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Chapter 015. Headache (Part 6)

Positron emission tomography (PET) activation in migraine. In spontaneous attacks of episodic migraine (A) there is activation of the region of the dorsolateral pons (intersection of dark blue lines); an identical pattern is found in chronic migraine (not shown). This area, which includes the noradrenergic locus coeruleus, is fundamental to the expression of migraine. Moreover, lateralization of changes in this region of the brainstem correlates with lateralization of the head pain in hemicranial migraine; the scans shown in panels B and C are of patients with acute migraine headache on the right and left side, respectively. (From S Afridi et. | Chapter 015. Headache Part 6 Positron emission tomography PET activation in migraine. In spontaneous attacks of episodic migraine A there is activation of the region of the dorsolateral pons intersection of dark blue lines an identical pattern is found in chronic migraine not shown . This area which includes the noradrenergic locus coeruleus is fundamental to the expression of migraine. Moreover lateralization of changes in this region of the brainstem correlates with lateralization of the head pain in hemicranial migraine the scans shown in panels B and C are of patients with acute migraine headache on the right and left side respectively. From S Afridi et al Arch Neurol 62 1270 2005 Brain 128 932 2005. Figure 15-3 Sow Fauci . s. Kisp r DL t-raunwald t. Hvurar ỈL. Loo-Oi ÖL Jamason JL. LoscalioJi WfFW fñrttpjtajf- Ç-J 17th E44 Onj 4dÿ Î tÇ4t lWldJ nt 1J __ Copyright Tha Mc 3rawrMil Companc . Inc a ï HijWs raïariiid. Ö Sourc Fauci - s. Kispar DL lỉ-raunvald t. HflUTttr ỈL. Lofifl DL . Jama son LoscalioJi WfFW Ânrỉii í- Ç-J 17th E44 nj h5tp 1l w iR . - t T i m er icir .ç nrk Copyright The Md3rawrMill CompañíaL Inc All HijWs raĩỂíiíid. Posterior hypothalamic gray matter activationon positron emission tomography PET in a patient with acute cluster headache. Posterior hypothalamic gray matter activation on positron emission tomography PET in a patient with acute cluster headache A . From A May et al Lancet 352 275 1998. High-resolution T1 weighted MRI obtained using voxel-based morphometry demonstrates increased gray matter activity lateralized to the side of pain in a patient with cluster headache B . From A May et al Nat Med 5 836 1999. Diagnosis and Clinical Features Diagnostic criteria for migraine headache are listed in Table 15-4. A high index of suspicion is required to diagnose migraine the migraine aura consisting of visual disturbances with flashing lights or zigzag lines moving across the visual field or of other neurologic symptoms is reported in only 20-25