Neurosensory Assessments of Headache

头痛的神经感觉评估

• 批准号: 8970065
• 负责人: Mark A Tommerdahl
• 金额: $ 22.35万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-08-15 至 2017-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8970065
• 关键词: Aftercare; Anxiety; Area; Basic Science; Biological; Biopsy; Blood Tests; Brain; Brain Concussion; Cerebrum; Clinical Research; Computer Peripherals; Computers; Data; Dependence; Devices; Diagnosis; Diagnostic; Discrimination; Disease; Evaluation; Feedback; Fingers; Floor; Future; Goals; Headache; Headache Disorders; Health; Health system; Image; Individual; Intervention; Investigation; Lead; Longitudinal Studies; Measurement; Measures; Mediating; Medicine; Mental Depression; Methodology; Methods; Migraine; Monitor; Mus; Neuraxis; Neurological status; Pain; Pain Threshold; Pain-Free; Pathology; Patient Self-Report; Patients; Performance; Physicians; Probability; Process; Protocols documentation; Publishing; Recovery; Reporting; Research; Running; Sensory; Site; Skin; Subgroup; Symptoms; Syndrome; System; Tactile; Technology; Testing; Therapeutic; Time; Trauma; Treatment Efficacy; Treatment outcome; Visit; Work; base; burden of illness; clinically significant; cost; design; diaries; disability; effective therapy; experience; human subject; improved; in vivo; indexing; information processing; innovation; laptop; meetings; nerve supply; nonhuman primate; novel; patient population; response; tool; treatment planning; treatment strategy; vibration

 DESCRIPTION (provided by applicant): Headache medicine depends upon subjective reports of pain. For primary headache disorders such as migraine, no blood test, imaging, or other objective means accurately assesses either the burden of illness or its time course. This dependence on subjectivity persists from diagnosis, through evaluation of treatment efficacy, to determination of disability. Many patients with longstanding migraine underreport symptoms, explaining that they have a high pain tolerance or have simply become accustomed to their headaches. Others may exaggerate symptoms due to anxiety, pain catastrophizing, depression, or secondary gain issues. An objective, quantitative biological measurement of migraine would greatly improve diagnosis and treatment. Ideally, repeat testing would track changes in headache pain and/or chronification. This problem motivated us to develop an objective, quantitative, non-invasive method to assess changes in CNS information processing that occur with the type of systemic cortical alterations that have been suggested to occur with migraine sufferers. This system, which delivers tactile (skin) stimulation to the fingertips, takes advantag of dense innervation in the fingertips projecting to adjacent areas in the brain. Sensory percepts are highly influenced by interactions between these adjacent brain areas and effectively provide a non-invasive biopsy of brain function. The stimulation protocols were both designed and validated from our findings from in vivo studies of cerebral cortical dynamics in non-human primates. Thus, they provide cortical dynamic metrics, or cortical metrics- and while independently obtained cortical metrics are predominantly influenced by specific cortical mechanisms, combining the metrics generates an individual CNS profile that can be used to characterize an individual's neurological status.. Proof of concept, with pilot data, has been obtained for differentiating migraineurs from healthy subjects as well as individuals with concussion. This application proposes to not only fully validate that difference but to determine i there is a correlation between a subject's migraine related self-reported pain and their CNS profile. An additional innovative feature of this application is that it proposes to (1) determine subject's CNS profile before their initial physician visit, (2) track the response of the patient t the intervention prescribed by the clinician and (3) retrospectively determine the capacity of the initial CNS profile to predict treatment outcomes. RELEVANCE: The overall goal of the proposed work is to investigate the utility of novel sensory-based methodologies that are currently being used in both basic and clinical research to track recovery in headache patients post- treatment. Recently, utilizing state-of-the-art technology, we built a multi-site tactile stimulator that allows for investigation of central nervos system (CNS) health and advanced methods in sensory perceptual metrics. These metrics have been demonstrated to be sensitive to changes in centrally mediated mechanisms; and systemic alterations of cortical health (via neurodegenerational, neurodevelopmental, pharmacological or trauma induced changes) robustly change the measures. It is anticipated that clinicians will be able to utilize these measures to improve diagnostic performance and enable assessment of efficacy of treatment. The study itself will serve to validate the utility of a number of these measures in headache and eventually provide health workers with a means to detect when an individual is under-reporting or over-reporting pain symptoms, and to track the recovery of an individual from headache. Better methods for measuring the progression of headache and response to treatment could lead to better diagnostics and therapeutics. Additionally, the information from this study could aid in understanding centrally mediated mechanisms that undergo significant alterations with headache.

 描述（适用提供）：头痛药物取决于主观的疼痛报告。对于偏头痛等主要的头部疾病，没有血液检查，成像或其他客观手段来准确评估疾病的燃烧或其时间病程。这种对主观性的依赖性持续到诊断，通过评估治疗效率，确定残疾。许多长期偏头痛症状的患者说，他们的疼痛耐受性很高，或者只是习惯了其头部。其他人可能由于焦虑，疼痛灾难性，抑郁或继发性收益问题而夸大症状。偏头痛的客观，定量的生物学测量将大大改善诊断和治疗。理想情况下，重复测试将跟踪头痛疼痛和/或编年期的变化。这个问题促使我们开发了一种客观，定量的，非侵入性的方法，以评估CNS信息处理的变化，这些变化是随着偏头痛患者的系统性皮质改变的类型而发生的。该系统将触觉（皮肤）刺激的触点传递给了指尖，它利用了投射到大脑相邻区域的指尖神经支配。感觉知觉受这些相邻大脑区域之间相互作用的高度影响，并有效地提供了对脑功能的无创活检。刺激方案既是根据非人类隐私中脑皮质动力学的体内研究研究结果设计和验证的。它们提供皮质动态指标或皮质指标，而独立获得的皮质指标主要受到特定皮质机制的影响，但组合度量产生单个CNS概况，可用于表征个体的神经系统状态。该应用程序的建议不仅要充分验证这种差异，还要确定I与受试者相关的自我报告的疼痛与其中枢神经系统概况之间存在相关性。该应用程序的另一个创新特征是，它提出了（1）在初次造成的物理访问之前确定受试者的CNS概况，（2）跟踪患者的反应t临床规定的干预措施，（3）追溯确定初始CNS概况的能力，以预测治疗结果。 相关性：拟议工作的总体目标是研究基于新型的基于感觉的方法的实用性，这些方法目前正在基础和临床研究中使用，以跟踪治疗后标头患者的恢复。最近，利用最先进的技术，我们构建了一个多站点触觉刺激器，该刺激器允许在感觉知觉指标中投资中央神经系统（CNS）健康和高级方法。这些指标已被证明对中心介导的机制的变化很敏感。皮质健康的全身改变（通过神经退行性，神经发育，药物或创伤引起的变化）可鲁棒地改变测量结果。预计临床医生将能够利用这些措施来提高诊断性能并实现治疗有效性的评估。该研究本身将有助于验证标题中许多这些措施的效用，并最终为卫生工作者提供一种检测个人何时报告不足或报告疼痛症状的方法，并跟踪从Hearderche中恢复个人的方法。测量标头进展和对治疗反应的更好方法可以导致更好的诊断和治疗。此外，这项研究的信息可以有助于理解通过标头发生重大变化的集中介导的机制。