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Stankewitz A, Mayr A, Irving S, Witkovsky V, Schulz E. Pain and the emotional brain: pain-related cortical processes are better reflected by affective evaluation than by cognitive evaluation. Sci Rep 2023; 13:8273. [PMID: 37217563 DOI: 10.1038/s41598-023-35294-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Accepted: 05/16/2023] [Indexed: 05/24/2023] Open
Abstract
The experience of pain has been dissociated into two interwoven aspects: a sensory-discriminative aspect and an affective-motivational aspect. We aimed to explore which of the pain descriptors is more deeply rooted in the human brain. Participants were asked to evaluate applied cold pain. The majority of the trials showed distinct ratings: some were rated higher for unpleasantness and others for intensity. We compared the relationship between functional data recorded from 7 T MRI with unpleasantness and intensity ratings and revealed a stronger relationship between cortical data and unpleasantness ratings. The present study underlines the importance of the emotional-affective aspects of pain-related cortical processes in the brain. The findings corroborate previous studies showing a higher sensitivity to pain unpleasantness compared to ratings of pain intensity. For the processing of pain in healthy subjects, this effect may reflect the more direct and intuitive evaluation of emotional aspects of the pain system, which is to prevent harm and to preserve the physical integrity of the body.
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Affiliation(s)
- Anne Stankewitz
- Department of Neuroradiology, Klinikum Rechts Der Isar, Technische Universität München, Munich, Germany
| | - Astrid Mayr
- Department of Radiology, University Hospital, Ludwig-Maximilians-Universität München, A: Marchioninistr. 15, 81377, München, Germany
| | - Stephanie Irving
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Viktor Witkovsky
- Department of Theoretical Methods, Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovak Republic
| | - Enrico Schulz
- Department of Radiology, University Hospital, Ludwig-Maximilians-Universität München, A: Marchioninistr. 15, 81377, München, Germany.
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK.
- Department of Medical Psychology, Ludwig-Maximilians-Universität München, Munich, Germany.
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Valentini E, Shindy A, Witkovsky V, Stankewitz A, Schulz E. Interindividual Variability and Individual Stability of Pain- and Touch-Related Neuronal Gamma Oscillations. J Neurophysiol 2023. [PMID: 37017318 PMCID: PMC10396281 DOI: 10.1152/jn.00530.2021] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2023] Open
Abstract
Background. Brief painful laser and innocuous tactile stimuli have been associated with an increase of neuronal oscillations in the gamma range. However, it is indicated that event-related gamma oscillations may be highly variable across individuals, but no study has systematically studied interindividual variability and individual stability of induced gamma synchronisation. Here, we addressed this question using two datasets. Methods. The present study includes two EEG datasets. The first dataset contains two repeated sessions of tactile and painful stimulation from 22 participants. The second dataset contains a single session of painful stimulation from 48 participants. Results. In the first dataset, we observed gamma responses in the majority of the included participants. We found a broad interindividual variety of gamma magnitudes, time-frequency response patterns, and scalp topographies. Some participants showed a gamma response with individually unique time-frequency patterns, others did not exhibit any gamma response. This was reproducible and therefore stable; subjects with a large gamma magnitude in the first session showed a large gamma magnitude and a similar response pattern in the follow-up session. The second dataset confirmed the large between-subject variability, but only a fraction of the included participants exhibited laser-induced gamma synchronisation. Conclusions. Our results indicate that current EEG measures do not reflect the complex reality of the diverse individual response patterns to brief pain and touch experiences. The present findings question whether a similar phenomenon would be observed in other neuroscience domains. Group results may be replicable, but could be driven by a subgroup of the sample.
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Affiliation(s)
- Elia Valentini
- Department of Psychology and Centre for Brain Science, University of Essex, Colchester, United Kingdom
| | - Alina Shindy
- Department of Neurology, University Hospital, LMU Munich, Munich, Germany
| | - Viktor Witkovsky
- Department of Theoretical Methods, Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovak Republic
| | - Anne Stankewitz
- Department of Neuroradiology, Technische Universität München, Munich, Germany
| | - Enrico Schulz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
- Department of Medical Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
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Deak B, Eggert T, Mayr A, Stankewitz A, Filippopulos F, Jahn P, Witkovsky V, Straube A, Schulz E. Intrinsic Network Activity Reflects the Fluctuating Experience of Tonic Pain. Cereb Cortex 2022; 32:4098-4109. [PMID: 35024821 DOI: 10.1093/cercor/bhab468] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 11/16/2021] [Accepted: 11/18/2021] [Indexed: 11/14/2022] Open
Abstract
Although we know sensation is continuous, research on long-lasting and continuously changing stimuli is scarce and the dynamic nature of ongoing cortical processing is largely neglected. In a longitudinal study, 38 participants across four sessions were asked to continuously rate the intensity of an applied tonic heat pain for 20 min. Using group-independent component analysis and dual regression, we extracted the subjects' time courses of intrinsic network activity. The relationship between the dynamic fluctuation of network activity with the varying time courses of three pain processing entities was computed: pain intensity, the direction of pain intensity changes, and temperature. We were able to dissociate the spatio-temporal patterns of objective (temperature) and subjective (pain intensity/changes of pain intensity) aspects of pain processing in the human brain. We found two somatosensory networks with distinct functions: one network that encodes the small fluctuations in temperature and consists mainly of bilateral primary somatosensory cortex (SI), and a second right-lateralized network that encodes the intensity of the subjective experience of pain consisting of SI, secondary somatosensory cortex, the posterior cingulate cortex, and the thalamus. We revealed the somatosensory dynamics that build up toward a current subjective percept of pain. The timing suggests a cascade of subsequent processing steps toward the current pain percept.
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Affiliation(s)
- Bettina Deak
- Department of Neurology, LMU University Hospital, Ludwig-Maximilians-Universität München, 81377 Munich, Germany
| | - Thomas Eggert
- Department of Neurology, LMU University Hospital, Ludwig-Maximilians-Universität München, 81377 Munich, Germany
| | - Astrid Mayr
- Department of Neurology, LMU University Hospital, Ludwig-Maximilians-Universität München, 81377 Munich, Germany.,Department of Radiology, LMU University Hospital, Ludwig-Maximilians-Universität München, 81377 Munich, Germany
| | - Anne Stankewitz
- Department of Neurology, LMU University Hospital, Ludwig-Maximilians-Universität München, 81377 Munich, Germany
| | - Filipp Filippopulos
- Department of Neurology, LMU University Hospital, Ludwig-Maximilians-Universität München, 81377 Munich, Germany
| | - Pauline Jahn
- Department of Neurology, LMU University Hospital, Ludwig-Maximilians-Universität München, 81377 Munich, Germany
| | - Viktor Witkovsky
- Department of Theoretical Methods, Institute of Measurement Science, Slovak Academy of Sciences, 841 04 Bratislava, Slovak Republic
| | - Andreas Straube
- Department of Neurology, LMU University Hospital, Ludwig-Maximilians-Universität München, 81377 Munich, Germany
| | - Enrico Schulz
- Department of Neurology, LMU University Hospital, Ludwig-Maximilians-Universität München, 81377 Munich, Germany.,Department of Medical Psychology, Ludwig-Maximilians-Universität München, 80336 Munich, Germany
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Stankewitz A, Schulz E. Intrinsic network connectivity reflects the cyclic trajectory of migraine attacks. Neurobiology of Pain 2022; 11:100085. [PMID: 35243179 PMCID: PMC8861450 DOI: 10.1016/j.ynpai.2022.100085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/28/2022] [Accepted: 02/05/2022] [Indexed: 11/06/2022]
Abstract
Migraineurs undergo cyclic cortical changes, already detectable in pain-free phase. Increasing magnitudes of intrinsic network connectivity towards the next attack. Network decoupling was observed during the ictal phase. Network alterations can explain the variety of ictal and pre-ictal migraine symptoms. Need for early therapeutic approaches during the pain-free interval.
Background Episodic migraine is considered to be cyclic in nature, triggered by the hypothalamus. To assess the natural trajectory of intrinsic networks over an entire migraine cycle, we designed a longitudinal intra-individual study using functional magnetic resonance imaging (fMRI). Methods Intrinsic network connectivity was assessed for 12 migraineurs in 82 sessions including spontaneous, untriggered headache attacks and follow-up recordings towards the next attack. Results We found cyclic changes in the visual, auditory, and somatosensory networks, in limbic networks (e.g. thalamo-insular, parahippocampal), and in the salience network (anterior insula and dorsal anterior cingulate cortex). Connectivity changes also extended to further cortical networks, such as the central executive network, the default mode network, as well as subcortical networks. Almost all of these network connectivity changes followed the trajectory of a linear increase over the pain-free interval that peaked immediately prior to the headache, and “dropped” to the baseline level during the headache. These network alterations are associated with a number of cortical functions that may explain the variety of ictal and pre-ictal physiological and psychological migraine symptoms. Conclusion Our results suggest that migraine disease is associated with widespread cyclic alterations of intrinsic networks that develop before the headache is initiated, i.e. during the interictal and premonitory phase. The increasing magnitude of connectivity within these networks towards the next attack may reflect an increasing effort to maintain network integrity.
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Mayr A, Jahn P, Stankewitz A, Deak B, Winkler A, Witkovsky V, Eren O, Straube A, Schulz E. Patients with chronic pain exhibit individually unique cortical signatures of pain encoding. Hum Brain Mapp 2021; 43:1676-1693. [PMID: 34921467 PMCID: PMC8886665 DOI: 10.1002/hbm.25750] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 11/22/2021] [Accepted: 12/01/2021] [Indexed: 12/30/2022] Open
Abstract
Chronic pain is characterised by an ongoing and fluctuating intensity over time. Here, we investigated how the trajectory of the patients' endogenous pain is encoded in the brain. In repeated functional MRI (fMRI) sessions, 20 patients with chronic back pain and 20 patients with chronic migraine were asked to continuously rate the intensity of their endogenous pain. Linear mixed effects models were used to disentangle cortical processes related to pain intensity and to pain intensity changes. At group level, we found that the intensity of pain in patients with chronic back pain is encoded in the anterior insular cortex, the frontal operculum, and the pons; the change of pain in chronic back pain and chronic migraine patients is mainly encoded in the anterior insular cortex. At the individual level, we identified a more complex picture where each patient exhibited their own signature of endogenous pain encoding. The diversity of the individual cortical signatures of chronic pain encoding results bridge between clinical observations and neuroimaging; they add to the understanding of chronic pain as a complex and multifaceted disease.
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Affiliation(s)
- Astrid Mayr
- Department of Radiology, University Hospital LMU, Ludwig-Maximilians-Universität München, Munich, Germany.,Department of Neurology, University Hospital LMU, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Pauline Jahn
- Department of Neurology, University Hospital LMU, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Anne Stankewitz
- Department of Neurology, University Hospital LMU, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Bettina Deak
- Department of Neurology, University Hospital LMU, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Anderson Winkler
- Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland, USA
| | - Viktor Witkovsky
- Department of Theoretical Methods, Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovak Republic
| | - Ozan Eren
- Department of Neurology, University Hospital LMU, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Andreas Straube
- Department of Neurology, University Hospital LMU, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Enrico Schulz
- Department of Neurology, University Hospital LMU, Ludwig-Maximilians-Universität München, Munich, Germany.,Department of Medical Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
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Stankewitz A, Keidel L, Rehm M, Irving S, Kaczmarz S, Preibisch C, Witkovsky V, Zimmer C, Schulz E, Toelle TR. Migraine attacks as a result of hypothalamic loss of control. Neuroimage Clin 2021; 32:102784. [PMID: 34425551 PMCID: PMC8379646 DOI: 10.1016/j.nicl.2021.102784] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/06/2021] [Accepted: 08/06/2021] [Indexed: 12/27/2022]
Abstract
Hypothalamo-limbic connectivity reflects the cyclic nature of migraine. Hypothalamo-limbic connectivity is largest just before the attack. Hypothalamo-limbic connectivity is collapsing during the attack. Limbic perfusion is increasing and has a maximum during the attack. The disrupted connectivity allows high limbic perfusion, resulting in migraine attack.
Migraine is a complex neurological disorder affecting approximately 12% of the population. The pathophysiology is not yet fully understood, however the clinical features of the disease, such as the cyclic behaviour of attacks and vegetative symptoms, suggest a prominent role of the hypothalamus. Previous research has observed neuronal alterations at different time points during the migraine interval, specifically just before the headache is initiated. We therefore aimed to assess the trajectory of migraineurs’ brain activity over an entire migraine cycle. Using functional magnetic resonance imaging (fMRI) with pseudo-continuous arterial spin labelling (ASL), we designed a longitudinal intra-individual study to detect the rhythmicity of (1) the cerebral perfusion and (2) the hypothalamic connectivity over an entire migraine cycle. Twelve episodic migraine patients were examined in 82 sessions during spontaneous headache attacks with follow-up recordings towards the next attack. We detected cyclic changes of brain perfusion in the limbic circuit (insula and nucleus accumbens), with the highest perfusion during the headache attack. In addition, we found an increase of hypothalamic connectivity to the limbic system over the interictal interval towards the attack, then collapsing during the headache phase. The present data provide strong evidence for the predominant role of the hypothalamus in generating migraine attacks. Due to a genetically-determined cortical hyperexcitability, migraineurs are most likely characterised by an increased susceptibility of limbic neurons to the known migraine trigger. The hypothalamus as a metronome of internal processes is suggested to control these limbic circuits: migraine attacks may occur as a result of the hypothalamus losing control over the limbic system. Repetitive psychosocial stress, one of the leading trigger factors reported by patients, might make the limbic system even more vulnerable and lead to a premature triggering of a migraine attack. Potential therapeutic interventions are therefore suggested to strengthen limbic circuits with dedicated medication or psychological approaches.
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Affiliation(s)
- Anne Stankewitz
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany; Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Leonie Keidel
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Department of Ophthalmology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Mathias Rehm
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Stephanie Irving
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Stephan Kaczmarz
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Christine Preibisch
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Viktor Witkovsky
- Department of Theoretical Methods, Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovak Republic
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Enrico Schulz
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany; Department of Medical Psychology, Ludwig-Maximilians-Universität München, Munich, Germany.
| | - Thomas R Toelle
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Liebisch AP, Eggert T, Shindy A, Valentini E, Irving S, Stankewitz A, Schulz E. A novel tool for the removal of muscle artefacts from EEG: Improving data quality in the gamma frequency range. J Neurosci Methods 2021; 358:109217. [PMID: 33964345 DOI: 10.1016/j.jneumeth.2021.109217] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 04/07/2021] [Accepted: 05/02/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The past two decades have seen a particular focus towards high-frequency neural activity in the gamma band (>30 Hz). However, gamma band activity shares frequency range with unwanted artefacts from muscular activity. NEW METHOD We developed a novel approach to remove muscle artefacts from neurophysiological data. We re-analysed existing EEG data that were decomposed by a blind source separation method (independent component analysis, ICA), which helped to better spatially and temporally separate single muscle spikes. We then applied an adapting algorithm that detects these singled-out muscle spikes. RESULTS We obtained data almost free from muscle artefacts; we needed to remove significantly fewer artefact components from the ICA and we included more trials for the statistical analysis compared to standard ICA artefact removal. All pain-related cortical effects in the gamma band have been preserved, which underlines the high efficacy and precision of this algorithm. CONCLUSIONS Our results show a significant improvement of data quality by preserving task-relevant gamma oscillations of presumed cortical origin. We were able to precisely detect, gauge, and carve out single muscle spikes from the time course of neurophysiological measures without perturbing cortical gamma. We advocate the application of the tool for studies investigating gamma activity that contain a rather low number of trials, as well as for data that are highly contaminated with muscle artefacts. This validation of our tool allows for the application on event-free continuous EEG, for which the artefact removal is more challenging.
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Affiliation(s)
| | - Thomas Eggert
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Alina Shindy
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Elia Valentini
- Department of Psychology and Centre for Brain Science, University of Essex, Colchester, UK
| | - Stephanie Irving
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Anne Stankewitz
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Enrico Schulz
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany; Department of Medical Psychology, Ludwig-Maximilians-Universität München, Munich, Germany.
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Schulz E, Stankewitz A, Winkler AM, Irving S, Witkovský V, Tracey I. Ultra-high-field imaging reveals increased whole brain connectivity underpins cognitive strategies that attenuate pain. eLife 2020; 9:55028. [PMID: 32876049 PMCID: PMC7498261 DOI: 10.7554/elife.55028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 08/28/2020] [Indexed: 11/24/2022] Open
Abstract
We investigated how the attenuation of pain with cognitive interventions affects brain connectivity using neuroimaging and a whole brain novel analysis approach. While receiving tonic cold pain, 20 healthy participants performed three different pain attenuation strategies during simultaneous collection of functional imaging data at seven tesla. Participants were asked to rate their pain after each trial. We related the trial-by-trial variability of the attenuation performance to the trial-by-trial functional connectivity strength change of brain data. Across all conditions, we found that a higher performance of pain attenuation was predominantly associated with higher functional connectivity. Of note, we observed an association between low pain and high connectivity for regions that belong to brain regions long associated with pain processing, the insular and cingulate cortices. For one of the cognitive strategies (safe place), the performance of pain attenuation was explained by diffusion tensor imaging metrics of increased white matter integrity.
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Affiliation(s)
- Enrico Schulz
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.,Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Anne Stankewitz
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Anderson M Winkler
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom.,Emotion and Development Branch, National Institute of Mental Health, National Institutes of Health, Bethesda, United States
| | - Stephanie Irving
- Department of Neurology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Viktor Witkovský
- Department of Theoretical Methods, Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Irene Tracey
- Wellcome Centre for Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
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Magon S, May A, Stankewitz A, Goadsby PJ, Schankin C, Ashina M, Amin FM, Seifert CL, Mallar Chakravarty M, Müller J, Sprenger T. Cortical abnormalities in episodic migraine: A multi-center 3T MRI study. Cephalalgia 2018; 39:665-673. [PMID: 30525946 DOI: 10.1177/0333102418795163] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Several previous studies have investigated cortical abnormalities, specifically cortical thickness, in patients with migraine, with variable results. The relatively small sample sizes of most previous studies may partially explain these inconsistencies. OBJECTIVE To investigate differences of cortical thickness between control subjects and migraineurs in a large cohort. METHODS Three Tesla MRI data of 131 patients (38 with and 93 without aura) and 115 control subjects were analysed. A vertex-wise linear model was applied controlling for age, gender and MRI scanner to investigate differences between groups and determine the impact of clinical factors on cortical thickness measures. RESULTS Migraineurs showed areas of thinned cortex compared with controls bilaterally in the central sulcus, in the left middle-frontal gyrus, in left visual cortices and the right occipito-temporal gyrus. Frequency of migraine attacks and the duration of the disorder had a significant impact on cortical thickness in the sensorimotor cortex and middle-frontal gyrus. Patients without aura showed thinner cortex than controls bilaterally in the central sulcus and in the middle frontal gyrus, in the left primary visual cortices, in the left supramarginal gyrus and in the right cuneus. Patients with aura showed clusters of thinner cortex bilaterally in the subparietal sulcus (between the precuneus and posterior cingulate cortex), in the left intraparietal sulcus and in the right anterior cingulate. CONCLUSION These results indicate cortical abnormalities in specific brain regions in migraineurs. Some of the observed abnormalities may reflect a genetic susceptibility towards developing migraine attacks, while others are probably a consequence of repeated head pain attacks.
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Affiliation(s)
- Stefano Magon
- 1 Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland.,2 Medical Image Analysis Center, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Arne May
- 3 Institute for Systems Neuroscience, University of Hamburg, Hamburg, Germany
| | - Anne Stankewitz
- 3 Institute for Systems Neuroscience, University of Hamburg, Hamburg, Germany.,4 Department of Neurology, Technische Universität Muenchen, Munich, Germany
| | - Peter J Goadsby
- 5 Headache Group-Department of Neurology, University of California, San Francisco, CA, USA.,6 NIHR-Wellcome Trust King's Clinical Research Facility, King's College London, London, UK
| | - Christoph Schankin
- 7 Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Messoud Ashina
- 8 Danish Headache Center and Department of Neurology, University of Copenhagen, Copenhagen, Denmark
| | - Faisal M Amin
- 8 Danish Headache Center and Department of Neurology, University of Copenhagen, Copenhagen, Denmark
| | | | - M Mallar Chakravarty
- 9 Cerebral Imaging Centre, Douglas Mental Health University Institute Montreal, Montreal, Quebec, Canada.,10 Department of Psychiatry and Biological and Biomedical Engineering, McGill University, Montreal, Quebec, Canada
| | - Jannis Müller
- 1 Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Till Sprenger
- 1 Department of Neurology, University Hospital Basel, University of Basel, Basel, Switzerland.,11 Department of Neurology, DKD HELIOS Klinik Wiesbaden, Wiesbaden, Germany
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Stankewitz A, Sorg C, von Kalckreuth A, Schulz E, Valet M, Neufang S, Zimmer C, Henningsen P, Gündel H, Wohlschläger AM, Tölle TR. Fronto-Insular Connectivity during Pain Distraction Is Impaired in Patients with Somatoform Pain. J Neuroimaging 2018; 28:621-628. [PMID: 30028554 DOI: 10.1111/jon.12547] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND AND PURPOSE Somatoform pain disorder is characterized by chronic pain and various psychological symptoms including increased attention to mental and physical processes. Given that the medial prefrontal cortex (mPFC) of the default mode network (DMN) and the anterior insula of the salience network are critically involved in intrinsic and attentional processes, we investigated the involvement of these networks during the distraction from physical pain in somatoform pain patients. METHODS During painful and nonpainful heat stimulation, attentional distraction from physical processes was modulated with a Stroop task. Thirteen patients were investigated with functional magnetic resonance imaging (fMRI) and compared to 13 controls. Main outcomes were spatial maps of coherent fMRI activity based on independent component analysis and functional connectivity (FC) resulting from psychophysiological interaction analysis. RESULTS Behavioral pain intensity ratings were reduced during the distraction task in both groups. At brain level, we found deviant network activities in the DMN (particularly in the mPFC) and in the salience network (bilaterally in the anterior insula) in patients. During pain stimulation, Stroop-induced distraction decreased the FC between the mPFC and anterior insula in controls but not in patients. CONCLUSIONS Modulating the FC between the mPFC and the insula may be highly relevant for shifting the attention away from external stimuli, including nociceptive input. The observed alterations in somatoform pain patients may foster new strategies in cognitive behavioral training tools for these patients.
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Affiliation(s)
- Anne Stankewitz
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Christian Sorg
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,TUM Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Alexander von Kalckreuth
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Enrico Schulz
- Department of Neurology, Klinikum der Universität München, Ludwig-Maximilians-Universität, München, Germany
| | - Michael Valet
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,Benedictus Krankenhaus, Feldafing, Germany
| | - Susanne Neufang
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Wuerzburg, Wuerzburg, Germany
| | - Claus Zimmer
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Peter Henningsen
- Department of Psychosomatic Medicine, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Harald Gündel
- Department of Psychosomatic Medicine, University of Ulm, Ulm, Germany
| | - Afra M Wohlschläger
- Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.,TUM Neuroimaging Center, Klinikum rechts der Isar, Technische Universität München, Germany
| | - Thomas R Tölle
- Department of Neurology, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Affiliation(s)
- A Stankewitz
- Department of Systems Neuroscience, University of Hamburg, Germany
| | - A May
- Department of Systems Neuroscience, University of Hamburg, Germany
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Michail G, Dresel C, Witkovský V, Stankewitz A, Schulz E. Neuronal Oscillations in Various Frequency Bands Differ between Pain and Touch. Front Hum Neurosci 2016; 10:182. [PMID: 27199705 PMCID: PMC4850848 DOI: 10.3389/fnhum.2016.00182] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 04/11/2016] [Indexed: 12/19/2022] Open
Abstract
Although humans are generally capable of distinguishing single events of pain or touch, recent research suggested that both modalities activate a network of similar brain regions. By contrast, less attention has been paid to which processes uniquely contribute to each modality. The present study investigated the neuronal oscillations that enable a subject to process pain and touch as well as to evaluate the intensity of both modalities by means of Electroencephalography. Nineteen healthy subjects were asked to rate the intensity of each stimulus at single trial level. By computing Linear mixed effects models (LME) encoding of both modalities was explored by relating stimulus intensities to brain responses. While the intensity of single touch trials is encoded only by theta activity, pain perception is encoded by theta, alpha and gamma activity. Beta activity in the tactile domain shows an on/off like characteristic in response to touch which was not observed in the pain domain. Our results enhance recent findings pointing to the contribution of different neuronal oscillations to the processing of nociceptive and tactile stimuli.
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Affiliation(s)
- Georgios Michail
- Department of Neurology, Technische Universität MünchenMunich, Germany; TUM-Neuroimaging Center, Technische Universität MünchenMunich, Germany; Neurophysics Group, Department of Neurology, Charité-Universitätsmedizin BerlinBerlin, Germany
| | - Christian Dresel
- Department of Neurology, Technische Universität MünchenMunich, Germany; TUM-Neuroimaging Center, Technische Universität MünchenMunich, Germany
| | - Viktor Witkovský
- Department of Theoretical Methods, Institute of Measurement Science, Slovak Academy of Sciences Bratislava, Slovak Republic
| | - Anne Stankewitz
- Department of Neurology, Technische Universität München Munich, Germany
| | - Enrico Schulz
- Department of Neurology, Technische Universität MünchenMunich, Germany; TUM-Neuroimaging Center, Technische Universität MünchenMunich, Germany; Oxford Centre for Functional Magnetic Resonance Imaging of the Brain, Nuffield Department of Clinical Neurosciences, University of OxfordOxford, UK
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Magon S, May A, Stankewitz A, Goadsby PJ, Tso AR, Ashina M, Amin FM, Seifert CL, Chakravarty M, Müller J, Sprenger T. EHMTI-0079. Reduced volume of anterior thalamic nuclei in migraineurs. J Headache Pain 2014. [PMCID: PMC4181951 DOI: 10.1186/1129-2377-15-s1-f17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Magon S, May A, Stankewitz A, Goadsby PJ, Schankin C, Ashina M, Amin FM, Müller J, Seifert CL, Chakravarty M, Sprenger T. EHMTI-0186. Multi-center 3T MRI study of cortical thickness abnormalities in migraine. J Headache Pain 2014. [PMCID: PMC4180363 DOI: 10.1186/1129-2377-15-s1-a4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Wostrack M, Friedrich B, Hammer K, Harmening K, Stankewitz A, Ringel F, Shiban E, Boeckh-Behrens T, Prothmann S, Zimmer C, Meyer B, Förschler A, Ryang YM. Hippocampal damage and affective disorders after treatment of cerebral aneurysms. J Neurol 2014; 261:2128-35. [DOI: 10.1007/s00415-014-7464-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 08/02/2014] [Accepted: 08/04/2014] [Indexed: 01/02/2023]
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Stankewitz A, Valet M, Schulz E, Wöller A, Sprenger T, Vogel D, Zimmer C, Mühlau M, Tölle TR. Pain sensitisers exhibit grey matter changes after repetitive pain exposure: A longitudinal voxel-based morphometry study. Pain 2013; 154:1732-1737. [DOI: 10.1016/j.pain.2013.05.019] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 05/06/2013] [Accepted: 05/13/2013] [Indexed: 10/26/2022]
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Abstract
OBJECTIVE Migraine patients have dysfunctional cortical olfactory processing and very often report hypersensitivity and phobic symptoms to odors during acute headache attacks. However, imaging data of how the brain processes associate migraine symptoms, such as photophobia, phonophobia, or osmophobia, are rare. METHODS The present study aimed to explore neuronal processing in response to olfactory stimulation (rose odor) in migraine patients in and outside acute headache attacks. Using event-related fMRI we studied 20 migraine patients and compared behavioral and imaging data with sex- and age-matched healthy controls. Additionally, 13 of the 20 patients were scanned within 6 hours after the onset of a spontaneous migraine attack. RESULTS Imaging data showed that interictal migraineurs did not differ from control subjects. However, during spontaneous and untreated attacks, migraine patients showed significantly higher blood oxygen level-dependent signal intensities in brain areas including limbic structures (amygdala and insular cortices) and, more specifically, in the rostral pons in response to olfactory stimulation. CONCLUSIONS Increased activity in the rostral part of the pons has previously been specifically linked to the pain of the migraine attack. The present finding suggests that the activity level of this structure can be triggered by olfactory input and thus points to the strong physiologic relationship between the olfactory and the trigemino-nociceptive pathway in the pathophysiology of migraine disease.
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Affiliation(s)
- Anne Stankewitz
- Department of Systems Neuroscience, University Medical Center Hamburg Eppendorf, Hamburg, Germany
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Aderjan D, Stankewitz A, May A. Neuronal mechanisms during repetitive trigemino-nociceptive stimulation in migraine patients. Pain 2010; 151:97-103. [DOI: 10.1016/j.pain.2010.06.024] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Revised: 05/10/2010] [Accepted: 06/19/2010] [Indexed: 11/17/2022]
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Stankewitz A, May A. Understanding the migraineous brain: an exclusive focus on habituation may be misleading. Pain 2010. [DOI: 10.1016/j.pain.2010.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Stankewitz A, May A. The phenomenon of changes in cortical excitability in migraine is not migraine-specific – A unifying thesis. Pain 2009; 145:14-7. [DOI: 10.1016/j.pain.2009.03.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2008] [Revised: 02/23/2009] [Accepted: 03/11/2009] [Indexed: 10/20/2022]
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Abstract
Functional imaging of human trigemino-nociceptive processing provides meaningful insights into altered pain processing in head and face pain diseases. Although functional magnetic resonance imaging (fMRI) offers high temporal and spatial resolution, most studies available were done with radioligand-positron emission tomography, as fMRI requires non-magnetic stimulus equipment and fast on–off conditions. We developed a new approach for painful stimulation of the trigeminal nerve that can be implemented within an event-related design using fMRI and aimed to detect increased blood-oxygen-level-dependent (BOLD) signals as surrogate markers of trigeminal pain processing. Using an olfactometer, 20 healthy volunteers received intranasally standardized trigeminal nociceptive stimuli (ammonia gas) as well as olfactory (rose odour) and odourless control stimuli (air puffs). Imaging revealed robust BOLD responses to the trigeminal nociceptive stimulation in cortical and subcortical brain areas known to be involved in pain processing. Focusing on the trigeminal pain pathway, significant activations were observed bilaterally in brainstem areas at the trigeminal nerve entry zone, which are agreeable with the principal trigeminal nuclei. Furthermore, increased signal changes could be detected ipsilaterally at anatomical localization of the trigeminal ganglion and bilaterally in the rostral medulla, which probably represents the spinal trigeminal nuclei. However, brainstem areas involved in the endogenous pain control system that are close to this anatomical localization, such as raphe nuclei, have to be discussed. Our findings suggest that mapping trigeminal pain processing using fMRI with this non-invasive experimental design is feasible and capable of evoking specific activations in the trigeminal nociceptive system. This method will provide an ideal opportunity to study the trigeminal pain system in both health and pathological conditions such as idiopathic headache disorders.
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Affiliation(s)
- A Stankewitz
- Department of Systems Neuroscience, University Medical Centre Hamburg Eppendorf, Hamburg, Germany
| | - HL Voit
- Department of Radiology, University Medical Centre Erlangen, Nuremberg, Germany
| | - U Bingel
- Department of Neurology, University Medical Centre Hamburg Eppendorf, Hamburg, Germany
| | - C Peschke
- Department of Systems Neuroscience, University Medical Centre Hamburg Eppendorf, Hamburg, Germany
| | - A May
- Department of Systems Neuroscience, University Medical Centre Hamburg Eppendorf, Hamburg, Germany
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Stankewitz A, May A. Trigeminale Verarbeitung nozizeptiver Reize bei Migränepatienten – eine fMRI-Studie. KLIN NEUROPHYSIOL 2009. [DOI: 10.1055/s-0029-1216196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Stankewitz A, May A. Trigemino-nozizeptive Stimulation und kortikale Verarbeitung bei Migränikern. Akt Neurol 2008. [DOI: 10.1055/s-0028-1086741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
A cortical dysbalance has a pivotal role in the pathophysiology of migraine. Numerous electrophysiological and transcranial magnetic stimulation (TMS) studies have investigated the interictal excitability level in migraineurs and have shown a consistent lack of habituation during repetitive stimulation. There is some controversy in the current literature over whether this deficit is based on a lowered or an elevated preactivation level. However, the current discussion may be misguided. It seems that multiple external and intrinsic factors influence the level of cortical excitability and the frequency and intensity of attacks: Habituation is specific neither to migraine nor even to pain; the same phenomenon is found in tinnitus patients, for example. Cortical hyperexcitability is presumably the result of chronicity and the concomitant central sensitisation process.
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Affiliation(s)
- A Stankewitz
- Institut für systemische Neurowissenschaften, Universitätsklinikum Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany
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