather L Rossi
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania & Children's Hospital of Pennsylvania, Philadelphia, PA, USA
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Katagiri A, Okamoto K, Thompson R, Rahman M, Bereiter DA. Posterior hypothalamic modulation of ocular-responsive trigeminal subnucleus caudalis neurons is mediated by Orexin-A and Orexin1 receptors. Eur J Neurosci 2014; 40:2619-27. [PMID: 24904977 DOI: 10.1111/ejn.12635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Revised: 04/14/2014] [Accepted: 04/24/2014] [Indexed: 12/23/2022]
Abstract
Orexin-A (OxA) is synthesized in posterior and lateral regions of the hypothalamus and contributes to homeostatic regulation of body functions including pain modulation. To determine if orexinergic mechanisms contribute to posterior hypothalamus (PH)-induced modulation of ocular input to subnucleus caudalis/upper cervical (Vc/C1) neurons, the orexin-1 receptor antagonist SB334867 was applied to the dorsal brainstem surface prior to PH disinhibition, by bicuculline methiodide, in male rats under isoflurane anesthesia. Ocular input to Vc/C1 units by bright light or hypertonic saline was markedly reduced by PH disinhibition and reversed completely by local Vc/C1 application of SB334867. OxA applied to the Vc/C1 surface mimicked the effects of PH disinhibition in a dose-dependent manner. OxA-induced inhibition was prevented by co-application of SB334867, but not by the orexin-2 receptor antagonist TCS Ox2 29. PH disinhibition and local OxA application also reduced the high threshold convergent cutaneous receptive field area of ocular units, suggesting widespread effects on somatic input to Vc/C1 ocular units. Vc/C1 application of OxA or SB334867 alone did not affect the background discharge of ocular units and suggested that the PH-OxA influence on ocular unit activity was not tonically active. Vc/C1 application of OxA or SB334867 alone also did not alter mean arterial pressure, whereas PH disinhibition evoked prompt and sustained increases. These results suggest that stimulus-evoked increases in PH outflow acts through OxA and orexin-1 receptors to alter the encoding properties of trigeminal brainstem neurons responsive to input from the ocular surface and deep tissues of the eye.
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Affiliation(s)
- Ayano Katagiri
- Department of Diagnostic and Biological Sciences, University of Minnesota School of Dentistry, Minneapolis, MN, USA
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Ahn AH, Brennan KC. Unanswered questions in headache: so what is photophobia, anyway? Headache 2013; 53:1673-4. [PMID: 24111735 DOI: 10.1111/head.12227] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2013] [Indexed: 11/28/2022]
Abstract
Photophobia refers to a sensory disturbance provoked by light. However, because it arises distinctly in a broad range of clinical conditions, its definition remains elusive. Many underscore the painful sensory aspects of photophobia, while others emphasize its unpleasant, affective qualities. To add further complexity, recent discoveries in photophobia research have raised disparate and potentially conflicting results. In this installment of an occasional series, we asked clinicians and scientists to give their interpretation of what these discoveries tell us about photophobia in the clinic, and vice versa.
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Affiliation(s)
- Andrew H Ahn
- Departments of Neurology and Neuroscience, University of Florida, Gainesville, FL, USA
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