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Review
. 2019 Nov;39(13):1710-1719.
doi: 10.1177/0333102419867280. Epub 2019 Aug 29.

Hypothalamic regulation of headache and migraine

Arne May  1 , Rami Burstein  2
Affiliations
Review

Hypothalamic regulation of headache and migraine

Arne May et al. Cephalalgia. 2019 Nov.

Abstract

Background: The clinical picture, but also neuroimaging findings, suggested the brainstem and midbrain structures as possible driving or generating structures in migraine.

Findings: This has been intensely discussed in the last decades and the advent of modern imaging studies refined the involvement of rostral parts of the pons in acute migraine attacks, but more importantly suggested a predominant role of the hypothalamus and alterations in hypothalamic functional connectivity shortly before the beginning of migraine headaches. This was shown in the NO-triggered and also in the preictal stage of native human migraine attacks. Another headache type that is clinically even more suggestive of hypothalamic involvement is cluster headache, and indeed a structure in close proximity to the hypothalamus has been identified to play a crucial role in attack generation.

Conclusion: It is very likely that spontaneous oscillations of complex networks involving the hypothalamus, brainstem, and dopaminergic networks lead to changes in susceptibility thresholds that ultimately start but also terminate headache attacks. We will review clinical and neuroscience evidence that puts the hypothalamus in the center of scientific attention when attack generation is discussed.

Keywords: Migraine; attack; brainstem; hypothalamus; network.

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Conflict of interest statement

Declaration of conflicting interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Prominent anatomical connections of the hypothalamus (here in orange) with other brain areas. While an important function of the hypothalamus is to link the central nervous system to the endocrine system via the pituitary gland, it also has pivotal modulatory functions on the sympathetic and parasympathetic system (not pictured) and modulates most hormonal and other rhythms of the body. Th: thalamus; Cingulate: cingulate cortex; Insula: insular cortex; PAG: periaquadal gray; TCC: trigeminocervical complex.
See this image and copyright information in PMC

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