Format

Send to

Choose Destination
Cephalalgia. 2019 Aug 29:333102419867280. doi: 10.1177/0333102419867280. [Epub ahead of print]

Hypothalamic regulation of headache and migraine.

Author information

1
1 Department of Systems Neuroscience, University Medical Center Eppendorf, Hamburg, Germany.
2
2 Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical center, Department of Anesthesia, Harvard medical School, Boston, MA, USA.

Abstract

BACKGROUND:

The clinical picture, but also neuroimaging findings, suggested the brainstem and midbrain structures as possible driving or generating structures in migraine.

FINDINGS:

This has been intensely discussed in the last decades and the advent of modern imaging studies refined the involvement of rostral parts of the pons in acute migraine attacks, but more importantly suggested a predominant role of the hypothalamus and alterations in hypothalamic functional connectivity shortly before the beginning of migraine headaches. This was shown in the NO-triggered and also in the preictal stage of native human migraine attacks. Another headache type that is clinically even more suggestive of hypothalamic involvement is cluster headache, and indeed a structure in close proximity to the hypothalamus has been identified to play a crucial role in attack generation.

CONCLUSION:

It is very likely that spontaneous oscillations of complex networks involving the hypothalamus, brainstem, and dopaminergic networks lead to changes in susceptibility thresholds that ultimately start but also terminate headache attacks. We will review clinical and neuroscience evidence that puts the hypothalamus in the center of scientific attention when attack generation is discussed.

KEYWORDS:

Migraine; attack; brainstem; hypothalamus; network

PMID:
31466456
DOI:
10.1177/0333102419867280

Supplemental Content

Full text links

Icon for Atypon
Loading ...
Support Center