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NEUROLOGY 2009;73:978-983
© 2009 American Academy of Neurology

Gray matter changes related to chronic posttraumatic headache

M. Obermann, MD, K. Nebel, PhD, C. Schumann, D. Holle, MD, E. R. Gizewski, MD, M. Maschke, MD, P. J. Goadsby, MD, H. -C. Diener, MD and Z. Katsarava, MD

From the Departments of Neurology (M.O., K.N., C.S., D.H., M.M., H.-C.D., Z.K.) and Neuroradiology (E.R.G.), University of Duisburg-Essen; Department of Neurology and Neurophysiology (M.M.), Bruederkrankenhaus Trier, Germany; and Department of Neurology (P.J.G.), University of California, San Francisco.

Address correspondence and reprint requests to Dr. Mark Obermann, Department of Neurology, University of Duisburg-Essen, Hufelandstr. 55, 45122 Essen, Germany mark.obermann{at}uni-due.de

Background: Although up to 15% of patients with whiplash injury develop chronic headache, the basis and mechanisms of this posttraumatic headache are not well understood.

Methods: Thirty-two patients with posttraumatic headache following whiplash injury were investigated within 14 days after the accident and again after 3 months using magnetic resonance–based voxel-based morphometry. Twelve patients developed chronic headache lasting longer than 3 months and were studied a third time after 1 year.

Results: Patients who developed chronic headache revealed decreases in gray matter in the anterior cingulate and dorsolateral prefrontal cortex after 3 months. These changes resolved after 1 year, in parallel to the cessation of headache. The same patients who developed chronic headache showed an increase of gray matter in antinociceptive brainstem centers, thalamus, and cerebellum 1 year after the accident.

Conclusion: We demonstrate adaptive gray matter changes of pain processing structures in patients with chronic posttraumatic headache in regard to neuronal plasticity, thus providing a biologically plausible basis for this common, disabling problem.

Abbreviations: ANOVA = analysis of variance; DLPFC = dorsolateral prefrontal cortex bilaterally; FWE = family-wise error correction; HAM = Hamilton Depression Rating Scale; NDI = Neck-Disability-Index; PAG = periaqueductal gray; TE = echo time; TR = repetition time; TI = inversion time; VRS = verbal rating scale.

Supported by the German Federal Ministry of Education and Research [Grant BMBF 01EM 0513 to Drs. Obermann and Nebel].

Disclosure: Author disclosures are provided at the end of the article.

Received December 20, 2008. Accepted in final form July 6, 2009.






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