RES E A R C H Open Access
Volumetric abnormalities of thalamic
subnuclei in medication-overuse headache
, Zhihua Jia
, Xiaoyan Chen
, Mengqi Liu
, Shuangfeng Liu
, Lin Ma
and Shengyuan Yu
Background: The thalamus exerts a pivotal role in pain processing and cortical excitability control and a previous
voxel-based morphometry study confirmed increased volume in bilateral thalamus in medication-overuse headache
(MOH). The aim of this study is to investigate altered thalamic subnuclei volume in MOH compared with normal
controls, and to evaluate the relationship of each thalamic subnuclei volume with the clinical variables.
Methods: High resolution three-dimensional T1-weighted fast spoiled gradient recalled echo MR images were
obtained from 27 patients with MOH and 27 normal controls (NC). Thalamic subnuclei templates were created
based on Talairach template with MNI space transformation, and the individual thalamic subnuclei templates were
generated by applying the deformation field from structural image segment to the thalamic subnuclei templates,
and then individual thalamci subnuclei volume were calculated.
Results: The whole thalamus and each thalamic subnuclei presented increased volume compared with NC (P <0.05).
The correlation analysis demonstrated that the whole thalamus volume and each thalamic subnuclei volume showed a
negative relationship with HAMD scores(P < 0.05), and no any correlation with HAMA, VAS score and disease duration
Conclusion: Increased gray matter volume in the whole thalamus and all the thalamus subnuclei may reflect central
sensitization and higher-order of pain alteration in MOH. These structural changes in the thalamus may also be
influenced by mood disturbances related to the MOH.
Keywords: Medication-overuse headache, Migraine, Thalamus, Magnetic resonance imaging
Medication-overuse headache (MOH) was defined as a
headache occurring on 15 or more days per month de-
veloping as a consequence of regular overuse of acute or
symptomatic headache medication for more than
3 months  . MOH has a prevalence of 0.6–2.0% in the
general population [2, 3], and was associated with mood
disorders in 27–85% and anxiety disorders in 61–83%.
MOH patients experience reduced quality of life com-
pared with those who do not suffer from headaches .
A pre-existing headache disorder seems to be required
to develop MOH . It is well known that previous
primary headaches such as migraine are the most
important risk factors for the development of MOH,
50%–70% MOH have co-occurrence of migraine in
population-based studies [6, 7]. Many psychosocial and
socioeconomic factors which are prevailed in patients
with chronic forms of headache are also associated with
MOH. However, the mechanism behind how chronic ex-
posure to abortive medication leads to MOH remains
unclear. Alteration of cortical neuronal excitability, cen-
tral sensitization involving the trigeminal nociceptive
system have been suggested to play a part in the patho-
physiology of MOH .
The thalamus contains third-order trigeminovascular
nociceptive neurons and exerts a pivotal role in pain
processing and cortical excitability control [9, 10].
Microstructural and functional alterations of the thal-
amus have been found in migraine patients [11, 12]. Sig-
nificant volume reductions of the following thalamic
* Correspondence: firstname.lastname@example.org; email@example.com
Zhiye Chen and Zhihua Jia contributed equally to this work.
Lin Ma and Shengyuan Yu contributed equally to this work.
Department of Radiology, Chinese PLA General Hospital, 28 Fuxing Road,
Beijing 100853, China
Department of Neurology, Chinese PLA General Hospital, 28 Fuxing Road,
Beijing 100853, China
Full list of author information is available at the end of the article
The Journal of Headache
© The Author(s). 2017 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0
International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and
reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to
the Creative Commons license, and indicate if changes were made.
Chen et al. The Journal of Headache and Pain (2017) 18:82