Elsevier

Neurologic Clinics

Volume 15, Issue 1, 1 February 1997, Pages 85-105
Neurologic Clinics

CLINICAL NEUROPHYSIOLOGY OF HEADACHE

https://doi.org/10.1016/S0733-8619(05)70296-6Get rights and content

Most chronic headaches are so-called functional disorders without a structural lesion. In theory, neurophysiologic methods could be useful adjuncts to the evaluation of such disorders, as they are able to explore functional aspects. In practice, they have been (and still are) used widely in headache patients, but their pathophysiologic contribution far outweighs their diagnostic usefulness.

This article does not review all neurophysiologic studies performed in headache patients in detail but rather synthesizes the major reproducible findings and examines their potential interest. To avoid tedious enumerations, many of the published available data are summarized in tables in which the reader can find relevant references.

This article subdivides the neurophysiologic methods into three major groups: (1) electroencephalography (EEG), (2) evoked potentials, and (3) electromyography (EMG). EEG and evoked potentials are of interest chiefly in migraine, whereas EMG is relevant to tension-type headache.

Section snippets

ELECTROENCEPHALOGRAPHY

EEG is traditionally considered to be a useful adjunct to the clinical evaluation of headache, but, unfortunately, there is little scientific backing for this tradition. Few articles describe EEG findings that meet the criteria generally accepted for determining the clinical usefulness of a diagnostic test.39 Comprehensive reviews of EEG findings in migraine have been published by Hockaday and Debney45 and by Sand.93 In subjects with migraine, an incidence of EEG abnormalities as high as 70%

EVOKED POTENTIALS

Following the seminal observation by Golla and Winter37 of increased photic driving in the EEG of patients with migraine, the reactivity of electrocortical activity to visual stimuli has been assessed with a number of different techniques. Moreover, event-related potentials have yielded interesting results in relation to the biobehavioral aspects of migraine.

ELECTROMYOGRAPHY

Although EEG and evoked potentials have disclosed interesting pathophysiologic abnormalities in migraine, they are normal in tension-type headache (TH).100 By contrast, EMG has been studied extensively in TH in particular at a time when this headache type was thought to be due to an exaggerated contraction of pericranial muscles and thus called muscle contraction headache. More recently, attention has been paid to inhibitory reflexes of jaw-closing muscles, to other facial reflexes, and to limb

CONCLUSIONS

Methods of clinical neurophysiology are of little use for the diagnosis of headache disorders. They are, however, invaluable tools for a better understanding of the pathophysiology of so-called functional headaches. They are, indeed, atraumatic; able to explore simple or more complex neural activities; and, to some extent, capable of reflecting activity in certain neurotransmitter systems as well as the action of pharmacologic agents of the CNS. Because neurophysiologic methods are only

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    Address reprint requests to Jean Schoenen, Department of Neurology, University of Liége, CHR Citadelle, B-4000 Liége, Belgium

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    From the Department of Neurology, University of Lièege, Liège, Belgium

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