Cortical excitability in episodic cluster headache

Filippo Brighina, Brigida Fierro, Giuseppe Cosentino, Roberta Baschi, Simona Talamanca

Risultato della ricerca: Otherpeer review


Background: Cluster headache (CH) is a severe primary headachedisorder, whose pathophysiological processes remain largely unknown.Along with central disinhibition of the trigeminal nociceptive system andhypothalamic impairment, a cortical involvement has been supposed.Aim: To evaluate cortical excitability in episodic CH patients by usingdifferent paradigms of transcranial magnetic stimulation (TMS).Methods: Twenty-five patients with episodic CH and thirteen healthysubjects underwent an experimental session where we evaluated, in bothhemispheres, motor-cortical response to: 1) single-pulse TMS: i.e. motorthreshold (MT); input-output (IO) curves and cortical silent period (CSP) and2) paired-pulse TMS: i.e. intracortical facilitation (ICF) and short intracorticalinhibition (SICI). Thirteen patients were evaluated outside bout, while theremaining twelve patients were inside bout at the time of recording.Results: We showed increased ICF values in the hemisphere ipsilateral tothe side of pain in patients evaluated both outside and inside bout.Differently, IO curves showed increased slope in both hemispheres inpatients examined outside bout, but only in the hemisphere contralateralto the affected side in those evaluated during bout.Conclusions: Our results show a condition of increased cortical excitabilityin episodic CH both outside and inside bout. Interestingly, corticalexcitability was greater in the hemisphere ipsilateral to the side of pain inpatients outside bout, but decreased in patients inside bout possibly due toactivation of compensatory inhibitory mechanisms of cortical excitability.Along with subcortical and peripheral mechanisms, changes in corticalexcitability could also play an important role in the pathophysiology of CH.No conflict of interest.
Lingua originaleEnglish
Numero di pagine1
Stato di pubblicazionePublished - 2014


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