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Cephalalgia. 2017 Jul;37(8):764-779. doi: 10.1177/0333102416652625. Epub 2016 Jun 1.

Pain modulation is affected differently in medication-overuse headache and chronic myofascial pain - A multimodal MRI study.

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1 Clinic of Neuroradiology, University Hospital Zurich, Zurich, Switzerland.
2 Division of Neuropsychology, Institute of Psychology, University of Zurich, Zurich, Switzerland.
3 RehaClinic, Bad Zurzach and Baden, Switzerland.
4 University of Zurich, Zürich, Switzerland.
5 Centre for Pain Medicine, Swiss Paraplegic-Centre, Nottwil, Switzerland.
6 Department of Neurology, University Hospital Zurich, Switzerland.
7 Neurological Center Rosenhuegel and Karl Landsteiner Institute for Epilepsy Research and Cognitive Neurology, Vienna, Austria.


Background Neuroimaging studies revealed structural and functional changes in medication-overuse headache (MOH), but it remains unclear whether similar changes could be observed in other chronic pain disorders. Methods In this cross-sectional study, we investigated functional connectivity (FC) with resting-state functional magnetic resonance imaging (fMRI) and white matter integrity using diffusion tensor imaging (DTI) to measure fractional anisotropy (FA) and mean diffusivity (MD) in patients with MOH ( N = 12) relative to two control groups: patients with chronic myofascial pain (MYO; N = 11) and healthy controls (CN; N = 16). Results In a data-driven approach we found hypoconnectivity in the fronto-parietal attention network in both pain groups relative to CN (i.e. MOH < CN and MYO < CN). In contrast, hyperconnectivity in the saliency network (SN) was detected only in MOH, which correlated with FA in the insula. In a seed-based analysis we investigated FC between the periaqueductal grey (PAG) and all other brain regions. In addition to overlapping hyperconnectivity seen in patient groups (relative to CN), MOH had a distinct connectivity pattern with lower FC to parieto-occipital regions and higher FC to orbitofrontal regions compared to controls. FA and MD abnormalities were mostly observed in MOH, involving the insula. Conclusions Hyperconnectivity within the SN along with associated white matter changes therein suggest a particular role of this network in MOH. In addition, abnormal connectivity between the PAG and other pain modulatory (frontal) regions in MOH are consistent with dysfunctional central pain control.


Functional magnetic resonance imaging; diffusion tensor imaging; functional connectivity; headache; medication overuse; myofascial pain

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