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Ceriani CEJ. Vestibular Migraine Pathophysiology and Treatment: a Narrative Review. Curr Pain Headache Rep 2024; 28:47-54. [PMID: 37889468 DOI: 10.1007/s11916-023-01182-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE OF REVIEW To review the diagnosis of vestibular migraine (VM) and update the clinician on the most recent developments in our understanding of its pathophysiology and treatment. RECENT FINDINGS Functional imaging studies have identified multiple regions of the brain with abnormal activity and connectivity in VM. There is evidence of abnormal sensory processing and integration in VM patients. Calcitonin gene-related peptide (CGRP) has also been found to play a role in trigeminal and vestibular nucleus pathways. Research into treatment modalities has identified several neuromodulation devices that may be effective in VM. There are a growing number of evidence-based preventive options for VM, including medications that target CGRP. VM is best understood as a sensory processing disorder. CGRP appears to play a role, and further research is needed to fully understand its effects. Treatment options are expanding, but there is still a need for more randomly controlled trials in this area.
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Affiliation(s)
- Claire E J Ceriani
- Jefferson Headache Center, Department of Neurology, Thomas Jefferson University, 900 Walnut St., Ste 200, Philadelphia, PA, 19107, USA.
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Xiong X, Dai L, Chen W, Lu J, Hu C, Zhao H, Ke J. Dynamics and concordance alterations of regional brain function indices in vestibular migraine: a resting-state fMRI study. J Headache Pain 2024; 25:1. [PMID: 38178029 PMCID: PMC10768112 DOI: 10.1186/s10194-023-01705-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/12/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Prior MRI studies on vestibular migraine (VM) have revealed abnormalities in static regional intrinsic brain activity (iBA) and dynamic functional connectivity between brain regions or networks. However, the temporal variation and concordance of regional iBA measures remain to be explored. METHODS 57 VM patients during the interictal period were compared to 88 healthy controls (HC) in this resting-state functional magnetic resonance imaging (fMRI) study. The dynamics and concordance of regional iBA indices, including amplitude of low-frequency fluctuations (ALFF) and regional homogeneity (ReHo), were examined by utilizing sliding time-window analysis. Partial correlation analyses were performed between clinical parameters and resting-state fMRI indices in brain areas showing significant group differences. RESULTS The VM group showed increased ALFF and ReHo dynamics, as well as increased temporal concordance between ALFF and ReHo in the bilateral paracentral lobule and supplementary motor area relative to the HC group. We also found decreased ReHo dynamics in the right temporal pole, and decreased ALFF dynamics in the right cerebellum posterior lobe, bilateral angular gyrus and middle occipital gyrus (MOG) in the VM group compared with the HC group. Moreover, a positive correlation was observed between ALFF dynamics in the left MOG and vertigo disease duration across all VM patients. CONCLUSION Temporal dynamics and concordance of regional iBA indices were altered in the motor cortex, cerebellum, occipital and temporoparietal cortex, which may contribute to disrupted multisensory processing and vestibular control in patients with VM. ALFF dynamics in the left MOG may be useful biomarker for evaluating vertigo burden in this disorder.
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Affiliation(s)
- Xing Xiong
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China
- Institute of Medical imaging, Soochow University, Soochow, Jiangsu Province, People's Republic of China
| | - Lingling Dai
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China
- Institute of Medical imaging, Soochow University, Soochow, Jiangsu Province, People's Republic of China
| | - Wen Chen
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China
- Institute of Medical imaging, Soochow University, Soochow, Jiangsu Province, People's Republic of China
| | - Jiajie Lu
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China
| | - Chunhong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China
- Institute of Medical imaging, Soochow University, Soochow, Jiangsu Province, People's Republic of China
| | - Hongru Zhao
- Department of Neurology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China.
| | - Jun Ke
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006, Jiangsu, China.
- Institute of Medical imaging, Soochow University, Soochow, Jiangsu Province, People's Republic of China.
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Zhe X, Zhang H, Tang M, Lei X, Zhang X, Jin C. Brain functional connectivity patterns associated with symptoms of vestibular migraine. Front Neurosci 2023; 17:1231273. [PMID: 38156263 PMCID: PMC10753008 DOI: 10.3389/fnins.2023.1231273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 11/30/2023] [Indexed: 12/30/2023] Open
Abstract
Background Several functional magnetic resonance imaging (fMRI) investigations of patients with vestibular migraine (VM) have revealed abnormal functionality in different networks, indicating that VM is related to alterations in brain function. We sought to investigate the resting-state functional connectivity (FC) patterns during the interictal period in VM by combining data-driven voxel-wise degree centrality (DC) calculations and seed-based FC analyses, and thereby determine the associations between cerebral function and clinical symptoms. Methods Thirty-eight patients with VM and 33 matched normal controls were recruited. DC was calculated and compared between the groups, and the FC of locations showing DC alterations was further tested using a seed-based technique. The participants' clinical indicators were correlated with the DC and FC values of the brain areas. Results In contrast to the control group, the VM group showed considerably lower DC values in the bilateral medial prefrontal cortex (mPFC) and significantly higher DC values in the right occipital lobe. In the seed-based FC analyses, patients with VM demonstrated fewer connections of the bilateral mPFC with the bilateral posterior cingulate cortex, right parahippocampus, right cerebellar posterior lobe, bilateral cuneus, and left precuneus. In addition, clinical data from patients, such as pain intensity, episode frequency, and the Dizziness Handicap Inventory score, were negatively related to these FC and DC impairments. Conclusion Our findings showed changes in the default mode network and visual cortex in patients with VM, providing further insights into the complexity of the mechanisms underlying VM.
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Affiliation(s)
- Xia Zhe
- Department of Medical Imaging, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Hailian Zhang
- Department of Radiology, The Fifth People's Hospital of Qinghai Province, Xining, Qinghai, China
| | - Min Tang
- Department of MRI, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Xiaoyan Lei
- Department of MRI, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Xiaoling Zhang
- Department of MRI, Shaanxi Provincial People’s Hospital, Xi’an, Shaanxi, China
| | - Chenwang Jin
- Department of Medical Imaging, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, China
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Qiu D, Ge Z, Mei Y, Wang W, Xiong Z, Li X, Yuan Z, Zhang P, Zhang M, Liu X, Zhang Y, Yu X, Tang H, Wang Y. Mapping brain functional networks topological characteristics in new daily persistent headache: a magnetoencephalography study. J Headache Pain 2023; 24:161. [PMID: 38053071 DOI: 10.1186/s10194-023-01695-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 11/20/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND The brain functional network topology in new daily persistent headache (NDPH) is not well understood. In this study, we aim to assess the cortical functional network topological characteristics of NDPH using non-invasive neural signal recordings. METHODS Resting-state magnetoencephalography (MEG) was used to measure power fluctuations in neuronal oscillations from distributed cortical parcels in 35 patients with NDPH and 40 healthy controls (HCs). Their structural data were collected by 3T MRI. Functional connectivity (FC) of neural networks from 1 to 80 Hz frequency ranges was analyzed with topographic patterns and calculated network topological parameters with graph theory. RESULTS In the delta (1-4 Hz) and beta (13-30 Hz) bands, the lateral occipital cortex and superior frontal gyrus FC were increased in NDPH groups compared to HCs. Graph theory analysis revealed that the NDPH had significantly increased global efficiency in the delta band and decreased nodal clustering coefficient (left medial orbitofrontal cortex) in the theta (4-8 Hz) band. The clinical characteristics had a significant correlation with network topological parameters. Age at onset of patients showed a positive correlation with global efficiency in the delta band. The degree of depression of patients showed a negative correlation with the nodal clustering coefficient (left medial orbitofrontal cortex) in the theta band. CONCLUSION The FC and topology of NDPH in brain networks may be altered, potentially leading to cortical hyperexcitability. Moreover, medial orbitofrontal cortex is involved in the pathophysiological mechanism of depression in patients with NDPH. Increased FC observed in the lateral occipital cortex and superior frontal gyrus during resting-state MEG could serve as one of the imaging characteristics associated with NDPH.
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Affiliation(s)
- Dong Qiu
- Department of Neurology, Headache Center, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Zhaoli Ge
- Department of Neurology, Shenzhen Second People's Hospital, Shenzhen, 518000, Guangdong, China
| | - Yanliang Mei
- Department of Neurology, Headache Center, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Wei Wang
- Department of Neurology, Headache Center, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Zhonghua Xiong
- Department of Neurology, Headache Center, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Xiaoshuang Li
- Department of Neurology, Headache Center, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Ziyu Yuan
- Department of Neurology, Headache Center, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Peng Zhang
- Department of Neurology, Headache Center, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Mantian Zhang
- Department of Neurology, Headache Center, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Xin Liu
- Department of Neurology, Headache Center, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Yaqing Zhang
- Department of Neurology, Headache Center, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Xueying Yu
- Department of Neurology, Headache Center, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Hefei Tang
- Department of Neurology, Headache Center, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China
| | - Yonggang Wang
- Department of Neurology, Headache Center, Beijing Tiantan Hospital, Capital Medical University, No.119 South Fourth Ring West Road, Fengtai District, Beijing, 100070, China.
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Yang X, Guo D, Huang W, Chen B. Intrinsic Brain Functional Activity Abnormalities in Episodic Tension-Type Headache. Neural Plast 2023; 2023:6560298. [PMID: 37266410 PMCID: PMC10232109 DOI: 10.1155/2023/6560298] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 04/16/2023] [Accepted: 04/23/2023] [Indexed: 06/03/2023] Open
Abstract
Objective The neurobiological basis of episodic tension-type headache (ETTH) remains largely unclear. The aim of the present study was to explore intrinsic brain functional activity alterations in ETTH. Methods Resting-state functional magnetic resonance imaging (rs-fMRI) data were collected from 32 patients with ETTH and 32 age- and gender-matched healthy controls (HCs). Differences in intrinsic brain functional activity between patients with ETTH and HCs were analyzed utilizing the fractional amplitude of low-frequency fluctuation (fALFF) approach. Correlation analyses were performed to examine the relationship between fALFF alterations and clinical characteristics. Results Compared to HCs, patients with ETTH exhibited increased fALFF in the right posterior insula and anterior insula and decreased fALFF in the posterior cingulate cortex. Moreover, the fALFF in the right anterior insula was negatively correlated with attack frequency in ETTH. Conclusions This study highlights alterations in the intrinsic brain functional activity in the insula and posterior cingulate cortex in ETTH that can help us understand its neurobiological underpinnings.
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Affiliation(s)
- Xiu Yang
- Department of Neurology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, China
| | - DianXuan Guo
- Department of Geriatrics, The Affiliated Huaian Hospital of Xuzhou Medical University, Huaian, China
| | - Wei Huang
- Department of Medical Imaging, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, China
| | - Bing Chen
- Department of Neurology, The Affiliated Huaian No. 1 People's Hospital of Nanjing Medical University, Huaian, China
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Wang W, Yuan Z, Zhang X, Bai X, Tang H, Mei Y, Qiu D, Zhang Y, Zhang P, Zhang X, Zhang Y, Yu X, Sui B, Wang Y. Mapping the aberrant brain functional connectivity in new daily persistent headache: a resting-state functional magnetic resonance imaging study. J Headache Pain 2023; 24:46. [PMID: 37098469 PMCID: PMC10131335 DOI: 10.1186/s10194-023-01577-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 04/13/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND AND PURPOSE The pathogenesis of new daily persistent headache (NDPH) is not fully understood. We aim to map aberrant functional connectivity (FC) in patients with NDPH using resting-state functional magnetic resonance imaging (MRI). METHODS Brain structural and functional MRI data were acquired from 29 patients with NDPH and 37 well-matched healthy controls (HCs) in this cross-sectional study. Region of interest (ROI) based analysis was used to compare FC between patients and HCs, with 116 brain regions in the automated anatomical labeling (AAL) atlas were defined as seeds. The correlations between aberrant FC and patients' clinical characteristics, and neuropsychological evaluation were also investigated. RESULTS Compared with HCs, patients with NDPH showed increased FC in the left inferior occipital gyrus, right thalamus and decreased FC in right lingual gyrus, left superior occipital gyrus, right middle occipital gyrus, left inferior occipital gyrus, right inferior occipital gyrus, right fusiform gyrus, left postcentral gyrus, right postcentral gyrus, right thalamus and right superior temporal gyrus. There were no correlation between FC of these brain regions and clinical characteristics, neuropsychological evaluation after Bonferroni correction (p > 0.05/266). CONCLUSIONS Patients with NDPH showed aberrant FC in multiple brain regions involved in perception and regulation of emotion and pain. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05334927.
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Affiliation(s)
- Wei Wang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Ziyu Yuan
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Xueyan Zhang
- Department of Neurology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450000, China
| | - Xiaoyan Bai
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing Neurosurgical Institute, Beijing, 100070, China
| | - Hefei Tang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Yanliang Mei
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Dong Qiu
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Yingkui Zhang
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
| | - Peng Zhang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Xue Zhang
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, Beijing Neurosurgical Institute, Beijing, 100070, China
| | - Yaqing Zhang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Xueying Yu
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Binbin Sui
- Tiantan Neuroimaging Center of Excellence, China National Clinical Research Center for Neurological Diseases, Beijing, 100070, China.
| | - Yonggang Wang
- Headache Center, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.
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