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01.02.2019 | Original Article

Withdrawal from acute medication normalises short-term cortical synaptic potentiation in medication overuse headache

verfasst von: Francesca Cortese, Francesco Pierelli, Flavia Pauri, Cherubino Di Lorenzo, Chiara Lepre, Giulia Malavolta, Chiara Merluzzo, Vincenzo Parisi, Anna Ambrosini, Mariano Serrao, Gianluca Coppola

Erschienen in: Neurological Sciences | Ausgabe 5/2019

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Abstract

Objectives

To study the effects of a standard acute medication withdrawal program on short-term cortical plasticity mechanisms in patients with medication overuse headache (MOH).

Methods

Thirteen patients with MOH and 16 healthy volunteers underwent repetitive transcranial magnetic stimulation (rTMS) over the left motor cortex; in patients with MOH, recordings were performed before and after a 3-week medication withdrawal program. Ten trains of 10 stimuli each (120% resting motor threshold) were delivered at 1 Hz or 5 Hz in two separate sessions in a randomised order. Motor evoked potential (MEP) amplitudes were measured from the right first dorsal interosseous muscle and the slope of the linear regression line from the first to the tenth stimuli was calculated for each participant.

Results

All subjects exhibited MEP amplitude inhibition in response to 1 Hz rTMS. Alternatively, the 5-Hz trains of rTMS inhibited rather than potentiated MEP amplitudes in patients with MOH. The physiological potentiating effect of 5 Hz rTMS on MEP amplitudes was restored after drug withdrawal and in proportion with the percentage reduction in monthly headache days in patients with MOH.

Conclusions

The results suggest that acute medication withdrawal normalises brain responses in patients with MOH. Clinical improvements after medication withdrawal may reflect the reversal of neurophysiological dysfunction. Accordingly, medication withdrawal should be offered to patients with MOH as early as possible in order to prevent the development of more pronounced alterations in brain plasticity.

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Titel: Withdrawal from acute medication normalises short-term cortical synaptic potentiation in medication overuse headache
verfasst von: Francesca Cortese
Francesco Pierelli
Flavia Pauri
Cherubino Di Lorenzo
Chiara Lepre
Giulia Malavolta
Chiara Merluzzo
Vincenzo Parisi
Anna Ambrosini
Mariano Serrao
Gianluca Coppola
Publikationsdatum: 01.02.2019
Verlag: Springer International Publishing
Erschienen in: Neurological Sciences / Ausgabe 5/2019
Print ISSN: 1590-1874
Elektronische ISSN: 1590-3478
DOI: https://doi.org/10.1007/s10072-019-03735-4

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Withdrawal from acute medication normalises short-term cortical synaptic potentiation in medication overuse headache

Abstract

Objectives

Methods

Results

Conclusions

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Abstract

Objectives

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