Neuroimaging Studies of Secondary Headaches
摘要
The main objective of this chapter is to summarize recent brain structural and functional neuroimaging findings in individuals with post-traumatic headache (PTH) following mild traumatic brain injury (mTBI) to better understand the neuropathological mechanisms that may contribute to headache persistence and recovery. In addition, neuroimaging findings in headache attributed to intracranial vascular or nonvascular disorder and infection were discussed. Longitudinal and cross-sectional research imaging articles were selected based on their relevance to PTH recovery and persistence. Imaging studies in individuals with persistent PTH following mTBI have identified regions of structural change and alterations in brain function. Brain regions involved in cognitive control and pain modulation appear particularly involved in persistent PTH. Some studies have identified associations between regional brain alterations and increased headache severity, but there is also evidence that alterations in structure and function can normalize as individuals recover from PTH. Neuroimaging can also be utilized to diagnose secondary headaches caused by cranial and vascular disorders and nonvascular disorders such as intracranial hypertension, hypotension, infection, and tumors. Imaging techniques, such as computerized tomography, digital subtraction angiography, and magnetic resonance imaging, help identify structural, vascular, and functional changes in cortical hypodensity, gray matter volume, and functional connectivity. Although the field of neuroimaging research in PTH continues to evolve, there is some early evidence to suggest longitudinal brain structural changes and abnormal functional connectivity in those with PTH persistence reflecting neural disruption. Conversely, the normalization of these changes in those with headache recovery suggests potential neural plasticity. However, more research is needed to establish predictive biomarkers of PTH persistence and to standardize neuroimaging modalities in practice. Neuroimaging’s wide applications for identifying headaches emphasize the need to understand the etiology of secondary headaches to tailor diagnoses and management.