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. 2019 Mar 6;39(10):1867-1880.
doi: 10.1523/JNEUROSCI.2153-18.2018. Epub 2019 Jan 8.

Non-Trigeminal Nociceptive Innervation of the Posterior Dura: Implications to Occipital Headache

Rodrigo Noseda  1 , Agustin Melo-Carrillo  2 , Rony-Reuven Nir  2 , Andrew M Strassman  2 , Rami Burstein  2
Affiliations

Non-Trigeminal Nociceptive Innervation of the Posterior Dura: Implications to Occipital Headache

Rodrigo Noseda et al. J Neurosci. .

Abstract

Current understanding of the origin of occipital headache falls short of distinguishing between cause and effect. Most preclinical studies involving trigeminovascular neurons sample neurons that are responsive to stimulation of dural areas in the anterior 2/3 of the cranium and the periorbital skin. Hypothesizing that occipital headache may involve activation of meningeal nociceptors that innervate the posterior ⅓ of the dura, we sought to map the origin and course of meningeal nociceptors that innervate the posterior dura overlying the cerebellum. Using AAV-GFP tracing and single-unit recording techniques in male rats, we found that neurons in C2-C3 DRGs innervate the dura of the posterior fossa; that nearly half originate in DRG neurons containing CGRP and TRPV1; that nerve bundles traverse suboccipital muscles before entering the cranium through bony canals and large foramens; that central neurons receiving nociceptive information from the posterior dura are located in C2-C4 spinal cord and that their cutaneous and muscle receptive fields are found around the ears, occipital skin and neck muscles; and that administration of inflammatory mediators to their dural receptive field, sensitize their responses to stimulation of the posterior dura, peri-occipital skin and neck muscles. These findings lend rationale for the common practice of attempting to alleviate migraine headaches by targeting the greater and lesser occipital nerves with anesthetics. The findings also raise the possibility that such procedures may be more beneficial for alleviating occipital than non-occipital headaches and that occipital migraines may be associated more closely with cerebellar abnormalities than in non-occipital migraines.SIGNIFICANCE STATEMENT Occipital headaches are common in both migraine and non-migraine headaches. Historically, two distinct scenarios have been proposed for such headaches; the first suggests that the headaches are caused by spasm or tension of scalp, shoulders, and neck muscles inserted in the occipital region, whereas the second suggests that these headaches are initiated by activation of meningeal nociceptors. The current study shows that the posterior dura overlying the cerebellum is innervated by cervicovascular neurons in C2 DRG whose axons reach the posterior dura through multiple intracranial and extracranial pathways, and sensitization of central cervicovascular neurons from the posterior dura can result in hyper-responsiveness to stimulation of neck muscles. The findings suggest that the origin of occipital and frontal migraine may differ.

Keywords: DRG; cerebellum; cervical; dura; migraine; neck muscles.

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Figures

Figure 1.
Figure 1.
Anterograde tracing of C2 DRG peripheral axons to the posterior dura (extracranial component). A, Illustration of the rat's skull view from behind showing intra-ganglionar injection of rAAV-GFP viral vector into C2 DRG. B, Transversal view of a C2 DRG section showing GFP expression in successfully transduced cells (green, left), some of which were also immunoreactive to CGRP (red, middle). Superimposition of these images and DAPI (blue) is displayed at the right with white arrowheads indicating double-labeled cells (yellow). C, Cross-section of the whole neck at the level of C1 vertebra showing the distribution and trajectories of GFP-labeled nerves and fibers traveling along blood vessels (BV), fascia, and muscle from C2 DRG to the cranium. The image shows the left dorsolateral quadrant of the neck and was created by stitching 268 high-resolution images into a single composite. Numbers and frames indicate the areas where the images displayed at the right and bottom were taken. The only not-numbered image was taken from another cross-section of the neck in the same animal. D, Cervical nerves and bundles of fibers expressing GFP were observed crossing neck muscles, traveling along blood vessels and fascia before entering the cranium in the occipital region through (E) a canal between the occipital bone (occ) and the periotic capsule (pcap) (1), emissary canals near the occipital condyle (2), the hypoglossal canal (3), foramen magnum (fmag) (4), and jugular foramen (5). Interparietal bone (ipar), parietal bone (par). Scale bars, 100 μm.
Figure 2.
Figure 2.
Anterograde tracing of C2 DRG peripheral axons in the posterior dura (intracranial component). A, Flat mount of the dura overlying the cerebellum showing GFP-labeled axons from C2 DRG spreading within the dura immediately after entering the cranium. These GFP-labeled dural axons were immunoreactive to CGRP (red) as evidenced in the superimposition of images at the bottom, where white arrowheads indicate double labeling of these axons (yellow) in the DAPI (blue) counterstained dura. B, Representative examples of GFP-labeled axons spreading extensively within the posterior dura overlying the cerebellum (left), large intra-cranial blood vessels (right), and (C) the dura covering the upper cervical segments of the spinal cord. D, Reconstruction of the GFP-labeled axons shown in A–C. Inset, Illustration of the rat brain showing the region of interest. Scale bars, 100 μm.
Figure 3.
Figure 3.
Retrograde labeling in C2 DRG from the posterior dura. A, Illustration of the rat's skull view from behind showing the area of FG application (green) on the posterior dura. B, Transversal view of a C2 DRG section showing retrogradely-labeled neurons filled with FG near the anterior edge of the left ganglion. C, A proportion of FG-labeled neurons (green) in C2 DRG was also immunoreactive to CGRP, TRPV1, or IB4 (red). Images in the left column were created by superimposition of the images in the right column. Filled arrowheads point to FG-positive cells. Open arrowheads indicate double-labeled cells with FG and with each of the three markers of sensory neurons used (yellow). Scale bars, 100 μm.
Figure 4.
Figure 4.
Electrophysiological characterization of posterior dura-sensitive neurons in C2–C4 dorsal horn. A, Illustration of the rat's skull, exposed posterior dura, neck muscles, and skin showing the mapping of all RFs obtained from a single dura-sensitive neuron at baseline. B, Identification of C2–C4 neurons responding to electrical and mechanical stimulation of the posterior dura, neck muscle, and skin.
Figure 5.
Figure 5.
Schematic representation of C2 to C4 spinal cord segments showing the recording sites marked by electrolytic lesions made at the end of each experiment. Red dots represent recording sites where neurons displaying sensitized responses were found. An example of these lesions in C2 spinal cord segment is shown in the dark-field image at the right. Scale bar, 500 μm.
Figure 6.
Figure 6.
RFs and neuronal responses to mechanical stimulation of the posterior dura. A, Illustration of the rat's skull showing the area of exposition of the posterior dura (gray) and dural RFs of C2–C4 spinal cord dura-sensitive neurons measured during mechanical stimulation with VFH at baseline (dark blue) and 2 h after application of IS (light blue). B, C, Responses of individual neurons to mechanical stimulation of the posterior dura before (B) and after IS (C). Neurons were classified as sensitized (red) if their response magnitude increased by at least 50% after IS. Numbers in parenthesis represent firing rate in mean spikes/s during baseline (10 s) and stimulation (10 s). Shaded areas indicate the period of mechanical stimulation.
Figure 7.
Figure 7.
RFs and neuronal responses to mechanical stimulation of neck muscles. A, Illustration of superficial and deep group of neck muscles showing the most sensitive area (blue) to mechanical stimulation with VFH. B, C, Responses of individual neurons to mechanical stimulation of muscle RFs before (B) and after IS (C). Neurons were classified as sensitized (red) if their response magnitude increased by at least 50% after IS. Numbers in parenthesis represent firing rate in mean spikes/s during baseline (10 s) and stimulation (10 s). Shaded areas indicate the period of mechanical stimulation.
Figure 8.
Figure 8.
RFs and neuronal responses to innocuous and noxious mechanical stimulation of the skin. A, Illustration of the rat's head and neck showing the cutaneous RFs of C2–C4 spinal cord dura-sensitive neurons measured during mechanical stimulation at baseline (dark blue) and 2 h after application of IS (light blue). B, Responses of individual neurons to mechanical stimulation (brush, pressure, and pinch) of the skin before (left columns) and after IS (right columns). Neurons were classified as sensitized (red) if their response magnitude increased by at least 50% after IS. Numbers in parenthesis represent firing rate in mean spikes/s during baseline (10 s) and stimulation (10 s). Shaded areas indicate the period of mechanical stimulation.
Figure 9.
Figure 9.
Neuronal responses of sensitized neurons to mechanical stimulation of (A) the posterior dura, (B) neck muscle, and (C) skin (brush, pressure, and pinch) before (green) and 2 h after application of IS (red). Thick lines and shadowed areas represent mean and SE, respectively.
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