Neuroimaging of primary headaches

Mark Kruit, MD

Focus

In this theme, we aim to increase our knowledge of the mechanisms behind important headache disorders, such as migraine and cluster headache. Our research focuses on the one hand on changes in the human brain that may be considered as consequences of headache attacks. On the other hand, we focus on brain changes before, during and after headache attacks that may illustrate and relate to how, why and when headache attacks occur, or how structural brain changes might develop. For both directions of research, we evaluate short-term, but also long-term changes in function, perfusion, biochemical composition and anatomical structure of the brains of headache patients compared with subjects without headache. For these purposes we exploit the whole spectrum of available MRI techniques, and correlate our findings with results from other clinical, biochemical and functional tests. In this theme we closely collaborate with the Headache research group of the dept. of Neurology (projectleader: Prof.dr.M.D. Ferrari) and multiple other disciplines.

Study populations

Our initial work in this theme started in 1998 with the CAMERA-project, that was based on a large population-based epidemiological study (GEM study and MORGEN study; RIVM Bilthoven, NL), in which we were able to evaluate over 400 migraine patients and control subjects with interviews, physical and neurological examinations, MRI-scans of the brain, blood tests and cognitive function tests. We demonstrated that migraineurs are at increased risk of white matter lesions and cerebellar infarcts. This captured worldwide attention, and gave rise to a paradigm shift in the perception of migraine: from an episodic but essentially harmless disorder, into a potential progressive degenerative brain disorder.

To assess whether progression of brain lesions is related to the occurrence of headache attacks, or whether other factors may explain the occurrence of lesions, and to evaluate whether there are functional consequences of the lesions, we started to re-evaluate the CAMERA-cohort in 2008 with the same tests and MRI-scans, and extended the project with extensive cerebellar function tests and evaluation of presence of a cardiac right-to-left shunt.

In other projects in this research theme we evaluate(d) several groups of migraine patients and patients with cluster headache who were recruited from the Neurology outpatient clinic or who can be derived from the "LUMINA migraine database" from the LUMC Neurology department (www.lumc.nl/hoofdpijn; the first web-based tool to recruit migraine patients from the general population). In different studies we focus on patient groups of different disease severity, and evaluate different phases of the headache attacks, also by scanning both before, during and after attacks. Furthermore, we evaluate MRI and other data from participants from the PROSPER study, in whom migraine diagnoses are also available.

Collaborative networks

This research program is characterized by multidisciplinary collaborations. Besides a close collaboration within the LUMC Headache research group, the theme is embedded within the LUMC Neuroimaging Research Group, the C.J. Gorter Center for High Field MRI, the Leiden Institute for Brain and Cognition, the Laboratory for Clinical and Experimental Image Processing. Further, we closely collaborate with the Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging (NIH, Bethesda, USA), the dept. of Neurology of University of Toledo College of Medicine (Toledo, Ohio, USA), the Dutch National Institute of Public Health and the Environment (Bilthoven), the depts. of Radiology of the Slingeland Ziekenhuis and Academic Hospital Maastricht, the Neuroscience Institute (Erasmus MC, Rotterdam), the depts. of Clinical Neurophysiology of AZM and LUMC, and the dept. of Neurology of Radboud University Medical Center (Nijmegen).

Hoofdpijn Onderzoek