Top

Published in:

Open Access 01-12-2018 | Research article

Neurophysiological correlates of clinical improvement after greater occipital nerve (GON) block in chronic migraine: relevance for chronic migraine pathophysiology

Authors: Alessandro Viganò, Maria Claudia Torrieri, Massimiliano Toscano, Francesca Puledda, Barbara Petolicchio, Tullia Sasso D’Elia, Angela Verzina, Sonia Ruggiero, Marta Altieri, Edoardo Vicenzini, Jean Schoenen, Vittorio Di Piero

Published in: The Journal of Headache and Pain | Issue 1/2018

Abstract

Background

Therapeutic management of Chronic Migraine (CM), often associated with Medication Overuse Headache (MOH), is chiefly empirical, as no biomarker predicting or correlating with clinical efficacy is available to address therapeutic choices. The present study searched for neurophysiological correlates of Greater Occipital Nerve Block (GON-B) effects in CM.

Methods

We recruited 17 CM women, of whom 12 with MOH, and 19 healthy volunteers (HV). Patients had no preventive treatment since at least 3 months. After a 30-day baseline, they received a bilateral betamethasone-lidocaine GON-B of which the therapeutic effect was assessed 1 month later. Habituation of visual evoked potentials (VEP) and intensity dependence of auditory evoked potentials (IDAP) were recorded before and 1 week after the GON-B.

Results

At baseline, CM patients had a VEP habituation not different from HV, but a steeper IDAP value than HV (p = 0.01), suggestive of a lower serotonergic tone. GON-B significantly reduced the number of total headache days per month (− 34.9%; p = 0.003). Eight out 17CM patients reversed to episodic migraine and medication overuse resolved in 11 out of 12 patients. One week after the GON-B VEP habituation became lacking respect to baseline (p = 0.01) and to that of HV (p = 0.02) like in episodic migraine, while the IDAP slope significantly flattened (p < 0.0001). GON-B-induced reduction in headache days positively correlated with IDAP slope decrease (rho = 0.51, p = 0.03).

Conclusions

GON-B may be effective in the treatment of CM, with or without MOH. The pre-treatment IDAP increase is compatible with a weak central serotonergic tone, which is strengthened after GON-B, suggesting that serotonergic mechanisms may play a role in CM and its reversion to episodic migraine. Since the degree of post-treatment IDAP decrease is correlated with clinical improvement, IDAP might be potentially useful as an early predictor of GON-B efficacy.

Natoli JL, Manack A, Dean B et al (2010) Global prevalence of chronic migraine: a systematic review. Cephalalgia Int J Headache 30:599–609. https://doi.org/10.1111/j.1468-2982.2009.01941.x CrossRef

Dodick DW (2006) Clinical practice. Chronic daily headache. N Engl J Med 354:158–165. https://doi.org/10.1056/NEJMcp042897 CrossRefPubMed

Bigal ME, Serrano D, Buse D et al (2008) Acute migraine medications and evolution from episodic to chronic migraine: a longitudinal population-based study. Headache 48:1157–1168. https://doi.org/10.1111/j.1526-4610.2008.01217.x CrossRefPubMed

Scher AI, Rizzoli PB, Loder EW (2017) Medication overuse headache: an entrenched idea in need of scrutiny. Neurology 89:1296–1304. https://doi.org/10.1212/WNL.0000000000004371 CrossRefPubMed

Silberstein SD, Lipton RB, Dodick DW et al (2007) Efficacy and safety of topiramate for the treatment of chronic migraine: a randomized, double-blind, placebo-controlled trial. Headache 47:170–180. https://doi.org/10.1111/j.1526-4610.2006.00684.x CrossRefPubMed

Aurora SK, Dodick DW, Turkel CC et al (2010) OnabotulinumtoxinA for treatment of chronic migraine: results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 1 trial. Cephalalgia Int J Headache 30:793–803. https://doi.org/10.1177/0333102410364676 CrossRef

Diener HC, Dodick DW, Aurora SK et al (2010) OnabotulinumtoxinA for treatment of chronic migraine: results from the double-blind, randomized, placebo-controlled phase of the PREEMPT 2 trial. Cephalalgia Int J Headache 30:804–814. https://doi.org/10.1177/0333102410364677 CrossRef

May A, Schulte LH (2016) Chronic migraine: risk factors, mechanisms and treatment. Nat Rev Neurol 12:455–464. https://doi.org/10.1038/nrneurol.2016.93 CrossRefPubMed

Hepp Z, Dodick DW, Varon SF et al (2017) Persistence and switching patterns of oral migraine prophylactic medications among patients with chronic migraine: a retrospective claims analysis. Cephalalgia Int J Headache 37:470–485. https://doi.org/10.1177/0333102416678382 CrossRef

10.

Blumenfeld AM, Bloudek LM, Becker WJ et al (2013) Patterns of use and reasons for discontinuation of prophylactic medications for episodic migraine and chronic migraine: results from the second international burden of migraine study (IBMS-II). Headache 53:644–655. https://doi.org/10.1111/head.12055 CrossRefPubMed

11.

Inan LE, Inan N, Karadaş Ö et al (2015) Greater occipital nerve blockade for the treatment of chronic migraine: a randomized, multicenter, double-blind, and placebo-controlled study. Acta Neurol Scand 132:270–277. https://doi.org/10.1111/ane.12393 CrossRefPubMed

12.

Cuadrado ML, Aledo-Serrano Á, Navarro P et al (2017) Short-term effects of greater occipital nerve blocks in chronic migraine: a double-blind, randomised, placebo-controlled clinical trial. Cephalalgia Int J Headache 37:864–872. https://doi.org/10.1177/0333102416655159 CrossRef

13.

Puledda F, Goadsby PJ, Prabhakar P (2018) Treatment of disabling headache with greater occipital nerve injections in a large population of childhood and adolescent patients: a service evaluation. J Headache Pain 19:5. https://doi.org/10.1186/s10194-018-0835-5 CrossRefPubMedPubMedCentral

14.

Afridi SK, Shields KG, Bhola R, Goadsby PJ (2006) Greater occipital nerve injection in primary headache syndromes--prolonged effects from a single injection. Pain 122:126–129. https://doi.org/10.1016/j.pain.2006.01.016 CrossRefPubMed

15.

Martelletti P, Katsarava Z, Lampl C et al (2014) Refractory chronic migraine: a consensus statement on clinical definition from the European headache federation. J Headache Pain 15:47. https://doi.org/10.1186/1129-2377-15-47 CrossRefPubMedPubMedCentral

16.

Magis D, Vigano A, Sava S et al (2013) Pearls and pitfalls: electrophysiology for primary headaches. Cephalalgia Int J Headache 33:526–539. https://doi.org/10.1177/0333102413477739 CrossRef

17.

de Tommaso M, Ambrosini A, Brighina F et al (2014) Altered processing of sensory stimuli in patients with migraine. Nat Rev Neurol 10:144–155. https://doi.org/10.1038/nrneurol.2014.14 CrossRefPubMed

18.

Ambrosini A, de Noordhout AM, Sándor PS, Schoenen J (2003) Electrophysiological studies in migraine: a comprehensive review of their interest and limitations. Cephalalgia Int J Headache 23(Suppl 1):13–31. https://doi.org/10.1046/j.1468-2982.2003.00571.x CrossRef

19.

Coppola G, Di Lorenzo C, Schoenen J, Pierelli F (2013) Habituation and sensitization in primary headaches. J Headache Pain 14:65. https://doi.org/10.1186/1129-2377-14-65 CrossRefPubMedPubMedCentral

20.

Coppola G, Pierelli F, Schoenen J (2009) Habituation and migraine. Neurobiol Learn Mem 92:249–259. https://doi.org/10.1016/j.nlm.2008.07.006 CrossRefPubMed

21.

Schoenen J (2011) Is chronic migraine a never-ending migraine attack? Pain 152:239–240. https://doi.org/10.1016/j.pain.2010.12.002 CrossRefPubMed

22.

Coppola G, Schoenen J (2012) Cortical excitability in chronic migraine. Curr Pain Headache Rep 16:93–100. https://doi.org/10.1007/s11916-011-0231-1 CrossRefPubMed

23.

Coppola G, Currà A, Di Lorenzo C et al (2010) Abnormal cortical responses to somatosensory stimulation in medication-overuse headache. BMC Neurol 10:126. https://doi.org/10.1186/1471-2377-10-126 CrossRefPubMedPubMedCentral

24.

Chen W-T, Wang S-J, Fuh J-L et al (2012) Visual cortex excitability and plasticity associated with remission from chronic to episodic migraine. Cephalalgia Int J Headache 32:537–543. https://doi.org/10.1177/0333102412443337 CrossRef

25.

Wutzler A, Winter C, Kitzrow W et al (2008) Loudness dependence of auditory evoked potentials as indicator of central serotonergic neurotransmission: simultaneous electrophysiological recordings and in vivo microdialysis in the rat primary auditory cortex. Neuropsychopharmacol Off Publ Am Coll Neuropsychopharmacol 33:3176–3181. https://doi.org/10.1038/npp.2008.42 CrossRef

26.

Ambrosini A, Rossi P, De Pasqua V et al (2003) Lack of habituation causes high intensity dependence of auditory evoked cortical potentials in migraine. Brain J Neurol 126:2009–2015. https://doi.org/10.1093/brain/awg206 CrossRef

27.

Magis D, Ambrosini A, Bendtsen L et al (2007) Evaluation and proposal for optimalization of neurophysiological tests in migraine: part 1--electrophysiological tests. Cephalalgia Int J Headache 27:1323–1338. https://doi.org/10.1111/j.1468-2982.2007.01440.x CrossRef

28.

Rocco A, Afra J, Toscano M et al (2007) Acute subcortical stroke and early serotonergic modification: a IDAP study. Eur J Neurol 14:1378–1382. https://doi.org/10.1111/j.1468-1331.2007.01985.x CrossRefPubMed

29.

Toscano M, Viganò A, Puledda F et al (2014) Serotonergic correlation with anger and aggressive behavior in acute stroke patients: an intensity dependence of auditory evoked potentials (IDAP) study. Eur Neurol 72:186–192. https://doi.org/10.1159/000362268 CrossRefPubMed

30.

Di Clemente L, Coppola G, Magis D et al (2009) Nitroglycerin sensitises in healthy subjects CNS structures involved in migraine pathophysiology: evidence from a study of nociceptive blink reflexes and visual evoked potentials. Pain 144:156–161. https://doi.org/10.1016/j.pain.2009.04.018 CrossRefPubMed

31.

Panconesi A (2008) Serotonin and migraine: a reconsideration of the central theory. J Headache Pain 9:267–276. https://doi.org/10.1007/s10194-008-0058-2 CrossRefPubMedPubMedCentral

32.

Buse DC, Silberstein SD, Manack AN et al (2013) Psychiatric comorbidities of episodic and chronic migraine. J Neurol 260:1960–1969. https://doi.org/10.1007/s00415-012-6725-x CrossRefPubMed

33.

Chen W-T, Wang S-J, Fuh J-L et al (2011) Persistent ictal-like visual cortical excitability in chronic migraine. Pain 152:254–258. https://doi.org/10.1016/j.pain.2010.08.047 CrossRefPubMed

34.

Lai T-H, Protsenko E, Cheng Y-C et al (2015) Neural plasticity in common forms of chronic headaches. Neural Plast 2015:205985. https://doi.org/10.1155/2015/205985 CrossRefPubMedPubMedCentral

35.

Brennan KC, Pietrobon D (2018) A systems neuroscience approach to migraine. Neuron 97:1004–1021. https://doi.org/10.1016/j.neuron.2018.01.029 CrossRefPubMed

36.

Froemke RC (2015) Plasticity of cortical excitatory-inhibitory balance. Annu Rev Neurosci 38:195–219. https://doi.org/10.1146/annurev-neuro-071714-034002 CrossRefPubMedPubMedCentral

37.

Kuhlman SJ, Olivas ND, Tring E et al (2013) A disinhibitory microcircuit initiates critical-period plasticity in the visual cortex. Nature 501:543–546. https://doi.org/10.1038/nature12485 CrossRefPubMedPubMedCentral

38.

Coppola G, Vandenheede M, Di Clemente L et al (2005) Somatosensory evoked high-frequency oscillations reflecting thalamo-cortical activity are decreased in migraine patients between attacks. Brain J Neurol 128:98–103. https://doi.org/10.1093/brain/awh334 CrossRef

39.

Cosentino G, Fierro B, Vigneri S et al (2014) Cyclical changes of cortical excitability and metaplasticity in migraine: evidence from a repetitive transcranial magnetic stimulation study. Pain 155:1070–1078. https://doi.org/10.1016/j.pain.2014.02.024 CrossRefPubMed

40.

Song Z, Ultenius C, Meyerson BA, Linderoth B (2009) Pain relief by spinal cord stimulation involves serotonergic mechanisms: an experimental study in a rat model of mononeuropathy. Pain 147:241–248. https://doi.org/10.1016/j.pain.2009.09.020 CrossRefPubMed

41.

Song Z, Meyerson BA, Linderoth B (2011) Spinal 5-HT receptors that contribute to the pain-relieving effects of spinal cord stimulation in a rat model of neuropathy. Pain 152:1666–1673. https://doi.org/10.1016/j.pain.2011.03.012 CrossRefPubMed

42.

Meunier CNJ, Amar M, Lanfumey L et al (2013) 5-HT(1A) receptors direct the orientation of plasticity in layer 5 pyramidal neurons of the mouse prefrontal cortex. Neuropharmacology 71:37–45. https://doi.org/10.1016/j.neuropharm.2013.03.003 CrossRefPubMed

43.

Meunier CNJ, Callebert J, Cancela J-M, Fossier P (2015) Effect of dopaminergic D1 receptors on plasticity is dependent of serotoninergic 5-HT1A receptors in L5-pyramidal neurons of the prefrontal cortex. PLoS One 10:e0120286. https://doi.org/10.1371/journal.pone.0120286 CrossRefPubMedPubMedCentral

44.

Yang Y-C, Hu C-C, Huang C-S, Chou P-Y (2014) Thalamic synaptic transmission of sensory information modulated by synergistic interaction of adenosine and serotonin. J Neurochem 128:852–863. https://doi.org/10.1111/jnc.12499 CrossRefPubMed

45.

Kemp A (1991) Manahan-Vaughan D (2005) the 5-hydroxytryptamine4 receptor exhibits frequency-dependent properties in synaptic plasticity and behavioural metaplasticity in the hippocampal CA1 region in vivo. Cereb Cortex N Y N 15:1037–1043. https://doi.org/10.1093/cercor/bhh204 CrossRef

Title: Neurophysiological correlates of clinical improvement after greater occipital nerve (GON) block in chronic migraine: relevance for chronic migraine pathophysiology
Authors: Alessandro Viganò
Maria Claudia Torrieri
Massimiliano Toscano
Francesca Puledda
Barbara Petolicchio
Tullia Sasso D’Elia
Angela Verzina
Sonia Ruggiero
Marta Altieri
Edoardo Vicenzini
Jean Schoenen
Vittorio Di Piero
Publication date: 01-12-2018
Publisher: Springer Milan
Published in: The Journal of Headache and Pain / Issue 1/2018
Print ISSN: 1129-2369
Electronic ISSN: 1129-2377
DOI: https://doi.org/10.1186/s10194-018-0901-z

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Neurophysiological correlates of clinical improvement after greater occipital nerve (GON) block in chronic migraine: relevance for chronic migraine pathophysiology

Abstract

Background

Methods

Results

Conclusions

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Please log in to get access to this content

Other articles of this Issue 1/2018

The journey from genetic predisposition to medication overuse headache to its acquisition as sequela of chronic migraine

Psychological distress, neuroticism and disability associated with secondary chronic headache in the general population – the Akershus study of chronic headache

Dihydroergotamine inhibits the vasodepressor sensory CGRPergic outflow by prejunctional activation of α2-adrenoceptors and 5-HT1 receptors

PACAP in hypothalamic regulation of sleep and circadian rhythm: importance for headache

NR2B-Tyr phosphorylation regulates synaptic plasticity in central sensitization in a chronic migraine rat model

Polygenic risk score: use in migraine research