TY - JOUR
T1 - Regional cerebral blood flow as predictor of response to occipital nerve block in cluster headache
AU - Medina, Sonia
AU - Bakar, Norazah Abu
AU - O’Daly, Owen
AU - Miller, Sarah
AU - Makovac, Elena
AU - Renton, Tara
AU - Williams, Steve C.R.
AU - Matharu, Manjit
AU - Howard, Matthew A.
N1 - Funding Information:
The present study was funded by an In-Service Training Scholarship Scheme from the Government of His Majesty The Sultan and Yang Di-Pertuan of Brunei Darussalam. SM, MAH, OOD and SCW are supported by the NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Trust. SM, MAH, TFR and SCW are also supported by a Medical Research Council EMCG grant (MR/N026969/1).
Funding Information:
SM, MAH, OOD and SCW are supported by the NIHR Biomedical Research Centre for Mental Health at the South London and Maudsley NHS Trust. SM, MAH, TFR and SCW are also supported by a Medical Research Council EMCG grant (MR/N026969/1). We would like to thank The Government of Brunei for funding the present study. We would like to thank Dr. Jade Jackson, Dr. Francesca Puledda and Dr. Philip Holland for their valuable comments and suggestions.
Publisher Copyright:
© 2021, The Author(s).
PY - 2021/12
Y1 - 2021/12
N2 - Background: Cluster headache is an excruciating disorder with no cure. Greater occipital nerve blockades can transiently suppress attacks in approximately 50% of patients, however, its mechanism of action remains uncertain, and there are no reliable predictors of treatment response. To address this, we investigated the effect of occipital nerve blockade on regional cerebral blood flow (rCBF), an index of brain activity, and differences between treatment responders and non-responders. Finally, we compared baseline perfusion maps from patients to a matched group of healthy controls. Methods: 21 male, treatment-naive patients were recruited while in a cluster headache bout. During a pain-free phase between headaches, patients underwent pseudo-continuous arterial spin labelled MRI assessments to provide quantitative indices of rCBF. MRIs were performed prior to and 7-to-21 days following treatment. Patients also recorded the frequency of their headache attacks in a daily paper diary. Neuropsychological assessment including anxiety, depression and quality of life measures was performed in a first, scanning free session for each patient. Results: Following treatment, patients demonstrated relative rCBF reductions in posterior temporal gyrus, cerebellum and caudate, and rCBF increases in occipital cortex. Responders demonstrated relative rCBF increases, compared to non-responders, in medial prefrontal cortex and lateral occipital cortex at baseline, but relative reductions in cingulate and middle temporal cortices. rCBF was increased in patients compared to healthy controls in cerebellum and hippocampus, but reduced in orbitofrontal cortex, insula and middle temporal gyrus. Conclusions: We provide new mechanistic insights regarding the aetiology of cluster headache, the mechanisms of action of occipital nerve blockades and potential predictors of treatment response. Future investigation should determine whether observed effects are reproducible and extend to other headache disorders.
AB - Background: Cluster headache is an excruciating disorder with no cure. Greater occipital nerve blockades can transiently suppress attacks in approximately 50% of patients, however, its mechanism of action remains uncertain, and there are no reliable predictors of treatment response. To address this, we investigated the effect of occipital nerve blockade on regional cerebral blood flow (rCBF), an index of brain activity, and differences between treatment responders and non-responders. Finally, we compared baseline perfusion maps from patients to a matched group of healthy controls. Methods: 21 male, treatment-naive patients were recruited while in a cluster headache bout. During a pain-free phase between headaches, patients underwent pseudo-continuous arterial spin labelled MRI assessments to provide quantitative indices of rCBF. MRIs were performed prior to and 7-to-21 days following treatment. Patients also recorded the frequency of their headache attacks in a daily paper diary. Neuropsychological assessment including anxiety, depression and quality of life measures was performed in a first, scanning free session for each patient. Results: Following treatment, patients demonstrated relative rCBF reductions in posterior temporal gyrus, cerebellum and caudate, and rCBF increases in occipital cortex. Responders demonstrated relative rCBF increases, compared to non-responders, in medial prefrontal cortex and lateral occipital cortex at baseline, but relative reductions in cingulate and middle temporal cortices. rCBF was increased in patients compared to healthy controls in cerebellum and hippocampus, but reduced in orbitofrontal cortex, insula and middle temporal gyrus. Conclusions: We provide new mechanistic insights regarding the aetiology of cluster headache, the mechanisms of action of occipital nerve blockades and potential predictors of treatment response. Future investigation should determine whether observed effects are reproducible and extend to other headache disorders.
KW - Arterial spin Labelling
KW - Cluster headache
KW - Greater occipital nerve block
KW - Regional cerebral blood flow
KW - Trigeminal cephalgia
UR - http://www.scopus.com/inward/record.url?scp=85112350359&partnerID=8YFLogxK
U2 - 10.1186/s10194-021-01304-9
DO - 10.1186/s10194-021-01304-9
M3 - Article
C2 - 34384347
AN - SCOPUS:85112350359
SN - 1129-2369
VL - 22
JO - Journal of Headache and Pain
JF - Journal of Headache and Pain
IS - 1
M1 - 91
ER -