Neuroimaging
Sarah McWilliams in Practical Radiological Anatomy, 2011
Fig. 1.12 (a) Axial T2-weighted images through the brain showing the flocculus of the cerebellum (1). Meckel's cave is seen on either side of the petrous bone as a high-signal CSF-containing space. The trigeminal ganglion lies within this (2). Signal voids from the basilar artery and the carotid arteries are seen (3). (4) Nerves VII and VIII are seen entering the internal auditory canal. (5) The anterior inferior cerebellar artery is seen winding around the cerebellopontine angle. (b) A slightly higher section of the brain stem, again showing the pons. The basilar artery is seen as a signal void within the prepontine cistern. Nerves V are seen (17) originating from the pons, running anteriorly. The cerebella vermis (6) is marked posteriorly: globe (7), optic nerves (8), medial rectus (9), lateral rectus (10), temporal lobe (11), cerebellum (12) and petrous bone (13). (c) An axial T2-weighted image showing the nerves V (17) bilaterally as they originate from the anterior aspect of the pons: fourth ventricle (14), cerebella vermis (15) and serpiginous superior ophthal-mic vein (16).
Headache
Peter R Wilson, Paul J Watson, Jennifer A Haythornthwaite, Troels S Jensen in Clinical Pain Management, 2008
Activation of the trigeminal ganglion and the trigeminal nucleus by neurogenic inflammation has been intensively studied in animal models34, 35 and may be involved in the migraine attack leading to the concept of migraine being a trigeminovascular disease. Whether the activation of the trigeminal system is primary or secondary to the migraine pain is yet unknown, but these models have also been very useful for the study of pain-producing mechanisms and for the screening procedure of possible therapeutic agents. Calcitonin gene-related peptide (CGRP) in the external jugular venous blood was increased in one study,36 but in a recent, controlled study37 no such increase was found. However, CGRP infusion induces headache in migraine patients38 and a CGRP antagonist BIBN4096BS has been shown to be effective in the treatment of migraine attacks.39
Myofascial Pain Syndrome
Gary W. Jay in Chronic Pain, 2007
The patient, a 39-year-old right-handed female, was seen two-and-a-half years after she developed headache and facial pain. The facial pain had been initially diagnosed as trigeminal neuralgia, and a Janetta procedure was performed (a neurosurgical procedure where titanium was placed between the trigeminal ganglion ipsilateral to the pain and an artery that may have been lying on the ganglia, inducing the trigeminal neuralgia). This did not help the facial pain, or the headache. A second surgery was performed a week later to repair a CSF (cerebral spinal fluid) leak. Several months later, a Gamma Knife procedure was performed [using radiation to stop, in this case, the semilunar (trigeminal) ganglion from functioning]. This induced facial dysesthesias or painful numbness in all three divisions of the ipsilateral (same side) trigeminal nerve. Months later, the patient was seen at one of the country’s better known medical centers. There, another surgery was performed to stop another CSF leak. The patient was diagnosed with hemicrania continua, a relatively rare form of headache that is exquisitely sensitive to indomethacin. However, the indomethacin did not help at all; so almost a dozen more medications were tried, none of which was helpful.
Prepontine cisternal routine for intrathecal targeted drug delivery in craniofacial cancer pain treatment: technical note
Published in Drug Delivery, 2022
Haocheng Zhou, Dong Huang, Dingquan Zou, Junjiao Hu, Xinning Li, Yaping Wang
The prepontine cistern is one subarachnoid space located dorsally to the clivus and ventrally to the pons. The prepontine cistern contains two cranial nerves, that is the fifth cranial nerve (trigeminal nerve) and the sixth cranial nerve (abducens nerve). The abducens nerve has been considered to transverse the anterior pontine membrane rather than through the prepontine cistern (Matsuno et al., 1988). The trigeminal nerve leaves the mid-pons anteriorly and then courses across the space of prepontine cistern. Subsequently, the fifth cranial nerve courses through the porus trigeminus and enters the Meckel cave, which forms the trigeminal or Gasserian ganglion. The trigeminal ganglion then separates into ophthalmic, maxillary and mandibular branches, which mainly governs the sensory perception in the region of face and head.
Calcitonin gene-related peptide (CGRP): role in migraine pathophysiology and therapeutic targeting
Published in Expert Opinion on Therapeutic Targets, 2020
Anne-Sophie Wattiez, Levi P. Sowers, Andrew F. Russo
Within the CNS, CGRP and its receptor are present in multiple pathways believed to play a role in migraine pathophysiology [8]. The trigeminal ganglion (located outside of the BBB) projects to the trigeminal nucleus caudalis (TNC) where second-order neurons carry the signals to the posterior thalamic area (PTA). We use PTA as a term to encompass all nuclei in the posterior thalamic area. The PTA appears to be a sensory integration center that is abnormal during migraine. Neurons in the thalamus receive input from the TNC and retinal ganglion cells [36], and several key studies have demonstrated in rodents the importance of the PTA in the development of photophobia and highlight the PTA as a possible center for the integration of light and pain [36–38]. CGRP likely contributes to this pathway as both CGRP and its receptors are present in discrete nuclei of the PTA. This is further supported by a study showing that injection of CGRP into the PTA facilitates neuronal firing [38]. Moreover, somatosensory and nociceptive stimuli from ascending pathways converge on the CGRP-producing neurons of the subparafasicular and intralaminar nuclei [39]. In humans, the posterior thalamus is known to be activated during migraine attacks and has altered functional connectivity with multiple brain regions [40,41]. Taken together, these data suggest that pre- and post-synaptic neuromodulatory actions of CGRP that have been reported in other neural circuits [42], could contribute to a state where the PTA is hypersensitive to sensory stimuli.
The first-line cluster headache medication verapamil alters the circadian period and elicits sex-specific sleep changes in mice
Published in Chronobiology International, 2021
Mark J. Burish, Chorong Han, Kazuaki Mawatari, Marvin Wirianto, Eunju Kim, Kaori Ono, Randika Parakramaweera, Zheng Chen, Seung-Hee Yoo
The hypothalamus and cerebellum are central nervous system structures known to have pronounced circadian oscillations and may be important structures in the pathophysiology of cluster headache (Arkink et al. 2017; Clelland et al. 2014; May et al. 1998; Naegel et al. 2014; Teepker et al. 2012; Yang et al. 2015). The trigeminal ganglion is an important peripheral nervous system structure for cluster headache pain (Jarrar et al. 2003; May et al. 2018; McGeeney 2018), though its circadian oscillations are not well studied. To examine whether verapamil treatment can affect the expression of clock genes in these areas, we measured mRNA expression levels of 10 core clock genes collected at ZT6 and ZT18 from verapamil-treated and control mice (Figure 5). Verapamil altered circadian expression of Clock, Bmal1, Per1, Rev-erbα, and Dbp at ZT6 significantly in the cerebellum from verapamil-treated mice compared to control mice. In the hypothalamus, verapamil altered expression of Bmal1, Per1, and Cry2 at both time points, changed expression of Per2 and Per3 at ZT6, and changed Cry1 expression at ZT18. Furthermore, in the trigeminal ganglion, we found altered mRNA expression of Per3 at both time points, altered mRNA expression of Bmal1 and Per2 at ZT6, and altered mRNA expression of Cry1 at ZT18. Taken together, these results show that verapamil can alter circadian clock gene expression in brain regions and in the trigeminal ganglion. Interestingly, Bmal1 mRNA expression was consistently downregulated by verapamil at ZT6 in all tissues as compared to control.
Related Knowledge Centers
- Cerebrospinal Fluid
- Internal Carotid Plexus
- Mandibular Nerve
- Maxillary Nerve
- Ophthalmic Nerve
- Petrous Part of The Temporal Bone
- Pons
- Trigeminal Nerve
- Dura Mater
- Trigeminal Cave
- Petrous Part of The Temporal Bone