The trigeminal nerve plays a crucial role in the pathogenesis of primary headache disorders, such as migraine and cluster headache. The peripheral aspect of the trigeminal nerve distributes in 3 branches that innervate U-shaped dermatomes in the face. These branches enter the brainstem in somatotopic order: fibres from the ophthalmic branch (V1) enter the brainstem ventrally, fibres from the mandibular branch (V3) enter dorsally, and fibres from the maxillary branch (V2) enter between V1 and V2.
Besides these peripheral dermatomes, animal studies suggest an alternative dermatome in the central presentation of the spinal trigeminal nucleus [2]. Here, there is a so-called âonion-shaped patternâ with fibres of the perioral regions represented more rostrally and those of the periauricular regions more caudally. Dr Lisa-Marie Sturm (University Clinic Hamburg Eppendorf, Germany) and colleagues investigated the somatotopic organisation of the trigeminal nerve within the brainstem in humans (NTC03999060) [1].
A 3-Tesla functional MRI study was conducted in 26 healthy volunteers. In total, 4 areas on the left hemiface were targeted using nociceptive electrical stimulation. Stimulated areas were chosen based on their representation within the brainstem, aimed to ensure adequate spatial resolution between the areas in the spinal trigeminal nucleus. A distinct blood-oxygen-level-dependent (BOLD) signal was found in the spinal trigeminal nucleus for each stimulus site on the face.
âThere is a certain somatotopy of trigeminal afferent fibres in the spinal trigeminal nucleus,â Dr Sturm concluded. âThe current assumption for an onion-ring model for nociceptive input of the trigeminal nerve is presumably also present in humans.â
- Sturm ML. Trigeminal nerve: functional brainstem somatotopy during nociception. AL061, IHC 2021, 8â12 September.
- Pfaller K, Arvidsson J. J Comp Neurol. 1988;268(1):91â108.
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Table of Contents: IHC 2021
Featured articles
Letter from the Editor
COVID-19
Telemedicine beneficial for headache care during the pandemic
Comparison of headaches after SARS-CoV-2 vaccination
Grey matter cortical changes in patients with persistent headache after COVID-19
Increased risk of cerebral venous thrombosis in COVID-19
Patient Perception and Symptoms
Predictors of health-related quality of life in cluster headache
Dry eye disease is more prevalent in migraine
Voice change and throat swelling are cranial autonomic symptoms in primary headache
Association between physical inactivity and headache disorders
Increased suicidal attempts and risks of ideation in medication-overuse headache
Cardioembolic Comorbidities
AI-enabled ECG algorithm predicts atrial fibrillation risk in migraine
Migraine may not be a risk factor for stroke
Imaging
Functional brainstem somatotopy of the trigeminal nerve during nociception
Morphological changes in cluster headache between attacks
Interictal pontine metabolism in migraine patients without aura
Genome-Wide Association Studies
Largest genome-wide association study of migraine to date
Robust evidence that cluster headache has a genetic basis
Pharmacological Treatment
Insights in drug-drug interactions facilitate rational polypharmacy
Rimegepant confers long-term improvements in MMDs
First real-world effectiveness data of erenumab is promising
Galcanezumab effective in patients with episodic or chronic cluster headache
Central effects and affected somatosensory processing with galcanezumab in migraine
Long-term safety and tolerability of atogepant in migraine
Non-Pharmacological Treatment
Occipital nerve stimulation effective and safe in chronic cluster headache
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