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Sample records for female migraine patients

  1. Decreased functional connectivity density in pain-related brain regions of female migraine patients without aura.

    PubMed

    Gao, Qing; Xu, Fei; Jiang, Cui; Chen, Zhifeng; Chen, Huafu; Liao, Huaqiang; Zhao, Ling

    2016-02-01

    Migraine is one of the most prevalent neurological disorders which is suggested to be associated with dysfunctions of the central nervous system. The purpose of the present study was to detect the altered functional connectivity architecture in the large-scale network of the whole brain in migraine without aura (MWoA). Meanwhile, the brain functional hubs which are targeted by MWoA could be identified. A new voxel-based method named functional connectivity density (FCD) mapping was applied to resting-state functional magnetic resonance imaging data of 55 female MWoA patients and 44 age-matched female healthy controls (HC). Comparing to HC, MWoA patients showed abnormal short-range FCD values in bilateral hippocampus, bilateral insula, right amygdale, right anterior cingulate cortex, bilateral putamen, bilateral caudate nucleus and the prefrontal cortex. The results suggested decreased intraregional connectivity of these pain-related brain regions in female MWoA. In addition, short-range FCD values in left prefrontal cortex, putamen and caudate nucleus were significantly negatively correlated with duration of disease in MWoA group, implying the repeated migraine attacks over time may consistently affect the resting-state functional connectivity architecture of these brain hubs. Our findings revealed the dysfunction of brain hubs in female MWoA, and suggested the left prefrontal cortex, putamen and caudate nucleus served as sensitive neuroimaging markers for reflecting the disease duration of female MWoA. This may provide us new insights into the changes in the organization of the large-scale brain network in MWoA.

  2. Effect of biofeedback-assisted autogenic training on headache activity and mood states in Korean female migraine patients.

    PubMed

    Kang, Eun-Ho; Park, Joo-Eon; Chung, Chin-Sang; Yu, Bum-Hee

    2009-10-01

    Biofeedback with or without combined autogenic training is known to be effective for the treatment of migraine. This study aimed to examine the effect of biofeedback treatment on headache activity, anxiety, and depression in Korean female patients with migraine headache. Patients were randomized into the treatment group (n=17) and monitoring group (n=15). Mood states including anxiety and depression, and psychophysiological variables such as mean skin temperature of the patients were compared with those of the normal controls (n=21). We found greater treatment response rate (defined as > or =50% reduction in headache index) in patients with biofeedback-assisted autogenic training than in monitoring group. The scores on the anxiety and depression scales in the patients receiving biofeedback-assisted autogenic training decreased after the biofeedback treatment. Moreover, the decrease in their anxiety levels was significantly related to the treatment outcome. This result suggests that the biofeedback-assisted autogenic training is effective for the treatment of migraine and its therapeutic effect is closely related to the improvement of the anxiety level.

  3. Dietary and Lifestyle Changes in the Treatment of a 23-Year-Old Female Patient With Migraine

    PubMed Central

    Martin, Brett R.; Seaman, David R.

    2015-01-01

    Objective The purpose of this case report is to describe the chiropractic management of a patient with atypical migraine headache. Clinical Features A 23-year-old woman experienced migraines for 3 months. She had no previous history of migraines and was unresponsive to pharmaceutical and musculoskeletal therapies. The migraine headaches could not be classified according to the common categories associated with migraines. She had a change in diet due to severe gastroesophageal reflux causing her to reduce or avoid consuming foods. She also had a history of smoking and alcohol consumption. Intervention and Outcome Dietary and lifestyle changes were recommended in conjunction with the administration of a multivitamin, magnesium oxide, and Ulmus rubra. Her migraine headaches improved with the resolution of her gastroesophageal reflux symptoms. Conclusion This patient with atypical migraines and a history of poor dietary and lifestyle choices improved using nutritional changes and supplementing with a multivitamin and magnesium oxide. PMID:26778934

  4. Clinical profile and functional disability of patients with migraine

    PubMed Central

    Renjith, Vishnu; Pai, Mamatha Shivananda; Castelino, Flavia; Pai, Aparna; George, Anice

    2016-01-01

    Background: Migraine is a common disabling primary headache disorder. Globally, migraine was ranked as the seventh highest cause of disability. Aim: The aim of the study was to explore the clinical profile and functional disability of patients with migraine. Settings and Design: A cross-sectional survey was conducted at the neurology outpatient department of a tertiary care hospital in Karnataka. Materials and Methods: Using a consecutive sampling technique, 60 patients were recruited for the study. Descriptive and inferential statistics were used to analyze the data. Results: Majority of the participants were in the age group of 18–40 years with a mean age 35.22 years. There was a female preponderance with 70% of study participants being females. The various symptoms experienced by patients include throbbing pain (90%), photophobia (93.3%), phonophobia (85%), nausea (76.7%), and vomiting (41.7%). Most of the subjects (73.3%) under the study belonged to moderate to severe levels of functional disability. About 53.3% of patients were in the category of episodic migraine and 46.7% were in the category of chronic migraine. Conclusion: Migraine is associated with moderate to severe functional disability. Frequency of migraine has a positive correlation with the levels of disability/migraine disability assessment scores of migraineurs. PMID:27114657

  5. Prophylactic treatment of migraine; the patient's view, a qualitative study

    PubMed Central

    2012-01-01

    Background Prophylactic treatment is an important but under-utilised option for the management of migraine. Patients and physicians appear to have reservations about initiating this treatment option. This paper explores the opinions, motives and expectations of patients regarding prophylactic migraine therapy. Methods A qualitative focus group study in general practice in the Netherlands with twenty patients recruited from urban and rural general practices. Three focus group meetings were held with 6-7 migraine patients per group (2 female and 1 male group). All participants were migraine patients according to the IHS (International Headache Society); 9 had experience with prophylactic medication. The focus group meetings were analysed using a general thematic analysis. Results For patients several distinguished factors count when making a decision on prophylactic treatment. The decision of a patient on prophylactic medication is depending on experience and perspectives, grouped into five categories, namely the context of being active or passive in taking the initiative to start prophylaxis; assessing the advantages and disadvantages of prophylaxis; satisfaction with current migraine treatment; the relationship with the physician and the feeling to be heard; and previous steps taken to prevent migraine. Conclusion In addition to the functional impact of migraine, the decision to start prophylaxis is based on a complex of considerations from the patient's perspective (e.g. perceived burden of migraine, expected benefits or disadvantages, interaction with relatives, colleagues and physician). Therefore, when advising migraine patients about prophylaxis, their opinions should be taken into account. Patients need to be open to advice and information and intervention have to be offered at an appropriate moment in the course of migraine. PMID:22405186

  6. Suicidal ideation and risk factors in Korean migraine patients.

    PubMed

    Kim, Sun-Young; Park, Sung-Pa

    2014-10-01

    Population-based studies have reported an increased risk of suicidal ideation in patients with migraine. However, there is some controversy as to whether migraine itself is a risk factor for suicidal ideation after adjusting for psychiatric comorbidities. We calculated the frequency of suicidal ideation among patients with migraine visiting a tertiary care hospital and determined its risk factors. Patients with migraine and healthy controls completed self-report questionnaires to assess depression, anxiety, and suicidal ideation, and the frequency of suicidal ideation. Risk factors for suicidal ideation were investigated in terms of demographic, clinical, and psychiatric variables. One hundred eighty-five patients with migraine (156 females and 29 males; mean age 39.1 years) and 53 age and education-matched healthy controls participated in the study. The frequency of suicidal ideation was significantly greater in patients with migraine than healthy controls (odds ratio [OR]=5.09, 95% confidence interval [CI] 1.17-22.10, p=0.003), but this significance was not sustained after adjusting for comorbid depression and anxiety. The risk of suicidal ideation in patients with migraine was associated with lower education levels, higher frequency of migraine attacks, stronger intensity of headaches, and presence of phonophobia, chronic migraine, depression, and anxiety. The strongest predictor was depression (OR=15.36, 95% CI 5.39-43.78, p<0.001), followed by the intensity of headache while completing the questionnaire (OR=1.293, 95% CI 1.077-1.553; p=0.006). The contribution of migraine-specific variables to suicidal ideation is trivial compared to that of depression and headache intensity.

  7. Reduction in retinal nerve fiber layer thickness in migraine patients.

    PubMed

    Gipponi, Stefano; Scaroni, Niccolò; Venturelli, Elisabetta; Forbice, Eliana; Rao, Renata; Liberini, Paolo; Padovani, Alessandro; Semeraro, Francesco

    2013-06-01

    confocal images. The statistical analysis has been performed using the Statistical Package for Social Sciences program. The Student's t test has been used to compare numeric variables between migraine and control groups. p value >0.05 has been considered not significant. We have analyzed 40 female subjects, 24 included in the study group and 16 included in the control group. Two migraine patients have been excluded. No differences have been found in the visual acuity between the two groups. Comparing RNFLs of a single eye per person in the two groups, we have found that migraine patients showed significant reduction in the superior quadrants (p < 0.005). Also evaluating both eyes per person there was a significant difference in the same quadrant between the two groups (p < 0.05). The result of this present study show that migraine patients have RNFL thickness reduction in the superior retinal quadrant compared with normal subjects. It is important to underline that RNFL thickness measurement could be a new interesting technique to evaluate the evolution of migraine and perhaps to study if prophylactic treatment could reduce retinal abnormalities seen in migraine patients. OCT-SD is a simple exam that could be repeated and then used for evaluation of headache progression during the time. Our study shows that RNFLs thickness does not depend on illness duration and frequency.

  8. Measuring Serum Level of Ionized Magnesium in Patients with Migraine

    PubMed Central

    ASSARZADEGAN, Farhad; ASADOLLAHI, Mostafa; DERAKHSHANFAR, Hojjat; KASHEFIZADEH, Azam; ARYANI, Omid; KHORSHIDI, Mona

    2015-01-01

    Objective Migraine is known as one of the most disabling types of headache. Among the variety of theories to explain mechanism of migraine, role of serum magnesium is of great importance. Serum magnesium, as a pathogenesis factor, was considerably lower in patients with migraine. We established this study to see if serum ionized magnesium, not its total serum level, was different in migraineurs from normal individuals. Materials & Methods In this case control study, all participants were recruited from Neurology Clinic of Imam Hossein Hospital, Tehran, Iran. Ninety-six people were entered in the study, 48 for each of case and control groups. The two groups were matched by age and sex. Migrainous patients were selected according to the criteria of International Headache Society. Various characteristics of headache were recorded based on patients’ report. Controls had no history of migraine or any significant chronic headaches. Serum ionized magnesium level was measured in both of the case and control groups and the results were compared to each other. P value of <0.05 was considered as significant. Results Case group consisted of 13 males, 35 females, and control group included 14 males, as well as 34 females. Mean age was 33.47± 10.32 yr for case and 30.45 ±7.12 yr for control group. Twenty-eight patients described the intensity of their headaches as moderate; 15 patients had severe and the 5 remainders had only mild headaches. Mean serum level of ionized Mg was 1.16± 0.08 in case group and 1.13± 0.11 in control group of no significant difference (P >0.05). Conclusion Serum ionized magnesium, which is the active form of this ion, was not significantly different in migraineurs and those without migraine. This may propose a revision regarding pathogenesis of migraine and question the role of magnesium in this type of headache. PMID:26401148

  9. Topiramate-induced paresthesia is more frequently reported by migraine than epileptic patients.

    PubMed

    Sedighi, Behnaz; Shafiei, Kaveh; Azizpour, Iman

    2016-04-01

    Topiramate is an approved and effective drug in migraine prophylaxis. Paresthesia is the most commonly reported side effect. The primary objective of this study was to compare the frequency of topiramate-induced paresthesia in migraine headache to epileptic patients. Patients with migraine without aura and epilepsy were enrolled in this observational study. All cases were interviewed by telephone about their history of paresthesia. Confounding factors were controlled through logistic regression. The odds ratio of developing topiramate-induced paresthesia in migraine compared to epilepsy patients was 3.4. Three factors were independent contributors to developing topiramate-induced paresthesia: female sex (odds ratio 2.1), topiramate dosage (odds ratio 0.3) and duration of therapy. Our findings indicate an independent association between migraine and development of paresthesia. Migraineurs were more likely than epileptic patients to report paresthesia as topiramate adverse effects. Female sex, treatment duration and topiramate dosage contribute significantly to subsequent development of paresthesia.

  10. Case reports on two patients with episodic vertigo, fluctuating hearing loss and migraine responding to prophylactic drugs for migraine. Menière's disease or migraine-associated vertigo?

    PubMed

    Teggi, R; Fabiano, B; Recanati, P; Limardo, P; Bussi, M

    2010-08-01

    Recent reports have focused on a possible association between migraine and Menière's disease; patients suffering from Menière's disease present a higher rate of migraine. In some cases, the clinical features of migraine-associated vertigo may mimic the presentation of Menière's disease. The present report focuses on two cases of females with recurrent episodes of rotational vertigo, fluctuating hearing loss and tinnitus lasting from a few minutes to several hours; both cases also presented migrainous attacks. As a result of repeated cochleovestibular attacks, both patients presented a permanent low frequency sensorineural hearing loss. Preventive therapies for Menière's disease did not reduce vertigo attacks, while topiramate and acetylsalicylic acid treatment resulted in a significant reduction of both migraine and vertigo. Both the diagnosis of Menière's disease and of migraine-associated vertigo rely on clinical history and both disorders lack a specific diagnostic test. In the early stages, differential diagnosis between Menière's disease and migraine-associated vertigo is often very difficult; previous investigations focused on the possibility that subjects with migraine may experience all symptoms of Menière's disease, including sensorineural fluctuating hearing loss. In conclusion, a trial with prophylactic drug treatment for migraine might be suggested in patients with clear symptoms of migraine and recurrent cochleovestibular disorders.

  11. Topiramate weight loss in migraine patients.

    PubMed

    Alberici, Antonella; Borroni, Barbara; Manelli, Filippo; Griffini, Simona; Zavarise, Paola; Padovani, Alessandro; Dalla Volta, Giorgio

    2009-03-15

    Topiramate (TPM) is generally recognized efficacious and safe in migraine prevention. A significant proportion of patients undergoing TPM administration may show weight loss. In epileptic subjects, high body mass index (BMI) was found to be predictive of weight loss under TPM therapy. We therefore aimed to study whether common clinical determinants may be associated to TPM weigh loss in migraine patients. In our clinical series, high BMI was not found a predictor of weight loss under TPM treatment. Unknown genetic and environmental factors that may determine the courses of weight loss under TPM therapy are still do be identified.

  12. Prophylaxis of migraine: general principles and patient acceptance

    PubMed Central

    D’Amico, Domenico; Tepper, Stewart J

    2008-01-01

    Migraine is a chronic neurological condition with episodic exacerbations. Migraine is highly prevalent, and associated with significant pain, disability, and diminished quality of life. Migraine management is an important health care issue. Migraine management includes avoidance of trigger factors, lifestyle modifications, non-pharmacological therapies, and medications. Pharmacological treatment is traditionally divided into acute or symptomatic treatment, and preventive treatment or prophylaxis. Many migraine patients can be treated using only acute treatment. Patients with severe and/or frequent migraines require long-term preventive therapy. Prophylaxis requires daily administration of anti-migraine compounds with potential adverse events or contraindications, and may also interfere with other concurrent conditions and treatments. These problems may induce patients to reject the idea of a preventive treatment, leading to poor patient adherence. This paper reviews the main factors influencing patient acceptance of anti-migraine prophylaxis, providing practical suggestions to enhance patient willingness to accept pharmacological anti-migraine preventive therapy. We also provide information about the main clinical characteristics of migraine, and their negative consequences. The circumstances warranting prophylaxis in migraine patients as well as the main characteristics of the compounds currently used in migraine prophylaxis will also be briefly discussed, focusing on those aspects which can enhance patient acceptance and adherence. PMID:19337456

  13. Endothelial Nitric Oxide Synthase and Angiotensin Converting Enzyme Gene Polymorphisms in Migraine Patients

    PubMed Central

    SİPAHİ, Tammam; GÜLDİKEN, Babürhan; KABAYEL, Levent; PALABIYIK, Orkide; ÖZKAN, Hülya; KILIÇ, Tülay Okman; SÜT, Necdet; TURGUT, Nilda

    2013-01-01

    Introduction In this study, we investigated the association of migraine with the Variable Number of Tandem Repeats (VNTR), repeated as 27 base pair, gene polymorphism in intron 4 of the endothelial nitric oxide synthase (eNOS) and the insertion/deletion of angiotensin converting enzyme (ACE) gene polymorphisms. Methods One hundred and five migraine and ninety seven healthy female control subjects were enrolled in the study. The patients were subdivided as migraine with aura and without aura, and the frequency and severity of migraine headaches were recorded. The eNOS VNTR (eNOS 4 a/b) and ACE insertion/deletion gene polymorphisms (ACE I/D) were assessed by polymerase chain reactions. Result The allele and genotype frequencies of eNOS 4 a/b gene polymorphism showed no difference between the migraine and control groups. The genotypic distribution of the ACE I/D gene polymorphism in the migraine group significantly differed from that in the control group. The DD and ID genotype increased the risk of migraine as much as 2.571 (95% CI-1.138–5.811) and 4.453 (95% CI-2.006–9.883) compared to the II genotype. The same increased risk sustained for both genotypes in the migraine with aura subgroup, but only the ID genotype remained as the risk factor in the migraine without aura subgroup (OR-3.750, 95% CI-1.493–9.420). No association of gene polymorphisms with migraine frequency and severity was observed. Conclusion Our findings support the relationship between migraine and the ACE I/D gene polymorphism. However, no association was found between migraine and the eNOS 4 a/b gene polymorphism.

  14. Migraine

    MedlinePlus

    ... my period. Could they be related to my menstrual cycle? More than half of migraines in women occur ... times of the month as well. How the menstrual cycle and migraine are linked is still unclear. We ...

  15. Post-Traumatic Stress Disorder in Migraine Patients: Migraine, Trauma and Alexithymia

    PubMed Central

    KARŞIKAYA, Süreyya; KAVAKCI, Önder; KUĞU, Nesim; GÜLER, Ayşegül Selcen

    2013-01-01

    Introduction In recent studies, it has been suggested that there is a relationship between migraine headaches and post-traumatic stress disorder (PTSD). The PTSD has not been diagnosed by a clinician in these studies; the evaluation has been carried out by the screening scales. Besides, it has also been asserted that there was relationship of alexithymia with migraine and other chronic painful disorders. In this study, our aim was to investigate the prevalence of clinically-diagnosed PTSD and alexithymic features among migraine patients. Methods Sixty consecutive migraine patients sent from neurology clinic and 60 healthy controls having similar features constituted the sample of this study. SCID-I/CV PTSD module and the Clinician-Administered PTSD Scale (CAPS) was administered to the sample. The subjects also filled in the socio-demographic data form and the Toronto Alexithymia Scale (TAS). The level of pain perceived by the migraine patients was evaluated using a Visual Analog Scale (VAS). Result 17 subjects (28%) in the migraine group and 5 individuals (8.3%) in the control group were diagnosed with PTSD. Hence, PTSD was found to be statistically significantly higher in the migraine group. 25 persons in the migraine group (41.6%) and 12 in the control group (20%) scored above the TAS cutoff score in terms of alexithymic features. Alexithymia was found to be statistically significantly higher in the migraine group). In the migraine group, VAS scores of the ones with PTSD were statistically significantly higher compared to that in ones without PTSD. 94% of the persons diagnosed with PTSD in the migraine group reported that their migraine headaches started after a traumatic experience. In the migraine group, no statistically significant correlation was detected between CAPS and VAS scores in subjects with PTSD. Conclusion In migraine patients, PTSD and alexithymic features have been found higher than in the healthy controls. Further studies are needed to search

  16. Evaluation of Eating Attitude in Patients with Migraine

    PubMed Central

    DEMİRCİ, Kadir; DEMİRCİ, Seden; AKPINAR, Abdullah; DEMİRDAŞ, Arif; ATAY, İnci Meltem

    2015-01-01

    Introduction This study aimed to investigate the eating attitudes in patients with migraine. Methods Fifty-nine patients (mean age: 32.54±8.47 years) diagnosed with migraine according to the International Classification of Headache Disorder, 2004, and 47 age-, gender- and education-matched healthy controls (mean age: 31.85±7.14 years) were enrolled for this study. Sociodemographic data were recorded, and the body mass index was calculated as kilograms per meter squared. Data regarding the duration of illness and attack, frequency of migraine attacks, and the presence of aura were recorded. Migraine severity was assessed by Migraine Disability Assessment Score (MIDAS). Eating Attitudes Test (EAT), Beck Depression Inventory (BDI), and Beck Anxiety Inventory were applied to all participants. Results The patients with migraine had significantly higher EAT scores, levels of anxiety, and depression than controls (p<.01). Furthermore, 11.9% of patients with migraine had an EAT score of 30 or higher, which is suggestive of a disordered eating attitude, whereas this rate was 2.1% in healthy controls (p<.05). The scores of EAT and BDI had positive correlation with the scores of MIDAS in patients with migraine (r=.298, p<.05; r=.332, p=.01, respectively). Conclusion In our study, disordered eating attitudes and the levels of anxiety and depression were high in patients with migraine than controls. Our study is important to demonstrate the connection between migraine and disordered eating attitudes. PMID:28360741

  17. Calcitonin gene-related peptide induced migraine attacks in patients with and without familial aggregation of migraine.

    PubMed

    Guo, Song; Christensen, Anne Francke; Liu, Marie Louise; Janjooa, Benjamin Naveed; Olesen, Jes; Ashina, Messoud

    2017-02-01

    Background Calcitonin gene-related peptide provokes migraine attacks in 65% of patients with migraine without aura. Whether aggregation of migraine in first-degree relatives (family load) or a high number of risk-conferring single nucleotide polymorphisms contributes to migraine susceptibility to calcitonin gene-related peptide infusion in migraine patients is unknown. We hypothesized that genetic enrichment plays a role in triggering of migraine and, therefore, migraine without aura patients with high family load would report more migraine attacks after calcitonin gene-related peptide infusion than patients with low family load. Methods We allocated 40 previously genotyped migraine without aura patients to receive intravenous infusion of 1.5 µg/min calcitonin gene-related peptide and recorded migraine attacks including headache characteristics and associated symptoms. Information of familial aggregation was obtained by telephone interview of first-degree relatives using a validated semi-structured questionnaire. Results Calcitonin gene-related peptide infusion induced a migraine-like attack in 75% (12 out of 16) of patients with high family load compared to 52% (12 out of 23) with low family load ( P = 0.150). In addition, we found that the migraine response after calcitonin gene-related peptide was not associated with specific or a high number of risk-conferring single nucleotide polymorphisms of migraine without aura. Conclusion We found no statistical association between familial aggregation of migraine and hypersensitivity to calcitonin gene-related peptide infusion in migraine without aura patients. We also demonstrated that the currently known single nucleotide polymorphisms conferring risk of migraine without aura have no additive effect on calcitonin gene-related peptide induced migraine-like attacks.

  18. Vestibular rehabilitation outcomes in patients with and without vestibular migraine.

    PubMed

    Vitkovic, Jessica; Winoto, Arimbi; Rance, Gary; Dowell, Richard; Paine, Mark

    2013-12-01

    Vestibular rehabilitation programs do appear to play a beneficial role in the treatment of dizziness in patients with vestibular migraine. Anecdotally, however, patients with vestibular migraine may report persistent significant symptoms at the end of a standard treatment period where other non-migrainous patients are accomplishing their treatment goals. Therefore, the objective of this study was to assess the efficacy of vestibular rehabilitation in patients with vestibular migraine compared to patients with vestibular symptoms without migraine. Thirty-six patients (vestibular migraine = 20, vestibular impairment = 16) with significant daily vestibular symptoms received a nine week customized vestibular rehabilitation program. Each subject attended five therapy appointments occurring at initial, two, five, nine and six months. A range of subjective and physical performance outcome measures were taken at baseline, nine weeks and six months. The vestibular migraine group showed poorer subjective performance at the onset of therapy, which was not reflected in the difference in physical performance between the groups. Both groups benefitted equally from rehabilitation. The same degree of improvement was observed in the migraine group regardless of medication regime. This study has validated vestibular rehabilitation as an effective treatment in dizzy patients both with and without vestibular migraine where the use of medication did not preclude benefit from therapy. However, further research is required to clarify the role of specific vestibular suppressant medications and the scheduling of their use in relation to physical therapy.

  19. The dyspeptic syndrome in migraine: morphofunctional evaluation on 53 patients.

    PubMed

    Centonze, V; Polito, B M; Cassiano, M A; Doronzo, F; Ricchetti, G; Portincasa, P; Bassi, A; Albano, O

    1996-01-01

    The authors, in order to evaluate the important role of gastrointestinal dysfunction during the migraine attack, have studied 53 patients with migraine without aura during the asymptomatic stage between attacks. Patients were examined functionally with a pH meter test of the gastroesophageal tract over 24 hours and morphologically with esophagogastroduodenoscopy. The results of this study point out that in a high percentage of patients with migraine, both evaluations are normal. The authors suggest the possibility of detecting, even hypothetically, an alteration of the common neurotransmitter substrate in the origin of migraine attacks and accompanying symptoms.

  20. Ophthalmoplegic migraine. Two patients with an absolute response to indomethacin.

    PubMed

    Pareja, J A; Churruca, J; de la Casa Fages, B; de Silanes, C López; Sánchez, C; Barriga, F J

    2010-06-01

    Two patients suffering from ophthalmoplegic migraine had a strictly unilateral headache absolutely responsive to indomethacin, but not to other non-steroidal anti-inflammatory drugs, analgesics or corticosteroids. Such observations raise a therapeutic alternative and suggest that ophthalmoplegic migraine may present with different headache phenotypes.

  1. Reduced breath holding index in patients with chronic migraine.

    PubMed

    Akgün, Hakan; Taşdemir, Serdar; Ulaş, Ümit Hıdır; Alay, Semih; Çetiz, Ahmet; Yücel, Mehmet; Öz, Oğuzhan; Odabaşı, Zeki; Demirkaya, Şeref

    2015-09-01

    Migraine is a neurovascular disorder characterized by autonomic nervous system dysfunction and severe headache attacks. Studies have shown that changes in the intracranial vessels during migraine have an important role in the pathophysiology. Many studies have been conducted on the increased risk of stroke in patients with migraine, but insufficient data are available on the mechanism underlying the increase. This study aimed to evaluate basal cerebral blood flow velocity and vasomotor reactivity in patients with chronic migraine. We evaluated 38 patients with chronic migraine. Three of them were excluded because they had auras and four of them were excluded because of their use of medication that can affect cerebral blood flow velocity and breath holding index (beta or calcium channel blockers). Our study population consisted of 31 patients with chronic migraine without aura and 29 age- and gender-matched healthy individuals who were not taking any medication. The mean blood flow velocity and breath holding index were measured on both sides from the middle cerebral artery and posterior cerebral artery, with temporal window insonation. The breath holding index for middle cerebral artery and posterior cerebral artery was significantly lower in the migraine group compared to that of the control group (p < 0.05).The vasomotor reactivity indicates the dilatation potential of a vessel, and it is closely related to autoregulation. According to our results, the vasodilator response of cerebral arterioles to hypercapnia was lower in patients with chronic migraine. These findings showed the existence of impairments in the harmonic cerebral hemodynamic mechanisms in patients with chronic migraine. This finding also supports the existing idea of an increased risk of stroke in patients with chronic migraine due to impaired vasomotor reactivity.

  2. Migraine

    MedlinePlus

    ... be triggered by many things. But the exact chain of events remains unclear. Most medical experts believe ... anxiety Migraines can also be triggered by certain foods. Most common are: Chocolate Dairy foods, especially certain ...

  3. Osmophobia and olfactory functions in patients with migraine.

    PubMed

    Kayabaşoglu, Gürkan; Altundag, Aytug; Kotan, Dilcan; Dizdar, Denizhan; Kaymaz, Recep

    2017-02-01

    Olfactory dysfunction and migraine has been associated for a long time. In this study, we planned to compare olfactory functions in patients with migraine and osmophobia with patients having migraine but no osmophobia, in addition with a normal control group using "Sniffin' Sticks" test. The main distinction of this study is that all qualitative and quantitative properties of olfactory functions; threshold, discrimination and identification, are evaluated separately and jointly. Thirty healthy person aged between 16 and 56 (18 women, 12 men) and 60 migraine patients aged between 15 and 54 (39 women, 21 man) were included in the study. All patients have been inquired about osmophobia and have been assessed with Hedonic tone assessment. Osmophobia has been tested for perfume, cigarette smoke, leather, stale food, soy sauce, fish, spices and coffee smells. Olfactory functions has been assessed with "Sniffin' Sticks" smell test. Thresholds, discrimination and identification have been determined for each patient. In migraine patients with osmophobia, threshold was 7.75 ± 2.3, in migraine patients without osmophobia threshold was 8.25 ± 1.5 and threshold was 10.75 ± 1.3 for the control group. Discrimination score was 6 ± 1.2 in migraine patients with osmophobia, 9 ± 0.8 in patients without osmophobia and was 12 ± 1.4 in the control group. In migraine patient with or without osmophobia Threshold/Discrimination/Identification (TDI) scores were lower than the control group. The most important parameter in our study is that discrimination scores were especially lower in patients with osmophobia. We believe that this decrease in discrimination in migraine patients with osmophobia; who claim that they smell everything and they are sensitive to all smells, is significant. Further studies about smell discrimination will help better understand some conditions; especially anosmia and hyposmia after upper respiratory tract infections and parosmia.

  4. Improvement of migraine headaches in severely obese patients after bariatric surgery

    PubMed Central

    Vithiananthan, S.; Nash, J.M.; Thomas, J.G.; Wing, R.R.

    2011-01-01

    Objectives: Research increasingly suggests that obesity is an exacerbating factor for migraine. However, it is less clear whether weight loss may help to alleviate migraine in obese individuals. We examined whether weight loss after bariatric surgery is associated with improvements in migraine headaches. Methods: In this prospective observational study, 24 patients who had migraine according to the ID-Migraine screener were assessed before and 6 months after bariatric surgery. At both time points, patients had their weight measured and reported on frequency of headache days, average headache pain severity, and headache-related disability over the past 90 days via the Migraine Disability Assessment questionnaire. Changes in headache measures and the relation of weight loss to these changes were assessed using paired-sample t tests and logistic regression, respectively. Results: Patients were mostly female (88%), middle-aged (mean age 39.3), and severely obese (mean body mass index 46.6) at baseline. Mean (±SD) number of headache days was reduced from 11.1 ± 10.3 preoperatively to 6.7 ± 8.2 postoperatively (p < 0.05), after a mean percent excess weight loss (%EWL) of 49.4%. The odds of experiencing a ≥50% reduction in headache days was related to greater %EWL, independent of surgery type (p < 0.05). Reductions in severity were also observed (p < 0.05) and the number of patients reporting moderate to severe disability decreased from 12 (50.0%) before surgery to 3 (12.5%) after surgery (p < 0.01). Conclusions: Severely obese migraineurs experience marked alleviation of headaches after significant weight reduction via bariatric surgery. Future studies are needed to determine whether more modest, behaviorally produced weight losses can effect similar migraine improvements. Classification of evidence: This study provides Class III evidence that bariatric surgery is associated with reduction of migraine headaches in severely obese individuals. PMID:21444898

  5. Optimizing prophylactic treatment of migraine: Subtypes and patient matching

    PubMed Central

    Dib, Michel

    2008-01-01

    Advances in our understanding of the pathophysiology of migraine have resulted in important breakthroughs in treatment. For example, understanding of the role of serotonin in the cerebrovascular circulation has led to the development of triptans for the acute relief of migraine headaches, and the identification of cortical spreading depression as an early central event associated wih migraine has brought renewed interest in antiepileptic drugs for migraine prophylaxis. However, migraine still remains inadequately treated. Indeed, it is apparent that migraine is not a single disease but rather a syndrome that can manifest itself in a variety of pathological conditions. The consequences of this may be that treatment needs to be matched to particular patients. Clinical research needs to be devoted to identifying which sort of patients benefit best from which treatments, particularly in the field of prophylaxis. We propose four patterns of precipitating factors (adrenergic, serotoninergic, menstrual, and muscular) which may be used to structure migraine prophylaxis. Finally, little is known about long-term outcome in treated migraine. It is possible that appropriate early prophylaxis may modify the long-term course of the disease and avoid late complications. PMID:19209286

  6. Integrated care for chronic migraine patients: epidemiology, burden, diagnosis and treatment options.

    PubMed

    Diener, Hans-Christoph; Solbach, Kasja; Holle, Dagny; Gaul, Charly

    2015-08-01

    Migraine is a common neurological disorder, characterised by severe headaches. Epidemiological studies in the USA and Europe have identified a subgroup of migraine patients with chronic migraine. Chronic migraine is defined as ≥15 headache days per month for ≥3 months, in which ≥8 days of the month meet criteria for migraine with or without aura, or respond to treatment specifically for migraine. Chronic migraine is associated with a higher burden of disease, more severe psychiatric comorbidity, greater use of healthcare resources, and higher overall costs than episodic migraine (<15 headache days per month). There is a strong need to improve diagnosis and therapeutic treatment of chronic migraine. Primary care physicians, as well as hospital-based physicians, are integral to the identification and treatment of these patients. The latest epidemiological data, as well as treatment options for chronic migraine patients, are reviewed here.

  7. Migraine.

    PubMed

    MacGregor, E Anne

    2017-04-04

    This issue provides a clinical overview of migraine, focusing on risk, prevention, diagnosis, treatment, follow-up, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of additional science writers and physician writers.

  8. Migraine medication attributes are important for patient compliance.

    PubMed

    Massiou, Hélène

    2003-01-01

    The determinant of patient compliance with an anti-migraine drug is a complex alchemy. Studies of patient needs consistently show that pain freedom, speed of onset and no headache recurrence are important features of an anti-migraine product. Adverse events are important in migraine management, and concerns about them may significantly affect patient compliance. A high efficacy/tolerance ratio is definitely an essential factor, but irrational factors, such as the patient's expectations, knowledge, prejudices and concerns about the drug, may also interfere. Patients' worries about such events may instigate avoidance of prescription medicine that leads to increased intensity and duration of pain, an increased need to rest, reduced productivity and cancellation of social and work-related activities.

  9. Sickness absence among female employees with migraine and co-existing conditions.

    PubMed

    Mäki, K; Vahtera, J; Virtanen, M; Elovainio, M; Pentti, J; Keltikangas-Järvinen, L; Kivimäki, M

    2008-11-01

    This prospective cohort study examined the risk of sickness absence among 27,127 female public-sector employees by status of migraine and co-existing conditions. A baseline survey was used to assess chronic disorders and demographic factors. Information on sickness absence in the 3 years following the survey was obtained from employers' registers. Migraine was related to 5.4 extra sickness absence days per person-year, with the corresponding figures being 14.6 and 6.1 for depression and respiratory disorders, respectively. After adjusting for age, marital status, socioeconomic status and presence of depression or respiratory disorders, employees with migraine had a 1.21 (95% confidence interval 1.18, 1.24) times higher risk of self-certified sickness absence episodes (< or = 3 days) than did those without migraine. The corresponding excess risk for medically certified absence episodes (> 3 days) was 1.15 (1.12, 1.19). Among employees with depression or respiratory disorders, secondary migraine was associated with an increased risk of sickness absence episode of 1.15 to 1.23. These findings suggest that migraine is associated with increased risk of recorded sickness absence independent of depression and respiratory disorders.

  10. Cerebellar function and ischemic brain lesions in migraine patients from the general population.

    PubMed

    Koppen, Hille; Boele, Henk-Jan; Palm-Meinders, Inge H; Koutstaal, Bastiaan J; Horlings, Corinne Gc; Koekkoek, Bas K; van der Geest, Jos; Smit, Albertine E; van Buchem, Mark A; Launer, Lenore J; Terwindt, Gisela M; Bloem, Bas R; Kruit, Mark C; Ferrari, Michel D; De Zeeuw, Chris I

    2017-02-01

    Objective The objective of this article is to obtain detailed quantitative assessment of cerebellar function and structure in unselected migraine patients and controls from the general population. Methods A total of 282 clinically well-defined participants (migraine with aura n = 111; migraine without aura n = 89; non-migraine controls n = 82; age range 43-72; 72% female) from a population-based study were subjected to a range of sensitive and validated cerebellar tests that cover functions of all main parts of the cerebellar cortex, including cerebrocerebellum, spinocerebellum, and vestibulocerebellum. In addition, all participants underwent magnetic resonance imaging (MRI) of the brain to screen for cerebellar lesions. As a positive control, the same cerebellar tests were conducted in 13 patients with familial hemiplegic migraine type 1 (FHM1; age range 19-64; 69% female) all carrying a CACNA1A mutation known to affect cerebellar function. Results MRI revealed cerebellar ischemic lesions in 17/196 (8.5%) migraine patients and 3/79 (4%) controls, which were always located in the posterior lobe except for one control. With regard to the cerebellar tests, there were no differences between migraine patients with aura, migraine patients without aura, and controls for the: (i) Purdue-pegboard test for fine motor skills (assembly scores p = 0.1); (ii) block-design test for visuospatial ability (mean scaled scores p = 0.2); (iii) prism-adaptation task for limb learning (shift scores p = 0.8); (iv) eyeblink-conditioning task for learning-dependent timing (peak-time p = 0.1); and (v) body-sway test for balance capabilities (pitch velocity score under two-legs stance condition p = 0.5). Among migraine patients, those with cerebellar ischaemic lesions performed worse than those without lesions on the assembly scores of the pegboard task ( p < 0.005), but not on the primary outcome measures of the other tasks. Compared with controls and non

  11. Steady-State Visual Evoked Potentials and Phase Synchronization in Migraine Patients

    NASA Astrophysics Data System (ADS)

    Angelini, L.; Tommaso, M. De; Guido, M.; Hu, K.; Ivanov, P. Ch.; Marinazzo, D.; Nardulli, G.; Nitti, L.; Pellicoro, M.; Pierro, C.; Stramaglia, S.

    2004-07-01

    We investigate phase synchronization in EEG recordings from migraine patients. We use the analytic signal technique, based on the Hilbert transform, and find that migraine brains are characterized by enhanced alpha band phase synchronization in the presence of visual stimuli. Our findings show that migraine patients have an overactive regulatory mechanism that renders them more sensitive to external stimuli.

  12. Demographic, clinical and comorbidity data in a large sample of 1,147 patients with migraine in Mexico City.

    PubMed

    Téllez-Zenteno, José F; García-Ramos, Guillermo; Zermeño-Pöhls, Fernando; Velazquez, Antonio

    2005-06-01

    The objective was to identify the sociodemographic and clinical characteristics of a large sample of patients with migraine in Mexico City. This cross-sectional study was performed in two tertiary centers in Mexico City and affiliated hospitals. We evaluated the presence of migraine through a standardised interview according to the criteria of the International Headache Society. We studied 1,147 patients. The mean age was 37.1+/-13.6 (6-77) years. Nine hundred and twenty one patients were female (80%). The age of onset of migraine was 19.4+/-10.3 (1-69) years. Six hundred and four patients had migraine with aura (53%) and 543 without aura (47%). The female/male ratio was 4:1. One hundred and forty-seven patients had cardiovascular problems (13%), 72 had neurological problems (6%), 233 had gastrointestinal problems (20%) and 323 had psychiatric problems (28%). In this study we described the clinical characteristics of a large sample of patients with migraine in Mexico City. Our sample has similar characteristics to other countries.

  13. Reversible, strokelike migraine attacks in patients with previous radiation therapy.

    PubMed Central

    Bartleson, J. D.; Krecke, Karl N.; O'Neill, Brian P.; Brown, Paul D.

    2003-01-01

    We report 2 adults with a past history of radiation therapy to the head for malignancy (one with primary B-cell lymphoma confined to the skull and the other with multiple hemangioendotheliomas) who developed episodes consistent with migraine with and without aura. In addition to more typical migraine attacks and beginning many years after their radiation therapy, both patients have experienced infrequent, stereotyped, prolonged, reversible neurologic deficits associated with headache, occasional seizures, and striking, transient, cortical gadolinium enhancement of the posterior cerebral gyri on MRI. Interictal MRI brain scans show stable abnormalities consistent with the patients' previous radiation therapy. The neurologic deficits often progressed over a few days, sometimes lasted weeks, and completely resolved. Electroencephalograms did not show epileptiform activity. Thorough investigation showed no residual or recurrent tumor and no recognized cause for the patients' attacks. We postulate a causal relationship between the patients' remote radiation therapy and their prolonged, strokelike migraine attacks. Radiation-induced vascular changes could provoke the episodes, with or without an underlying migraine diathesis. Recognition of this syndrome can help avoid invasive testing. PMID:12672284

  14. Retinol-binding protein-4 and hs-CRP levels in patients with migraine.

    PubMed

    Tanik, Nermin; Celikbilek, Asuman; Metin, Aslı; Gocmen, Ayse Yesim; Inan, Levent Ertugrul

    2015-10-01

    Retinol-binding protein-4 (RBP4) and high-sensitivity C-reactive protein (hs-CRP) levels are associated with inflammation in patients with migraine. The release of proinflammatory cytokines during migraine results in recurrent sterile neurogenic inflammation. This study aimed to determine the correlation between RBP4 and hs-CRP levels, and migraine, which is considered an inflammatory disease. The study included 48 migraine patients and 40 age- and gender-matched controls. Migraine was diagnosed according to International Classification of Headache Disorders-II. The serum RBP4 level was measured using a commercial ELISA kit and hs-CRP was measured using an enzyme immunoassay test kit. The serum RBP4 level was significantly lower in the migraine patients than in the controls (P < 0.001), whereas the hs-CRP level was significantly higher in the migraine patients (P < 0.001). RBP4 and hs-CRP levels did not differ between the migraine patients with and without aura (P > 0.05). Migraine headache severity, frequency and duration were not correlated with serum RBP or hs-CRP levels (P > 0.05). The observed high hs-CRP level and low RBP4 level in migraine patients suggest that vitamin A might play a major role in the pathogenesis of migraine. It is known that inflammation is a key factor in many diseases. Additional research might result in a better understanding of the anti-inflammatory effects of vitamin A.

  15. Abnormal Tilt Perception During Centrifugation in Patients with Vestibular Migraine.

    PubMed

    Wang, Joanne; Lewis, Richard F

    2016-06-01

    Vestibular migraine (VM), defined as vestibular symptoms caused by migraine mechanisms, is very common but poorly understood. Because dizziness is often provoked in VM patients when the semicircular canals and otolith organs are stimulated concurrently (e.g., tilting the head relative to gravity), we measured tilt perception and eye movements in patients with VM and in migraine and normal control subjects during fixed-radius centrifugation, a paradigm that simultaneously modulates afferent signals from the semicircular canals and otoliths organs. Twenty-four patients (8 in each category) were tested with a motion paradigm that generated an inter-aural centrifugal force of 0.36 G, resulting in a 20° tilt of the gravito-inertial force in the roll plane. We found that percepts of roll tilt developed slower in VM patients than in the two control groups, but that eye movement responses, including the shift in the eye's rotational axis, were equivalent in all three groups. These results demonstrate a change in vestibular perception in VM that is unaccompanied by changes in vestibular-mediated eye movements and suggest that either the brain's integration of canal and otolith signals or the dynamics of otolith responses are aberrant in patients with VM.

  16. Providing Care for Patients with Chronic Migraine: Diagnosis, Treatment, and Management.

    PubMed

    Dougherty, Carrie; Silberstein, Stephen D

    2015-09-01

    Chronic migraine, a subtype of migraine defined as ≥ 15 headache days per month for ≥ 3 months, in which ≥ 8 days per month meet criteria for migraine with or without aura or respond to migraine-specific treatment, is a disabling, underdiagnosed, and undertreated disorder associated with significant disability, poor health-related quality of life, and high economic burden. The keys to caring for chronic migraine patients include: (1) making a proper diagnosis; (2) identifying and eliminating exacerbating factors; (3) assessing for medication overuse (patients with chronic headache often overuse acute medications); and (4) continued management. Communication between patient and physician about treatment goals is important. The patient management guidelines presented in this article should help physicians improve treatment success and proactively address common comorbidities among their patients with chronic migraine.

  17. Part I: Pituitary adenylate cyclase-activating polypeptide-38 induced migraine-like attacks in patients with and without familial aggregation of migraine.

    PubMed

    Guo, Song; Vollesen, Anne Luise Haulund; Hansen, Rikke Dyhr; Esserlind, Ann-Louise; Amin, Faisal Mohammed; Christensen, Anne Francke; Olesen, Jes; Ashina, Messoud

    2017-02-01

    Background Intravenous infusion of adenylate cyclase-activating polypeptide-38 (PACAP38) provokes migraine-like attacks in 65-70% of migraine sufferers. Whether aggregation of migraine in first-degree relatives contributes to this discrepancy in PACAP38-induced response is unknown. We hypothesized that genetic enrichment plays a role in triggering of migraine and that migraine without aura patients with a high family load ( ≥ 2 first-degree relatives with migraine) would report more migraine-like attacks after intravenous infusion of human PACAP38. Methods In this study, we allocated 32 previously genotyped migraine without aura patients to receive intravenous infusion of 10 pmol/kg/min PACAP38 and recorded migraine-like attacks including headache characteristics and associated symptoms. Information of familial aggregation was obtained by telephone interview of first-degree relatives using a validated semi-structured questionnaire. Results PACAP38 infusion induced a migraine-like attack in 75% (nine out of 12) of patients with high family load compared to 70% (14 out of 20) with low family load ( P = 0.761). In an explorative investigation, we found that the migraine response after PACAP38 was not associated with the risk allele of rs2274316 ( MEF2D), which confers increased risk of migraine without aura and may regulate PACAP38 expression. Conclusion Migraine response to PACAP38 infusion in migraine without aura patients is not associated with high family load or the risk allele of rs2274316 ( MEF2D).

  18. Chronic migraine.

    PubMed

    Schwedt, Todd J

    2014-03-24

    Chronic migraine is a disabling neurologic condition that affects 2% of the general population. Patients with chronic migraine have headaches on at least 15 days a month, with at least eight days a month on which their headaches and associated symptoms meet diagnostic criteria for migraine. Chronic migraine places an enormous burden on patients owing to frequent headaches; hypersensitivity to visual, auditory, and olfactory stimuli; nausea; and vomiting. It also affects society through direct and indirect medical costs. Chronic migraine typically develops after a slow increase in headache frequency over months to years. Several factors are associated with an increased risk of transforming to chronic migraine. The diagnosis requires a carefully performed patient interview and neurologic examination, sometimes combined with additional diagnostic tests, to differentiate chronic migraine from secondary headache disorders and other primary chronic headaches of long duration. Treatment takes a multifaceted approach that may include risk factor modification, avoidance of migraine triggers, drug and non-drug based prophylaxis, and abortive migraine treatment, the frequency of which is limited to avoid drug overuse. This article provides an overview of current knowledge regarding chronic migraine, including epidemiology, risk factors for its development, pathophysiology, diagnosis, management, and guidelines. The future of chronic migraine treatment and research is also discussed.

  19. The minimal caloric test asymmetric response in vertigo-free migraine patients.

    PubMed

    Maranhão, Eliana Teixeira; Maranhão Filho, Péricles; Vincent, Maurice Borges; Luiz, Ronir Raggio

    2016-02-01

    Vertigo symptoms and subclinical vestibular dysfunctions may occur in migraine. The Minimal Caloric Test (MCT), an easy-to-perform, convenient and yet informative procedure was used to test the vestibular function in 30 vertigo-free migraine patients outside attacks and 30 paired controls. Although not statistically significant, a right-to-left nystagmus duration asymmetry greater than 25% was present in both groups. This difference was greater in the patients group, suggesting the presence of subclinical vestibular imbalance in migraine.

  20. Neuropsychological assessment in migraine patients: a descriptive review on cognitive implications.

    PubMed

    Foti, Maria; Lo Buono, Viviana; Corallo, Francesco; Palmeri, Rosanna; Bramanti, Placido; Marino, Silvia

    2017-04-01

    Migraine is considered a disabling disorder with highly prevalence in population. Recent studies report that migraine patients have a cognitive decline associated to structural brain alterations. We search on PubMed and Web of Science databases and screening references of included studies and review articles for additional citations. From 519 studies identified, only 16 met the inclusion criteria. All studies were conducted on 1479 migraineurs (190 non-migraine headache and 11,978 controls subject) and examined the association between migraine and cognitive impairment. The results are discordant. Indeed, while cognitive deficits during the attack of migraine are now recognized, only few studies confirmed the presence of cognitive impairment in migraine patients. Given the prevalence of migraine in the population (especially among women), and the early age of the population, an association between migraine and cognitive impairment could have substantial public health implications. Future studies should determine if specific migraine characteristics, for example, attack frequency, may impact the association between migraine and cognitive decline.

  1. Is Ciliary Muscle Affected in Migraine Patients with Aura and without Aura?

    PubMed Central

    Kıvanç, Sertaç Argun; Ulusoy, Mahmut Oğuz; Akova-Budak, Berna; Olcaysu, Osman Okan; Özcan, Muhammed Emin

    2015-01-01

    Background The aim of this study was to compare spherical equivalents (SE) and spherical equivalents with cycloplegic (CSE) values of migraine patients with and without visual aura, with those patients without migraine complaints. Material/Methods We included patients over the age of 18 years, who had 20/20 uncorrected vision, and who did not have ocular pathology in their examination. The patients were divided into 3 groups: Group 1: 86 eyes of 43 migraine patients without aura, Group 2: 38 eyes of 19 migraine patients with aura, and Group 3: 60 eyes of 30 patients without migraine. Spherical equivalents and spherical equivalents with cycloplegic from the auto-refractometrical values of the patients were compared. Results The mean age of the migraine and control patients was 34.2±8.3 and 33.6±10.8 years, respectively. Forty-three (69%) of 62 migraine patients had migraine without aura and 19 (31%) had migraine with aura. The right and left eyes of the patients were evaluated together and a significant correlation was found between the groups. To evaluate the impact of cycloplegia in patients, SE and CSE values were obtained and differences between these values were evaluated. It was found that the change in Group 2 patients was significantly lower than the change in Group 3 patients (p=0.024). Conclusions We found that the cycloplegic spherical equivalents values of our patients with aura were lower than control patients. We need further studies to reveal whether migraine with aura is the trigger or the result of those attacks. PMID:25919450

  2. High prevalence of Dopaminergic Premonitory Symptoms in migraine patients with Restless Legs Syndrome: a pathogenetic link?

    PubMed

    Cologno, Daniela; Cicarelli, Giulio; Petretta, Vittorio; d'Onofrio, Florindo; Bussone, Gennaro

    2008-05-01

    In order to assess the prevalence of Dopaminergic Premonitory Symptoms (DPS) in migraine patients with Restless Legs Syndrome (RLS), we chose migraine patients from a large Italian clinical headache population previously investigated for an association between primary headaches and RLS. We evaluated a total sample of 164 patients with migraine, in particular 114 with migraine without aura (MO), 10 with migraine with aura (MA) and 40 with MO and MA in various combinations between them or with episodic tension-type headache (ETTH), defined as a "mixed group". About 20% of all migraine patients referred at least one of the following DPS: yawning, nausea, somnolence or food craving, confirming data already indicated in the literature. Among migraine patients with RLS (25.6%), DPS were referred from about half of the patients (47.6%) compared to those without RLS (47.6% vs. 13.1%; p<0.001). Based on migraine subtype, patients with MO referred DPS (26.3%) more frequently compared to the MA group and "mixed group" (12.0%, p<0.05), particularly in the presence of RLS (63.0% vs. 20.0%, p<0.01). No statistical differences were found between clinical and demographic data of the subgroups or related to medical conditions investigated (anxiety, depression, sleep disorders, body mass index). It is interesting that the chances of having RLS in migraine patients were more than 5 times higher in the presence of DPS. These results could support a hypothetical dopaminergic imbalance in RLS and migraine, as the dopamine is involved in the pathogenesis of both disorders and it is responsible for the migraine DPS reported above.

  3. Vestibular migraine.

    PubMed

    Furman, Joseph M; Balaban, Carey D

    2015-04-01

    Vestibular migraine is now considered a distinct diagnostic entity by both the Barany Society and the International Headache Society. The recognition of vestibular migraine as a diagnostic entity required decades and was presaged by several reports indicating that a large proportion of patients with migraine headaches have vestibular symptoms and that a large proportion of patients with undiagnosed episodic vestibular symptoms have migraine headache. Despite the availability of diagnostic criteria for vestibular migraine, challenges to diagnosis include variability in terms of the character of dizziness, the presence or absence of clearly defined attacks, the duration of attacks, and the temporal association between headache or other migrainous features and vestibular symptoms. Also, symptoms of vestibular migraine often overlap with symptoms of other causes of dizziness, especially Ménière's disease and benign paroxysmal positional vertigo (BPPV). This article will discuss the demographics, epidemiology, clinical manifestations, physical examination findings, laboratory testing, comorbidities, treatment options, and pathophysiology of vestibular migraine. Future research in the field of vestibular migraine should include both clinical and basic science efforts to better understand the pathophysiology of this condition. Controlled treatment trials for vestibular migraine are desperately needed.

  4. A ‘complex’ of brain metabolites distinguish altered chemistry in the cingulate cortex of episodic migraine patients

    PubMed Central

    Becerra, L.; Veggeberg, R.; Prescot, A.; Jensen, J.E.; Renshaw, P.; Scrivani, S.; Spierings, E.L.H.; Burstein, R.; Borsook, D.

    2016-01-01

    Despite the prevalence of migraine, the pathophysiology of the disease remains unclear. Current understanding of migraine has alluded to the possibility of a hyperexcitable brain. The aim of the current study is to investigate human brain metabolite differences in the anterior cingulate cortex (ACC) during the interictal phase in migraine patients. We hypothesized that there may be differences in levels of excitatory neurotransmitters and/or their derivatives in the migraine cohort in support of the theory of hyperexcitability in migraine. 2D J-resolved proton magnetic resonance spectroscopy (1H-MRS) data were acquired on a 3 Tesla (3 T) MRI from a voxel placed over the ACC of 32 migraine patients (MP; 23 females, 9 males, age 33 ± 9.6 years) and 33 healthy controls (HC; 25 females, 8 males, age 32 ± 9.6 years). Amplitude correlation matrices were constructed for each subject to evaluate metabolite discriminability. ProFit-estimated metabolite peak areas were normalized to a water reference signal to assess subject differences. The initial analysis of variance (ANOVA) was performed to test for group differences for all metabolites/creatine (Cre) ratios between healthy controls and migraineurs but showed no statistically significant differences. In addition, we used a multivariate approach to distinguish migraineurs from healthy subjects based on the metabolite/Cre ratio. A quadratic discriminant analysis (QDA) model was used to identify 3 metabolite ratios sufficient to minimize minimum classification error (MCE). The 3 selected metabolite ratios were aspartate (Asp)/Cre, N-acetyl aspartate (NAA)/Cre, and glutamine (Gln)/Cre. These findings are in support of a ‘complex’ of metabolite alterations, which may underlie changes in neuronal chemistry in the migraine brain. Furthermore, the parallel changes in the three-metabolite ‘complex’ may confer more subtle but biological processes that are ongoing. The data also support the current theory that the

  5. Migraine and oral contraceptives.

    PubMed

    Mousa, G Y

    1982-10-01

    Migraine is a common complaint in optometric practice. Three cases of migrainous patients taking oral contraceptives are presented in this report. The role of oral contraceptives in triggering a migraine attack and possibly elevating the risk of a stroke in a patient with migraine is discussed. The counseling an optometrist can provide in such cases in discussed.

  6. Risk of Migraine in Patients With Asthma: A Nationwide Cohort Study.

    PubMed

    Peng, Yi-Hao; Chen, Kuan-Fei; Kao, Chia-Hung; Chen, Hsuan-Ju; Hsia, Te-Chun; Chen, Chia-Hung; Liao, Wei-Chih

    2016-03-01

    Asthma has been described as an "acephalic migraine" and "pulmonary migraine." However, no study has investigated the temporal frequency of migraine development in patients with asthma, and the results of previous studies may be difficult to generalize.We investigated the effect of asthma on the subsequent development of migraine by using a population-based data set in Taiwan.We retrieved our study sample from the National Health Insurance Research Database. Specifically, 25,560 patients aged 12 years and older with newly diagnosed asthma were identified as the asthma group, and 102,238 sex and age-matched patients without asthma were identified as the nonasthma group. Cox proportional-hazards regression models were employed to measure the risk of migraine for the asthmatic group compared with that for the nonasthmatic group.The risk of migraine in the asthmatic group was 1.45-fold higher (95% confidence interval 1.33-1.59) than that in the nonasthmatic group after adjustment for sex, age, the Charlson comorbidity index, common medications prescribed for patients with asthma, and annual outpatient department visits. An additional stratified analysis revealed that the risk of migraine remained significantly higher in both sexes and all age groups older than 20 years.Asthma could be an independent predisposing risk factor for migraine development in adults.

  7. [Chronic migraine].

    PubMed

    Diener, H C; Holle, D; Müller, D; Nägel, S; Rabe, K

    2013-12-01

    The classification of the International Headache Society (IHS) generally differentiates episodic from chronic headache. Chronic migraine is defined as headache on 15 and more days a month over more than 3 months and headache on 8 days or more fulfils the criteria for migraine or were triptan/ergot-responsive when thought to be migrainous in early stages of the attack. The prevalence of chronic migraine is estimated at 2-4 %. The quality of life is highly compromised in this condition and comorbidities are much more frequent compared to episodic migraine. Data from prospective randomized studies are scarce as most patients with chronic migraine were excluded from previous trials and only few studies were conducted for this condition. The efficacy for prophylactic treatment compared with placebo is proven for topiramate and onabotulinum toxin A.

  8. Changes in retinal vessel diameters in migraine patients during attack-free period

    PubMed Central

    Unlu, Metin; Sevim, Duygu Gulmez; Gultekin, Murat; Baydemir, Recep; Karaca, Cagatay; Oner, Ayse

    2017-01-01

    AIM To evaluate the retinal vessel diameters in patients with migraine by optical coherence tomography (OCT). METHODS In this cross-sectional study, 124 eyes of 62 patients with a diagnosis of unilateral migraine during attack-free period and 42 age- and sex-matched control subjects were included. Migraine patients were divided into the ≤2 migraine attacks per month group and the ≥5 migraine attacks per month group. All subjects underwent complete ophthalmological and neurological examinations before measurements. Retinal vessel diameters and choroidal thickness were examined with the Spectralis OCT. RESULTS The mean diameters of the arteries in the eyes on the headache side of control group, ≥5 migraine attacks per month and ≤2 migraine attacks per month group at 480 µm from the optic disk (Raster 3) were 119.54±46.69, 136.68±25.93 and 119.34±31.75 µm respectively with a steady decline to 105.57±32.15, 118.18±31.87 and 108.05±38.77 µm at 1440 µm (Raster 7), the last measurement point, respectively. The retinal artery diameter measurements were significantly increased in ≥5 migraine attacks per month patients at four out of five measured points compared to control group (P<0.05). There were no statistical differences at any of the points of vein measurements. The choroidal thickness measurements were significantly decreased in ≥5 migraine attacks per month patients at all measured points compared to control group (P<0.05). CONCLUSION The retinal artery diameter is found to increase significantly and the choroidal thickness is found to decrease in the eyes on the headache side in ≥5 migraine attacks per month patients compared to control group. PMID:28393037

  9. [MRI findings and effectiveness of cyproheptadine in two patients with ophthalmoplegic migraine].

    PubMed

    Sugiyama, Nobuyoshi; Hamano, Shin-ichiro; Tanaka, Manabu; Mochizuki, Mika; Nara, Takahiro

    2002-11-01

    We reported the MRI findings and clinical course of two patients with ophthalmoplegic migraine. Both patients presented with unilateral oculomotor nerve palsy. Contrast enhanced MR imaging revealed unilateral enhancement and thickening of the oculomotor nerve in one patient. Prednisolone was effective in both patients, but only could transiently. On the other hand, cyproheptadine hydrochloride could completely prevent recurrent attacks of ophthalmoplegic migraine. Thus, MR imaging with of contrast enhancement is useful in the diagnosis of ophthalmoplegic migraine. Cyproheptadine hydrochloride is better than prednisolone to prevention recurrent attacks and to avoid adverse effects.

  10. Therapeutic strategies in migraine patients with mood and anxiety disorders: clinical evidence.

    PubMed

    Finocchi, Cinzia; Villani, Veronica; Casucci, Gerardo

    2010-06-01

    Mood and anxiety disorders are comorbid with migraine. The coexistence of a psychiatric disorder alters the quality of life, the total disability, the course of migraine and the final prognosis; it increases the probability of central sensitization, other chronic pain conditions and the evolution to chronic migraine. All patients presenting with frequent episodic and chronic migraine should be screened for depression and anxiety. When these conditions are present, drugs for migraine prevention that may worsen the psychiatric comorbid disorder have to be avoided. When it is possible, both conditions should be treated with a single agent. Amitriptiline can be used both in mood disorders and migraine prevention. Flunarizine and beta-blockers may help if anxiety is present. Pregabalin has demonstrated efficacy in anxiety disorders and fibromyalgia. Divalproex sodium, topiramate and lamotrigine that have demonstrated efficacy in mood stabilization are also indicated in migraine without aura (divalproex sodium and topiramate) and with aura (lamotrigine). When a specific treatment for the comorbid psychiatric disorder is needed, the selective serotonin reuptake inhibitors or the serotonin norepinephrine reuptake inhibitors are the drugs of choice both in depression and anxiety, and the cognitive behavioural therapy has good evidence of efficacy in anxiety disorders. Vagal nerve stimulation may be an option in patients with refractory chronic migraine and depression.

  11. Optimal management of severe nausea and vomiting in migraine: improving patient outcomes.

    PubMed

    Láinez, Miguel Ja; García-Casado, Ana; Gascón, Francisco

    2013-10-11

    Migraine is a common and potentially disabling disorder for patients, with wide-reaching implications for health care services, society, and the economy. Nausea and vomiting during migraine attacks are common symptoms that affect at least 60% of patients suffering from migraines. These symptoms are often more disabling than the headache itself, causing a great burden on the patient's life. Nausea and vomiting may delay the use of oral abortive medication or interfere with oral drug absorption. Therefore, they can hinder significantly the management and treatment of migraine (which is usually given orally). The main treatment of pain-associated symptoms of migraine (such as nausea and vomiting) is to stop the migraine attack itself as soon as possible, with the effective drugs at the effective doses, seeking if necessary alternative routes of administration. In some cases, intravenous antiemetic drugs are able to relieve a migraine attack and associated symptoms like nausea and vomiting. We performed an exhaustive PubMed search of the English literature to find studies about management of migraine and its associated symptoms. Search terms were migraine, nausea, and vomiting. We did not limit our search to a specific time period. We focused on clinical efficacy and tolerance of the various drugs and procedures based on data from human studies. We included the best available studies for each discussed drug or procedure. These ranged from randomized controlled trials for some treatments to small case series for others. Recently updated books and manuals on neurology and headache were also consulted. We herein review the efficacy of the different approaches in order to manage nausea and vomiting for migraine patents.

  12. Lateral pterygoid muscle volume and migraine in patients with temporomandibular disorders

    PubMed Central

    Lopes, Sérgio Lúcio Pereira de Castro; Costa, André Luiz Ferreira; Gamba, Thiago de Oliveira; Cruz, Adriana Dibo; Min, Li Li

    2015-01-01

    Purpose Lateral pterygoid muscle (LPM) plays an important role in jaw movement and has been implicated in Temporomandibular disorders (TMDs). Migraine has been described as a common symptom in patients with TMDs and may be related to muscle hyperactivity. This study aimed to compare LPM volume in individuals with and without migraine, using segmentation of the LPM in magnetic resonance (MR) imaging of the TMJ. Materials and Methods Twenty patients with migraine and 20 volunteers without migraine underwent a clinical examination of the TMJ, according to the Research Diagnostic Criteria for TMDs. MR imaging was performed and the LPM was segmented using the ITK-SNAP 1.4.1 software, which calculates the volume of each segmented structure in voxels per cubic millimeter. The chi-squared test and the Fisher's exact test were used to relate the TMD variables obtained from the MR images and clinical examinations to the presence of migraine. Logistic binary regression was used to determine the importance of each factor for predicting the presence of a migraine headache. Results Patients with TMDs and migraine tended to have hypertrophy of the LPM (58.7%). In addition, abnormal mandibular movements (61.2%) and disc displacement (70.0%) were found to be the most common signs in patients with TMDs and migraine. Conclusion In patients with TMDs and simultaneous migraine, the LPM tends to be hypertrophic. LPM segmentation on MR imaging may be an alternative method to study this muscle in such patients because the hypertrophic LPM is not always palpable. PMID:25793177

  13. Optimal management of severe nausea and vomiting in migraine: improving patient outcomes

    PubMed Central

    Láinez, Miguel JA; García-Casado, Ana; Gascón, Francisco

    2013-01-01

    Migraine is a common and potentially disabling disorder for patients, with wide-reaching implications for health care services, society, and the economy. Nausea and vomiting during migraine attacks are common symptoms that affect at least 60% of patients suffering from migraines. These symptoms are often more disabling than the headache itself, causing a great burden on the patient’s life. Nausea and vomiting may delay the use of oral abortive medication or interfere with oral drug absorption. Therefore, they can hinder significantly the management and treatment of migraine (which is usually given orally). The main treatment of pain-associated symptoms of migraine (such as nausea and vomiting) is to stop the migraine attack itself as soon as possible, with the effective drugs at the effective doses, seeking if necessary alternative routes of administration. In some cases, intravenous antiemetic drugs are able to relieve a migraine attack and associated symptoms like nausea and vomiting. We performed an exhaustive PubMed search of the English literature to find studies about management of migraine and its associated symptoms. Search terms were migraine, nausea, and vomiting. We did not limit our search to a specific time period. We focused on clinical efficacy and tolerance of the various drugs and procedures based on data from human studies. We included the best available studies for each discussed drug or procedure. These ranged from randomized controlled trials for some treatments to small case series for others. Recently updated books and manuals on neurology and headache were also consulted. We herein review the efficacy of the different approaches in order to manage nausea and vomiting for migraine patents. PMID:24143125

  14. Migraine with persistent aura in a Mexican patient: case report and review of the literature.

    PubMed

    San-Juan, O D; Zermeño, P F

    2007-05-01

    Persistent aura symptoms in patients with migraine are rare but well documented. The International Headache Society defines persistent aura without infarction as when the aura symptoms persist for > 1 week without radiographic evidence of infarction. The visual aura of migraine attacks has been explained by cortical spreading depression. We describe a case of a 28-year-old Mexican woman, who presented with persistent aura symptoms, and a literature review. The patient had a 24-year history of migraine headache. In November 2005 the patient had an attack which started with scintillating scotomas bilaterally associated with photopsias and amaurosis followed by migraine headache. All imaging studies were negative. The episode lasted 35 days and probably resolved with nimodipine therapy. Persistent aura symptoms are rare entities. This is the first case documented of a Mexican patient with persistent aura without infarction and probably resolved with nimodipine therapy.

  15. Nitroglycerin induces migraine headache and central sensitization phenomena in patients with migraine without aura: a study of laser evoked potentials.

    PubMed

    de Tommaso, Marina; Libro, Giuseppe; Guido, Marco; Difruscolo, Olimpia; Losito, Luciana; Sardaro, Michele; Cerbo, Rosanna

    2004-06-17

    In migraineurs nitroglycerin (NTG) induces severe delayed headache, resembling spontaneous migraine attacks. The aim of the present study was to evaluate NTG laser evoked potentials (LEP) features amplitude and pain sensation to laser stimuli during NTG-induced headache. Nine patients were selected. Headache was induced by oral administration of 0.6 mg of NTG; signals were recorded through disk electrodes placed at the vertex and referred to linked earlobes. CO(2)-LEPs delivered by stimulation of the dorsum of both hands and the right and left supraorbital zones were evaluated after the onset of moderate or severe headache resembling spontaneous migraine and at least 72 h after the end of the headache phase. Patients exhibited a significant heat pain threshold reduction and an LEPs amplitude increment during headache when both the supraorbital zones were stimulated. NTG appeared to support a reliable experimental model of migraine, based on the neuronal effects on the integrative-nociceptive structures. The LEPs facilitation during NTG-induced headache may be subtended by a hyperactivity of nociceptive cortex as well as by a failure of pain-inhibitory control.

  16. Benefits of treating highly disabled migraine patients with zolmitriptan while pain is mild.

    PubMed

    Klapper, J; Lucas, C; Røsjø, Ø; Charlesworth, B

    2004-11-01

    Clinical trials of migraine therapy often require treatment when migraine pain intensity is moderate or severe, but many physicians find this practice artificial and patients often prefer to treat while pain is mild. This randomized, placebo-controlled study assessed the efficacy of zolmitriptan 2.5 mg in treating migraine while pain is mild, in patients who typically experience migraine attacks that are initially mild, but progress to moderate or severe. The intent-to-treat population comprised 280 patients (138 zolmitriptan; 148 placebo), with mean MIDAS grades of 29.6 (zolmitriptan) and 27.6 (placebo). Zolmitriptan 2.5 mg provided a significantly higher pain-free rate at 2 h (43.4% vs. 18.4% placebo; P < 0.0001). Significantly fewer zolmitriptan patients reported progression of headache pain to moderate or severe intensity 2 h postdose (53.7% vs. 70.4% placebo; P < 0.01), or required further medication within 24 h (46.4% vs. 71.1% placebo; P < 0.0001). The efficacy of zolmitriptan was more pronounced in patients treating during the first 15 min following pain onset. Adverse events were reported in 31.2% of patients treated with zolmitriptan (vs. 11.3% for placebo), and the incidence was lower in patients who treated early after attack onset. Zolmitriptan provides high efficacy when treating migraine while pain is mild, with the clinical benefits being more pronounced when treating early after migraine onset.

  17. Visual cortex and cerebellum hyperactivation during negative emotion picture stimuli in migraine patients

    PubMed Central

    Wang, Mengxing; Su, Jingjing; Zhang, Jilei; Zhao, Ying; Yao, Qian; Zhang, Qiting; Zhang, Hui; Wang, Shuo; Li, Ge-Fei; Liu, Jian-Ren; Du, Xiaoxia

    2017-01-01

    Migraines are a common and undertreated disease and often have psychiatric comorbidities; however, the abnormal mechanism of emotional processing in migraine patients has not been well clarified. This study sought to investigate the different brain functional activation to neutral, positive and negative emotional stimuli between migraine and healthy subjects. Twenty-six adults with migraines and 26 healthy adults, group-matched for sex and age, participated in this experiment. Although there were no significant differences between two groups during the viewing of positive affective pictures vs. neutral affective pictures, there were different activation patterns during the viewing of negative to neutral affective pictures in the two groups; the control group showed both increased and decreased activation patterns, while the migraine subjects showed only increased activation. Negative affective pictures elicited stronger activation than neutral affective pictures in migraineurs, which included the bilateral cerebellum anterior lobe/culmen, the bilateral lingual gyri, the bilateral precuneus and the left cuneus. Our data indicated that migraine patients were hypersensitive to negative stimuli, which might provide clues to aid in the understanding of the pathophysiology and psychiatric comorbidities of migraines. PMID:28181500

  18. Usage of triptans among migraine patients: an audit in nine GP practices.

    PubMed

    Williams, D; Cahill, T; Dowson, A; Fearon, H; Lipscombe, S; O'Sullivan, E; Rees, T; Strang, C; Valori, A; Watson, D

    2002-01-01

    A retrospective audit was carried out to investigate triptan usage over a period of one year among 360 adult patients with migraine in nine GP practices in the UK and the Republic of Ireland. Data from patient records were analysed, in conjunction with replies to a questionnaire about patients' perceptions of their migraine and its treatment. The majority of patients included in the audit were women (83%), and most patients (81%) were aged between 35 and 64 years. Most patients in the audit population (60%) were in the lowest band of triptan usage (1-36 tablets prescribed over 12 months); 7% had moderate usage (37-53 tablets). A minority of patients appeared to be taking triptans in higher quantities: about 15% of patients had been prescribed 54-94 triptan tablets over a year, 9% had received prescriptions for 95-149 tablets and 7% had received prescriptions for 150 or more tablets. These results indicated that some migraine patients were using triptans at higher than expected rates, and suggested that some patients might have been using their prescribed triptans inappropriately to treat a headache that they incorrectly perceived as migraine (e.g. chronic daily headache). Analyses were carried out to identify predictors of high usage. Predictors identified included the use of several other (non-triptan) medications to treat conditions other than migraine, one triptan dose being reported as sufficient to treat an attack, patient's perception of all headaches as migraine and lack of concern about taking too much medication. Patients identified as using triptans at a higher than expected rate can be called in for review of migraine diagnosis, identification of possible causes of any increased frequency of attacks, and investigation of suspected non-migrainous headaches, such as chronic daily headache and medication-induced headaches. For GPs, such actions would help achieve and maintain a high standard of care for their migraine patients, thus helping to contribute

  19. [Chronic migraine: its epidemiology and impact].

    PubMed

    Pozo-Rosich, Patricia

    2012-04-10

    Chronic migraine (that is to say, cases where migraine is suffered on 15 or more days per month) is an illness that affects approximately 0.5-2.5% of the population, depending on the statistics that are analysed and the definition of chronic migraine used. The incidence of transformation from episodic to chronic migraine is 3% per year, and 6% go from low-frequency (1-9 days/month) to high-frequency migraine (10-14 days/month). The risk factors for developing chronic migraine are genetic, frequent use of painkillers, being female, having poor hygienic-dietary habits, developing anxiety/depression, having a low socioeconomic status, suffering from obesity and being divorced or widowed. Despite the modification of the risk factors, it has still not been proved that the chances of developing chronic migraine can be lowered. Chronic migraine has an important impact on patients' quality of life, as measured on disability, quality of life and impact on daily activities scales. These patients have twice the chance of suffering from depression, anxiety and chronic pain, which means they therefore need greater health care. Many have still to be diagnosed and treated, however. In a Spanish epidemiological study, a follow-up was carried out on patients with chronic daily headache after undergoing a therapeutic intervention and up to 60% of the patients showed improvement. In other words, with increased interest and diagnosis of this illness, many patients would benefit from suitable treatments.

  20. Abnormal brain processing of cutaneous pain in patients with chronic migraine.

    PubMed

    de Tommaso, Marina; Valeriani, Massimiliano; Guido, Marco; Libro, Giuseppe; Specchio, Luigi Maria; Tonali, Pietro; Puca, Francomichele

    2003-01-01

    Syndromes with chronic daily headache include chronic migraine (CM). The reason for the transformation of migraine into chronic daily headache is still unknown. In this study, we aimed to evaluate heat pain thresholds and event-related potentials following CO(2)-laser thermal stimulation (LEPS) in hand and facial regions in patients with CM, to show changes in nociceptive brain responses related to dysfunction of pain elaboration at the cortical level. The results were compared with findings from normal control subjects and from subjects who suffer from migraine without aura. The effects of stimulus intensity, subjective pain perception and attention were monitored and compared with features of the LEPS. Twenty-five CM patients, 15 subjects suffering from migraine without aura and 15 normal control subjects were enrolled in the study. LEPS amplitude variation was reduced in CM patients with respect to the perceived stimulus intensity, in comparison with migraine without aura patients and control subjects. In both headache groups, the distraction from the painful laser stimulus induced by an arithmetic task failed to suppress the LEPS amplitude, in comparison with control subjects. These results suggest an abnormal cortical processing of nociceptive input in CM patients, which could lead to the chronic state of pain. In both headache groups, an inability to reduce pain elaboration during an alternative cognitive task emerged as an abnormal behaviour probably predisposing to migraine.

  1. Oxidative stress and decreased thiol level in patients with migraine: cross-sectional study.

    PubMed

    Eren, Yasemin; Dirik, Ebru; Neşelioğlu, Salim; Erel, Özcan

    2015-12-01

    Although migraine is a neurological disorder known since long, its physiopathology remains unclear. Recent studies suggest that migraine is associated with oxidative stress; however, they report divergent results. The aim of the present study was to evaluate total antioxidant status (TAS), total oxidant status (TOS), oxidative stress index (OSI), and serum thiol level in migraine patients with or without aura. The study group consisted of 141 migraine patients. The control group included 70 healthy subjects. TAS, TOS, OSI were evaluated using a method developed by Erel. Serum thiol level was measured using the Hu method. No difference was found in TAS, TOS, OSI between the patients and controls. The level of thiol was significantly lower in patients than in controls. Negative correlations were detected between thiol level and Migraine Disability Assessment score in patients. Although TAS, TOS, and OSI were similar to those of the control group, serum thiol level, an important marker of antioxidant capacity, was significantly lower in migraines compared with controls, and caused more serious disability. Novel treatment approaches may be developed based on these data, and compounds containing thiol, such as alpha lipoic acid and N-acetyl cysteine, may be used in prophylaxis.

  2. Sleep quality, morningness-eveningness preference, mood profile, and levels of serum melatonin in migraine patients: a case-control study.

    PubMed

    Kozak, Hasan Hüseyin; Boysan, Murat; Uca, Ali Ulvi; Aydın, Adem; Kılınç, İbrahim; Genç, Emine; Altaş, Mustafa; Güngör, Dilara Cari; Turgut, Keziban; Özer, Nejla

    2017-03-01

    The melatonin as the pineal gland's secretory product is implicated in the pathophysiology of migraine. Melatonin has critical functions in human physiology, and research underscores the importance of melatonin in circadian rhythm, sleep, and mood regulation. Clinical observations have indicated that migraine attacks have a seasonal, menstrual, and circadian timing, suggesting that chronobiological mechanisms and their alterations may causally involve in the etiology of the disease. However, the topic has received relatively little attention in the migraine literature. Associations between melatonin, circadian preference, sleep, and mood states were investigated in the current study. Fifty-five patients (47 females and 8 males) were compared to 57 gender and age-matched control subjects (40 females and 17 males). A socio-demographical questionnaire, the Beck Depression Inventory, Beck Anxiety Inventory (BAI), Pittsburgh Sleep Quality Index (PSQI), Profile of Mood States (POMS), and Morningness-Eveningness Questionnaire were administered to volunteers. Blood samples were taken from all participants at about 1:00 AM in an unlit room not to hamper melatonin secretion, and blood melatonin levels were measured using quantitative ELISA test. In comparison with controls, melatonin levels were significantly lower among migraine patients. Migraineurs reported significantly greater scores on the BAI, confusion-bewilderment subscale of the POMS, and total and sleep latency subscale of the PSQI. Migraine patients who had nausea during the migraine attacks and who reported bouts relevant to certain food consumption, such as cheese or chocolate, had significantly lower levels of melatonin. Contrarily, groups did not reveal statistically substantial difference in circadian preferences.

  3. Migraine and Stroke: “Vascular” Comorbidity

    PubMed Central

    Guidetti, Donata; Rota, Eugenia; Morelli, Nicola; Immovilli, Paolo

    2014-01-01

    Several comorbidities are associated to migraine. Recent meta-analyses have consistently demonstrated a relationship between migraine and stroke, which is well-defined for ischemic stroke and migraine with aura (MA), even stronger in females on oral contraceptives or smokers. However, there seems to be no clear-cut association between stroke in migraineurs and the common vascular risk factors, at least in the young adult population. Migraineurs also run an increased risk of hemorrhagic stroke, while the association between migraine and cardiovascular disease remains poorly defined. Another aspect is the relationship between migraine and the presence of silent brain lesions. It has been demonstrated that there is an increased frequency of ischemic lesions in the white matter of migraineurs, especially silent infarcts in the posterior circulation territory in patients with at least 10 attacks per month. Although there is a higher prevalence of patent foramen ovale (PFO) in migraineurs, the relationship between migraine and PFO remains controversial and PFO closure is not a recommended procedure to prevent migraine. As an increased frequency of cervical artery dissections has been observed in migrainous patients, it has been hypothesized that migraine may represent a predisposing factor for cervical artery dissection. There still remains the question as to whether migraine should be considered a true “vascular disease” or if the comorbidity between migraine and cerebrovascular disease may have underlying shared risk factors or pathophysiological mechanisms. Although further studies are required to clarify this issue, current evidence supports a clinical management where MA patients should be screened for other concomitant vascular risk factors and treated accordingly. PMID:25339937

  4. Sugar alters the level of serum insulin and plasma glucose and the serum cortisol:DHEAS ratio in female migraine sufferers.

    PubMed

    Kokavec, Anna; Crebbin, Susan J

    2010-12-01

    Early work has highlighted that a large percentage of migraineurs may have an altered glucidic methabolis due to carbohydrate-induced hyperinsulinism. The aim of this study was to assess the effect of sucrose on biomarkers of energy metabolism and utilization in migraineous females. A total of 16 participants (8 = Migraine, 8 = Non-migraine) at the mid-point of their menstrual cycle underwent a 15-h fast prior to ingesting 75 g sucrose dissolved in 175 g water. Blood sampling for the assessment of serum insulin, serum cortisol and serum dehydroepiandrosterone sulfate (DHEAS) and plasma glucose was conducted upon arrival at 09:00 h and then at regular 15-min intervals across a 150-min experimental period. The results showed a significant alteration in serum insulin and plasma glucose following sucrose ingestion in the migraine and non-migraine groups. In addition, significant group differences were observed in the level of serum insulin, serum DHEAS, and the cortisol:DHEAS ratio with migraine participants on average recording a higher sucrose-induced serum insulin level and lower DHEAS level and cortisol:DHEAS ratio when group data was compared. It was concluded that while sucrose consumption may potentiate serum insulin in migraineurs this does not result in the development of sucrose-induced hypoglycemia in migraine or non-migraine participants.

  5. Intravenous dihydroergotamine therapy for pediatric abdominal migraines.

    PubMed

    Raina, Madiha; Chelimsky, Gisela; Chelimsky, Thomas

    2013-10-01

    Abdominal migraines present with debilitating symptoms in adolescence. At our institution, the gastroenterology, neurology, and autonomic departments collaborated in treating patients with such presentations. This case series describes 6 patients who were given intravenous dihydroergotamine (DHE) for presumed abdominal migraines. DHE was only used when other agents like amitriptyline, verapamil, topiramate, or depakote had proved ineffective. DHE was started at 0.5 mg dose and on average 7 to 9 mg were given on each hospitalization. Patient ages ranged from 13 to 19 years with the majority being female. One patient did not respond to treatment. One patient was admitted 4 times for symptoms of abdominal migraines resolving with DHE. The average time between symptom relapse was about 5 to 12 months. Five of our 6 patients responded to the infusion without significant side effects. Based on these case series, DHE may be a treatment option in children with intractable abdominal migraine.

  6. EEG synchronization and migraine

    NASA Astrophysics Data System (ADS)

    Stramaglia, Sebastiano; Angelini, Leonardo; Pellicoro, Mario; Hu, Kun; Ivanov, Plamen Ch.

    2004-03-01

    We investigate phase synchronization in EEG recordings from migraine patients. We use the analytic signal technique, based on the Hilbert transform, and find that migraine brains are characterized by enhanced alpha band phase synchronization in presence of visual stimuli. Our findings show that migraine patients have an overactive regulatory mechanism that renders them more sensitive to external stimuli.

  7. Increased risk of rheumatoid arthritis in patients with migraine: a population-based, propensity score-matched cohort study.

    PubMed

    Wang, Yi-Chia; Huang, Ya-Ping; Wang, Mei-Ting; Wang, Hsin-I; Pan, Shin-Liang

    2017-02-01

    Previous cross-sectional studies have suggested an association between migraine and rheumatoid arthritis (RA), but no longitudinal study has been performed to evaluate the temporal relationship between the two conditions. The purpose of the present population-based, propensity score-matched cohort study was to investigate whether migraineurs are at a higher risk of developing RA. A total of 58,749 subjects aged between 20 and 90 years with at least two ambulatory visits with a diagnosis of migraine were recruited in the migraine group. We fit a logistic regression model that included age, sex, comorbid conditions, and socioeconomic status as covariates to compute the propensity score. The non-migraine group consisted of 58,749 propensity score-matched, randomly sampled subjects without migraine. The RA-free survival curves were generated using the Kaplan-Meier method. Stratified Cox proportional hazard regression was used to estimate the effect of migraine on the risk of RA. During follow-up, 461 subjects in the migraine group and 220 in the non-migraine group developed RA. The incidence rate of RA was 3.18 (95% confidence interval [CI] 2.90-3.49) per 1000 person-years in the migraine group and 1.54 (95% CI 1.34-1.76) per 1000 person-years in the non-migraine group. Compared to the non-migraine group, the crude hazard ratio of RA for the migraine group was 2.15 (95% CI 1.82-2.56, P < 0.0001), and the multivariable-adjusted hazard ratio was 1.91 (95% CI 1.58-2.31, P < 0.0001). This study showed that patients with migraine had an increased risk of developing RA.

  8. The Use of Complementary and Alternative Medicine in Patients with Migraine

    PubMed Central

    KARAKURUM GÖKSEL, Başak

    2013-01-01

    Although many patients with migraine get positive benefits from conventional pharmacological treatments, many others do not benefit sufficiently or experience adverse effects from these treatments. For that reason, these patients usually seek complementary and/or alternative medical (CAM) treatments all over the world. In general, although CAM therapies are not recommended by neurologist in Turkey, most of migraine patients, who do not respond conventional medicine treatments, seek alternative therapy. Acupuncture, botulinum toxin, mind-body interventions, and nutraceutical options are the most popular treatments. In this review, the available evidence for all these treatments will be discussed.

  9. Effects of topiramate on neurophysiological and neuropsychological tests in migraine patients.

    PubMed

    Kececi, Hulusi; Atakay, Selcuk

    2009-12-01

    Topiramate (TPM) is a antiepileptic drug that has multiple mechanisms of action. It is effective as a monotherapy for migraine prophylaxis. Unfortunately, TPM can frequently cause adverse effects, such as cognitive dysfunction. The present study examines the neuropsychological and neurophysiological effects of TPM in 35 consecutive migraine patients above 18years of age. The TPM dose was started at 25mg/day and increased by 25mg/week, until reaching the maximum dose of 50mg twice daily in the fourth week. Patients were evaluated for development of side effects of the medication and for its effectiveness on migraine. The Wechsler memory scale was used for neuropsychological evaluation and cognitive evoked potentials were used for neurophysiologic evaluations. Analyses of repeated measures show that visual analog scale pain values, as well as migraine attack frequency and headache duration, were decreased significantly during the study. The amplitudes and latencies of P300 did not change. The results of this study show that 100mg TPM is effective in the prevention of migraine headache and in reducing severity of attacks. Patients' cognitive complaints are frequent in the first month and decrease in the following month. Despite these complaints, only the attention section of the visual memory section of the Wechsler memory scale was affected - other sections were not affected. Also, P300 study did not reflect changes appropriate to these cognitive complaints.

  10. [Progression from episodic migraine to chronic migraine].

    PubMed

    Yamane, Kiyomi

    2014-01-01

    Migraine is, essentially, an episodic disease. However, characteristics of headache of some episodic migraine change like as tension-type headache and number of headache days also increased, as a result, develop into chronic migraine.However, it is difficult to distinguish chronic migraine and medication oversuse headache. For this reason, and because of the general rule, The international Classification of Headache Disorders, 3rd edition, beta version (ICHD- 3beta) defined the patients meeting criteria for chronic migraine and for medication overuse headache should be given both diagnoses. The pathophysiology of transformation from episodic to chronic migraine is still unknown. Epidemiological study revealed several risk factors such as medication overusue, frequency of headache, obesity, low education, low income, snoring, depression, neck/head trauma and so on. It is important to control these risk factors for migraine chronification.

  11. Disability and Functional Profiles of Patients with Migraine Measured with ICF Classification

    ERIC Educational Resources Information Center

    Raggi, Alberto

    2010-01-01

    To describe the functional profiles of patients with migraine, and the relationships between symptoms, activities and environmental factors, using WHO's International Classification of Functioning (ICF). Patients were consecutively enrolled at the Besta Institute of Milan. The ICF checklist was administered and two count-based indexes developed:…

  12. Influence of hydrotherapy on clinical and cardiac autonomic function in migraine patients

    PubMed Central

    Sujan, M. U.; Rao, M. Raghavendra; Kisan, Ravikiran; Abhishekh, Hulegar A.; Nalini, Atchayaram; Raju, Trichur R.; Sathyaprabha, T. N.

    2016-01-01

    Background: Migraine is associated with autonomic symptoms. The growing body of literature suggests that the dysfunctional autonomic nervous system might play a pivotal role in the pathogenesis of migraine. Thermal therapies have been hypothesized to modulate these changes and alleviate pain. However, data regarding the efficacy of hydrotherapy in migraine remain scant. We evaluated the effect of add on hydrotherapy procedure (a hot arm and foot bath with ice massage to head) in migraine patients. Methods: Forty chronic migraine patients fulfilling the International Classification of Headache Disorders II criteria were recruited from the neurology outpatient clinic. Patients were randomized to receive either hydrotherapy plus conventional pharmacological care (n = 20) or conventional medication only (n = 20). Hydrotherapy group received treatment with hot arm and foot bath (103°F to 110°F) and ice massage to head daily for 20 min for 45 days. Patients were assessed using headache impact test (HIT), visual analog scale for pain and cardiac autonomic function by heart rate variability (HRV) before and after intervention period. Results: There was a significant decrease in HIT score, frequency, and intensity of headaches following treatment in both the groups. However, it was more evident in add on hydrotherapy group compared to pharmacological treatment alone group. There was also significant improvement in the HRV parameters. In particular, there was a significant decrease in heart rate (P = 0.017), increase in high frequency (HF) (P = 0.014) and decrease in low frequency/HF ratio (P = 0.004) in add on hydrotherapy group. Conclusion: Our study shows that add on hydrotherapy enhanced the vagal tone in addition to reducing the frequency and intensity of headaches in migraine patients. PMID:26933356

  13. Human factors validation study of 3 mg sumatriptan autoinjector, for migraine patients

    PubMed Central

    Brand-Schieber, Elimor; Munjal, Sagar; Kumar, Rajesh; Andre, Anthony D; Valladao, Will; Ramirez, Margarita

    2016-01-01

    Background Migraine pain relief is reported by more than 50% of patients who receive low dose (3 mg) of sumatriptan. Currently, there is no two-step autoinjector of low-dose sumatriptan available on the market for acute migraine treatment. To fulfill this need, a fully assembled, single-dose, subcutaneous autoinjector (sumatriptan 3 mg; product-code DFN-11) was developed. The device allows for injection with a simple two-step, push-to-inject process and provides feedback of the injection activation, progress, and completion. Objective To determine if DFN-11 autoinjector can be used correctly and safely by migraine patients. Methods and participants A human factors validation study was conducted with 45 migraine patients (30 oral-only medications users; 15 injectable sumatriptan users) who performed one unaided simulated injection. Two days prior, half the oral participants were briefly trained. All others were only given the device to inspect and written instructions to review. No injections were performed during the initial session. All participants received written instructions at the injection session. Results All participants (45/45; 100%) performed the injection without any errors. Objective measures included device removal from packaging, cap removal, expiration date check, inspection of fluid in window, identification of allowable injection site, proper device positioning, dose confirmation, and device disposal. All participants (45/45; 100%) reported no difficulty administering the injection and no concerns about using the autoinjector during a severe migraine onset. Conclusion The results showed that the DFN-11 autoinjector can be used with safe handling without patterns of confusion, failures, high-risk errors, wet injections, or patient safety risks. The DFN-11 autoinjector was validated to be used correctly and safely by migraine patients, whether they were injection experienced, unexperienced, trained, or self-trained. PMID:27313479

  14. Capsaicin failed in suppressing cortical processing of CO2 laser pain in migraine patients.

    PubMed

    de Tommaso, Marina; Losito, Luciana; Difruscolo, Olimpia; Sardaro, Michele; Libro, Giuseppe; Guido, Marco; Lamberti, Paolo; Livrea, Paolo

    The aim of this study was to compare the properties of the nociceptive system in eight migraine without aura patients in the pain-free phase with 10 healthy controls, by evaluating the topography and the source of the CO2 laser-evoked potentials (LEPs) obtained by the right supraorbital skin, during and after capsaicin topical application. In healthy subjects the acute cutaneous pain induced by capsaicin reduced the amplitude of the vertex LEPs and induced a posterior shifting of the P2 wave dipolar source within the anterior cingulate cortex. These functional changes seemed significantly reduced in migraine patients, for a disturbed pattern of pain modulation at the cortical level, which may subtend the onset and persistence of migraine.

  15. Effects of remote cutaneous pain on trigeminal laser-evoked potentials in migraine patients.

    PubMed

    de Tommaso, Marina; Difruscolo, Olimpia; Sardaro, Michele; Libro, Giuseppe; Pecoraro, Carla; Serpino, Claudia; Lamberti, Paolo; Livrea, Paolo

    2007-06-01

    The present study aimed to evaluate heat pain thresholds and evoked potentials following CO(2) laser thermal stimulation (laser-evoked potentials, LEPs), during remote application of capsaicin, in migraine patients vs. non-migraine healthy controls. Twelve outpatients suffering from migraine without aura were compared with 10 healthy controls. The LEPs were recorded by 6 scalp electrodes, stimulating the dorsum of the right hand and the right supraorbital zone in basal condition, during the application of 3% capsaicin on the dorsum of the left hand and after capsaicin removal. In normal subjects, the laser pain and the N2-P2 vertex complex obtained by the hand and face stimulation were significantly reduced during remote capsaicin application, with respect to pre-and post-capsaicin conditions, while in migraine LEPs and laser pain were not significantly modified during remote painful stimulation. In migraine a defective brainstem inhibiting control may coexist with cognitive factors of focalised attention to facial pain, less sensitive to distraction by a second pain.

  16. [Formalized consensus: clinical practice recommendations for the management of the migraine in African adult patients].

    PubMed

    Ahmed, Mahmoud Ait Kaci; Haddad, Monia; Kouassi, Beugré; Ouhabi, Hamid; Serrie, Alain

    2016-01-01

    Migraine is a primary headache disorder (according to the latest International Headache Society criteria) affecting approximately 8% of African population. Women are more often affected than men and attacks usually occur before the age of 40 years Although some treatments, hygienic-dietary measures and other non-pharmacological methods can reduce the intensity and frequency of attacks, medicinal treatment of migraine attack is often necessary. Availability of treatments and access to care differ in Africa and led to the implementation of the first expert consensus recommendations for the management of the migraine in african adult patients. This multinational collaborative study is intended for health practitioners. It aims to provide 16 simple, evidence-based recommendations and is adapted to african medical practice.

  17. Psychiatric comorbidity in patients with chronic daily headache and migraine: a selective overview including personality traits and suicide risk.

    PubMed

    Pompili, Maurizio; Di Cosimo, Daniela; Innamorati, Marco; Lester, David; Tatarelli, Roberto; Martelletti, Paolo

    2009-08-01

    Studies on the prevalence and impact of psychiatric disorders among headache patients have yielded findings that have clarified the relationship between migraine and major affective disorders, anxiety, illicit drug abuse, nicotine dependence, and suicide attempts. Studies in both clinical and community-based settings have demonstrated an association between migraine and a number of specific psychiatric disorders. In large-scale population-based studies, persons with migraine are from 2.2 to 4.0 times more likely to have depression. In longitudinal studies, the evidence supports a bidirectional relationship between migraine and depression, with each disorder increasing the risk of the other disorder. Although a strong association has been demonstrated consistently for migraine and major depression, especially for migraine with aura, there has been less systematic research on the links between migraine and bipolar disorder. This review will focus on the way in which psychiatric disorders decrease the quality of life and result in a worse prognosis, chronicity of the disease, and a worse response to treatment. Short-term pharmaceutical care intervention improves the patients' mental health, but it does not significantly change the number and severity of headaches. The increase in self-efficacy and mental health associated with pharmaceutical care may be instrumental in improving the long-term pharmacotherapy of patients with migraine and headache.

  18. Migraine Prophylaxis

    PubMed Central

    Danys, Irena

    1991-01-01

    While the pathophysiology of recurrent migraine remains elusive, effective treatment for the prevention of attacks is available. Pharmacologic agents are useful adjuncts to a therapeutic approach that includes abundant patient education, rigorous follow up by the treating physician, and a commitment by both patient and physician to work out an individualized solution over time. PMID:21234086

  19. [Local and general humoral immunity in patients with migraine, Horton's syndrome and autonomic pain].

    PubMed

    Puzin, M N; Kulakov, A V; Balashov, K E; Sharov, M N; Vodop'ianov, N P

    1989-01-01

    Patients with migraines, Horton syndrome and autonomic pains were subjected to immunological investigation that revealed different degrees of local and general immunity disorders: increase in blood serum IfA and salival IgAc concentrations. These changes are believed to be capable of serving as diagnostic and prognostic indices.

  20. Occlusal abnormalities, pericranial muscle and joint tenderness and tooth wear in a group of migraine patients.

    PubMed

    Steele, J G; Lamey, P J; Sharkey, S W; Smith, G M

    1991-09-01

    Seventy-two migraine sufferers, whose attacks normally begin during or soon after waking from sleep, were compared with 37 age- and sex-matched controls to establish whether signs of mandibular dysfunction, occlusal discrepancies and known clenching or grinding habits were any more frequent among the former group. Temporomandibular joint tenderness or pain history, masticatory muscle tenderness and known clenching or grinding habits were found to occur at significantly increased levels in the migraine sufferers, with two-thirds of these patients reporting a parafunctional habit. Occlusal abnormalities, including non-working side or protrusive interferences and slides of greater than 1 mm to the intercuspal position, were found to occur at similar frequencies in the two groups. Assessment of wear of the occlusal surfaces also showed no difference, suggesting that any nocturnal habit with a role in migraine is more likely to be clenching in nature. In conclusion, evidence was found to support an aetiological role for nocturnal tooth clenching or grinding in migraine characterized by attacks that start predominantly during sleep or soon after waking, but no evidence of a link with occlusal factors was found in these patients.

  1. Increased Amplitude of Thalamocortical Low-Frequency Oscillations in Patients with Migraine

    PubMed Central

    Wilcox, Sophie L.; Veggeberg, Rosanna; Noseda, Rodrigo; Burstein, Rami; Borsook, David; Becerra, Lino

    2016-01-01

    For many years, neurobiological theories have emphasized the importance of neuronal oscillations in the emergence of brain function. At the same time, clinical studies have shown that disturbances or irregularities in brain rhythms may relate to various common neurological conditions, including migraine. Increasing evidence suggests that the CNS plays a fundamental role in the predisposition to develop different forms of headache. Here, we present human imaging data that strongly support the presence of abnormal low-frequency oscillations (LFOs) in thalamocortical networks of patients in the interictal phase of migraine. Our results show that the main source of arrhythmic activity was localized to the higher-order thalamic relays of the medial dorsal nucleus. In addition, spontaneous LFOs in the thalamus were selectively associated with the headache attack frequency, meaning that the varying amplitude of dysrhythmia could predispose patients to recurrent attacks. Rhythmic cortical feedback to the thalamus is a major factor in the amplification of thalamocortical oscillations, making it a strong candidate for influencing neuronal excitability. We further speculate that the intrinsic dynamics of thalamocortical network oscillations are crucial for early sensory processing and therefore could underlie important pathophysiological processes involved in multisensory integration. SIGNIFICANCE STATEMENT In many cases, migraine attacks are thought to begin centrally. A major obstacle to studying intrinsic brain activity has been the identification of the precise anatomical structures and functional networks that are involved in migraine. Here, we present imaging data that strongly support the presence of abnormal low-frequency oscillations in thalamocortical networks of patients in the interictal phase of migraine. This arrhythmic activity was localized to the higher-order thalamic relays of the medial dorsal nucleus and was selectively associated with headache attack

  2. Migraine in women.

    PubMed

    Lay, Christine L; Broner, Susan W

    2009-05-01

    Of the nearly 32 million Americans with migraine, 24 million are women. It is a disorder affecting women throughout their lifetimes, from childhood and puberty through the postmenopausal years. In childhood, before puberty girls are afflicted with migraine at approximately the same rate as boys, but after puberty, there is an emerging female predominance. Estrogen plays a key role in this epidemiologic variation but is not the only factor. There are numerous times when hormonal influences have an impact on migraine and its pattern, including menarche, oral contraceptive use, pregnancy, perimenopause, and menopause. Hence practitioners treating women with migraine need to have a clear understanding of these special considerations.

  3. Complicated Migraines.

    PubMed

    Blumenfeld, Alyssa E; Victorio, M Cristina; Berenson, Frank R

    2016-02-01

    Migraines are a common paroxysmal disorder that may present with a multitude of neurologic symptoms. Migraines have been re-categorized in the most recent edition of the International Classification of Headache Disorders. In this article, we review the literature on hemiplegic migraines, alternating hemiplegia of childhood, migraine with brainstem aura, retinal migraine, ophthalmoplegic migraine, Alice in Wonderland syndrome, and acute confusional migraine. We also discuss the principal clinical features, diagnostic criteria, and treatment options for these disorders.

  4. Matrix metalloproteinase (MMP)-2 gene polymorphisms affect circulating MMP-2 levels in patients with migraine with aura.

    PubMed

    Gonçalves, Flavia M; Martins-Oliveira, Alisson; Lacchini, Riccardo; Belo, Vanessa A; Speciali, Jose G; Dach, Fabíola; Tanus-Santos, Jose E

    2013-01-01

    Matrix metalloproteinases (MMP) are involved in the disruption of blood-brain barrier (BBB) during migraine attacks. In the present study, we hypothesized that two functional polymorphisms (C(-1306)T and C(-735)T) in MMP-2 gene and MMP-2 haplotypes are associated with migraine and modify MMP-2 and tissue inhibitor of MMP (TIMP)-2 levels in migraine. Genotypes for MMP-2 polymorphisms were determined by real time-PCR using Taqman allele discrimination assays. Haplotypes were inferred using the PHASE program. Plasma MMP-2 and TIMP-2 concentrations were measured by gelatin zymography and ELISA, respectively, in 148 healthy women without history of migraine and in 204 women with migraine (153 without aura; MWA, and 51 with aura; MA). Patients with MA had higher plasma MMP-2 concentrations and MMP-2/TIMP-2 ratios than patients with MWA and controls (P<0.05). While MMP-2 genotype and haplotype distributions for the polymorphisms were similar among the groups (P>0.05), we found that the CC genotype for C(-735)T polymorphism and the CC haplotype were associated with higher plasma MMP-2 concentrations in MA group (P<0.05). Our findings may help to understand the role of MMP-2 and its genetic variants in the pathophysiology of migraine and to identify a particular group of migraine patients with increased MMP-2 levels that would benefit from the use of MMP inhibitors.

  5. SMART syndrome (stroke-like migraine attacks after radiation therapy) in adult and pediatric patients.

    PubMed

    Armstrong, Amy E; Gillan, Eileen; DiMario, Francis Joseph

    2014-03-01

    SMART syndrome (stroke-like migraine attacks after radiation therapy) is a rare condition that involves complex migraines with focal neurologic findings in patients following cranial irradiation for central nervous system malignancies. Little is known about the mechanisms behind the disorder, making successful treatment challenging. We report 2 new cases of SMART syndrome in pediatric patients as well as review all documented cases of the syndrome. Each of our 2 pediatric patients suffered multiple episodes. Attacks were characterized by severe headache, visual disturbance, aphasia, and weakness. Recovery occurred over several days to weeks. The data from all documented reports of SMART syndrome indicate a greater prevalence for male gender. An age-dependent pattern of onset was also observed, with a greater variability of syndrome onset in patients who received cranial irradiation at a younger age. SMART appears to be a reversible, recurrent long-term complication of radiation therapy with possible age- and gender-related influences.

  6. Part II: Biochemical changes after pituitary adenylate cyclase-activating polypeptide-38 infusion in migraine patients.

    PubMed

    Guo, Song; Vollesen, Anne Luise Haulund; Hansen, Young Bae Lee; Frandsen, Erik; Andersen, Malene Rohr; Amin, Faisal Mohammad; Fahrenkrug, Jan; Olesen, Jes; Ashina, Messoud

    2017-02-01

    Background Intravenous infusion of pituitary adenylate cyclase-activating polypeptide-38 (PACAP38) provokes migraine attacks in 65-70% of migraine without aura (MO) patients. We investigated whether PACAP38 infusion causes changes in the endogenous production of PACAP38, vasoactive intestinal polypeptide (VIP), calcitonin gene-related peptide (CGRP), tumour necrosis factor alpha (TNFα), S100 calcium binding protein B (S100B), neuron-specific enolase and pituitary hormones in migraine patients. Methods We allocated 32 previously genotyped MO patients to receive intravenous infusion PACAP38 (10 pmol/kg/minute) for 20 minutes and recorded migraine-like attacks. Sixteen of the patients were carriers of the risk allele rs2274316 ( MEF2D), which confers increased risk of MO and may regulate PACAP38 expression, and 16 were non-carriers. We collected blood samples at baseline and 20, 30, 40, 60 and 90 minutes after the start of the infusion. A control group of six healthy volunteers received intravenous saline. Results PACAP38 infusion caused significant changes in plasma concentrations of VIP ( p = 0.026), prolactin ( p = 0.011), S100B ( p < 0.001) and thyroid-stimulating hormone (TSH; p = 0.015), but not CGRP ( p = 0.642) and TNFα ( p = 0.535). We found no difference in measured biochemical variables after PACAP38 infusion in patients who later developed migraine-like attacks compared to those who did not ( p > 0.05). There was no difference in the changes of biochemical variables between patients with and without the MEF2D-associated gene variant ( p > 0.05). Conclusion PACAP38 infusion elevated the plasma levels of VIP, prolactin, S100B and TSH, but not CGRP and TNFα. Development of delayed migraine-like attacks or the presence of the MEF2D gene variant was not associated with pre-ictal changes in plasma levels of neuropeptides, TNFα and pituitary hormones.

  7. Topiramate in migraine progression.

    PubMed

    Ruiz, Luigi; Ferrandi, Delfina

    2009-12-01

    Increasing evidence shows that migraine, typically considered as an episodic disease, is a chronic and, in some patients, progressive disorder. Among neuromodulators used for migraine prevention, topiramate has a high level of evidence-based efficacy. Through its wide range of mechanisms of action topiramate increases the activation threshold resulting in neuronal stabilization and thereby reducing cortical neurons hyperexcitability, which is believed to be an important electrophysiological feature underlying the pathogenesis of epilepsy and migraine. Recent studies show that migraineurs have subclinical structural brain changes and persistent alteration of pain perception, in some cases correlated with the duration of the disease and the frequency of attacks that might play a role in the transformation of episodic migraine to chronic forms. An early and prolonged preventive treatment might reduce the risk of such transformation. Recent evidence suggests that topiramate, by reducing migraine frequency and use of acute medication, may prevent the negative progression of migraine. Furthermore, two recently completed multicenter, randomised, placebo-controlled trials have shown that treatment with topiramate 100 mg/day is effective and well tolerated in patients already progressed to chronic migraine and difficult to treat conditions associated with medication-overuse. Topiramate seems to be a preventive treatment, which might be able to act at different levels of the migraine cycle: reduction of frequency in episodic migraine, prevention, and treatment of chronic migraine.

  8. Effects of topiramate use on body composition and resting metabolic rate in migraine patients.

    PubMed

    Yaman, Mehmet; Ucok, Kagan; Demirbas, Hayri; Genc, Abdurrahman; Oruc, Serdar; Karabacak, Hatice; Koyuncu, Gokhan

    2013-02-01

    Topiramate is an anticonvulsant agent effective in the prophylaxis of migraine, which also induces weight reduction by an unknown mechanism. We investigated the effect of topiramate on resting metabolic rate, anthropometric measurements, and body composition in patients with migraine independently from any intention to lose body weight. Forty patients (18-71 years old) with migraine were treated with 100 mg of topiramate/day over a period of 3 months. Anthropometric measurements, body fat proportions and resting metabolic rates of these patients were measured before and after treatment. At the end of 3 months, we detected mean 0.8 kg reduction in body weight and 0.3 kg/m(2) reduction in body mass index (BMI). Waist circumference decreased significantly (p = 0.01). Body fat ratio decreased (p = 0.016). Abdominal skinfold measurements decreased after treatment (p = 0.048); however, no difference was found in other regions (p > 0.05). We did not find a significant difference in resting metabolic rate (p > 0.05).These TPM-treated patients lost weight and had reduction in their mean BMI. It was seen that patients lost weight from body fat tissue and central area. We saw that TPM'S weight-reducing effect was independent from resting metaobolic rate. The weight-reducing effect of TPM may result from changes on the hypothalamus.

  9. Oral contraceptives in migraine.

    PubMed

    Allais, Gianni; Gabellari, Ilaria Castagnoli; De Lorenzo, Cristina; Mana, Ornella; Benedetto, Chiara

    2009-03-01

    Combined oral contraceptives are a safe and highly effective method of birth control, but they can also raise problems of clinical tolerability and/or safety in migraine patients. It is now commonly accepted that, in migraine with aura, the use of combined oral contraceptives is always contraindicated, and that their intake must also be suspended by patients suffering from migraine without aura if aura symptoms appear. The newest combined oral contraceptive formulations are generally well tolerated in migraine without aura, and the majority of migraine without aura sufferers do not show any problems with their use; nevertheless, the last International Classification of Headache Disorders identifies at least two entities evidently related to the use of combined oral contraceptives: exogenous hormone-induced headache and estrogen-withdrawal headache. As regards the safety, even if both migraine and combined oral contraceptive intake are associated with an increased risk of ischemic stroke, migraine without aura per se is not a contraindication for combined oral contraceptive use. Other risk factors (tobacco use, hypertension, hyperlipidemia, obesity and diabetes) must be carefully considered when prescribing combined oral contraceptives in migraine without aura patients, in particular in women aged over 35 years. Furthermore, the exclusion of a hereditary thrombophilia and of alterations of coagulative parameters should precede any decision of combined oral contraceptive prescription in migraine patients.

  10. Migraine Headaches

    MedlinePlus

    ... of your head, almost like someone stretched a rubber band around it. A migraine is different. Doctors ... provokes a migraine attack. Common migraine triggers include: stress menstruation (periods) skipping meals dehydration too much caffeine ( ...

  11. Migraine - resources

    MedlinePlus

    Resources - migraine ... The following organizations are good resources for information on migraines : American Migraine Foundation -- www.americanmigrainefoundation.org National Headache Foundation -- www.headaches.org National Institute of Neurological Disorders ...

  12. Social problem-solving, perceived stress, depression and life-satisfaction in patients suffering from tension type and migraine headaches.

    PubMed

    Eskin, Mehmet; Akyol, Ali; Çelik, Emine Yilmaz; Gültekin, Bülent Kadri

    2013-08-01

    This study aimed at investigating social problem solving, perceived stress, depression, and life-satisfaction in patients with tension type and migraine headaches. Forty-nine migraine and 42 tension type headache patients (n = 91) consenting to participate were compared to a total of 49 matched healthy control group. Participants filled in a questionnaire consisting self-report measures of problem solving, perceived stress, depression and life satisfaction. They were also asked about headache duration, frequency, pain severity, psychiatric treatment and sense of control in one's life. T-tests, chi-square, analysis of variance, logistic regression analysis and Pearson product moment correlation coefficient procedures were used to analyze the data. Tension type headache patients reported having had more frequent headaches than the migraine patients but migraine patients reported having had more intense pain than the tension type headache patients. Instances of psychiatric treatment were more common among tension type headache patients than the migraine and the control group. Compared to the healthy controls, headache patients displayed a deficiency in problem solving, higher levels of perceived stress and depression. Levels of problem solving skills in headache patients were related inversely to depression, perceived stress and the number of negative life events but problem solving skills of headache patients was related positively to life-satisfaction. The findings from this study suggested that cognitive behavioral problem solving therapy or training might be a viable option for reducing levels of stress and depression, and to increase life-satisfaction in patients suffering from primary headache.

  13. Weight reducing and metabolic effects of topiramate in patients with migraine--an observational study.

    PubMed

    Schütt, M; Brinkhoff, J; Drenckhan, M; Lehnert, H; Sommer, C

    2010-07-01

    Topiramate is an anticonvulsant agent effective in the prophylaxis of migraine, which also induces weight reduction by an unknown mechanism. We investigated the effect of topiramate on metabolic and endocrine parameters in patients with migraine independently of any intention to lose body weight. Six patients (26-61 years old, body mass indices [BMI] 20.9-32.1 kg/m(2)) with migraine were treated with an average dose of 100 mg topiramate/day over a period of 20 weeks. The following parameters were measured every 4-8 weeks: BMI, body fat proportion, waist and hip circumference, HOMA insulin resistance, fasting serum-/plasma concentrations of adiponectin, leptin, ghrelin, vascular endothelial growth factor (VEGF), cortisol, interleukin-6 and tumor necrosis factor (TNF)-alpha. Profound metabolic changes were observed for the whole treatment period. Compared with the baseline value, 20 weeks of treatment reduced the BMI by 7.2+/-1.4%, body fat proportion by 11.6+/-3.6%, waist circumference by 4.2+/-1.2%, leptin by 39.2+/-6.5% and HOMA insulin resistance by 37.3+/-5%, while adiponectin was increased by 69.9+/-17.3% (P<0.05, respectively). VEGF concentrations increased during the week 2-4 by 177.4+/-39.4% (P<0.05) followed by a continuous decrease. There were trends for a reduction in ghrelin concentration, whereas cortisol, interleukin-6 and TNF-alpha values were unchanged. In summary, in this small sample of migraine patients topiramate treatment was associated with increased insulin sensitivity, increased adiponectin concentration and a reduction of body fat in all treated patients. The role of increased VEGF concentrations prior to these metabolic changes is not clear and might, hypothetically, involve a centrally mediated effect of topiramate on body weight regulation.

  14. Abnormal brain processing of cutaneous pain in migraine patients during the attack.

    PubMed

    de Tommaso, Marina; Guido, Marco; Libro, Giuseppe; Losito, Luciana; Sciruicchio, Vittorio; Monetti, Carlo; Puca, Francomichele

    2002-11-15

    We examined cutaneous pain thresholds using CO(2) laser stimuli during migraine attacks, and defined the evoked cortical potential characteristics. Ten patients without aura were studied during attacks and for at least 72 h subsequently. Pain stimuli were generated on the dorsum of both hands and the right and left supraorbital zones, using pulses from a CO(2) laser. Absolute latencies of scalp potentials were measured at the highest peak of each response component, and the peak-to-peak amplitudes of N2a-P2 components were recorded. Cutaneous pain thresholds were significantly reduced on both the symptomatic and non-symptomatic sides during the attack, in comparison with the headache-free phase. The N2a-P2 complexes also increased in amplitude during attacks in comparison with the pain-free side. Thus, cutaneous hyperalgesia occurs during migraine attack, and is subtended by central sensitization phenomena, probably involving the cortex.

  15. Resolution of chronic migraine headaches with intrathecal ziconotide: a case report

    PubMed Central

    Narain, Sachin; Al-Khoury, Lama; Chang, Eric

    2015-01-01

    Background Migraine headaches are a common and functionally debilitating disorder affecting approximately 17% of women and 5.6% of men. Compared to episodic migraine patients, chronic migraineurs are more likely to be occupationally disabled, miss family activities, have comorbid anxiety and/or chronic pain disorders, and utilize significantly more health care dollars. Ziconotide is a calcium channel blocker used for the treatment of chronic severe pain without issues of tolerance or dependency found with opioid therapy. Case A 59-year-old female had an intrathecal baclofen pump placed for spasticity secondary to multiple sclerosis. Her symptoms also included lower extremity neuropathic pain and severe migraine headaches with 22 migraine headache days per month. Prior treatments included non-steroidal anti-inflammatory drugs, triptans, anticonvulsants, antihypertensives, and Botox injections which reduced her symptoms to four migraine days per month at best. While her spasticity had markedly improved with intrathecal baclofen, ziconotide was added to help her neuropathic pain complaints. Following initiation of low-dose ziconotide (1 µg/day), the patient noted both lower extremity pain improvement and complete resolution of migraine headaches resulting in zero migraine days per month. She has now been migraine free for 8 months. Conclusion Upon review of the available literature, there are no published cases of migraine improvement with intrathecal ziconotide. This represents the first case describing resolution of migraine symptoms with low-dose ziconotide. PMID:26392785

  16. Periictal and interictal headache including migraine in Dutch patients with epilepsy: a cross-sectional study.

    PubMed

    Hofstra, W A; Hageman, G; de Weerd, A W

    2015-03-01

    As early as in 1898, it was noted that there was a need to find "a plausible explanation of the long recognized affinities of migraine and epilepsy". However, results of recent studies are clearly conflicting on this matter. In this cross-sectional study, we aimed to define the prevalence and characteristics of both seizure-related and interictal headaches in patients with epilepsy (5-75years) seeking help in the tertiary epilepsy clinic SEIN in Zwolle. Using a questionnaire, subjects were surveyed on the existence of headaches including characteristics, duration, severity, and accompanying symptoms. Furthermore, details on epilepsy were retrieved from medical records (e.g., syndrome, seizure frequency, and use of drugs). Diagnoses of migraine, tension-type headache, or unclassifiable headache were made based on criteria of the International Classification of Headache Disorders. Between March and December 2013, 29 children and 226 adults were evaluated, 73% of whom indicated having current headaches, which is significantly more often when compared with the general population (p<0.001). Forty-nine percent indicated having solely interictal headache, while 29% had solely seizure-related headaches and 22% had both. Migraine occurs significantly more often in people with epilepsy in comparison with the general population (p<0.001), and the occurrence of tension-type headaches conforms to results in the general population. These results show that current headaches are a significantly more frequent problem amongst people with epilepsy than in people without epilepsy. When comparing migraine prevalence, this is significantly higher in the population of patients with epilepsy.

  17. Difficulties in work activities and the pervasive effect over disability in patients with episodic and chronic migraine.

    PubMed

    D'Amico, D; Grazzi, L; Curone, M; Di Fiore, P; Proietti Cecchini, A; Leonardi, M; Scaratti, C; Raggi, A

    2015-05-01

    Migraine is associated with reduced productivity in work-related activities. The degree to which problems with work are, in turn, associated to the level of migraine-related disability as well as to headache frequency has been poorly explored. The aim of the study was to assess if migraine patients with different degrees of work difficulties showed a different level of migraine-related disability. A consecutive sample of patients with episodic migraine (EM) or with chronic migraine (CM) with medication overuse (MO) attending the Headache Centre of the Neurological Institute C. Besta of Milan was studied. All patients completed the MIDAS and the WHODAS 2.0 questionnaires. The total scores of both questionnaires, frequency of headaches, average pain intensity, and the scores of each subscale of the WHODAS 2.0 were calculated separately for EM and CM patients. The score of WHODAS 2.0 "Work difficulties" subscale was used to divide the studied patients into two groups, i.e. those above and those below the median "Work difficulties" subscale score. Independent sample t test was used to compare these two groups as far as all the other studied variables. A total of 296 patients (102 with EM and 194 with CM-MO) were enrolled. Patients with higher work difficulties score also displayed higher scores in the other WHODAS 2.0 subscales; for those with CM-MO, the differences were significant. The results of this study indicate that having more and more severe workplace problems is associated to a higher disability level in migraineurs. Further studies are needed to better understand workplace disability in different migraine forms, particularly in a qualitative way.

  18. Reduced habituation to experimental pain in migraine patients: a CO(2) laser evoked potential study.

    PubMed

    Valeriani, M; de Tommaso, M; Restuccia, D; Le Pera, D; Guido, M; Iannetti, G D; Libro, G; Truini, A; Di Trapani, G; Puca, F; Tonali, P; Cruccu, G

    2003-09-01

    The habituation to sensory stimuli of different modalities is reduced in migraine patients. However, the habituation to pain has never been evaluated. Our aim was to assess the nociceptive pathway function and the habituation to experimental pain in patients with migraine. Scalp potentials were evoked by CO(2) laser stimulation (laser evoked potentials, LEPs) of the hand and facial skin in 24 patients with migraine without aura (MO), 19 patients with chronic tension-type headache (CTTH), and 28 control subjects (CS). The habituation was studied by measuring the changes of LEP amplitudes across three consecutive repetitions of 30 trials each (the repetitions lasted 5 min and were separated by 5-min intervals). The slope of the regression line between LEP amplitude and number of repetitions was taken as an index of habituation. The LEPs consisted of middle-latency, low-amplitude responses (N1, contralateral temporal region, and P1, frontal region) followed by a late, high-amplitude, negative-positive complex (N2/P2, vertex). The latency and amplitude of these responses were similar in both patients and controls. While CS and CTTH patients showed a significant habituation of the N2/P2 response, in MO patients this LEP component did not develop any habituation at all after face stimulation and showed a significantly lower habituation than in CS after hand stimulation. The habituation index of the vertex N2/P2 complex exceeded the normal limits in 13 out of the 24 MO patients and in none of the 19 CTTH patients (P<0.0001; Fisher's exact test). Moreover, while the N1-P1 amplitude showed a significant habituation in CS after hand stimulation, it did not change across repetitions in MO patients. In conclusion, no functional impairment of the nociceptive pathways, including the trigeminal pathways, was found in either MO or CTTH patients. But patients with migraine had a reduced habituation, which probably reflects an abnormal excitability of the cortical areas involved in

  19. The cost effectiveness of Botox in Italian patients with chronic migraine.

    PubMed

    Ruggeri, M

    2014-05-01

    Migraine is a primary headache which World Health Organization ranks in 19th place in the list of disabling diseases. In Europe, in 2004, the total costs for migraine were quantified by Stovner and Berg, Eur J Neurol, 12(s1) (2005) at 27 billion. The objective of this study is to provide an estimate of the incremental cost-effectiveness ratio (ICER) of the treatment of chronic migraine with Botox compared to treatment with placebo in the perspective of the Italian National Health Service and society. To do this we studied the disease progression in a cohort of 688 individuals (patients enrolled in the study PREEMPT) via the application of a Markov model. Over a period of 2 years, the total costs of the experimental arm of the model amounted to 3,274 compared with a gain of 1.34 QALYs. In contrast, the costs of the control arm amounted to 2,395 with a gain of 1.24 QALYs. It follows that the incremental costs amounted to 889 compared to an incremental gain of 0.09 QALYs in favor of the experimental arm. The relationship between costs and incremental QALYs generated an ICER of 9,407/QALY. The incremental cost-effectiveness ratio, therefore, is favorable compared to the value usually considered by NICE as a threshold limit for reimbursement which ranges between 20,000 and 40,000/QALY.

  20. Pathophysiology of Migraine

    PubMed Central

    BORAN, H. Evren; BOLAY, Hayrunnisa

    2013-01-01

    Migraine is a serious health problem which impair quality of life. It is the second most common primary headache that affects approximately more than %10 people in general population. Migraine pathophysiology is still unclear. Increasing results of studies suggest to migraine pathophysiology is related with primary neuronal mechanisms. Migraine pain starts in which region of brain and what brain regions are activated in different stages is unenlightened. There is evidences that growing number of studies which using new imaging techniques as positron emission tomography (PET) and functional magnetic resonans imaging (fMRI) show that migraine and cluster headaches are related with neuronal structures and vasodilatation. There are four phases to a migraine. The prodrome phase, aura, the attack, and the postdrome phase. Some datas obtained from last ten years indicate that cortical excitability has increased in interictal phase too. For many years, studies in rodents show trgimenial nerve is activated and it leads to vasodilatation and neurogenic inflammation in the headache phase. Although the majority of patients encountered in clinical practice are migraine without aura or chronic migraine, experimental studies of the migraine pathophysiology are focusing on the aura model which is used cortical spreading depression.

  1. Polytherapy for migraine prophylaxis.

    PubMed

    Casucci, G; Villani, V; Cologno, D; D'Onofrio, F

    2012-05-01

    Migraine is a chronic neurological disorder with episodic manifestations, progressive in some individuals. Preventive treatment is recommended for patients with frequent or disabling attacks. A sizeable proportion of migraineurs in need of preventive treatment does not significantly benefit from monotherapy. This short review evaluates the role of pharmacological polytherapy in migraine prevention.

  2. A prospective, open-label study of milnacipran in the prevention of headache in patients with episodic or chronic migraine.

    PubMed

    Engel, Emily Rubenstein; Kudrow, David; Rapoport, Alan M

    2014-03-01

    Migraine is a highly prevalent episodic and chronic neurological disorder that impacts otherwise healthy men and women in their most productive years. An anecdotal survey in our clinical practices suggested that milnacipran, a drug indicated for the treatment of fibromyalgia, reduced the incidence of headache in patients with migraine. In this 3-month, open-label, pilot study, 38 patients diagnosed with episodic migraine and 7 patients with chronic migraine maintained headache diaries to assess the effectiveness and tolerability of milnacipran in headache prevention. After a 1-month period to obtain baseline data, milnacipran treatment was initiated and doses were titrated up to 100 mg/day over 1 month. Maintenance therapy continued for an additional 3 months. The primary efficacy end point was change from baseline in the number of all headache days during the last 28 days of maintenance therapy analyzed, using last observation carried forward (LOCF). Change from baseline in migraine days during the last month of the maintenance period using LOCF was a secondary end point. Milnacipran 100 mg daily was associated with a significant reduction in headache (-4.2 days; P < 0.001) and migraine frequency (-2.2 days; P < 0.003). The adverse event profile was consistent with prior reports of milnacipran for the treatment of other conditions. However, compared with the recommended protocol, a more gradual increase in milnacipran dose was required to improve tolerability for some patients. The robust efficacy signal found in this study strongly suggests that a double-blind, placebo-controlled trial of milnacipran in migraine and chronic headache is warranted.

  3. Psychiatric disorders and muscle tenderness in episodic and chronic migraine.

    PubMed

    Mongini, Franco; Deregibus, Andrea; Rota, Eugenia

    2005-09-01

    This review first reports on the data concerning the relationship between migraine and personality traits and psychiatric disorders. The relationship between migraine and tenderness of the pericranial and cervical muscles is then discussed. In one study, a psychologic assessment was performed in 56 women with migraine, and the Minnesota Multiphase Personality Inventory (MMPI) and State Trait Anxiety Inventory were administered at baseline (T0) and after 6-7 years (T2). Frequency, severity and duration of migraine were recorded at T0, after treatment (T1) and at T2, and their relationship to the prevalence of depression, MMPI and State Trait Anxiety Inventory data were examined. Pain parameters improved in all patients in T0-1, but were higher at T2 in patients with depression at T0. The patients whose migraine improved at T2 had significantly lower MMPI and State Trait Anxiety Inventory scores at T0 and T2. Moreover, the prevalence of depression of the patients whose migraine improved at T2 was 37.5% at T0 and decreased to 12.5% at T2. The authors subsequently studied the function of the frontal lobe in 23 female patients previously treated for chronic migraine and 23 controls by applying three neuropsychologic tests (gambling task, tower of hanoi-3 and object alternation test). The patient group performed significantly worse on the tower of hanoi-3 and the object alternation test. In order to assess the extent to which muscle tenderness may relate to psychiatric disorders in patients with migraine and tension-type headache, diagnosed according International Headache Society criteria [2004], a psychologic assessment was performed and palpation tenderness scores calculated for the pericranial and cervical muscles in 459 patients. In total, 125 patients had frequent episodic migraine, 97 had chronic migraine, 82 had frequent episodic tension-type headache and chronic tension-type headache was present in 83. In a further 72 patients, both episodic migraine and

  4. Evaluation of Ocular Side Effects in the Patients on Topiramate Therapy for Control of Migrainous Headache

    PubMed Central

    Hesami, Omid; Hosseini, Seyedeh Simindokht; Hosseini-Zijoud, Seyed-Mostafa; Moghaddam, Nahid Beladi; Assarzadegan, Farhad; Mokhtari, Sara; Fakhraee, Shahrzad

    2016-01-01

    Introduction Topiramate, a sulfa-derivative monosaccharide, is an antiepileptic drug which is administered in the control of migraine. It is reported to cause various ocular side effects such as visual field defect and myopic shift. To investigate the alterations in refractive error, properties of the cornea and changes in the anterior chamber in patients that receive Topiramate for migraine control. Materials and Methods This is a hospital-based, non-interventional, observational study that is conducted at Imam Hossein Hospital, affiliated to Shahid Beheshti University of Medical Sciences, Department of Neurology, in collaboration with the department of Ophthalmology. Thirty three consecutive patients with the diagnosis of migraine that were candidate for Topiramate therapy were recruited. Patients with history of ocular trauma or surgery, keratoconus, glaucoma, congenital ocular malformations and any history of unexplained visual loss were excluded. After thorough ophthalmic examination, all the patients underwent central corneal thickness (CCT) measurement, and Pentacam imaging (Scheimpflug camera) at the baseline. Various parameters were extracted and used for analysis. Anterior chamber volume (ACV), anterior chamber depth (ACD), and anterior chamber angle (ACA) measurement was performed. These measurements were repeated on day 30th and 90th after the initiation of Topiramate therapy. According to the normality tests, parameters with normal distribution were analysed using the repeated measures test and the remaining parameters (with non-normal distribution) were analysed using the non-parametric k-sample test. A p-value< 0.05 was considered statistically significant, according to Bonferroni post hoc correction. Results There were 66 eyes of 33 patients under the diagnosis of migrainous headache, that Topiramate was initiated for headache control, included in the study. The mean value of refractive error had a statistically significant myopic change, from −0

  5. Not only headache: higher degree of sexual pain symptoms among migraine sufferers.

    PubMed

    Ifergane, Gal; Ben-Zion, Itzhak Z; Plakht, Ygal; Regev, Keren; Wirguin, Itzhak

    2008-04-01

    Chronic illness and chronic pain can have profound negative effects on relationship and sexual satisfaction, yet the influence of migraine on sexuality has not been previously evaluated. To assess sexual functions in subjects with migraine compared to those with no migraine. We evaluated female university students using the Israeli sexual behavior inventory (ISBI). Migraine was diagnosed according to self-reported symptoms according to the IHS criteria. Several dimensions of female sexuality--desire, orgasm, sexual avoidance, interpersonal sexual relationship, health influence, satisfaction and pain were evaluated using a structured questionnaire. Thirty-three (23.9%) of the participants met the IHS criteria for episodic migraine with and without aura. Sexual activity, desire, orgasm and satisfaction from sexual life did not differ significantly between migraine sufferers and non-sufferers. Migraine patients reported lower ISBI scores, higher health influence on sexual life, higher levels of sexual pain and lower sexual satisfaction. Migraine negatively affected the sexual life of sufferers. Sexual pain disorder is more common among migraine sufferers compared to non-migraineurs.

  6. Pressure pain thresholds assessed over temporalis, masseter, and frontalis muscles in healthy individuals, patients with tension-type headache, and those with migraine--a systematic review.

    PubMed

    Andersen, Sanne; Petersen, Marie Weinreich; Svendsen, Anette Sand; Gazerani, Parisa

    2015-08-01

    A systematic review was conducted to identify and summarize the available scientific literature addressing pressure pain threshold (PPT) values over the temporalis, masseter, and frontalis muscles in healthy humans, patients with tension-type headache (TTH), and those with migraine both in males and females. Six relevant medical databases for the literature search were included: PubMed, Web of Science, Cochrane, CINAHL, BioMed Central, and Embase. The search strategy was performed applying 15 keywords (eg, pressure pain threshold, temporalis muscle, tension type headache, pressure algometer) and their combinations. A total of 156 articles were identified, and 40 relevant articles were included. The main outcomes of the systematic review were extracted, and it was demonstrated that the PPT values in general were lower in patients compared with healthy subjects, and this was especially noted for temporalis in both females (migraine: 231.2 ± 38.3 kPa < TTH: 248.4 ± 39.3 kPa < healthy: 282.1 ± 70.8 kPa) and males (migraine: 225.5 ± 61.2 kPa < TTH: 264.2 ± 32.5 kPa < healthy: 314.8 ± 63.3 kPa). The masseter muscle seemed to be more sensitive than the other 2 muscles, in both females (healthy: masseter 194.1 ± 62.7 kPa < frontalis 277.5 ± 51.1 kPa < temporalis 282.1 ± 70.8 kPa) and males (healthy: masseter 248.2 ± 48.4 kPa < temporalis 314.8 ± 63.3 < frontalis 388 kPa). Females had lower PPT values than those of males in temporalis, masseter, and frontalis muscles. This work is the first to systematically review the scientific literature addressing PPT values over craniofacial muscles of healthy subjects, patients with TTH, and those with migraine to provide the PPT value ranges. Based on these findings, a set of guidelines was established to assist future studies including PPT assessments over craniofacial muscles.

  7. Prophylactic activity of increasing doses of intravenous histamine in refractory migraine: Retrospective observations of a series of patients with migraine without aura

    PubMed Central

    Pietrini, Umberto; De Luca, Massimo; Del Bene, Enrico; De Cesaris, Francesco; Bertinotti, Luca; Colangelo, Nicola; Moggi Pignone, Alberto

    2004-01-01

    Background: Histamine is thought to play a pivotal role in the modulation of peripheral and central pain. The administration of increasing doses of histamine may lead to desensitization of receptors of histamine types 1 and 2, causing meningeal vasodilation, and to depletion of neuropeptides in the trigeminal ganglion, thus inhibiting the initiation of migraine. Objective: In this study, the efficacy and tolerability of increasing doses of IV histamine in migraine prophylaxis were investigated. Methods: This single-center, open-label, retrospective, controlled study was conducted at the Headache Center (Department of Internal Medicine, University of Florence, Villa Monna Tessa, Italy). Patients included in the study had 3 to 6 migraines without aura per month that were refractory to common symptomatic and prophylactic agents in the 6 months preceding the study. Patients were treated with IV histamine hydrochloride for 21 days starting with a dosage of 0.5 mg/d and increasing to 4.0 mg/d. To assess the efficacy of the treatment, these patients were matched for age; sex; and frequency, duration, and severity of attacks with untreated migraineurs. Clinical benefit was defined as ⩽ 1 migraine of mild intensity per month. Tolerability was assessed during the hospitalization period, and patients were instructed to contact the Headache Center to report any adverse effects after hospital discharge. Results: The histamine group comprised 47 patients (40 women, 7 men; mean [SD] age, 42.0 [8.6] years) and the control group comprised 23 patients (20 women, 3 men; mean [SD] age, 38.8 [8.4] years). The histamine-treated patients showed a clinical benefit lasting for a mean of 10.4 (4.2) months, while the patients in the control group showed a clinical benefit of 3.8 (1.9) months. The difference in the duration of the clinical benefit between the 2 groups was 6.6 months (95% CI, 5.15-7.99). Adverse effects consisted of flushing, heat sensation during infusion, headache, and

  8. Prevalence of Irritable Bowel Syndrome (IBS), Migraine and Co-Existing IBS-Migraine in Medical Students

    PubMed Central

    Parvin, Rukhsana; Saha, Madhusudan; Bari, Md. Shafiqul; Huda, Md. Nazmul; Ghosh, Mridul Kanti

    2016-01-01

    Introduction Irritable Bowel Syndrome (IBS) and migraine frequently co-exist. Stress is a major contributing factor for both. Our medical students are subjected to stress related to the implicit responsibility of courses. But the prevalence of IBS, migraine and co-existing migraine in medical students is not known. Aim To estimate the prevalence of migraine, IBS and co-existing IBS and migraine among medical students. A Cross-Sectional Survey. Materials and Methods Self-reported questionnaire based study, was conducted in which migraine was defined according to International Headache Society (IHS) criteria while IBS by both Asian criteria and Rome III criteria. Both preclinical (n=142) and clinical students (n=151) of four medical colleges (government and private) of Dhaka and Sylhet district participated in the study. Statistical Analysis: Student’s t-test and chi-square test were used to compare the distributions of continuous data and categorical data respectively with significance level set at 0.05 or less. Results Among the 293 students (mean age 21.09 ± 2.24 years) volunteered in the study (Males= 177), 14 (4.8%, 11 males, 3 females, p = 0.175) met the criteria for IBS with comparable prevalence among preclinical and clinical (4.2% vs. 5.3%, p = 0.787) students from both private and government institutions (2.1% vs. 7.2%, p = 0.055). IBS-D was the most prevalent subtype (n = 8, M = 6) and abdominal pain relieved by defecation (n = 11), was the most prevalent symptom. Fifty percent (n = 7) of IBS patients considered their bowel habit as normal. Among the 221 (75.4%) students with headache, only 51 (17.4%, 20 males and 31 females, p = 0.001) were diagnosed of migraine, with comparable prevalence among preclinical and clinical students (16.2% vs. 18.5%, p = 0.645). Only 17 (33%) subjects with migraine had accompanying aura. Common triggers were stress (n = 43), lack of sleep (n = 42), and daily life events. Twelve (23.5%) subjects with migraine had migraine

  9. Antidepressants and risk of dementia in migraine patients: A population-based case-control study.

    PubMed

    Lee, Cynthia Wei-Sheng; Lin, Cheng-Li; Lin, Pan-Yen; Thielke, Stephen; Su, Kuan-Pin; Kao, Chia-Hung

    2017-04-06

    To ascertain the relationship between receipt of antidepressant agents and the risk of subsequent dementia in migraine patients. A population-based case-control analysis, using the Taiwan National Health Insurance Research Database. We identified 1774 patients with dementia and 1774 matched nondementia controls from migraine patients enrolled in the Taiwan National Health Insurance program between 2005 and 2011. The proportional distributions of exposure to three classes of antidepressant were compared between dementia and nondementia groups. Univariable and multivariable logistic regression analyses were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the risk of dementia based on antidepressant exposure. The proportions of subjects taking tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and new-generation antidepressants (NGAs) in dementia versus nondementia groups are 52.3 vs 51.2%, 25.5 vs 30.7%, and 18.8 vs 6.26%, respectively. The adjusted ORs of dementia were 1.02 (95% CI=0.89, 1.17; P=0.56) for TCAs, 0.58 (95% CI=0.50, 0.69; P<0.001) for SSRIs, and 4.23 (95% CI=3.34, 5.37; P<0.001) for NGAs. Treatment with SSRIs was associated with a decreased risk of dementia in migraine patients. TCAs showed no association with dementia risk, and NGAs showed increased risk. Given the possibility of confounding by indication, additional prospective trials and basic research are needed before drawing conclusions about the population-level risks for dementia onset conferred by antidepressant medications.

  10. Paradoxical Air Microembolism Induces Cerebral Bioelectrical Abnormalities and Occasionally Headache in Patent Foramen Ovale Patients With Migraine

    PubMed Central

    Sevgi, Eser Başak; Erdener, Sefik Evren; Demirci, Mehmet; Topcuoglu, Mehmet Akif; Dalkara, Turgay

    2012-01-01

    Background Although controversial, paradoxical embolism via patent foramen ovale (PFO) may account for some of the migraine attacks in a subset of migraine with aura (MA) patients. Induction of MA attacks with air bubble injection during transcranial Doppler ultrasound in MA patients with PFO supports this view. It is likely that cerebral embolism in patients with right-to-left shunt induces bioelectrical abnormalities to initiate MA under some conditions. Methods and Results We investigated changes in cerebral bioelectrical activity after intravenous microbubble injection in 10 MA patients with large PFO and right-to-left cardiac shunt. Eight PFO patients without migraine but with large right-to-left shunt and 12 MA patients without PFO served as controls. Four MA patients with PFO were reexamined with sham injections of saline without microbubbles. Bioelectrical activity was evaluated using spectral electroencephalography and, passage of microbubbles through cerebral arteries was monitored with transcranial Doppler ultrasound. Microbubble embolism caused significant electroencephalographic power increase in MA+PFO patients but not in control groups including the sham-injected MA+PFO patients. Headache developed in 2 MA with PFO patients after microbubble injection. Conclusions These findings demonstrate that air microembolism through large PFOs may cause cerebral bioelectrical disturbances and, occasionally, headache in MA patients, which may reflect an increased reactivity of their brain to transient subclinical hypoxia–ischemia, and suggest that paradoxical embolism is not a common cause of migraine but may induce headache in the presence of a large PFO and facilitating conditions. PMID:23316313

  11. Sympathetic Skin Responses from the Neck Area in Patients with Unilateral Migraine

    PubMed Central

    KORKMAZ, Bektaş; YILDIZ, Serpil; YILDIZ, Nebil

    2015-01-01

    Introduction In this study, in patients with unilateral migraine headache and in normal controls, it was aimed to assess the sympathetic function during attack, post attack, and interval periods and to compare these findings by recording sympathetic skin responses from the neck area, which was not studied before. Methods A total of 37 unilateral patients with migraine (30 women, seven men) who fulfilled the criteria of International Headache Society (2004) were recruited from our outpatient clinic. The control group consisted of 21 healthy individuals (16 women, five men) who are employees or students of our Medical Faculty. Mean latency and maximum amplitude values of sympathetic skin responses obtained from neck areas of the patients during attack, post attack, and interval periods were calculated. We compared the mean latency and the maximum amplitude values of the symptomatic side with the data of the asymptomatic side and with the data of the control group. We also compared the responses of the patients with right-sided headache with the responses of the patients with left-sided headache. All statistical analyses were performed using SPSS. Results On the neck area, we observed sympathetic hypo-function in the attack and interval periods and a relative hyper-function in the post attack period bilaterally, regardless of the symptomatic side. Conclusion These findings suggest that there is ongoing bilateral sympathetic hypo-function in the neck area and there occurs a temporary increase in the function of sympathetic sudomotor activity in the recovery period of headaches.

  12. An Association between Carpal Tunnel Syndrome and Migraine Headaches—National Health Interview Survey, 2010

    PubMed Central

    Law, Huay-Zong; Amirlak, Bardia; Cheng, Jonathan

    2015-01-01

    Background: Migraine headaches have not historically been considered a compression neuropathy. Recent studies suggest that some migraines are successfully treated by targeted peripheral nerve decompression. Other compression neuropathies have previously been associated with one another. The goal of this study is to evaluate whether an association exists between migraines and carpal tunnel syndrome (CTS), the most common compression neuropathy. Methods: Data from 25,880 respondents of the cross-sectional 2010 National Health Interview Survey were used to calculate nationally representative prevalence estimates and 95% confidence intervals (95% CIs) of CTS and migraine headaches. Logistic regression was used to calculate adjusted odds ratios (aORs) and 95% CI for the degree of association between migraines and CTS after controlling for known demographic and health-related factors. Results: CTS was associated with older age, female gender, obesity, diabetes, and smoking. CTS was less common in Hispanics and Asians. Migraine was associated with younger age, female gender, obesity, diabetes, and current smoking. Migraine was less common in Asians. Migraine prevalence was 34% in those with CTS compared with 16% in those without CTS (aOR, 2.60; 95% CI, 2.16–3.13). CTS prevalence in patients with migraine headache was 8% compared with 3% in those without migraine headache (aOR, 2.67; 95% CI, 2.22–3.22). Conclusions: This study is the first to demonstrate an association between CTS and migraine headache. Longitudinal and genetic studies with physician verification of migraine headaches and CTS are needed to further define this association. PMID:25878944

  13. Fatigue, sleep-wake pattern, depressive and anxiety symptoms and body-mass index: analysis in a sample of episodic and chronic migraine patients.

    PubMed

    Lucchesi, Cinzia; Baldacci, Filippo; Cafalli, Martina; Dini, Elisa; Giampietri, Linda; Siciliano, Gabriele; Gori, Sara

    2016-06-01

    Migraine clinical presentation and life-time course can be highly heterogeneous, with a subgroup of patients developing chronic migraine; moreover, migraine clinical spectrum is expanded by the association with different coexisting conditions and interictal dysfunctions. The aim of this study was to systematically evaluate migraine clinical features, daily functioning parameters, sleep pattern, presence of depressive-anxiety symptoms and body mass index (BMI) in a sample of 75 episodic and 75 chronic migraine without aura patients. Migraine-related disability, fatigue, daily sleepiness, subjective sleep quality, anxiety and depressive symptoms were, respectively, evaluated using the following questionnaires: Fatigue Severity Scale (FSS), Epworth Sleepiness Scale, Pittsburgh Sleep Quality Index (PSQI), Generalized Anxiety Disorder 7-item Scale (GAD-7), Patient Health Questionnaire 9-item Scale (PHQ-9). Mean FSS score (p < 0.001), PSQI score (p = 0.015), GAD-7 score (p = 0.019), PHQ-9 score (p < 0.001) and BMI score (p = 0.012) were significantly higher in chronic compared to episodic migraineurs. Additionally, a correlation analysis carried out in the total sample of 150 migraine patients documented a statistically significant, positive correlation between monthly frequency of migraine attacks and FSS score (p < 0.001), PSQI score (p = 0.006), GAD-7 score (p = 0.019), PHQ-9 score (p < 0.001) and BMI score (p = 0.049). Data from the present report seem to expand the concept of migraine as a continuum or spectrum, with greater occurrence of fatigue, poor sleep quality, anxiety-depressive symptoms and higher BMI score in chronic compared to episodic migraine patients; further investigation is certainly necessary to better define the biological basis and mechanisms associated with migraine transformation from episodic to chronic pattern.

  14. Effects of onabotulinumtoxinA treatment on efficacy, depression, anxiety, and disability in Turkish patients with chronic migraine.

    PubMed

    Demiryurek, Bekir Enes; Ertem, Devrimsel Harika; Tekin, Atilla; Ceylan, Mustafa; Aras, Yesim Guzey; Gungen, Belma Dogan

    2016-11-01

    Chronic migraine causes a serious labour loss and disability in the society and increases the risk of depression and anxiety by negatively affecting the quality of life. The purpose of this study was to investigate the effects of onabotulinumtoxinA (BoNT-A) treatment on efficacy before and after treatment in our cases with chronic migraine as well as on depression, anxiety and disability caused by migraine. According to the International Headache Classification (ICHD-III beta version), 60 adult patients who were diagnosed with chronic migraine were included in the study. A total of 155 IU BoNT-A treatment from 31 regions was administered in accordance with the protocol of PREEMPT study. Information about the characteristics of patients' headaches, background and family history, drugs they used was recorded. At the baseline and in the first and third month after the BoNT-A injection, VAS scores, the number of both headache days and attacks, the headache duration, the frequency of application to emergency services and the intake of both analgesics and triptans during attacks were evaluated. MIDAS, BDI and BAI were evaluated at the baseline and in the third month after the BoNT-A injection. BoNT-A injection provided a significant decrease in the number of days and severity of headaches, MIDAS disability scores and psychiatric complaints in cases with chronic migraine who did not respond to prophylactic treatments in the third month of the treatment.

  15. Free and total magnesium in lymphocytes of migraine patients - effect of magnesium-rich mineral water intake.

    PubMed

    Thomas, J; Millot, J M; Sebille, S; Delabroise, A M; Thomas, E; Manfait, M; Arnaud, M J

    2000-05-01

    Dietary surveys performed in Western countries show magnesium intakes lower than the recommended dietary allowances, suggesting a large prevalence of magnesium deficiency. Low brain magnesium as well as impaired magnesium metabolism have also been reported in various diseases such as migraine. To detect these deficiencies, a non-invasive and sensitive test assessing magnesium status is needed. Because magnesium is an intracellular cation, either total or ionized magnesium (Mg(2+)) of blood cells were suggested as the most adequate tests. Total magnesium levels in plasma, erythrocytes and lymphocytes and Mg(2+) in lymphocytes were analyzed in a group of 29 migraine patients and 18 control subjects. Results show significantly lower concentrations of total magnesium in erythrocytes (50.7+/-4.7 vs. 53.5+/-2.9 mg/l; P<0.01) and of Mg(2+) in lymphocytes (12.0+/-3.5 vs. 14.2+/-3.8 mg/l; P<0.05) in migraine patients as compared to controls. While a significant difference of mean values was noted between migraine patients and controls, an overlap of individual values was observed. These analyses were repeated on migraine patients before and after a 2-week intake of a mineral water containing 110 mg/l magnesium, and a significant increase in all intracellular magnesium concentrations with no effect on plasma magnesium was observed. These increased intracellular magnesium concentrations demonstrate the bioavailability of magnesium from this mineral water. Among the analyzed parameters, Mg(2+) in lymphocytes appears to be the most sensitive index of magnesium deficiency with a 15% decrease in migraine patients when compared to controls and a 16% increase after 2 weeks of a magnesium-rich mineral water intake.

  16. Acupuncture as prophylaxis for menstrual-related migraine: study protocol for a multicenter randomized controlled trial

    PubMed Central

    2013-01-01

    Background Menstrual-related migraine is a common form of migraine affecting >50% of female migraineurs. Acupuncture may be a choice for menstrual-related migraine, when pharmacological prophylaxis is not suitable. However, the efficacy of acupuncture has not been confirmed. We design and perform a randomized controlled clinical trial to evaluate the efficacy of acupuncture compared with naproxen in menstrual-related migraine patients. Methods/Design This is a multicenter, single blind, randomized controlled clinical trial. A total of 184 participants will be randomly assigned to two different groups. Participants will receive verum acupuncture and placebo medicine in the treatment group, while participants in the control group will be treated with sham acupuncture and medicine (Naproxen Sustained Release Tablets). All treatments will be given for 3 months (menstrual cycles). The primary outcome measures are the change of migraine days inside the menstrual cycle and the proportion of responders (defined as the proportion of patients with at least a 50% reduction in the number of menstrual migraine days). The secondary outcome measures are the change of migraine days outside the menstrual cycle, duration of migraine attack, the Visual Analogue Scale (VAS), and intake of acute medication. The assessment will be made at baseline (before treatment), 3 months (menstrual cycles), and 4 months (menstrual cycles) after the first acupuncture session. Discussion The results of this trial will be helpful to supply the efficacy of acupuncture for menstrual-related migraine prophylaxis. Trial registration ISRCTN: ISRCTN57133712 PMID:24195839

  17. [Unusual Migraine Manifestations].

    PubMed

    Schipper, Sivan; Gantenbein, Andreas R; Sandor, Peter S

    2016-06-08

    Migraine is a complex neurologic disorder by which several systems of the central nervous system (autonomous system, affective, cognitive, sensoric and motoric system) may be affected on different levels. Around a fourth of the patients have migraine aura. The most common aura is the visual aura, followed by sensoric aura. But motoric deficits as well as deficits of higher cortical centers (disorders of thinking, orientation, coherence or concentration) may occur as well. In analogy with a headache calendar, an aura calendar can deliver important help in the diagnostic process of rare migraine manifestations and prevent underdiagnosis of unusual migraine manifestations. Complex migraine manifestations are diagnoses of exlusion, and a broad diagnostic work-up is warranted in order to exclude dangerous neurologic pathologies. There are no specific therapeutic recommendations, as there is a lack of randomized controlled studies.

  18. Acute Treatment of Migraine

    PubMed Central

    ÖZTÜRK, Vesile

    2013-01-01

    Migraine is one of the most frequent disabling neurological conditions with a major impact on the patient’s quality of life. Migraine has been described as a chronic disorder that characterized with attacks. Attacks are characterized by moderate–severe, often unilateral, pulsating headache attacks, typically lasting 4 to 72 hours. Migraine remains underdiagnosed and undertreated despite advances in the understanding of its pathophysiology. This article reviews management of migraine acute pharmacological treatment. Currently, for the acute treatment of migraine attacks, non-steroidal anti-inflammatory drugs (NSAIDs) and triptans (serotonin 5HT1B/1D receptor agonists) are recommended. Before intake of NSAID and triptans, metoclopramide or domperidone is useful. In very severe attacks, subcutaneous sumatriptan is first choice. The patient should be treated early in the attack, use an adequate dose and formulation of a medication. Ideally, acute therapy should be restricted to no more than 2 to 3 days per week to avoid medication overuse.

  19. Cardiovascular responses to cognitive stress in patients with migraine and tension-type headache

    PubMed Central

    Leistad, Rune B; Sand, Trond; Nilsen, Kristian B; Westgaard, Rolf H; Stovner, Lars Jacob

    2007-01-01

    Background The purpose of this study was to investigate the temporal relationship between autonomic changes and pain activation in migraine and tension-type headache induced by stress in a model relevant for everyday office-work. Methods We measured pain, blood pressure (BP), heart rate (HR) and skin blood flow (BF) during and after controlled low-grade cognitive stress in 22 migraineurs during headache-free periods, 18 patients with tension-type headache (TTH) and 44 healthy controls. The stress lasted for one hour and was followed by 30 minutes of relaxation. Results Cardiovascular responses to cognitive stress in migraine did not differ from those in control subjects. In TTH patients HR was maintained during stress, whereas it decreased for migraineurs and controls. A trend towards a delayed systolic BP response during stress was also observed in TTH. Finger BF recovery was delayed after stress and stress-induced pain was associated with less vasoconstriction in TTH during recovery. Conclusion It is hypothesized that TTH patients have different stress adaptive mechanisms than controls and migraineurs, involving delayed cardiovascular adaptation and reduced pain control system inhibition. PMID:17683636

  20. Allergens might trigger migraine attacks.

    PubMed

    Bektas, Hesna; Karabulut, Hayriye; Doganay, Beyza; Acar, Baran

    2017-03-01

    Migraine is a common primary headache disorder. The mechanisms underlying the onset of a migraine attack are not completely understood. Environmental changes and a number of other factors could induce migraine attacks. The aim of this study was to investigate the relationship between the frequency of migraine attacks and allergens. Migraine patients without aura, and healthy individuals similar in age and gender without a history of headache and allergy were prospectively included in the study. The duration of migraine, the frequency of migraine attacks, the medication history, and the symptoms during attacks were questioned. Migraine disability assessment score (MIDAS) and visual analog scale (VAS) scores were obtained. Allergen extracts including dust, fungi, insect, animal epithelium, pollens, and food allergens were applied for allergy tests. 49 migraine patients and 49 healthy individuals were enrolled in the study. There was no significant difference in terms of age and gender. The median migraine disease duration, the number of attacks in a month, and the duration of attacks were, respectively, 5.5 years (1-44), 4 (1-10) day/month, and 24 (4-72) h. The mean MIDAS grade was 2.45 ± 0.14 (1-4), and mean VAS score was 7.89 ± 0.27 (4-10). The positivity of allergy tests was 55.1 % (27/49) in the migraine group and 32.7 % (16/49) in the control group (p < 0.05). The allergy tests were positive for house dust, red birch, hazel tree, olive tree, nettle, and wheat. The frequency of migraine attacks was higher in allergy-test-positive patients than in negative ones in the migraine group (p = 0.001). The migraine patients who had frequent attacks should be examined for allergies.

  1. Alterations in regional homogeneity assessed by fMRI in patients with migraine without aura stratified by disease duration

    PubMed Central

    2013-01-01

    Background Advanced neuroimaging approaches have been employed to prove that migraine was a central nervous system disorder. This study aims to examine resting-state abnormalities in migraine without aura (MWoA) patients stratified by disease duration, and to explore the neuroimaging markers for reflecting the disease duration. Methods 40 eligible MWoA patients and 20 matched healthy volunteers were included in the study. Regional homogeneity (ReHo) analysis was used to identify the local features of spontaneous brain activity in MWoA patients stratified by disease duration, and analysis was performed to investigate the correlation of overlapped brain dysfunction in MWoA patients with different disease duration (long-term and short-term) and course of disease. Results Compared with healthy controls, MWoA patients with long-term disease duration showed comprehensive neuronal dysfunction than patients with short-term disease duration. In addition, increased average ReHo values in the thalamus, brain stem, and temporal pole showed significantly positive correlations with the disease duration. On the contrary, ReHo values were negatively correlated with the duration of disease in the anterior cingulate cortex, insula, posterior cingulate cortex and superior occipital gyrus. Conclusions Our findings of progressive brain damage in relation to increasing disease duration suggest that migraine without aura is a progressive central nervous disease, and the length of the disease duration was one of the key reasons to cause brain dysfunction in MwoA patients. The repeated migraine attacks over time result in resting-state abnormalities of selective brain regions belonging to the pain processing and cognition. We predict that these brain regions are sensitive neuroimaging markers for reflecting the disease duration of migraine patients without aura. PMID:24134520

  2. TRPM8 and Migraine

    PubMed Central

    Dussor, Greg; Cao, Yu-Qing

    2017-01-01

    Migraine is among the most common diseases on earth and one of the most disabling, the latter due in large part to poor treatment efficacy. Development of new therapeutics is dependent on the identification of mechanisms contributing to migraine and discovery of targets for new drugs. Numerous genome-wide association studies (GWAS) have implicated the transient receptor-potential M8 (TRPM8) channel in migraine. This channel is predominantly expressed on peripheral sensory neurons and is known as the sensor for cold temperature in cutaneous tissue but is also expressed on deep visceral afferents where cold is not likely a stimulus. Consequently, a number of alternative endogenous agonists have been proposed. Apart from its role in cold sensation, TRPM8 also contributes to cold allodynia after nerve injury or inflammation, and it is necessary for cooling/menthol-based analgesia. How it might contribute to migraine is less clear. The purpose of this review is to discuss the anatomical and physiological mechanisms by which meningeal TRPM8 may play a role in migraine as well as the potential of TRPM8 as a therapeutic target. TRPM8 is expressed on sensory afferents innervating the meninges, and these neurons are subject to developmental changes that may influence their contribution to migraine. As in viscera, meningeal TRPM8 channels are unlikely to be activated by temperature fluctuations and their endogenous ligands remain unknown. Preclinical migraine studies show that activation of meningeal TRPM8 by exogenous agonists can both cause and alleviate headache behaviors, depending on whether other meningeal afferents concurrently receive noxious stimuli. This is reminiscent of the fact that cold can trigger migraine in humans but menthol can also alleviate headache. We propose that both TRPM8 agonists and antagonists may be potential therapeutics, depending on how migraine is triggered in individual patients. In this regard, TRPM8 may be a novel target for personalized

  3. A touchy subject: an assessment of cutaneous allodynia in a chronic migraine population

    PubMed Central

    Mathew, Paul G; Cutrer, Fred Michael; Garza, Ivan

    2016-01-01

    Background Cutaneous allodynia (CA) is a common feature of migraine, which has a complex underlying pathophysiology that is not well understood. In addition to pain, photophobia, phonophobia, osmophobia, nausea, and vomiting, CA can contribute to the overall disability caused by migraine. The presence of CA can be established via a validated questionnaire. Validated questionnaires and other tests are rarely performed in clinical practice. As such, current prevalence estimates for CA may be an underestimation. Methods Utilizing a validated questionnaire, we assessed the presence of CA in consecutive patients (n=44) presenting with chronic migraine at a tertiary headache center. Results CA appears to be quite prevalent, at ~90%, among female patients with chronic migraine. Conclusion CA prevalence in chronic migraine may be underestimated in the literature, and larger studies may better demonstrate a more accurate estimate of its prevalence. PMID:26955290

  4. The impact of comorbid migraine on quality of life outcomes after endoscopic sinus surgery

    PubMed Central

    DeConde, Adam S.; Mace, Jess C.; Smith, Timothy L.

    2014-01-01

    Objectives Chronic rhinosinusitis (CRS) and migraine are common entities with overlapping symptomatology yet little research exists which investigates the intersection of the two. This study seeks to investigate whether patients with CRS with and without a migraine history experience comparable quality-of-life (QOL) improvement after endoscopic sinus surgery (ESS). Study Design Retrospective analysis of a prospective cohort Methods An adult population (n=229) with medically refractory CRS was prospectively evaluated following ESS using disease-specific QOL surveys: the Rhinosinusitis Disability Index (RSDI), the Chronic Sinusitis Survey (CSS), and the Sinonasal Outcome Test-22 (SNOT-22). History of comorbid migraine was identified (n=46) and pre- and postoperative QOL was compared to patients without migraine (n=183). Results Patients migraine and CRS were more likely to be female (p=0.023), experience allergies (p=0.024), fibromyalgia (p=0.009), depression (p=0.010), and be less likely to have nasal polyposis (p=0.003). Objective measures of disease (endoscopy and computed tomography scores) were significantly lower in patients with migraine (p=0.027 and p=0.002, respectively), yet these patients scored lower on baseline RSDI and SNOT-22 scores (p=0.025 and p=0.019, respectively). QOL in both patients with and without migraine improved significantly after ESS (p<0.003) and by comparable magnitudes (p>0.062). Conclusion Patients with comorbid migraine and CRS are more likely to have less severe evidence of disease and worse preoperative baseline QOL scores. This may imply that comorbid migraine disorder, in the setting of CRS, compels these patients to seek surgical management earlier in the disease process. Regardless, ESS provides comparable improvement for both patients with and without comorbid migraine. PMID:24431279

  5. Interhemispheric differences of fMRI responses to visual stimuli in patients with side-fixed migraine aura.

    PubMed

    Hougaard, Anders; Amin, Faisal Mohammad; Hoffmann, Michael B; Rostrup, Egill; Larsson, Henrik B W; Asghar, Mohammad Sohail; Larsen, Vibeke Andrée; Olesen, Jes; Ashina, Messoud

    2014-06-01

    Migraine sufferers with aura often report photosensitivity and visual discomfort outside of attacks and many consider bright or flickering light an attack-precipitating factor. The nature of this visual hypersensitivity and its relation to the underlying pathophysiology of the migraine aura is unknown. Using fMRI measurements during visual stimulation we examined the visual cortical responsiveness of patients with migraine with aura. We applied a within-patient design by assessing functional interhemispheric differences in patients consistently experiencing visual aura in the same visual hemifield. We recruited 20 patients with frequent side-fixed visual aura attacks (≥90% of auras occurring in the same visual hemifield) and 20 age and sex matched healthy controls and compared the fMRI blood oxygenation level dependent (BOLD) responses to visual stimulation between symptomatic and asymptomatic hemispheres during the interictal phase and between migraine patients and controls. BOLD responses were selectively increased in the symptomatic hemispheres. This was found in the inferior parietal lobule (P = 0.002), the inferior frontal gyrus (P = 0.003), and the superior parietal lobule (P = 0.017). The affected cortical areas comprise a visually driven functional network involved in oculomotor control, guidance of movement, motion perception, visual attention, and visual spatial memory. The patients also had significantly increased response in the same cortical areas when compared to controls (P < 0.05). We discovered a lateralized alteration of a visually driven functional network in patients with side-fixed aura. These findings suggest a hyperexcitability of the visual system in the interictal phase of migraine with visual aura.

  6. [Chronic migraine: treatment].

    PubMed

    Pascual, Julio

    2012-04-10

    We define chronic migraine as that clinical situation in which migraine attacks appear 15 or more days per month. Until recently, and in spite of its negative impact, patients with chronic migraine were excluded of the clinical trials. This manuscript revises the current treatment of chronic migraine. The first step should include the avoidance of potential precipitating/aggravating factors for chronic migraine, mainly analgesic overuse and the treatment of comorbid disorders, such as anxiety and depression. The symptomatic treatment should be based on the use of nonsteroidal anti-inflammatory agents and triptans (in this case < 10 days per month). It is necessary to avoid the use of combined analgesics, opioids and ergotamine-containing medications. Preventive treatment includes a 'transitional' treatment with nonsteroidal anti-inflammatory agents or steroids, while preventive treatment exerts its actions. Even though those medications efficacious in episodic migraine prevention are used, the only drugs with demonstrated efficacy in the preventive treatment of chronic migraine are topiramate and pericranial infiltrations of Onabotulinumtoxin A.

  7. What Is Migraine?

    MedlinePlus

    ... of this page please turn JavaScript on. Feature: Migraine Headaches What is Migraine? Past Issues / Fall 2015 Table of Contents If ... exhausted or weak following a migraine. Who Gets Migraines? Migraines occur in both children and adults, but ...

  8. Migraine with Aura

    MedlinePlus

    Migraine with aura Overview By Mayo Clinic Staff Migraine with aura (also called classic migraine) is a headache that strikes after or along ... tingling in your hand or face. Treatments for migraine with aura and migraine without aura (also called ...

  9. Effects of affective pictures on pain sensitivity and cortical responses induced by laser stimuli in healthy subjects and migraine patients.

    PubMed

    de Tommaso, Marina; Calabrese, Rita; Vecchio, Eleonora; De Vito Francesco, Vito; Lancioni, Giulio; Livrea, Paolo

    2009-11-01

    Visually induced analgesia has been correlated with the affective content of pleasant, neutral or unpleasant pictures. The aim of the present study was to assess the effect of affective images vision on laser evoked potentials and pain perception, in a cohort of healthy subjects and migraine patients. Twenty-two healthy subjects and 24 migraine without aura patients (recorded during the inter-critical phase) participated in the study. Eighty-four colour slides, arranged in two blocks, each consisting of 14 pleasant, 14 unpleasant and 14 neutral images, in random presentation, were chosen from the International Affective Picture System. The CO(2) laser stimuli were delivered on the dorsum of the right hand and supra-orbital zone at 7.5-watt intensity and 25-ms duration, in basal condition and during the viewing of affective pictures. Migraine patients expressed higher scores of valence and arousal for pleasant and unpleasant pictures, compared to controls. In both groups, a late positive potential in the 400-700 ms time range was clear for pleasant and unpleasant pictures, but its amplitude was significantly reduced in migraine patients. The pain rating and the N2 component were reduced in both groups during the visual task compared to basal condition. In migraineurs and controls the P2 wave was reduced during the vision of pleasant pictures, compared to basal condition. This indicates that stimulation by images with different affective content reduces subjective pain for a cognitive mechanism of attentive engagement, while a special inhibition of later LEPs is produced by a positive emotional impact. In migraine, affective images are able to modulate pain perception and LEPs, differently from other modalities of distraction, suggesting a possible emotive elaboration of painful stimuli.

  10. A Healthier Weight May Mean Fewer Migraines

    MedlinePlus

    ... an association, and not a cause-and-effect relationship, between weight and migraine risk. The review was ... care professionals should discuss with their patients the relationship with migraines, and help them by providing education ...

  11. Symptomatic pharmacotherapy of migraine.

    PubMed

    Lobo, B L; Cooke, S C; Landy, S H

    1999-07-01

    This review summarizes data on the effectiveness of various symptomatic migraine pharmacotherapies and makes recommendations for treatment. A wide variety of agents are available for the symptomatic treatment of migraine headache, including over-the-counter analgesics, nonsteroidal anti-inflammatory drugs (NSAIDs), combination products, opiates, ergot alkaloids, corticosteroids, dopamine antagonists, and triptans. In the stepped-care approach, simple analgesics and NSAIDs are the recommended first step for the treatment of mild-to-moderate migraine headaches. Patients who do not respond to first-step treatments may be given ergots, combination products, dopamine antagonists, or triptans as the second step. Corticosteroids or opiates may be used as rescue treatment in patients who do not respond to second-step treatment. A stratified approach to care individualizes treatment based on the severity of the headache and other patient-specific factors. In a stratified approach, dihydroergotamine or triptans may be the first-step treatment for patients who present with a history of severe migraines that have responded poorly to previous treatments. Sumatriptan was the first triptan approved for the symptomatic treatment of migraine headache; newer triptans include zolmitriptan, naratriptan, and rizatriptan. Since sumatriptan is rapidly absorbed by the subcutaneous route, its time to onset of effect is shortest. Among triptan drugs that are administered orally, the relative time to onset may be shorter with rizatriptan than sumatriptan. Naratriptan has a longer time to onset but is associated with a lower rate of migraine recurrence than other triptans. graine headache, ergot alkaloids, triptans,

  12. The relation of PTSD symptoms to migraine and headache-related disability among substance dependent inpatients.

    PubMed

    McDermott, Michael J; Fulwiler, Joshua C; Smitherman, Todd A; Gratz, Kim L; Connolly, Kevin M; Tull, Matthew T

    2016-04-01

    Despite emerging evidence for the comorbidity of posttraumatic stress disorder (PTSD) and migraine, few studies have examined the relation of PTSD and migraine, particularly among clinical populations at-risk for both conditions (e.g., substance-dependent patients). This study examined the role of PTSD symptoms in migraine and headache-related disability within a sample of 153 substance-dependent inpatients (37.25% female, Mean age 36.46). PTSD symptoms predicted both migraine and headache-related disability above and beyond gender, depression and anxiety symptoms, the experience of a Criterion A traumatic event, and current alcohol use disorder. Findings highlight the strong association between migraine and PTSD symptoms in a unique population at risk for both conditions.

  13. Paradoxical topiramate-induced hyperphagia successfully treated with phentermine in a woman with migraine.

    PubMed

    Johnson, Jacinta L; Rolan, Paul E

    2015-08-01

    We report a 49-year-old female migraineur who experienced paradoxical hyperphagia and concurrent intrusive food thoughts leading to rapid weight gain and a substantial increase in waist circumference. A significant reduction in migraine frequency was also observed during topiramate treatment, a widely used migraine prophylactic agent which is generally associated with weight loss. Withdrawal of topiramate saw appetite return to baseline levels, however, migraine frequency was again increased. Topiramate was reinitiated in combination with phentermine, a drug indicated for weight management, without reoccurrence of adverse effects. Migraine control was maintained and progressive weight loss ensued. Combination treatment with phentermine may be a useful strategy should other patients experience this adverse reaction while gaining therapeutic anti-migraine benefit from topiramate.

  14. Preliminary evidence of reduced brain network activation in patients with post-traumatic migraine following concussion.

    PubMed

    Kontos, Anthony P; Reches, Amit; Elbin, R J; Dickman, Dalia; Laufer, Ilan; Geva, Amir B; Shacham, Galit; DeWolf, Ryan; Collins, Michael W

    2016-06-01

    Post-traumatic migraine (PTM) (i.e., headache, nausea, light and/or noise sensitivity) is an emerging risk factor for prolonged recovery following concussion. Concussions and migraine share similar pathophysiology characterized by specific ionic imbalances in the brain. Given these similarities, patients with PTM following concussion may exhibit distinct electrophysiological patterns, although researchers have yet to examine the electrophysiological brain activation in patients with PTM following concussion. A novel approach that may help differentiate brain activation in patients with and without PTM is brain network activation (BNA) analysis. BNA involves an algorithmic analysis applied to multichannel EEG-ERP data that provides a network map of cortical activity and quantitative data during specific tasks. A prospective, repeated measures design was used to evaluate BNA (during Go/NoGo task), EEG-ERP, cognitive performance, and concussion related symptoms at 1, 2, 3, and 4 weeks post-injury intervals among athletes with a medically diagnosed concussion with PTM (n = 15) and without (NO-PTM) (n = 22); and age, sex, and concussion history matched controls without concussion (CONTROL) (n = 20). Participants with PTM had significantly reduced BNA compared to NO-PTM and CONTROLS for Go and NoGo components at 3 weeks and for NoGo component at 4 weeks post-injury. The PTM group also demonstrated a more prominent deviation of network activity compared to the other two groups over a longer period of time. The composite BNA algorithm may be a more sensitive measure of electrophysiological change in the brain that can augment established cognitive assessment tools for detecting impairment in individuals with PTM.

  15. Preventive Effects of a Three-month Yoga Intervention on Endothelial Function in Patients with Migraine

    PubMed Central

    Naji-Esfahani, Hajar; Zamani, Mahsa; Marandi, Seyed Mohamad; Shaygannejad, Vahid; Javanmard, Shaghayegh Haghjooy

    2014-01-01

    Background: Migraine is a neurovascular disorder and any interventions improving endothelial function may contribute to its treatment and prevention of vascular complications like ischemic stroke. Yoga has been shown to have several beneficial effects on cardiovascular systems. However, no randomized controlled studies to date have investigated its effects on endothelial function of migraineurs. Methods: A total of 42 women patients with migraine were enrolled and randomized into either a Yoga exercise group or a control group. The control group received only medication for 12 weeks and the Yoga group was placed in yoga training program in addition to the same medical treatment. Blood test was given from all patients in order to measure plasma levels intercellular adhesion molecule (ICAM) and vascular cell adhesion molecule (VCAM) after yoga training program. Results: Totally 32 patients were participated in the final analyses (yoga: n = 18, control: n = 14). By analyzing data between yoga and control groups after the treatment period, there was a significant decreased in plasma level of VCAM in yoga group compare with the control group (15.29 ± 2.1 ng/ml vs. 21.70 ± 3.0 ng/ml, P < 0.05), whereas there was no significant difference in ICAM level between groups (19.1 ± 1.8 ng/ml vs. 20.97 ± 1.9 ng/ml P > 0.05). Conclusions: It seems that yoga exercises, as a complementary treatment beside pharmacological treatments, can be potentially an effective way of improving vascular functions in migraineurs. PMID:24829729

  16. Manual therapies for migraine: a systematic review.

    PubMed

    Chaibi, Aleksander; Tuchin, Peter J; Russell, Michael Bjørn

    2011-04-01

    Migraine occurs in about 15% of the general population. Migraine is usually managed by medication, but some patients do not tolerate migraine medication due to side effects or prefer to avoid medication for other reasons. Non-pharmacological management is an alternative treatment option. We systematically reviewed randomized clinical trials (RCTs) on manual therapies for migraine. The RCTs suggest that massage therapy, physiotherapy, relaxation and chiropractic spinal manipulative therapy might be equally effective as propranolol and topiramate in the prophylactic management of migraine. However, the evaluated RCTs had many methodological shortcomings. Therefore, any firm conclusion will require future, well-conducted RCTs on manual therapies for migraine.

  17. Obsessive-compulsive aspects as predictors of poor response to treatments in patients with chronic migraine and medication overuse.

    PubMed

    Curone, M; D'Amico, D; Bussone, G

    2012-05-01

    Patients with chronic migraine (CM) and medication overuse (MO) have a high frequency of psychiatric comorbidity or psychopathological traits, the presence of which may have important implications for the course of the CM and the MO, both for response to treatment and possible relapses. Overuse of symptomatic drugs is regarded as one of the most important risk factor for the transformation of episodic migraine into CM and drug-seeking tendency due to fear of headache in chronic migraine patients shares with obsessive-compulsive disorder (OCD) the compulsive quality of the behavior. Aim of this study was to review the clinical history of a sample of CM patients with MO in which an obsessive-compulsive trait was identified, performing a comparison with a sample of patients without obsessive-compulsive trait. We selected 14 patients with positivity to Spectrum Project OBS (obsessive-compulsive disorder) questionnaire and other 14 patients with negativity to the same tool from among a sample of patients who were enrolled in a previous study on the psychopathological profile of patients suffering from CM with MO. According to data obtained from the clinical records referring to the previous 5 years, patients with OBS questionnaire positivity showed a worse clinical course and a tendency to early relapse in MO after symptomatic medication withdrawal. Our results show that the comorbidity of OCD should be always evaluated in patients with CM and MO as it may play a relevant role--particularly if not treated--among the risk factors favoring the progression of episodic migraine to the chronic form, and/or the tendency to a pathological behavior that prompts the overuse of symptomatic medications.

  18. Early treatment of migraine attacks with triptans: a strategy to enhance outcomes and patient satisfaction?

    PubMed

    D'Amico, Domenico; Moschiano, Franca; Bussone, Gennaro

    2006-07-01

    Treating migraine attacks early with triptans may be more effective than late triptan administration. However, in published studies, the definition of 'early' varied (in terms of time, pain intensity or presence of allodynia) or was unclear. Therefore, clear clinical indications have not been established. Appropriately designed trials to address this issue remain a priority. Early triptan treatment may also have disadvantages, including inadvertent treatment of tension-type headaches and danger of medication overuse. At present, only those migraineurs with rapid pain worsening, high pain recurrence rate and clinical indications of allodynia should be encouraged to take triptans as quickly as possible. This recommendation implies a requirement for patient education and the need to carefully tailor treatment to individual needs.

  19. Low brain magnesium in migraine

    SciTech Connect

    Ramadan, N.M.; Halvorson, H.; Vande-Linde, A.; Levine, S.R.; Helpern, J.A.; Welch, K.M.

    1989-10-01

    Brain magnesium was measured in migraine patients and control subjects using in vivo 31-Phosphorus Nuclear Magnetic Resonance Spectroscopy. pMg and pH were calculated from the chemical shifts between Pi, PCr and ATP signals. Magnesium levels were low during a migraine attack without changes in pH. We hypothesize that low brain magnesium is an important factor in the mechanism of the migraine attack.

  20. Butterbur extract: prophylactic treatment for childhood migraines.

    PubMed

    Utterback, Gretchann; Zacharias, Rayna; Timraz, Shahrazad; Mershman, Denay

    2014-02-01

    The incidence of migraine headaches in childhood is increasing. Migraines are often difficult to diagnose in pediatrics and even more difficult to treat and prevent. In order to decrease the impact of the condition on the child and the family, prophylactic treatment is recommended if the child is experiencing disabling migraines. The medications currently prescribed for the prevention of pediatric migraines often have significant side effects and are of questionable therapeutic value. For those patients and parents who are interested in alternative therapies and natural remedies for preventive treatment of pediatric migraines, butterbur extract derived from the butterbur plant, Petasites hybridus, has emerged as a promising treatment. This paper discusses the impact of migraines among pediatric patients, the rationale for the preventative treatment of pediatric migraines, the current therapies and the relevance of butterbur extract as a prophylactic treatment for migraines in this patient population.

  1. Migraine headaches: diagnosis and management.

    PubMed

    Moloney, Margaret F; Johnson, Constance J

    2011-01-01

    In spite of the fact that migraines are one of the major problems seen by primary care providers, almost half of people with migraines do not obtain appropriate diagnosis and/or treatment. Migraine occurs in about 18% of women, and is often aggravated by hormonal shifts occurring around women's menses, during pregnancy, and during perimenopause. Quality of life with migraines is often greatly diminished, and many women miss work days and/or are less productive with migraines. Women's health care providers are very likely to see women with poorly managed migraines, but are often not comfortable diagnosing and treating their patients with headaches. A variety of self-care treatments, acute care prescription and non-prescription headache medications, and preventive medications are available and if used by a knowledgeable provider can provide relief for many women who might not otherwise receive appropriate care.

  2. Vestibular Migraine

    PubMed Central

    AKDAL, Gülden

    2013-01-01

    The co-occurrence between migraine and vertigo has been noticed for a long time ago. In recent years, however, growing numbers of epidemiological and clinical studies have definitely shown the significant relation between these two diseases. Recently, the term “vestibular migraine” is used commonly in studies. Vestibular migraine has taken place in appendix in the latest International Headache Society Classification. In this review, epidemiology, clinical features, diagnostic criteria and treatment of vesti-bular migraine will be discussed.

  3. Chronic migraine.

    PubMed

    Valade, D

    2013-05-01

    The second edition of the International Classification of Headache Disorders revised in 2006 (ICHD-2R) gives a definition which requires 15 or more headache days per month over the past 3months with at least eight headache days per month that meet criteria for migraine without aura or that responds to migraine specific treatment. Approximately 2% of the global population suffers of chronic migraine (CM). Frequency of headache and degree of disability distinguish CM from episodic migraine (EM). There is a high frequency of medication overuse. The treatment depends on evaluation with education, lifestyle modifications, and trigger management, behavioral and pharmacologic therapies.

  4. 'Visual snow' - a disorder distinct from persistent migraine aura.

    PubMed

    Schankin, Christoph J; Maniyar, Farooq H; Digre, Kathleen B; Goadsby, Peter J

    2014-05-01

    Patients with 'visual snow' report continuous tiny dots in the entire visual field similar to the noise of an analogue television. As they frequently have migraine as a comorbidity with ophthalmological, neurological and radiological studies being normal, they are offered various diagnoses, including persistent migraine aura, post-hallucinogen flashback, or psychogenic disorder. Our aim was to study patients with 'visual snow' to characterize the phenotype. A three-step approach was followed: (i) a chart review of patients referred to us identified 22 patients with 'visual snow'. Fifteen had additional visual symptoms, and 20 patients had comorbid migraine, five with aura; (ii) to identify systematically additional visual symptoms, an internet survey (n = 275) of self-assessed 'visual snow' subjects done by Eye On Vision Foundation was analysed. In two random samples from 235 complete data sets, the same eight additional visual symptoms were present in >33% of patients: palinopsia (trailing and afterimages), entoptic phenomena (floaters, blue field entoptic phenomenon, spontaneous photopsia, self-light of the eye), photophobia, and nyctalopia (impaired night vision); and (iii) a prospective semi-structured telephone interview in a further 142 patients identified 78 (41 female) with confirmed 'visual snow' and normal ophthalmological exams. Of these, 72 had at least three of the additional visual symptoms from step (ii). One-quarter of patients had 'visual snow' as long as they could remember, whereas for the others the mean age of onset was 21 ± 9 years. Thirty-two patients had constant visual symptoms, whereas the remainder experienced either progressive or stepwise worsening. Headache was the most frequent symptom associated with the beginning or a worsening of the visual disturbance (36%), whereas migraine aura (seven patients) and consumption of illicit drugs (five, no hallucinogens) were rare. Migraine (59%), migraine with aura (27%), anxiety and depression

  5. A possible role for mitochondrial dysfunction in migraine.

    PubMed

    Stuart, S; Griffiths, L R

    2012-12-01

    Migraine is a common neurological disorder characterised by debilitating head pain and an assortment of additional symptoms which can include nausea, emesis, photophobia, phonophobia and occasionally visual sensory disturbances. Migraine is a complex disease caused by an interplay between predisposing genetic variants and environmental factors. It affects approximately 12 % of studied Caucasian populations with affected individuals being predominantly female. Genes involved in neurological, vascular or hormonal pathways have all been implicated in predisposition towards developing migraine. All of these are nuclear encoded genes, but given the role of mitochondria in a number of neurological disorders and in energy production it is possible that mitochondrial variants may play a role in the pathogenesis of this disease. Mitochondrial DNA has been a useful tool for studying population genetics and human genetic diseases due to the clear inheritance shown through successive generations. Given the clear gender bias found in migraine patients it may be important to investigate X-linked inheritance and mitochondrial-related variants in this disorder. This paper explores the possibility that mitochondrial DNA changes may play a role in migraine. Few variants in the mitochondrial genome have so far been investigated in migraine and new studies should be aimed towards investigating the role of mitochondrial DNA in this common disorder.

  6. Disability and mood state in patients with episodic and chronic migraine associated to medication overuse.

    PubMed

    Raggi, A; Giovannetti, A M; Leonardi, M; Schiavolin, S; D'Amico, D; Curone, M; Usai, S; Bussone, G; Grazzi, L

    2012-05-01

    This study aims to compare disability and mood state in patients with episodic (EM) and chronic migraine associated to medication overuse (CM-MO), and to assess the relationships between the two outcomes. Patients, matched for age and gender, were administered the MIDAS, the WHO-DAS-2 and BDI-2. Difference between EM and CM-MO was assessed with the Kolmogorov-Smirnov Test; difference in distribution of patients with severe disability and low mood was tested with contingency coefficient; the correlation between MIDAS, WHO-DAS-2 and BDI-2 was tested with Spearman's index. Seventy patients were enrolled: CM-MO patients reported higher BDI-2 scores and higher MIDAS and WHO-DAS-2 scores, and were more likely to have severe disability and low mood state than those with EM; BDI-2 scores were correlated with disability scores, particularly with WHO-DAS-2. The study shows that disability and mood state are negatively impacted by the presence of more frequent headaches and by the overuse of acute medications.

  7. Roads Less Traveled: Sexual Dimorphism and Mast Cell Contributions to Migraine Pathology

    PubMed Central

    Loewendorf, Andrea I.; Matynia, Anna; Saribekyan, Hakob; Gross, Noah; Csete, Marie; Harrington, Mike

    2016-01-01

    Migraine is a common, little understood, and debilitating disease. It is much more prominent in women than in men (~2/3 are women) but the reasons for female preponderance are not clear. Migraineurs frequently experience severe comorbidities, such as allergies, depression, irritable bowel syndrome, and others; many of the comorbidities are more common in females. Current treatments for migraine are not gender specific, and rarely are migraine and its comorbidities considered and treated by the same specialist. Thus, migraine treatments represent a huge unmet medical need, which will only be addressed with greater understanding of its underlying pathophysiology. We discuss the current knowledge about sex differences in migraine and its comorbidities, and focus on the potential role of mast cells (MCs) in both. Sex-based differences in pain recognition and drug responses, fluid balance, and the blood–brain barrier are recognized but their impact on migraine is not well studied. Furthermore, MCs are well recognized for their prominent role in allergies but much less is known about their contributions to pain pathways in general and migraine specifically. MC-neuron bidirectional communication uniquely positions these cells as potential initiators and/or perpetuators of pain. MCs can secrete nociceptor sensitizing and activating agents, such as serotonin, prostaglandins, histamine, and proteolytic enzymes that can also activate the pain-mediating transient receptor potential vanilloid channels. MCs express receptors for both estrogen and progesterone that induce degranulation upon binding. Furthermore, environmental estrogens, such as Bisphenol A, activate MCs in preclinical models but their impact on pain pathways or migraine is understudied. We hope that this discussion will encourage scientists and physicians alike to bridge the knowledge gaps linking sex, MCs, and migraine to develop better, more comprehensive treatments for migraine patients. PMID:27148260

  8. Managing Migraine Headaches in Children and Adolescents.

    PubMed

    Green, Antoinette; Kabbouche, Marielle; Kacperski, Joanne; Hershey, Andrew; O'Brien, Hope

    2016-01-01

    The diagnosis and management of migraine headaches can be challenging in children and adolescents. The description of migraine in this population may include symptoms that are not typically described in adults. Treatment options for pediatric migraine is increasing, however remain limited. This article will go through the key components to diagnosing migraine in pediatric patients as well as give options for short and long-term management.

  9. Migraine headache prophylaxis in adolescents.

    PubMed

    Fantasia, Heidi Collins

    2014-01-01

    Migraine headache is estimated to affect up to 28 percent of adolescents, most of whom are female. Chronic migraine in this population has been associated with reduced quality of life and academic disruption due to missed school days. Historically, migraine headache was treated episodically as it occurred. In March 2014 the U.S. Food and Drug Administration approved an existing medication, topiramate (Topamax®), for migraine prophylaxis in adolescents between the ages of 12 and 17. This is the first FDA approval of a drug for migraine prevention in this population. There are several possible adverse effects of taking topiramate, some potentially serious, so adequate education for adolescents and their families on all the potential benefits and risks is imperative.

  10. Robust and Accurate Modeling Approaches for Migraine Per-Patient Prediction from Ambulatory Data.

    PubMed

    Pagán, Josué; De Orbe, M Irene; Gago, Ana; Sobrado, Mónica; Risco-Martín, José L; Mora, J Vivancos; Moya, José M; Ayala, José L

    2015-06-30

    Migraine is one of the most wide-spread neurological disorders, and its medical treatment represents a high percentage of the costs of health systems. In some patients, characteristic symptoms that precede the headache appear. However, they are nonspecific, and their prediction horizon is unknown and pretty variable; hence, these symptoms are almost useless for prediction, and they are not useful to advance the intake of drugs to be effective and neutralize the pain. To solve this problem, this paper sets up a realistic monitoring scenario where hemodynamic variables from real patients are monitored in ambulatory conditions with a wireless body sensor network (WBSN). The acquired data are used to evaluate the predictive capabilities and robustness against noise and failures in sensors of several modeling approaches. The obtained results encourage the development of per-patient models based on state-space models (N4SID) that are capable of providing average forecast windows of 47 min and a low rate of false positives.

  11. Robust and Accurate Modeling Approaches for Migraine Per-Patient Prediction from Ambulatory Data

    PubMed Central

    Pagán, Josué; Irene De Orbe, M.; Gago, Ana; Sobrado, Mónica; Risco-Martín, José L.; Vivancos Mora, J.; Moya, José M.; Ayala, José L.

    2015-01-01

    Migraine is one of the most wide-spread neurological disorders, and its medical treatment represents a high percentage of the costs of health systems. In some patients, characteristic symptoms that precede the headache appear. However, they are nonspecific, and their prediction horizon is unknown and pretty variable; hence, these symptoms are almost useless for prediction, and they are not useful to advance the intake of drugs to be effective and neutralize the pain. To solve this problem, this paper sets up a realistic monitoring scenario where hemodynamic variables from real patients are monitored in ambulatory conditions with a wireless body sensor network (WBSN). The acquired data are used to evaluate the predictive capabilities and robustness against noise and failures in sensors of several modeling approaches. The obtained results encourage the development of per-patient models based on state-space models (N4SID) that are capable of providing average forecast windows of 47 min and a low rate of false positives. PMID:26134103

  12. Vitamin supplementation as possible prophylactic treatment against migraine with aura and menstrual migraine.

    PubMed

    Shaik, Munvar Miya; Gan, Siew Hua

    2015-01-01

    Migraine is the most common form of headache disorder globally. The etiology of migraine is multifactorial, with genetic components and environmental interactions considered to be the main causal factors. Some researchers postulate that deficits in mitochondrial energy reserves can cause migraine or an increase in homocysteine levels can lead to migraine attacks; therefore, vitamins could play a vital role in migraine prevention. For instance, riboflavin influences mitochondrial dysfunction and prevents migraine. Genes such as flavoenzyme 5,10-methylenetetrahydrofolate reductase (MTHFR), especially the C677T variant, have been associated with elevated plasma levels of homocysteine and migraine with aura. Homocysteine catalyzation requires the presence of vitamins B6, B12, and folic acid, which can decrease the severity of migraine with aura, making these vitamins potentially useful prophylactic agents for treating migraine with aura. Menstrual migraine, on the other hand, is associated with increased prostaglandin (PG) levels in the endometrium, indicating a role for vitamin E, which is an anti-PG. Vitamin C can also be used as a scavenger of reactive oxygen species for treating neurogenic inflammation in migraine patients. This paper reviews possible therapies based on vitamin supplementation for migraine prophylaxis, focusing on migraine with aura and menstrual migraine.

  13. Chronic migraine: a therapeutic challenge for clinicians.

    PubMed

    Irimia, Pablo; Carmona-Abellán, Mar; Martínez-Vila, Eduardo

    2012-12-01

    Chronic migraine is a common disabling condition. Severe migraine attacks should be treated with triptans, but these agents are contraindicated in patients with vascular problems and may not be effective or tolerated in around one third of the patients. New acute migraine therapies without vasoconstrictive activity and triptan-specific side effects are emerging. For the prophylaxis of chronic migraine, only topiramate and OnabotulinumtoxinA have been shown to be effective in placebo-controlled randomized trials, so novel therapeutic strategies are needed. The growing understanding of the pathophysiology of chronic migraine will contribute to the identification of new treatment targets.

  14. Vascular risk factors, endothelial function, and carotid thickness in patients with migraine: relationship to atherosclerosis.

    PubMed

    Hamed, Sherifa A; Hamed, Enas A; Ezz Eldin, Azza M; Mahmoud, Nagia M

    2010-03-01

    Recent studies indicated that migraine is associated with specific vascular risk profile. However, the functional and structural vascular abnormalities in migraine are rarely addressed. We evaluated the vascular risk factors, endothelial function, and carotid artery (CA)-intima-media thickness (IMT), segregators of preclinical atherosclerosis, in migraineurs. This preliminary study included 63 adults with headache (migraine with aura [n=14], migraine without aura [n=24], transformed migraine [n=6], and tension headache [n=19]) and 35 matched healthy subjects. The following vascular risks were assessed: body mass index (BMI), systolic blood pressure (SBP) and diastolic blood pressures (DBP), serum levels of C-reactive protein, fasting glucose, fasting insulin, total cholesterol, and triglycerides. Plasma endothelin (ET)-1, a vasoactive peptide produced by vascular smooth muscle cells and marker for endothelial injury and atherosclerosis, was measured. Endothelial-dependent vasoreactivity was assessed using brachial artery flow-mediated dilatation (FMD) in response to hyperemia. CA-IMT, structural marker of early atherosclerosis, was measured. Compared with control subjects, SBP, DBP, glucose, insulin, ET-1, and CA-IMT were elevated with migraine. FMD% was inversely correlated with SBP (P < .001), DBP (P < .01), glucose (P < .001), and insulin levels (P < .01). CA-IMT was correlated with BMI (P < .05), SBP (P < .01), total cholesterol (P < .01), triglycerides (P < .001), glucose (P < .001), insulin (P < .01), and FMD% (P < .05). In multivariate analysis, ET-1 was correlated with duration of illness, SBP, DBP, glucose, insulin, IMT, and FMD%. We conclude that endothelial injury, impaired endothelial vasoreactivity, and increased CA-IMT occur with migraine and are associated with vascular risk factors that strongly suggest that migraine could be a risk for atherosclerosis.

  15. Migraine headache and labor market outcomes.

    PubMed

    Rees, Daniel I; Sabia, Joseph J

    2015-06-01

    While migraine headache can be physically debilitating, no study has attempted to estimate its effects on labor market outcomes. Using data drawn from the National Longitudinal Study of Adolescent Health, we estimate the effect of being diagnosed with migraine headache on labor force participation, hours worked, and wages. Ordinary least squares (OLS) estimates suggest that migraines are associated with reduced labor force participation and lower wages among females. A negative association between migraine headache and the wages of female respondents is also obtained using an instrumental variables (IV) approach, although the IV estimates are imprecise relative to the OLS estimates.

  16. Lifestyle Factors and Migraine in Childhood.

    PubMed

    Russo, Antonio; Bruno, Antonio; Trojsi, Francesca; Tessitore, Alessandro; Tedeschi, Gioacchino

    2016-02-01

    Migraine is one of the most common pain symptoms in children. Indeed, a high percentage of adult migraine patients report to have suffered from recurrent headache during the childhood. In particular, children could experience the so-called childhood periodic syndromes (such as cyclic vomiting, abdominal migraine, and benign paroxysmal vertigo) that have been usually considered precursors of migraine or they could develop overt migraine headaches. However, typical cohort of migraine symptoms could be absent and children could not achieve all clinical features necessary for a migraine attack diagnosis according to classification criteria. Nevertheless, migraine is characterized also in childhood by a significant negative impact on the quality of life and a high risk of developing chronic and persistent headache in adulthood. Several studies have emphasized the role of different risk factors for migraine in children. Among these, obesity and overweight, particular food or the regular consumption of alcohol or caffeine, dysfunctional family situation, low level of physical activity, physical or emotional abuse, bullying by peers, unfair treatment in school, and insufficient leisure time seem to be strictly related to migraine onset or progression. Consequently, both identification and avoidance of triggers seem to be mandatory in children with migraine and could represent an alternative approach to the treatment of migraine abstaining from pharmacologic therapies.

  17. Clinical image: MRI during migraine with aura

    SciTech Connect

    McNeal, A.C.

    1996-03-01

    Migraine refers to severe headaches that are usually unilateral, throbbing, and associated with nausea, vomiting, photophobia, and phonophobia. Migraine with aura (formerly called {open_quotes}classic migraine{close_quotes}) consists of the headache preceded or accompanied by neurological dysfunction. This dysfunction (aura) usually involves visual and sensory symptoms. The patient described herein experienced migraine with aura. MRI during and after the attack showed a reversible abnormality of the right posterior cerebral artery, with no parenchymal lesions. This appears to be the first report of abnormal MR vascular imaging during migraine with aura. 10 refs., 2 figs.

  18. A Possible Pathogenic Linkage Among Headache, Migraine, and Nocturnal Enuresis in Children

    PubMed Central

    Dell’Aquila, Livia; Perrone, Giacomo; Spina, Giulia; Miconi, Francesco; Rapaccini, Valentina; Del Vescovo, Ester; Di Lazzaro, Vincenzo; Verrotti, Alberto

    2016-01-01

    Purpose This study aims to evaluate the prevalence of headaches and migraine in children with nocturnal enuresis (NE) and to improve knowledge on these conditions. In particular, for this purpose, a possible pathogenic relationship linking both conditions and the impact of headaches and migraine on NE persistence was evaluated. Methods Researchers enrolled 123 children with NE, aged between 5 and 15 years, referred to the Service of Pediatrics, Campus Bio-Medico University Hospital of Rome between January 2014 and January 2015. Parents of all children enrolled in the study were invited to complete a self-reported questionnaire. The study protocol was approved by the Human Research Ethics Committee of Campus-Bio-Medico University. The NE group data was compared with the data of a control group (107 children). Results Of the eligible patients, 7.8% suffer from headaches/migraine (mean age, 9.63 years; interquartile range [IQR], 3.5 years) and 47.1% have a family history of headaches (mean age, 8.46 years; IQR, 3.75 years). Of the 8 patients with headaches, all are male, 3 have tension-type headaches (2 of them have maternal family history) and 5 have migraine (3 of them have maternal family history). Of the 35.3% with a migraine family history (mean age, 8.36 years; IQR, 3.5 years), 22 are male, and 14 are female. Three of these patients have migraine. A total of 92.2% suffer from NE but not from headaches (mean age, 8.43 years; IQR, 3 years). Of these patients, 33 are female (35.1%), and 61 are male (64.9%). In the control group, 4.7% (5 out of 107) of the children suffer from headaches, and of these, 4 are affected by nonmigraine headaches and 1 by migraine. Conclusions In conclusion, according to the hypothesis, NE and headaches/migraine could be linked by several similarities. PMID:28043109

  19. Prophylactic Treatment of Migraine

    PubMed Central

    GÜRSOY, Azize Esra; ERTAŞ, Mustafa

    2013-01-01

    Migraine is a common chronic neurological disease characterized by episodic attacks of headache and associated symptoms. The pharmacological treatment of migraine may be acute or prophylactic, and patients with frequent, severe headaches often require both approaches. Prophylactic treatment is used to reduce the frequency, duration, or severity of attacks, to enhance the benefits of acute treatments, and to improve patient’s ability to function normally. Prophylactic treatment may also prevent progression from episodic migraine to chronic migraine and may result in reductions in health-care cost. The currently available pharmacological options for migraine prophylaxis include a wide array of medications. The major medication groups for prophylactic treatment include β-blockers, anticonvulsant, drugs such as topiramate and valproate, antidepressant drugs, such as amitriptyline and selective serotonin and selective serotonin-norepinephrine reuptake inhibitors (SNRIs), calcium channel antagonists and neurotoxins. The agent for prophylactic treatment should be chosen based on the efficacy and side-effect profile of the drug, and the patient’s coexistent and comorbid conditions.

  20. Per cent of patients with chronic migraine who responded per onabotulinumtoxinA treatment cycle: PREEMPT

    PubMed Central

    Silberstein, Stephen D; Dodick, David W; Aurora, Sheena K; Diener, Hans-Christoph; DeGryse, Ronald E; Lipton, Richard B; Turkel, Catherine C

    2015-01-01

    Objective The approved use of onabotulinumtoxinA for prophylaxis of headaches in patients with chronic migraine (CM) involves treatment every 12 weeks. It is currently unknown whether patients who fail to respond to the first onabotulinumtoxinA treatment cycle will respond to subsequent treatment cycles. To help inform decisions about treating non-responders, we examined the probability of treatment cycle 1 non-responders responding in cycle 2, and cycle 1 and 2 non-responders responding in cycle 3. Methods Pooled PREEMPT data (two studies: a 24-week, 2-cycle, double-blind, randomised (1:1), placebo-controlled, parallel-group phase, followed by a 32-week, 3-cycle, open-label phase) evaluated onabotulinumtoxinA (155–195 U) for prophylaxis of headaches in persons with CM (≥15 days/month with headache ≥4 h/day). End points of interest included the proportion of study patients who first achieved a ≥50% reduction in headache days, moderate/severe headache days, total cumulative hours of headache on headache days, or a ≥5-point improvement in Headache Impact Test (HIT)-6. For treatment cycle 1, all eligible participants were included. For subsequent cycles, responders in a previous cycle were no longer considered first responders. Results Among onabotulinumtoxinA-treated patients (n=688) 49.3% had a ≥50% reduction in headache-day frequency during treatment cycle 1, with 11.3% and 10.3% of patients first responding during cycles 2 and 3, respectively. 54.2%, 11.6% and 7.4% of patients first responded with a ≥50% reduction in cumulative hours of headache, and 56.3%, 14.5% and 7.7% of patients first responded with a ≥5-point improvement in total HIT-6 during treatment cycles 1, 2 and 3, respectively. Conclusions A meaningful proportion of patients with CM treated with onabotulinumtoxinA who did not respond to the first treatment cycle responded in the second and third cycles of treatment. Trial registration number NCT00156910, NCT00168428. PMID

  1. Association of ACE Gene I/D polymorphism with migraine in Kashmiri population

    PubMed Central

    Wani, Irfan Yousuf; Sheikh, Saleem; Shah, Zafar Amin; Pandith, Arshid A.; Wani, Mushtaq; Asimi, Ravouf; Wani, Maqbool; Sheikh, Shahnawaz; Mehraj, Iqra

    2016-01-01

    Introduction: Migraine is a complex, recurrent headache disorder that is one of the most common complaints in neurology practice. The role of various genes in its pathogenesis is being studied. We did this study to see whether an association exists between ACE gene I/D polymorphism and migraine in our region. Materials and Methods: The study included 100 patients diagnosed with migraine and 121 healthy controls. The study subject were age and gender matched. The analysis was based on Polymerase Chain Reaction (PCR) and included following steps: DNA extraction from blood, PCR and Restriction Fragment Length Polymorphism (RFLP). Results: Out of 100 cases, 69 were females and 31 were males. Fifty-seven were having migraine without aura and 43 had migraine with aura. 45 of the cases had II polymorphism, 40 had ID polymorphism and 15 had DD polymorphism in ACE gene. Conclusion: We were not able to find a statistically significant association between ACE gene I/D polymorphism with migraine. The reason for difference in results between our study and other studies could be because of different ethnicity in study populations. So a continuous research is needed in this regard in order to find the genes and different polymorphism that increase the susceptibility of Kashmiri population to migraine. PMID:27011636

  2. Assessing and Managing All Aspects of Migraine: Migraine Attacks, Migraine-Related Functional Impairment, Common Comorbidities, and Quality of Life

    PubMed Central

    Buse, Dawn C.; Rupnow, Marcia F. T.; Lipton, Richard B.

    2009-01-01

    Migraine can be characterized as a chronic disorder with episodic attacks and the potential for progression to chronic migraine. We conducted a PubMed literature search (January 1, 1970 through May 31, 2008) for studies on the impact of migraine, including disability, health-related quality of life (HRQoL), comorbidities, and instruments used by health care professionals to treat patients with migraine. Numerous studies have shown that migraine substantially impairs a person's functions during attacks and diminishes HRQoL during and between attacks. Despite its impact, migraine remains underestimated, underdiagnosed, and undertreated. Several tools are available to help physicians assess the impact of migraine on the daily activities and HRQoL of their patients, such as the 36-Item Short-Form Health Survey and the Headache Impact Test. Improving communication during the office visit through active listening, use of open-ended questions, and use of the “ask-tell-ask” strategy can also help in assessing migraine-related impairment. Together, these tools and communication techniques can lead to a more complete assessment of how migraine affects patients' lives and can aid in the development of the optimal treatment plan for each patient. Both pharmacotherapy (acute and preventive treatment strategies) and nonpharmacological therapies play important roles in the management of migraine. PMID:19411439

  3. Clinical pharmacology of current and future drugs for the acute treatment of migraine: a review and an update.

    PubMed

    Tfelt-Hansen, Peer

    2012-02-01

    Migraine is a common disorder with a female prevalence of 17% and a male prevalence of 9%. Migraine is most often disabling and the patients need treatment of the attacks. The introduction of triptans has been a revolution for many migraine patients but only a minority of patients use these specific drugs. The pharmacokinetics and efficacy and tolerability of triptans are reviewed. The triptans can most likely with advantage be combined with NSAIDs and prokinetic drugs. Among future drugs, CGRP receptor antagonists are the most promising. These drugs have shown excellent tolerability with no more adverse events than placebo, but only one quarter of migraine patients have been pain-free after 2 hours in phase III studies. The development of current CGRP antagonists has been stopped.

  4. Palinopsia induced by topiramate and zonisamide in a patient with migraine.

    PubMed

    Sierra-Hidalgo, Fernando; de Pablo-Fernández, Eduardo

    2013-01-01

    Palinopsia is an illusory visual phenomenon consisting in the persistence or recurrence of visual images after the exciting stimulus object has been removed. It has been reported in association with parietal and occipital lobe lesions, migraine auras, and related to the use of several drugs and illicit drugs. Here, we report the case of a 23-year-old woman with a 4-year history of episodic migraine with aura who developed palinopsia during sequential prophylactic therapies with topiramate and zonisamide. Although the exact physiopathology of this phenomenon remains unknown, topiramate- and zonisamide-induced palinopsia support an increase on serotonergic activity as a possible mechanism for this visual disorder.

  5. Migraine in the era of precision medicine

    PubMed Central

    Zhang, Lv-Ming; Yu, Sheng-Yuan

    2016-01-01

    Migraine is a common neurovascular disorder in the neurologic clinics whose mechanisms have been explored for several years. The aura has been considered to be attributed to cortical spreading depression (CSD) and dysfunction of the trigeminovascular system is the key factor that has been considered in the pathogenesis of migraine pain. Moreover, three genes (CACNA1A, ATP1A2, and SCN1A) have come from studies performed in individuals with familial hemiplegic migraine (FHM), a monogenic form of migraine with aura. Therapies targeting on the neuropeptids and genes may be helpful in the precision medicine of migraineurs. 5-hydroxytryptamine (5-HT) receptor agonists and calcitonin gene-related peptide (CGRP) receptor antagonists have demonstrated efficacy in the acute specific treatment of migraine attacks. Therefore, ongoing and future efforts to find new vulnerabilities of migraine, unravel the complexity of drug therapy, and perform biomarker-driven clinical trials are necessary to improve outcomes for patients with migraine. PMID:27127758

  6. Contribution of polymorphisms in ESR1, ESR2, FSHR, CYP19A1, SHBG, and NRIP1 genes to migraine susceptibility in Turkish population.

    PubMed

    CoŞkun, Salih; Yůcel, Yavuz; Çim, Abdullah; Cengiz, Beyhan; Oztuzcu, Serdar; Varol, Sefer; Özdemir, Hasan H; Uzar, ErtuĞrul

    2016-03-01

    Migraine, a highly prevalent headache disorder, is regarded as a polygenic multifactorial disease. Single-nucleotide polymorphisms (SNPs) in the genes that involved in sex hormone metabolism may comprise risk for migraine, but the results of previous genetic association studies are conflicting. The aim of this study was to evaluate genetic variants in genes involved in oestrogen receptor and oestrogen hormone metabolism in a Turkish population. A total of 12 SNPs in the ESR1, ESR2, FSHR, CYP19A1, SHBG and NRIP1 genes were genotyped in 142 migraine cases and 141 nonmigraine controls, using a BioMark 96.96 dynamic array system. In addition, gene-gene interactions were analysed using generalized multifactor dimensionality reduction (GMDR) methods. According to GMDR analysis, our results indicated that there was a significant association between migraine and gene-gene interaction among the CYP19A1, FSHR, ESR1 and NRIP1. Single-gene variant analysis showed that a significant association was observed between the TT genotype of rs10046 and migraine susceptibility.When the analysis was performed only in women, the GG genotype of rs2229741 was different between migraineurs and controls.When the female migraine patients were divided into two groups, migraine related to menstruation (MRM) or migraine not related to menstruation (MNRM), GG genotype of rs726281 was significantly associated with MRM. These results suggested that rs10046 could play a potential role in migraine susceptibility in Turkish population. Also, the rare GG genotype of rs726281 appears to influence migraine susceptibility in a recessive manner in MRM subgroup of female patients. In addition, variant GG genotype of rs2229741 may reduce the risk of migraine in Turkish women.

  7. Migraine attacks the Basal Ganglia

    PubMed Central

    2011-01-01

    Background With time, episodes of migraine headache afflict patients with increased frequency, longer duration and more intense pain. While episodic migraine may be defined as 1-14 attacks per month, there are no clear-cut phases defined, and those patients with low frequency may progress to high frequency episodic migraine and the latter may progress into chronic daily headache (> 15 attacks per month). The pathophysiology of this progression is completely unknown. Attempting to unravel this phenomenon, we used high field (human) brain imaging to compare functional responses, functional connectivity and brain morphology in patients whose migraine episodes did not progress (LF) to a matched (gender, age, age of onset and type of medication) group of patients whose migraine episodes progressed (HF). Results In comparison to LF patients, responses to pain in HF patients were significantly lower in the caudate, putamen and pallidum. Paradoxically, associated with these lower responses in HF patients, gray matter volume of the right and left caudate nuclei were significantly larger than in the LF patients. Functional connectivity analysis revealed additional differences between the two groups in regard to response to pain. Conclusions Supported by current understanding of basal ganglia role in pain processing, the findings suggest a significant role of the basal ganglia in the pathophysiology of the episodic migraine. PMID:21936901

  8. Combination of acupuncture and spinal manipulative therapy: management of a 32-year-old patient with chronic tension-type headache and migraine

    PubMed Central

    Ohlsen, Bahia A.

    2012-01-01

    Objective The purpose of this case study is to describe the treatment using acupuncture and spinal manipulation for a patient with a chronic tension-type headache and episodic migraines. Clinical Features A 32-year-old woman presented with headaches of 5 months' duration. She had a history of episodic migraine that began in her teens and had been controlled with medication. She had stopped taking the prescription medications because of gastrointestinal symptoms. A neurologist diagnosed her with mixed headaches, some migrainous and some tension type. Her headaches were chronic, were daily, and fit the International Classification of Headache Disorders criteria of a chronic tension-type headache superimposed with migraine. Intervention and Outcome After 5 treatments over a 2-week period (the first using acupuncture only, the next 3 using acupuncture and chiropractic spinal manipulative therapy), her headaches resolved. The patient had no recurrences of headaches in her 1-year follow-up. Conclusion The combination of acupuncture with chiropractic spinal manipulative therapy was a reasonable alternative in treating this patient's chronic tension-type headaches superimposed with migraine. PMID:23449932

  9. Shared genetic factors in migraine and depression

    PubMed Central

    Stam, A H.; de Vries, B; Janssens, A C.J.W.; Vanmolkot, K R.J.; Aulchenko, Y S.; Henneman, P; Oostra, B A.; Frants, R R.; van den Maagdenberg, A M.J.M.; Ferrari, M D.; van Duijn, C M.; Terwindt, G M.

    2010-01-01

    Objective: To investigate the co-occurrence of migraine and depression and assess whether shared genetic factors may underlie both diseases. Methods: Subjects were 2,652 participants of the Erasmus Rucphen Family genetic isolate study. Migraine was diagnosed using a validated 3-stage screening method that included a telephone interview. Symptoms of depression were assessed using the Center for Epidemiologic Studies Depression scale and the depression subscale of the Hospital Anxiety and Depression Scale (HADS-D). The contribution of shared genetic factors in migraine and depression was investigated by comparing heritability estimates for migraine with and without adjustment for symptoms of depression, and by comparing the heritability scores of depression between migraineurs and controls. Results: We identified 360 migraine cases: 209 had migraine without aura (MO) and 151 had migraine with aura (MA). Odds ratios for depression in patients with migraine were 1.29 (95% confidence interval [CI] 0.98–1.70) for MO and 1.70 (95% CI 1.28–2.24) for MA. Heritability estimates were significant for all migraine (0.56), MO (0.77), and MA (0.96), and decreased after adjustment for symptoms of depression or use of antidepressant medication, in particular for MA. Comparison of the heritability scores for depression between patients with migraine and controls showed a genetic correlation between HADS-D score and MA. Conclusions: There is a bidirectional association between depression and migraine, in particular migraine with aura, which can be explained, at least partly, by shared genetic factors. GLOSSARY CES-D = Center for Epidemiologic Studies Depression Scale; CI = confidence interval; ERF = Erasmus Rucphen Family; HADS-D = Hospital Anxiety and Depression Scale; IHS = International Headache Society; MA = migraine with aura; MO = migraine without aura; OR = odds ratio. PMID:20071666

  10. The Effect of Orem's Self-Care Model on Quality of Life in Patients with Migraine: a Randomized Clinical Trial.

    PubMed

    Mahmoudzadeh Zarandi, Fatemeh; Raiesifar, Afsaneh; Ebadi, Abbas

    2016-03-01

    Many aspects of the lives of migraineurs are commonly affected by the condition, including occupational affairs, social and family life, responsibilities and ultimately the quality of life. This study was designed to determine the effect of orem's self-care nursing model on quality of life in patients with a migraine. This study was carried out in Tehran, Iran. According to the pre-post design of the randomized clinical trial, 88 patients were selected. After obtaining approval from the ethics committee of the Baqiyatallah Medical Sciences University's Research Deputy; Patients who signed the informed consent aged 20-55 years and without any more disease or disability affecting the quality of life were selected and randomly assigned to a group. Data collection tools were a demographic questionnaire, general health survey short form (SF36), and Orem cognition form and self-care checklist. Self-care model were held as four 30-45 minutes training sessions based on self-care deficit needs for the experimental group. The quality of life scores was measured in two stages, before and three months after intervention then were compared in both groups. Data were analyzed with statistical software SPSS and use of descriptive analysis tests, Chi-square, Mann-Whitney u and Wilcoxon. The final analysis was performed on 43 experimental and 40 controls. No significant difference was detected in the two groups in terms of demographic variables (P>0.05). All dimensions of quality of life including physical functioning, physical role limitation, body pain, general health, vitality, social functioning and emotional role limitation and mental health in the experimental group showed a significant increase after intervention compared to the control group (P<0.05). It was concluded that performing Orem's self-care nursing model improves function and overall quality of life and reduces the high cost of a migraine and migraine-related disability to individuals and society.

  11. Diagnosis and management of migraines and migraine variants.

    PubMed

    Harmon, Tomia Palmer

    2015-06-01

    Migraine headache is a neurologic disorder that occurs in 18% of women and 6% of men. Adults and children with mild to moderate migraine headaches seeking acute therapy should be treated with nonsteroidal anti-inflammatory drugs because of the efficacy, cost, and decreased side effects. Some children and adults require preventive therapy (those with headaches lasting >12 h, those patients with >4 headaches in 1 month, those with headaches that affect their ability to function). Studies have shown that early treatment with large doses of medication work well for the treatment of moderate to severe migraine headache.

  12. [Mnemonic complaints and chronic migraine].

    PubMed

    Santos-Lasaosa, S; Viloria-Alebesque, A; Morandeira-Rivas, C; Lopez Del Val, L J; Bellosta-Diago, E; Velazquez-Benito, A

    2013-08-16

    INTRODUCTION. Patients with chronic migraine often report lower cognitive performance, which affects their quality of life. AIMS. To analyse whether the mnemonic capacity of patients with chronic migraine is altered or not. SUBJECTS AND METHODS. A cross-sectional study was conducted in patients with chronic migraine evaluated consecutively in our unit, and paired by age (18-60 years) and gender with a control group consisting of cognitively healthy volunteers. The following cognitive instruments were administered: Folstein Minimental State Examination (MMSE), Memory Alteration Test (M@T), Montreal Cognitive Assessment (MoCA) and working memory. RESULTS. A total of 30 patients with chronic migraine were included (mean age: 49.33 ± 10.05 years) paired with a control group of 30 healthy volunteers (mean age: 44.83 ± 10.91 years). The mean elapsed time since onset of the patients with chronic migraine was 4.47 ± 2.74 years. On performing a comparative analysis between the two groups, significant differences were found with overall lower scores in the group of patients with chronic migraine in the MoCA (24.16 versus 29), M@T (43.76 versus 48.8) and working memory tests (17.5 versus 24.26). Performance in the MMSE was similar in both groups. CONCLUSIONS. Patients with chronic migraine can have lower cognitive performance regardless of distracting elements, such as pharmacological factors or psychiatric comorbidity, since chronic migraine can be understood as yet another element within the spectrum of chronic pain.

  13. Motion sickness in migraine sufferers.

    PubMed

    Marcus, Dawn A; Furman, Joseph M; Balaban, Carey D

    2005-12-01

    Motion sickness commonly occurs after exposure to actual motion, such as car or amusement park rides, or virtual motion, such as panoramic movies. Motion sickness symptoms may be disabling, significantly limiting business, travel and leisure activities. Motion sickness occurs in approximately 50% of migraine sufferers. Understanding motion sickness in migraine patients may improve understanding of the physiology of both conditions. Recent literature suggests important relationships between the trigeminal system and vestibular nuclei that may have implications for both motion sickness and migraine. Studies demonstrating an important relationship between serotonin receptors and motion sickness susceptibility in both rodents and humans suggest possible new motion sickness prevention therapies.

  14. Reduction of CD4(+)CD25(+) regulatory T-cells in migraine: Is migraine an autoimmune disorder?

    PubMed

    Arumugam, Murugesan; Parthasarathy, Varadarajan

    2016-01-15

    Migraine is believed to be a chronic neurological disorder with the exact aetiology being unknown. But, there is a debate on the role of immune dysfunction in migraine pathophysiology. Hence, authors made a debut attempt to explore the link between lymphocyte subset populations and migraine. A significant increase in CD4(+) and decrease in CD8(+) population were observed in migraine patients compared to healthy volunteers. Interestingly, the immunoregulator CD4(+)CD25(+) levels were less in migraine patients compared to the healthy volunteers. The results of the present study indicate that failure of immunoregulation could be implicated in the pathophysiology of migraine.

  15. Malignant syphilis in an immunocompetent female patient*

    PubMed Central

    Requena, Camila Bueno; Orasmo, Cínthia Rosane; Ocanha, Juliana Polizel; Barraviera, Silvia Regina Catharino Sartore; Marques, Mariangela Esther Alencar; Marques, Silvio Alencar

    2014-01-01

    Malignant syphilis is an uncommon manifestation of secondary syphilis, in which necrotic lesions may be associated with systemic signs and symptoms. Generally it occurs in an immunosuppressed patient, mainly HIV-infected, but might be observed on those who have normal immune response. Since there is an exponential increase in the number of syphilis cases, more diagnoses of malignant syphilis must be expected. We report a case in an immunocompetent female patient. PMID:25387504

  16. Behavioral Weight Loss Treatments for Individuals with Migraine and Obesity.

    PubMed

    Cervoni, Cynthia; Bond, Dale S; Seng, Elizabeth K

    2016-02-01

    Migraine and obesity are each prevalent disorders involving significant personal and societal burden. Epidemiologic research demonstrates a link between migraine and obesity that is further substantiated by putative behavioral, psychosocial, and physiological mechanisms. As obesity is considered a modifiable risk factor for exacerbation of migraine, weight loss may be a particularly useful treatment option for people with comorbid migraine and obesity. Behavioral weight loss interventions complement existing behavioral treatments for migraine and offer patients evidence-based effective strategies for achieving weight loss that could help reduce frequency, severity, and impact of migraine attacks.

  17. Hemiplegic Migraine Presenting with Prolonged Somnolence: A Case Report

    PubMed Central

    Saleh, Christian; Pierquin, Geneviève; Beyenburg, Stefan

    2016-01-01

    Hemiplegic migraine is a rare and complex disease, characterized by migraine with a reversible motor aura. Hemiplegic migraine can be easily misdiagnosed at its first presentation with an atypical severe form of migraine, a stroke, multiple sclerosis, metabolic disorders, conversion disorder or an epilepsy. We present the case of a young 24-year-old male patient, who since the age of 4 years had been having multiple episodes of migraine associated with hemiparesis, paraesthesia, prolonged somnolence, aphasia and confusion. We review the literature and discuss important diagnostic findings in hemiplegic migraine to help establishing a prompt diagnosis. PMID:27790126

  18. Basilar artery migraine and reversible imaging abnormalities.

    PubMed

    Maytal, J; Libman, R B; Lustrin, E S

    1998-01-01

    We report a case of a basilar artery migraine in a 17-year-old boy with transient CT and MR abnormalities after each of two migraine episodes. A repeat MR study 6 months after the last event showed complete resolution of the lesion. Transient abnormalities on brain images similar to those shown in our case have been reported in patients with migraine and other neurologic conditions and are most likely related to cerebral vasogenic edema.

  19. Consensus formalisé: recommandations de pratiques cliniques pour la prise en charge de la migraine du patient adulte africain

    PubMed Central

    Ahmed, Mahmoud Ait Kaci; Haddad, Monia; Kouassi, Beugré; Ouhabi, Hamid; Serrie, Alain

    2016-01-01

    La migraine est une céphalée primaire (selon les derniers critères de l'International Headache Society) qui affecte environ 8% de la population africaine. Les femmes sont plus fréquemment touchées que les hommes et les crises apparaissent le plus souvent avant l’âge de 40 ans. Bien qu'un certain nombre de traitements, de mesure hygiéno-diététiques, et d'autres méthodes non pharmacologiques permettent de limiter l'intensité et la fréquence des crises, la prise en charge médicamenteuse de la crise de migraine est très souvent nécessaire. La disponibilité des traitements et l'accès aux soins diffèrent sur le continent africain et ont conduit à la réalisation du 1er consensus d'experts pour la prise en charge du patient adulte africain. Destiné aux praticiens, ce travail collaboratif multinational a pour objectif de fournir 16 recommandations de pratiques cliniques simples, fondées sur les preuves, et adaptées aux conditions de l'exercice médical en Afrique. PMID:27642420

  20. Management of the acute migraine headache.

    PubMed

    Aukerman, Glen; Knutson, Doug; Miser, William F

    2002-12-01

    As many as 30 million Americans have migraine headaches. The impact on patients and their families can be tremendous, and treatment of migraines can present diagnostic and therapeutic challenges for family physicians. Abortive treatment options include nonspecific and migraine-specific therapy. Nonspecific therapies include analgesics (aspirin, nonsteroidal anti-inflammatory drugs, and opiates), adjunctive therapies (antiemetics and sedatives), and other nonspecific medications (intranasal lidocaine or steroids). Migraine-specific abortive therapies include ergotamine and its derivatives, and triptans. Complementary and alternative therapies can also be used to abort the headache or enhance the efficacy of another therapeutic modality. Treatment choices for acute migraine should be based on headache severity, migraine frequency, associated symptoms, and comorbidities.

  1. Epigone migraine vertigo (EMV): a late migraine equivalent.

    PubMed

    Pagnini, P; Vannucchi, P; Giannoni, B; Pecci, R

    2014-02-01

    Migrainous headache is determined by pathogenetic mechanisms that are also able to affect the peripheral and/or central vestibular system, so that vestibular symptoms may substitute and/or present with headache. We are convinced that there can be many different manifestations of vestibular disorders in migrainous patients, representing true different clinical entities due to their different characteristics and temporal relashionship with headache. Based on such considerations, we proposed a classification of vertigo and other vestibular disorders related to migraine, and believe that a particular variant of migraine-related vertigo should be introduced, namely "epigone migraine vertigo" (EMV): this could be a kind of late migraine equivalent, i.e. a kind of vertigo, migrainous in origin, starting late in the lifetime that substitutes, as an equivalent, pre-existing migraine headache. To clarify this particular clinical picture, we report three illustrative clinical cases among 28 patients collected during an observation period of 13 years (November 1991 - November 2004). For all patients, we collected complete personal clinical history. All patients underwent standard neurotological examination, looking for spontaneous-positional, gaze-evoked and caloric induced nystagmus, using an infrared video camera. We also performed a head shaking test (HST) and an head thrust test (HTT). Ocular motility was tested looking at saccades and smooth pursuit. To exclude other significant neurological pathologies, a brain magnetic resonance imaging (MRI) with gadolinium was performed. During the three months after the first visit, patients were invited to keep a diary noting frequency, intensity and duration of vertigo attacks. After that period, we suggested that they use prophylactic treatment with flunarizine (5 mg per day) and/or acetylsalicylic acid (100 mg per day), or propranolol (40 mg twice a day). All patients were again recommended to note in their diary the frequency

  2. Rofecoxib versus ibuprofen for acute treatment of migraine: a randomised placebo controlled trial

    PubMed Central

    Misra, U; Jose, M; Kalita, J

    2004-01-01

    Background: Rofecoxib is a potent cyclo-oxygenase-2 inhibitor with a long duration of action. Its role in migraine has not been systematically evaluated. Aim: To study the efficacy of rofecoxib in migraine. Method: In a randomised placebo controlled trial rofecoxib 25 mg, ibuprofen 400 mg, and placebo were compared regarding their efficacy in relieving acute migraine attack. Migraine patients with 2–6 attacks per month were recruited. Headache severity, functional disability, and severity of associated symptoms were graded on a 0–3 scale. The primary endpoint was pain relief at two hours. Relief of associated symptoms and sustained pain relief for 24 hours were also noted. Result: One hundred and twenty four patients were randomised into rofecoxib (42), ibuprofen (40), and placebo (42) groups. One hundred and one patients were followed up: 33 on rofecoxib, 35 ibuprofen, and 33 placebo. Patients' ages ranged from 16–62 (mean 31.4) years, and 83 were females. Pain relief at two hours was noted in 45.5% on rofecoxib, 55.6% on ibuprofen, and 9.1% in the placebo group. The associated symptoms at two hours were reduced in 39.4% on rofecoxib, 50% on ibuprofen, and 9.1% in the placebo group. Sustained 24 hour pain relief was noted in 36.4% on rofecoxib, 41% on ibuprofen, and 6.1% in the placebo group. In the ibuprofen group, five patients had abdominal pain but there were no side effects in those on rofecoxib or in the control group. Both rofecoxib and ibuprofen were significantly effective in relieving pain, associated symptoms at two hours, and in sustained pain relief. There was no significant difference between rofecoxib and ibuprofen in aborting acute migraine attacks. Conclusions: Both ibuprofen and rofecoxib were superior to placebo in aborting an acute migraine attack, and there was no significant difference in their efficacy in an acute migraine attack. PMID:15579612

  3. Vestibular Migraine in Children and Adolescents: Clinical Findings and Laboratory Tests

    PubMed Central

    Langhagen, Thyra; Lehrer, Nicole; Borggraefe, Ingo; Heinen, Florian; Jahn, Klaus

    2015-01-01

    Introduction: Vestibular migraine (VM) is the most common cause of episodic vertigo in children. We summarize the clinical findings and laboratory test results in a cohort of children and adolescents with VM. We discuss the limitations of current classification criteria for dizzy children. Methods: A retrospective chart analysis was performed on 118 children with migraine related vertigo at a tertiary care center. Patients were grouped in the following categories: (1) definite vestibular migraine (dVM); (2) probable vestibular migraine (pVM); (3) suspected vestibular migraine (sVM); (4) benign paroxysmal vertigo (BPV); and (5) migraine with/without aura (oM) plus vertigo/dizziness according to the International Classification of Headache Disorders, 3rd edition (beta version). Results: The mean age of all patients was 12 ± 3 years (range 3–18 years, 70 females). 36 patients (30%) fulfilled criteria for dVM, 33 (28%) for pVM, 34 (29%) for sVM, 7 (6%) for BPV, and 8 (7%) for oM. Somatoform vertigo (SV) co-occurred in 27% of patients. Episodic syndromes were reported in 8%; the family history of migraine was positive in 65%. Mild central ocular motor signs were found in 24% (most frequently horizontal saccadic pursuit). Laboratory tests showed that about 20% had pathological function of the horizontal vestibulo-ocular reflex, and almost 50% had abnormal postural sway patterns. Conclusion: Patients with definite, probable, and suspected VM do not differ in the frequency of ocular motor, vestibular, or postural abnormalities. VM is the best explanation for their symptoms. It is essential to establish diagnostic criteria in clinical studies. In clinical practice, however, the most reasonable diagnosis should be made in order to begin treatment. Such a procedure also minimizes the fear of the parents and children, reduces the need to interrupt leisure time and school activities, and prevents the development of SV. PMID:25674076

  4. Effects of left primary motor and dorsolateral prefrontal cortex transcranial direct current stimulation on laser-evoked potentials in migraine patients and normal subjects.

    PubMed

    Vecchio, Eleonora; Ricci, Katia; Montemurno, Anna; Delussi, Marianna; Invitto, Sara; de Tommaso, Marina

    2016-07-28

    Migraine is characterized by an altered cortical excitability. Because transcranial direct current stimulation (tDCS) can change brain activity noninvasively, it is possible to hypothesize its efficacy in modulating pain in migraine. In this study, we compared the effects of tDCS of the left primary motor cortex (M1) and left dorsolateral prefrontal cortex (DLPFC) both on subjective pain and on evoked responses induced by laser stimulation (LEPs). Thirty-two patients and sixteen controls were randomized to receive sham stimulation and real tDCS with the anode centered over M1 or DLPFC. Laser Evoked potentials were recorded in basal, sham and tDCS conditions. We did not find significant acute changes in LEPs parameters and pain perception among subjects who received tDCS of both M1 and DLPFC. After DLPFC tDCS, we observed a significant increase of N2-P2 component habituation in migraine patients while M1 stimulation reduced it. These findings may suggest a modulation of abnormal pain processing induced by DLPFC and M1 anodal tDCS and outline the need for future investigations exploring the possible neuronal plasticity changes supporting the clinical effect on migraine.

  5. Increased Serum CD14 Level Is Associated with Depletion of TNF-α in Monocytes in Migraine Patients during Interictal Period

    PubMed Central

    Michalak, Slawomir; Kalinowska-Lyszczarz, Alicja; Wegrzyn, Danuta; Niezgoda, Adam; Losy, Jacek; Osztynowicz, Krystyna; Kozubski, Wojciech

    2017-01-01

    The aim of the present study was to investigate the levels of circulating CD14 in relation to the expression of tumor necrosis factor alpha (TNF-α) in monocytes, and serum levels of TNF-α and macrophage inflammatory protein-1 (MIP-1) in migraine patients. Numerous studies revealed controversial changes in the components of the immune system during attacks and the interictal period in migraine patients. Our study included 40 migraineurs and 39 controls. The levels of TNF-α, MIP-1 and CD14 were measured in peripheral monocytes and in sera with the Enzyme-Linked Immunosorbent Assay (ELISA) method, and the monocyte expression of TNF-α was also analysed by immunostaining. Serum CD14 concentrations were higher and the expression of TNF-α in monocytes was decreased in migraineurs. The serum MIP-1 level correlated with Verbal Rating Scale (VRS); the MIP-1:CD14 ratio in monocytes correlated with Visual Analogue Scale (VAS); the MIP-1:CD14 ratio correlated with Migraine Severity (MIGSEV)-Pain scores; and serum CD14 concentration correlated with migraine duration in years. Increased serum CD14 and depletion of TNF-α in monocytes can orchestrate other components of the immune system during the interictal period. PMID:28208835

  6. Pediatric migraine variants: a review of epidemiology, diagnosis, treatment, and outcome.

    PubMed

    Lagman-Bartolome, Ana Marissa; Lay, Christine

    2015-06-01

    Pediatric migraine variants, previously known as childhood periodic syndromes, migraine equivalents, or migraine precursors, are a group of periodic or paroxysmal disorders occurring in patients who also have migraine with or without aura, or who have an increased likelihood of developing migraine. They have common key clinical features including periodic or paroxysmal character, normal neurological examination between attacks, family history of migraine, and clinical evolution to classic types of migraine. This article aims to review the pathophysiology, evaluation, and management of the pediatric migraine variants including abdominal migraine, benign paroxysmal vertigo, cyclic vomiting syndrome, and benign paroxysmal torticollis as well as the episodic syndromes that may lead to migraine, infantile colic, alternating hemiplegia of childhood, and vestibular migraine.

  7. Headaches and Migraines: Migraine 101 Quiz

    MedlinePlus

    ... for migraine headaches. Dietary triggers for migraines include: Chocolate Cheese Food additives such as MSG Alcohol A, B, and C A, B, C, and D True/False: Migraines sometimes run in families. True/False: A bad headache is usually a sign of a brain tumor. Answer Key False. In most cases of ...

  8. Urethral hemangioma in a prepubertal female patient

    PubMed Central

    Li, Chiao-Ching; Li, Chiao-Zhu; Yen, Ching-Heng; Tsai, Wen-Chuan; Wu, Sheng-Tang; Cha, Tai-Lung; Meng, En

    2017-01-01

    Abstract Rationale: Urethral hemangiomas commonly occur in men or elderly women. We presented a rare case of urethral hemangioma in a prepubertal female patient. Patients concerns: An 8-year-old girl had the complaints of bloody staining of clothing, a foul perineal odor, and urethral pain. She was brought to our genitourinary outpatient department for survey and a single, 1-cm compressible reddish nodule at the 10-2 o’clock position in the distal urethra was found. Diagnoses: Urethral hemangioma in a prepubertal girl was diagnosed after excision of the urethral nodule. Interventions: Excision with 8 “stay” sutures in the protruding urethral mucosa was performed. Outcomes: Normal micturition without symptom recurrence was noted at the 3-month follow-up. Lessons: Urethral hemangioma is also found in prepubertal female patient. Increased physician awareness and early recognition of a urethral hemangioma can avoid unnecessary examinations and patient anxiety. The procedure of excision with 8 “stay” sutures in the protruding urethral mucosa facilitates mobilization from the distal urethra and provides a good surgical view of abnormal proliferative blood vessels. Therefore, the lesion can be removed as clean as possible. PMID:28353601

  9. ASICs as therapeutic targets for migraine

    PubMed Central

    2015-01-01

    Migraine is the most common neurological disorder and one of the most common chronic pain conditions. Despite its prevalence, the pathophysiology leading to migraine is poorly understood and the identification of new therapeutic targets has been slow. Several processes are currently thought to contribute to migraine including altered activity in the hypothalamus, cortical-spreading depression (CSD), and afferent sensory input from the cranial meninges. Decreased extracellular pH and subsequent activation of acid-sensing ion channels (ASICs) may contribute to each of these processes and may thus play a role in migraine pathophysiology. Although few studies have directly examined a role of ASICs in migraine, studies directly examining a connection have generated promising results including efficacy of ASIC blockers in both preclinical migraine models and in human migraine patients. The purpose of this review is to discuss the pathophysiology thought to contribute to migraine and findings that implicate decreased pH and/or ASICs in these events, as well as propose issues to be resolved in future studies of ASICs and migraine. PMID:25582295

  10. The prognosis of childhood abdominal migraine

    PubMed Central

    Dignan, F; Abu-Arafeh, I; Russell, G

    2001-01-01

    AIMS—To determine the clinical course of childhood abdominal migraine, seven to 10 years after the diagnosis.
METHODS—A total of 54 children with abdominal migraine were studied; 35 were identified from a population survey carried out on Aberdeen schoolchildren between 1991 and 1993, and 19 from outpatient records of children in the same age group who had attended the Royal Aberdeen Children's Hospital. Controls were 54 children who did not have abdominal pain in childhood, matched for age and sex, obtained from either the population survey or the patient administration system. Main outcome measures were presence or resolution of abdominal migraine and past or present history of headache fulfilling the International Headache Society (IHS) criteria for the diagnosis of migraine.
RESULTS—Abdominal migraine had resolved in 31 cases (61%). Seventy per cent of cases with abdominal migraine were either current (52%) or previous (18%) sufferers from headaches that fulfilled the IHS criteria for migraine, compared to 20% of the controls.
CONCLUSIONS—These results support the concept of abdominal migraine as a migraine prodrome, and suggest that our diagnostic criteria for the condition are robust.

 PMID:11316687

  11. Prevention of episodic migraines with topiramate: results from a non-interventional study in a general practice setting.

    PubMed

    Nelles, Gereon; Schmitt, Lukas; Humbert, Thomas; Becker, Veit; Sandow, Petra; Bornhoevd, Karin; Fritzsche, Dirk; Schäuble, Barbara

    2010-02-01

    The majority of patients with migraine headaches are treated in non-specialized institutions though data on treatment outcomes are largely derived from tertiary care centers. The current non-interventional study explores efficacy and tolerability outcomes of patients with episodic migraines receiving topiramate as preventive agent in a general practice setting. A total of 366 patients (87% female, mean age 41.8 +/- 11.6 years) were eligible for migraine prevention and treated with flexible dose topiramate for 6 months (core phase), and optionally for a total of 12 months (follow-up phase). Overall, 261 patients (77.7% of safety analysis set, SAF) completed the core phase. Reasons for discontinuation included adverse events (2.1%), lost to follow-up (1.8%), other reasons (1.5%), and end of therapy (0.3%) though in the majority of patients who discontinued no reasons were listed. The median daily dose at endpoint was 50 mg/day (range, 25-187.5 mg/day). The median days with migraine headaches decreased from 6.0 to 1.2 days (p < 0.001), median pain intensity score decreased from 17.0 to 3.2 points (p < 0.001). In women with reported menstruation-associated migraine, the median number of migraine attacks decreased from 4.0 to 0.9 (p < 0.001). Absenteeism as well as triptan use decreased significantly, and significant improvements in activities of daily living and quality of life were reported. The most frequently reported AEs were paraesthesia (4.2%) and nausea (3%). Results suggest that migraine prevention with topiramate in a general practice is generally well tolerated and associated with a significant improvement in migraine headaches and related functional impairment.

  12. Visual evoked potentials in migraine patients: alterations depend on pattern spatial frequency.

    PubMed

    Oelkers, R; Grosser, K; Lang, E; Geisslinger, G; Kobal, G; Brune, K; Lötsch, J

    1999-06-01

    Visual information is conducted by two parallel pathways (luminance- and contour-processing pathways) which are thought to be differentially affected in migraine and can be investigated by means of pattern-reversal visual evoked potentials (VEPs). Components and habituation of VEPs at four spatial frequencies were compared between 26 migraineurs (13 without aura, MO; 13 with aura, MA) and 28 healthy volunteers. Migraineurs were recorded in the headache-free interval (at least 72 h before and after an attack). Five blocks of 50 responses to chequerboards of 0.5, 1, 2 and 4 cycles per degree (c.p.d.) were sequentially averaged and analysed for latency and amplitude. Differences in VEPs were dependent on spatial frequency. Only when small checks were presented, i.e. at high spatial frequency (2 and 4 c.p.d.), was the latency of N2 significantly prolonged in MA and did it tend to be delayed in MO subjects. Habituation behaviour was not significantly different between groups under the stimulating conditions employed. Prolonged N2 latency might be explained by the lack or attenuation of a contour-specific component N130 in migraineurs, indicating an imbalance of the two visual pathways with relative predominance of the luminance-processing Y system. These results reflect an interictally persisting dysfunction of precortical visual processing which might be relevant in the pathophysiology of migraine.

  13. Genetics of Migraine: Insights into the Molecular Basis of Migraine Disorders.

    PubMed

    Sutherland, Heidi G; Griffiths, Lyn R

    2017-04-01

    migraine. Further studies are required to fully understand these findings and translate them into treatment options for migraine patients.

  14. New advances in prevention of migraine

    PubMed Central

    Al-Quliti, Khalid W.; Assaedi, Ekhlas S.

    2016-01-01

    Despite being one of the most common disabling primary headaches, migraine continues to be under-diagnosed and under-treated. A migraine challenges not only the patient suffering from the migraine, but also physicians; especially in recognizing candidates for prophylaxis and selecting the appropriate preventive medication. Recently, there have been major advances in the diagnosis and treatment of migraine, with different guidelines of migraine management across the world. Here, we review migraine’s abortive and prophylactic medications, based on their pharmacologic category, citing their recommended doses, efficacy, and side effects. Additionally, we highlight the prophylactic treatment of specific patient populations and present suggested treatment approaches in view of recent international treatment guidelines that consider factors other than drug efficacy when choosing the optimal preventive therapy. Finally, we introduce drugs in different stages of development, which have novel mechanisms of action or have new therapeutic targets. PMID:27356650

  15. Alexithymia and its impact on quality of life in a group of Brazilian women with migraine without aura

    PubMed Central

    2013-01-01

    Background Migraine is a type of primary headache widely known for its impact on quality of life of patients. Although the psychological aspects of the disease are receiving increasing attention in current research, some of them, as alexithymia, are still seldom explored. This study aimed to provide evidence on the relationships between markers of depression, anxiety, alexithymia, self-reflection, insight and quality of life in migraine. Methods Forty female outpatients from a Brazilian specialized headache hospital service and a paired control group were compared. Results The results revealed that women with migraine had higher levels of depression, anxiety and alexithymia, and lower levels of quality of life, self-reflection and insight, compared to controls. Quality of life in women with migraine was predicted by levels of depression and one alexithymia factor (ability to express emotions and fantasies). A binary regression analysis between clinical and control groups revealed the migraine group to comprise individuals with high anxiety, low quality of life in the physical domain and the presence of a concrete thinking style. Conclusions The results highlight the relevance of considering psychological variables in the routine healthcare practices for migraine patients in general, while keeping steady attention to individual case features. PMID:23565860

  16. ID migraine questionnaire in temporomandibular disorders with craniofacial pain: a study by using a multidisciplinary approach.

    PubMed

    Di Paolo, Carlo; Di Nunno, Anna; Vanacore, Nicola; Bruti, Gianluca

    2009-08-01

    To evaluate the prevalence of migraine and related disability and the role of ID migraine questionnaire as a screening tool in patients with temporomandibular disorders (TMDs) and craniofacial pain (CFP). TMDs patients with CFP underwent stomatognathic (RDC/TMD criteria) and neurological visits (IHS criteria, 2004). ID migraine questionnaire and MIgraine Disability Assessment Scale (MIDAS) were also administered. Out of 45 patients, 69% met diagnosis of migraine plus chronic tension-type headache (CTTH); 9% presented CTTH and 20% were migraineurs. Out of 39 migraineurs who completed MIDAS, 56% presented the highest disability grade. Out of 37 patients who completed ID migraine questionnaire, 32 resulted affected by probable migraine with a diagnostic sensibility and specificity of 94% and 100%, respectively. Our findings showed a clinical association between TMDs and migraine. We support a clinical role of ID migraine and MIDAS in TMDs patients with CFP and we underline the importance of a multidisciplinary evaluation in this group of migraineurs.

  17. Migraine Susceptibility Genes in Han Chinese of Fujian Province

    PubMed Central

    Lin, Qi-fang; Chen, Zi-chun; Fu, Xian-guo; Yang, Jing; Cao, Luo-yuan; Yao, Long-teng; Xin, Yong-tong

    2017-01-01

    Background and Purpose Five single-nucleotide polymorphisms (SNPs) (rs4379368, rs10504861, rs10915437, rs12134493 and rs13208321) were recently identified in a Western population with migraine. These migraine-associated SNPs have not been evaluated in a Han Chinese population. This study investigated the associations of specific SNPs with migraine in a Han population. Methods This was a case-control study of Han Chinese residing in Fujian Province. Polymerase chain reaction—restriction-fragment-length polymorphism analysis and direct sequencing were used to characterize the relationships of SNPs in a control group of 200 subjects and in a migraine group of 201 patients. Results The frequencies of the five SNPs did not differ between patients with migraine and healthy non migraine controls. However, subgroup analysis indicated certain SNPs were more strongly associated with migraine with aura or migraine without aura than with controls. The CT genotype of rs4379368 was more common in migraine patients with aura (75%) than in migraine patients without aura (47.9%) and controls (48.5%) (p<0.05), and the TT genotype of rs10504861 was more common in migraine patients with aura than in controls (8.3% vs. 0.5%) (p<0.05). Meanwhile, the CC genotype of rs12134493 was less common in migraine patients without aura than in controls (80.6% vs. 88%) (p<0.05). Conclusions Our findings suggest that the rs4379368 and rs10504861 SNPs are markers for susceptibility to migraine with aura and that rs12134493 is a marker for the risk of migraine without aura in this Han population. Future studies should further explore if these associations vary by ethnicity. PMID:28079315

  18. Relationship between primary restless legs syndrome and migraine with aura.

    PubMed

    Acar, Bilgehan Atılgan; Acar, Türkan; Alagöz, Aybala Neslihan; Karacan, Alper; Varım, Ceyhun; Uyanık, Mehmet Şevki; Kaya, Tezcan; Akdemir, Ramazan

    2016-08-01

    In this study, the prevalence and characteristics of definite migraine in primary restless legs syndrome (pRLS) patients and matched control patients (CPs) were investigated. We evaluated 63 consecutive adult pRLS patients and 141 age- and sex-matched controls in this case-control study. The diagnosis of migraine and its subtypes were defined based on The International Classification of Headache Disorders-II. Only those with "definite" migraine were included in the study. The mean age of 63 adult pRLS patients (15 men and 48 women) who participated in the study was 49.4 years. A total of 27 patients (42.9%) had definite migraine. Of these migraineurs, seven (11.1%) were without aura and 20 (31.8%) were with aura. The mean age of the 141 matched CPs was 48.7 years. A total of 32 CPs (22.7%) experienced migraine. Among these 32 migraineurs, 28 (19.9%) were without aura and four (2.8%) were with aura. Migraine and migraine with aura were significantly more common in pRLS patients than in CPs. pRLS patients with migraine were more anxious and experienced a shorter duration of RLS symptoms than pRLS patients without migraine. Migraineurs in the pRLS group tended to have high scores for severity of migraine headache by Visual Analog Scale score and high levels of disability by Migraine Disability Assessment grading than those in the control group. pRLS patients showed a positive association with definite migraine headaches. In contrast to results highlighted in recent studies, we found a strong link between migraine with aura and pRLS.

  19. A 14-month study of change in disability and mood state in patients with chronic migraine associated to medication overuse.

    PubMed

    Raggi, A; Leonardi, M; Giovannetti, A M; Schiavolin, S; Bussone, G; Grazzi, L; Usai, S; Curone, M; Di Fiore, P; D'Amico, D

    2013-05-01

    This paper aims to evaluate changes in disease severity, disability and mood state in patients with chronic migraine associated to medication overuse (CM-MO). MIDAS was used for assessing disease activity, WHO-DAS-2 for disability, DBI-2 for mood state. ANOVA was used to test change over time; t-test to assess follow-up differences in WHO-DAS-2 and BDI-2 between patients with MIDAS ≤20 and ≥21. Change in MIDAS, WHO-DAS-2 and BDI-2 scores were computed: Pearson's index was used to assess correlation between them; linear regression to assess change in WHO-DAS-2, using MIDAS and BDI-2 change as predictors. Mean MIDAS decreased significantly (from 101.9 to 52.0). In 26.1 % of the sample, MIDAS fell below 21 at follow-up: these patients had lower WHO-DAS-2 score. WHO-DAS-2 change was little correlated to MIDAS change and strongly correlated to changes in BDI-2 scores. 57.1 % of WHO-DAS-2 change variance is explained by change in BDI-2 and MIDAS scores. There was a clear clinical improvement 14 months after detoxification, and a modest reduction in disability which is explained by reduced disease activity and improved mood state. An appropriate treatment of CM-MO, based on detoxification and prophylaxis, is likely to reduce disease burden: recognition and treatment of mood problems may be a key factor to reduce disability.

  20. Asynchronicity of facial blood perfusion in migraine.

    PubMed

    Zaproudina, Nina; Teplov, Victor; Nippolainen, Ervin; Lipponen, Jukka A; Kamshilin, Alexei A; Närhi, Matti; Karjalainen, Pasi A; Giniatullin, Rashid

    2013-01-01

    Asymmetrical changes in blood perfusion and asynchronous blood supply to head tissues likely contribute to migraine pathophysiology. Imaging was widely used in order to understand hemodynamic variations in migraine. However, mapping of blood pulsations in the face of migraineurs has not been performed so far. We used the Blood Pulsation Imaging (BPI) technique, which was recently developed in our group, to establish whether 2D-imaging of blood pulsations parameters can reveal new biomarkers of migraine. BPI characteristics were measured in migraineurs during the attack-free interval and compared to healthy subjects with and without a family history of migraine. We found a novel phenomenon of transverse waves of facial blood perfusion in migraineurs in contrast to healthy subjects who showed synchronous blood delivery to both sides of the face. Moreover, the amplitude of blood pulsations was symmetrically distributed over the face of healthy subjects, but asymmetrically in migraineurs and subjects with a family history of migraine. In the migraine patients we found a remarkable correlation between the side of unilateral headache and the direction of the blood perfusion wave. Our data suggest that migraine is associated with lateralization of blood perfusion and asynchronous blood pulsations in the facial area, which could be due to essential dysfunction of the autonomic vascular control in the face. These findings may further enhance our understanding of migraine pathophysiology and suggest new easily available biomarkers of this pathology.

  1. Asynchronicity of Facial Blood Perfusion in Migraine

    PubMed Central

    Zaproudina, Nina; Teplov, Victor; Nippolainen, Ervin; Lipponen, Jukka A.; Kamshilin, Alexei A.; Närhi, Matti; Karjalainen, Pasi A.; Giniatullin, Rashid

    2013-01-01

    Asymmetrical changes in blood perfusion and asynchronous blood supply to head tissues likely contribute to migraine pathophysiology. Imaging was widely used in order to understand hemodynamic variations in migraine. However, mapping of blood pulsations in the face of migraineurs has not been performed so far. We used the Blood Pulsation Imaging (BPI) technique, which was recently developed in our group, to establish whether 2D-imaging of blood pulsations parameters can reveal new biomarkers of migraine. BPI characteristics were measured in migraineurs during the attack-free interval and compared to healthy subjects with and without a family history of migraine. We found a novel phenomenon of transverse waves of facial blood perfusion in migraineurs in contrast to healthy subjects who showed synchronous blood delivery to both sides of the face. Moreover, the amplitude of blood pulsations was symmetrically distributed over the face of healthy subjects, but asymmetrically in migraineurs and subjects with a family history of migraine. In the migraine patients we found a remarkable correlation between the side of unilateral headache and the direction of the blood perfusion wave. Our data suggest that migraine is associated with lateralization of blood perfusion and asynchronous blood pulsations in the facial area, which could be due to essential dysfunction of the autonomic vascular control in the face. These findings may further enhance our understanding of migraine pathophysiology and suggest new easily available biomarkers of this pathology. PMID:24324592

  2. Real-Time Sharing and Expression of Migraine Headache Suffering on Twitter: A Cross-Sectional Infodemiology Study

    PubMed Central

    Nascimento, Thiago D; DosSantos, Marcos F; Danciu, Theodora; DeBoer, Misty; van Holsbeeck, Hendrik; Lucas, Sarah R; Aiello, Christine; Khatib, Leen; Bender, MaryCatherine A; Zubieta, Jon-Kar

    2014-01-01

    Background Although population studies have greatly improved our understanding of migraine, they have relied on retrospective self-reports that are subject to memory error and experimenter-induced bias. Furthermore, these studies also lack specifics from the actual time that attacks were occurring, and how patients express and share their ongoing suffering. Objective As technology and language constantly evolve, so does the way we share our suffering. We sought to evaluate the infodemiology of self-reported migraine headache suffering on Twitter. Methods Trained observers in an academic setting categorized the meaning of every single “migraine” tweet posted during seven consecutive days. The main outcome measures were prevalence, life-style impact, linguistic, and timeline of actual self-reported migraine headache suffering on Twitter. Results From a total of 21,741 migraine tweets collected, only 64.52% (14,028/21,741 collected tweets) were from users reporting their migraine headache attacks in real-time. The remainder of the posts were commercial, re-tweets, general discussion or third person’s migraine, and metaphor. The gender distribution available for the actual migraine posts was 73.47% female (10,306/14,028), 17.40% males (2441/14,028), and 0.01% transgendered (2/14,028). The personal impact of migraine headache was immediate on mood (43.91%, 6159/14,028), productivity at work (3.46%, 486/14,028), social life (3.45%, 484/14,028), and school (2.78%, 390/14,028). The most common migraine descriptor was “Worst” (14.59%, 201/1378) and profanity, the “F-word” (5.3%, 73/1378). The majority of postings occurred in the United States (58.28%, 3413/5856), peaking on weekdays at 10:00h and then gradually again at 22:00h; the weekend had a later morning peak. Conclusions Twitter proved to be a powerful source of knowledge for migraine research. The data in this study overlap large-scale epidemiological studies, avoiding memory bias and experimenter

  3. Managing the female patient with hereditary angioedema.

    PubMed

    Banerji, Aleena; Riedl, Marc

    2016-06-01

    Hereditary angioedema (HAE) is a rare disorder resulting from decreased functional levels of C1-inhibitor (C1-INH), which manifests as periodic episodes of localized edema which can be extremely painful, debilitating and even fatal if the swelling affects the larynx. HAE can complicate many aspects of obstetric/gynecologic care, and an awareness of the disease is critical for clinicians involved in the care of women because of potential HAE-related complications pertaining to pregnancy, labor and delivery, and other women's health issues. This article provides a review of published literature specific to HAE and its management in female patients, including important concerns regarding obstetric/gynecologic care. A growing body of relevant experience is presented to help guide the care of women with HAE.

  4. Fertility preservation in female classic galactosemia patients.

    PubMed

    van Erven, Britt; Gubbels, Cynthia S; van Golde, Ron J; Dunselman, Gerard A; Derhaag, Josien G; de Wert, Guido; Geraedts, Joep P; Bosch, Annet M; Treacy, Eileen P; Welt, Corrine K; Berry, Gerard T; Rubio-Gozalbo, M Estela

    2013-07-16

    Almost every female classic galactosemia patient develops primary ovarian insufficiency (POI) as a diet-independent complication of the disease. This is a major concern for patients and their parents, and physicians are often asked about possible options to preserve fertility. Unfortunately, there are no recommendations on fertility preservation in this group. The unique pathophysiology of classic galactosemia with a severely reduced follicle pool at an early age requires an adjusted approach. In this article recommendations for physicians based on current knowledge concerning galactosemia and fertility preservation are made. Fertility preservation is only likely to be successful in very young prepubertal patients. In this group, cryopreservation of ovarian tissue is currently the only available technique. However, this technique is not ready for clinical application, it is considered experimental and reduces the ovarian reserve. Fertility preservation at an early age also raises ethical questions that should be taken into account. In addition, spontaneous conception despite POI is well described in classic galactosemia. The uncertainty surrounding fertility preservation and the significant chance of spontaneous pregnancy warrant counseling towards conservative application of these techniques. We propose that fertility preservation should only be offered with appropriate institutional research ethics approval to classic galactosemia girls at a young prepubertal age.

  5. Associations Between Sleep Quality and Migraine Frequency

    PubMed Central

    Lin, Yu-Kai; Lin, Guan-Yu; Lee, Jiunn-Tay; Lee, Meei-Shyuan; Tsai, Chia-Kuang; Hsu, Yu-Wei; Lin, Yu-Zhen; Tsai, Yi-Chien; Yang, Fu-Chi

    2016-01-01

    Abstract Migraine has been associated with sleep disturbances. Relationship between sleep quality and migraine frequency is yet to be determined. The present study aimed to investigate sleep disturbances among low-frequency, moderate-frequency, high-frequency, and chronic migraineurs, with and without auras, with well-controlled confounding variables. This cross-sectional controlled study included 357 subjects from an outpatient headache clinic in Taiwan. Standardized questionnaires were utilized to collect demographic, migraine, sleep, depression, anxiety, and restless leg syndrome characteristics in all participants. According to frequency of migraine attacks, patients were divided into 4 groups: with 1 to 4 migraine days per month, 5 to 8 migraine days in a month, 9 to 14 migraine days in a month, and >14 migraine days per month. The Pittsburgh Sleep Quality Index (PSQI) and subgroup items were used to evaluate sleep quality. The association between migraine frequency and sleep quality was investigated using multivariable linear regression and logistic regression. The PSQI total score was highest in patients with high frequent migraine (10.0 ± 3.4) and lowest in controls (7.0 ± 3.4) with a significant trend analysis (P for trend = 0.006). Migraine frequency had an independent effect on the items “Cannot get to sleep within 30 minutes” (P < 0.001), “Wake up in the middle of the night or early morning” (P < 0.001), “Bad dreams” (P = 0.001), “Pain” (P = 0.004), and “Quality of sleep” (P < 0.001). The result showed the effect of migraine frequency in both the aura-present (P for trend = 0.008) and the aura-absent subgroups (P for trend = 0.011). High migraine frequency correlates with poor sleep quality and a higher prevalence of poor sleepers. These associations occur in migraine with aura and without aura. PMID:27124064

  6. A treatment for the acute migraine attack.

    PubMed

    Adam, E I

    1987-01-01

    A compound analgesic/anti-emetic formulation was significantly effective in reducing the severity of acute attacks of migraine, in a double-blind, randomized, crossover trial of 34 patients referred to a migraine clinic. The preparation contained paracetamol (acetaminophen) 500 mg, codeine phosphate 8 mg, buclizine hydrochloride 6.25 mg and dioctyl sodium sulphosuccinate 10 mg. The dosage was two tablets taken as early as possible in the acute attack. No specific factors could be identified which influenced response to treatment. Patients with a long history of migraine (more than 10 years) responded as well as those with a recent onset of the condition.

  7. Migraines: What a Pain!

    MedlinePlus

    ... caffeine (like cola drinks) certain foods (cheese, pizza, chocolate, ice cream, fatty or fried food, lunch meats, ... from your migraine triggers. If certain foods like chocolate or cheese or caffeinated drinks trigger your migraines, ...

  8. Effectiveness and Safety of Transcatheter Patent Foramen Ovale Closure for Migraine (EASTFORM) Trial

    PubMed Central

    Xing, Ying-qi; Guo, Yu-Zhu; Gao, Yong-Sheng; Guo, Zhen-Ni; Niu, Peng-Peng; Yang, Yi

    2016-01-01

    We evaluated the safety and effectiveness of transcatheter patent foramen ovale (PFO) closure for the treatment of migraine in a Chinese population. This non-randomized clinical trial enrolled 258 consecutive substantial or severe migraineurs with a right-to-left shunt (RLS) (grade II–IV) and grouped subjects according to their election or refusal of PFO closure. Migraine was diagnosed according to the International Classification of Headache Disorders III-beta and evaluated using the Headache Impact Test-6 (HIT-6). In total, 241 participants (125 in the transcatheter closure group and 116 in the control group) were included in the study. In general, the PFO closure procedure was found to be safe. At 1 month after closure, 76.1% of patients returned for c-TCD evaluation; of these, 85.7% were downgraded to negative status or a grade-I shunt. Residual shunts and placebo effects were thought to resolve by 12 months post-procedure, when migraine impact was reported to decrease by 73.6%. Transcatheter PFO closure was demonstrated to be effective for the treatment of migraine by comparing HIT-6 scores between the transcatheter closure and control groups (p < 0.001). Our results suggest that transcatheter PFO closure is a safe and effective approach for the treatment of migraine in the Chinese population, especially in females with constant RLS. Clinical trial no. NCT02127294 (registered on April 29, 2014). PMID:27966652

  9. Comorbidity of Migraine

    PubMed Central

    BIÇAKCI, Şebnem

    2013-01-01

    Migraine is a common neurological disorder and can be severely disabling during attacks. The highest prevalence occurs between the ages of 25 and 55 years. Prior studies have found that migraine occurs together with other illnesses at a greater coincidental rate than is seen in the general population. These occurrences are called “comorbidities”. To delineate the comorbidities of migraine is important, because it can help improve treatment strategies and the understanding of the possible pathophysiology of migraine.

  10. Comorbidity of Migraine with ADHD

    ERIC Educational Resources Information Center

    Fasmer, Ole Bernt; Riise, Trond; Lund, Anders; Dilsaver, Steven C.; Hundal, Oivind; Oedegaard, Ketil J.

    2012-01-01

    Objective: The purpose of this study was to investigate how often drugs used to treat migraine and ADHD are prescribed to the same patients to assess, indirectly, the comorbidity of these disorders. Method: We used data from the Norwegian prescription database for 2006, including the total Norwegian population (N = 4,640,219). Results:…

  11. Chronic migraine in women.

    PubMed

    Cady, Roger K

    2014-02-01

    Chronic migraine is a frequent, severely disabling headache that often evolves from EM. Treatment should be individualized with consideration of the patient as a whole person rather than just the headaches. Many options have been used for acute and preventive pharmacologic management, although good scientific and clinical evidence is limited to a few options. Evidence supports the efficacy and tolerability of both topiramate and onabotulinumtoxinA for prevention of CM headaches. However, only onabotulinumtoxinA is approved by the FDA for preventive treatment of CM.

  12. Accompanying Symptoms Overlap during Attacks in Menière’s Disease and Vestibular Migraine

    PubMed Central

    Lopez-Escamez, Jose Antonio; Dlugaiczyk, Julia; Jacobs, Julien; Lempert, Thomas; Teggi, Roberto; von Brevern, Michael; Bisdorff, Alexandre

    2014-01-01

    Menière’s disease and vestibular migraine (VM) are the most common causes of spontaneous recurrent vertigo. The current diagnostic criteria for the two disorders are mainly based on patients’ symptoms, and no biological marker is available. When applying these criteria, an overlap of the two disorders is occasionally observed in clinical practice. Therefore, the present prospective multicenter study aimed to identify accompanying symptoms that may help to differentiate between MD, VM, and probable vestibular migraine (pVM). Two hundred and sixty-eight patients were included in the study (MD: n = 119, VM: n = 84, pVM: n = 65). Patients with MD suffered mainly from accompanying auditory symptoms (tinnitus, fullness of ear, and hearing loss), while accompanying migraine symptoms (migraine-type headache, photo-/phonophobia, visual aura), anxiety, and palpitations were more common during attacks of VM. However, it has to be noted that a subset of MD patients also experienced (migraine-type) headache during the attacks. On the other hand, some VM/pVM patients reported accompanying auditory symptoms. The female/male ratio was statistically higher in VM/pVM as compared to MD, while the age of onset was significantly lower in the former two. The frequency of migraine-type headache was significantly higher in VM as compared to both pVM and MD. Accompanying headache of any type was observed in declining order in VM, pVM, and MD. In conclusion, the present study confirms a considerable overlap of symptoms in MD, VM, and pVM. In particular, we could not identify any highly specific symptom for one of the three entities. It is rather the combination of symptoms that should guide diagnostic reasoning. The identification of common symptom patterns in VM and MD may help to refine future diagnostic criteria for the two disorders. PMID:25566172

  13. The Effects of Exposure to Low Frequency Electromagnetic Fields in the Treatment of Migraine Headache: A Cohort Study

    PubMed Central

    Mohammadianinejad, Seyed Ehsan; Babaei, Manuchehr; Nazari, Pedram

    2016-01-01

    Introduction Findings have indicated that increased usage of mobile phones may be concomitant with higher rate of headache attacks due to the low radiofrequency electromagnetic fields (RF-EMF). The aim of this study was to determine the effects of low RF-EMF on the treatment outcome in migraine patients. Methods This cohort study was performed on 114 migraine patients referred to the Neurology Clinic of Golestan Hospital in Ahvaz, Southwest Iran, from September 2014 to March 2015. Patients with migraine were interviewed using a standardized questionnaire exploring mobile phones, Wi-Fi devices and fixed-line telephone use as RF-EMF sources. After 3 months, we determined patients’ response to treatment. Generalized estimating equation (GEE) tests were carried out to analyze data, using SPSS version 17. Results Out of 114 individuals who participated, 82 (71.9%) were female and 32 (28.1%) cases were male. The number and severity of migraine headaches were correlated significantly with an increased use of mobile phones during day and Wi-Fi per week (p<0.05). The usage of fixed-line telephones had no significant relationship with the study variables (p>0.05). Conclusion It is recommended that the patients with migraine headache limit mobile phone use and instead, use the fixed-line telephone for their daily telecommunications. PMID:28163863

  14. The migraine generator revisited: continuous scanning of the migraine cycle over 30 days and three spontaneous attacks.

    PubMed

    Schulte, Laura H; May, Arne

    2016-07-01

    Functional imaging using positron emission tomography and later functional magnetic resonance imaging revealed a particular brainstem area that is believed to be specifically activated in migraine during, but not outside of the attack, and consequently has been coined the 'migraine generator'. However, the pathophysiological concept behind this term is not undisputed and typical migraine premonitory symptoms such as fatigue and yawning, but also a typical association of attacks to circadian and menstrual cycles, all make the hypothalamus a possible regulating region of migraine attacks. Neuroimaging studies investigating native human migraine attacks however are scarce and for methodological but also clinical reasons there are currently no studies investigating the last 24 h before headache onset. Here we report a migraine patient who had magnetic resonance imaging every day for 30 days, always in the morning, to cover, using functional imaging, a whole month and three complete, untreated migraine attacks. We found that hypothalamic activity as a response to trigeminal nociceptive stimulation is altered during the 24 h prior to pain onset, i.e. increases towards the next migraine attack. More importantly, the hypothalamus shows altered functional coupling with the spinal trigeminal nuclei and the region of the migraine generator, i.e. the dorsal rostral pons during the preictal day and the pain phase of native human migraine attacks. These data suggest that although the brainstem is highly linked to the migraine biology, the real driver of attacks might be the functional changes in hypothalamo-brainstem connectivity.

  15. Choroidoretinal granuloma in a young female patient.

    PubMed

    Massa, Horace F; Gatzioufas, Zisis; Mangioris, Georgios; Panos, Georgios D

    2014-04-17

    A 16-year-old Brazilian female patient presented with blurring of vision in the right eye. Corrected visual acuity was OD 2/20, OS 20/20. Afferent pupillary defect was absent and anterior segment examination revealed anterior uveitis. Fundus examination showed light vitritis and a raised grey-white granuloma located at posterior pole with focal serous retinal detachment on optical coherence. Indocyacnine green angiography disclosed a complete mask effect in granuloma's area. Differential diagnoses were infectious (bacterial, viral, fungal and parasites) diseases, systemic inflammatory diseases, tumours. Blood serologies (HIV, toxoplasma, Borrelia, cytomegalovirus (CMV), herpes simplex virus (HSV), varicella-zoster virus (VZV), rubeola) showed positive results for IgM and IgG for toxoplasma, and anterior chamber tap (PCR for toxoplasma, CMV, HSV, VZV) revealed toxoplasma DNA. Anti-toxoplasma therapy, pyrimethamine, sulfadiazine and calcium folinate, was administered immediately. On follow-up granuloma regression was observed, with complete visual restoration. This case demonstrates a clinically challenging posterior pole granuloma.

  16. How patient-centered do female physicians need to be? Analogue patients' satisfaction with male and female physicians' identical behaviors.

    PubMed

    Hall, Judith A; Roter, Debra L; Blanch-Hartigan, Danielle; Mast, Marianne Schmid; Pitegoff, Curtis A

    2015-01-01

    Previous research suggests that female physicians may not receive appropriate credit in patients' eyes for their patient-centered skills compared to their male counterparts. An experiment was conducted to determine whether a performance of higher (versus lower) verbal patient-centeredness would result in a greater difference in analogue patient satisfaction for male than female physicians. Two male and two female actors portrayed physicians speaking to a patient using high or low patient-centered scripts while not varying their nonverbal cues. One hundred ninety-two students served as analogue patients by assuming the patient role while watching one of the videos and rating their satisfaction and other evaluative responses to the physician. Greater verbal patient-centeredness had a stronger positive effect on satisfaction and evaluations for male than for female physicians. This pattern is consistent with the hypothesis that the different associations between patient-centeredness and patients' satisfaction for male versus female physicians occur because of the overlap between stereotypical female behavior and behaviors that comprise patient-centered medical care. If this is the case, high verbal patient-centered behavior by female physicians is not recognized as a marker of clinical competence, as it is for male physicians, but is rather seen as expected female behavior.

  17. Bowenwork for Migraine Relief: a Case Report

    PubMed Central

    Gustafson, Sandra L.

    2016-01-01

    Introduction Migraine is a complex neurological disorder characterized by episodic, neurogenic, cerebrovascular inflammation and hypersensitization of brain tissues and the central nervous system, causing severe pain and debility. Research literature points mostly to pharmaceutical prophylactic and symptomatic treatments, nonpharmaceutical, complementary and alternative medicine (CAM) approaches, acupuncture, massage and bodywork studies, and none has been published on Bowenwork for migraine intervention. This prospective case report describes one migraineur’s response to Bowenwork (a soft-tissue bodywork technique) with cessation of migraine, neck pain, and analgesic consumption, and improved well-being and activity function. Methods The client received 14 Bowenwork sessions over a four-month period using the self-reporting Measure Yourself Medical Outcome Profile version 2 (MYMOP2) to evaluate clinically meaningful changes. Baseline MYMOP2 data were recorded prior to the first and subsequent Bowenwork sessions to track changes in migraine and neck pain occurrences, other symptoms, medication use, functional ability and sense of well-being. Specific Bowenwork procedures were applied in each session to address various symptoms. The client did not receive other migraine treatment during this study. Participant A 66-year-old Caucasian female with a history of debilitating migraine since childhood, and severe neck pain and jaw injuries resulting from two motor vehicle accidents (MVAs) sustained as an adult. She had previously sought medical, pharmaceutical and CAM treatments for migraine, neck pain, and right-sided thoracic outlet syndrome (TOS) symptoms, with no satisfactory relief. Results The client progressively reported decreased migraine and neck pain until acquiring a respiratory infection with prolonged coughing spells causing symptoms to recur (session 11). Prior to session 12, she experienced an allergic reaction to ingesting an unknown food allergen

  18. Molecular factors in migraine

    PubMed Central

    Kowalska, Marta; Prendecki, Michał; Kozubski, Wojciech; Lianeri, Margarita; Dorszewska, Jolanta

    2016-01-01

    Migraine is a common neurological disorder that affects 11% of adults worldwide. This disease most likely has a neurovascular origin. Migraine with aura (MA) and more common form - migraine without aura (MO) – are the two main clinical subtypes of disease. The exact pathomechanism of migraine is still unknown, but it is thought that both genetic and environmental factors are involved in this pathological process. The first genetic studies of migraine were focused on the rare subtype of MA: familial hemiplegic migraine (FHM). The genes analysed in familial and sporadic migraine are: MTHFR, KCNK18, HCRTR1, SLC6A4, STX1A, GRIA1 and GRIA3. It is possible that migraine is a multifactorial disease with polygenic influence. Recent studies have shown that the pathomechanisms of migraine involves both factors responsible for immune response and oxidative stress such as: cytokines, tyrosine metabolism, homocysteine; and factors associated with pain transmission and emotions e.g.: serotonin, hypocretin-1, calcitonin gene-related peptide, glutamate. The correlations between genetic variants of the HCRTR1 gene, the polymorphism 5-HTTLPR and hypocretin-1, and serotonin were observed. It is known that serotonin inhibits the activity of hypocretin neurons and may affect the appearance of the aura during migraine attack. The understanding of the molecular mechanisms of migraine, including genotype-phenotype correlations, may contribute to finding markers important for the diagnosis and treatment of this disease. PMID:27191890

  19. Migraine with aura and patent foramen ovale: myth or reality?

    PubMed

    Finocchi, C; Del Sette, M

    2015-05-01

    Several observational studies report that subjects with migraine with aura have a higher prevalence of right-to left shunt, commonly due to patent foramen ovale, and that patent foramen ovale is more prevalent in subjects with migraine with aura. Although migraine without aura has been less extensively studied, it does not seem to be associated with an increased prevalence of right-to left shunt. The mechanism that underlies the possible relationship between patent foramen ovale and migraine with aura remains speculative. The proposed mechanisms are migraine-triggering vasoactive chemicals bypassing the pulmonary filter and reaching the cerebral circulation and paradoxical microembolization. However, it is unclear, at this time, if there is a causal or comorbid association between the two conditions. In some families atrial shunts show a dominant inheritance that seems to be linked to inheritance of migraine with aura. Migraine with aura is an independent risk factor for ischemic stroke, and patent foramen ovale is present more frequently in patients with cryptogenic stroke than in controls. At this moment, there is no convincing evidence that excess stroke risk of migraine is simply mediated by patent foramen ovale through paradoxical embolism. Several non-controlled studies suggest that closure of the foramen ovale significantly reduces attack frequency in migraine patient, but the only prospective placebo-controlled trial does not support these results. Patent foramen ovale closure, at present, is not indicated as a treatment for migraine in clinical practice.

  20. The debate on the link between subclinical hypothyroidism and childhood migraine: is initial endocrinological evaluation necessary for children with migraine?

    PubMed

    Ekici, Bariş; Cebeci, Ayşe Nurcan

    2015-06-01

    Subclinical hypothyroidism (SH) is characterized by mildly elevated thyroid stimulating hormone (TSH) levels with normal serum-free thyroxine (fT4). While the prevalence of SH is 2 % in pediatric population, it has been reported much higher in children with migraine headache. In this study, the presence of subclinical hypothyroidism and associated endocrinological abnormalities in children with migraine naïve to treatment was investigated. Children with migraine who were diagnosed in Pediatric Neurology Clinic based on the second edition of the International Classification of Headache Disorders and who did not receive any medication were recruited in this cross-sectional study. All patients were examined by the same pediatric endocrinologist and anthropometric measurements, systemic blood pressure, pubertal stages were recorded. Fasting serum levels of thyroid function tests, lipids, glucose and insulin were obtained. Ninety-eight children (55 female) with a mean age of 11.45 ± 3.1 years were evaluated. Of those, 39 were prepubertal and 59 were pubertal. Subclinical hypothyroidism (TSH ≥ 5.0 mIU/L with normal fT4) was detected in five patients (5.1 %); none had positive thyroid antibodies. Other conditions were obesity (n = 6), hirsutism (n = 4), short stature (n = 3), polycystic ovaries (PCO, n = 3), precocious puberty (n = 2) and gynecomastia (n = 1). Of five patients with SH, only one had obesity. Our results revealed that the prevalence of SH in children with migraine is not as high as previously reported. Since no significant endocrinologic disturbance was found in those children, we suggest that the initial endocrinological evaluation or screening for SH is unnecessary.

  1. fNIRS measurements in migraine

    NASA Astrophysics Data System (ADS)

    Akin, Ata; Emir, Uzay E.; Bilensoy, Didem; Erdogan, Gulin; Candansyar, Selcuk; Bolay, Hayrunnisa

    2005-04-01

    Migraine is a complex chronic neurovascular disorder in which the interictal changes in neuronal excitability and vascular reactivity in the cerebral cortex were detected. The extent and direction of the changes in cerebral blood flow that affect cerebral hemodynamics during attacks, however, are still a matter of debate. This may have been due to the logistic and technical problems posed by the different techniques to determine cerebral blood flow during migraine attacks and the different definitions of patient populations. In this study, we have investigated hypercapnia challenges by breath holding task on subjects with and without migraine by using functional near infrared spectroscopy (fNIRS). Measurements of the relative changes in concentration of deoxy-hemoglobin [Hb] and oxy-hemoglobin [HbO2] are performed on four healthy subjects during three breath holdings of 30 seconds (s.) interleaved with 90 s. of normal breathing. We have observed [Hb]increase during breath holding interval in subject without migraine whereas in subject with migraine [Hb] decreases during breath holding interval. The result of our study suggest that hypercapnia effect on cerebral hemodynamic of subject with migraine and without migraine could be due to different vascular reactivity to PCO2 (carbon dioxide partial pressure) in arteries.

  2. Prophylactic onabotulinumtoxinA in patients with chronic migraine and comorbid depression: An open-label, multicenter, pilot study of efficacy, safety and effect on headache-related disability, depression, and anxiety

    PubMed Central

    Boudreau, Guy P; Grosberg, Brian M; McAllister, Peter J; Lipton, Richard B; Buse, Dawn C

    2015-01-01

    Background Chronic migraine is associated with significant headache-related disability and psychiatric comorbidity. OnabotulinumtoxinA (BOTOX®) is effective and well tolerated in the prophylactic treatment of chronic migraine. This study aimed to provide preliminary data on the efficacy and safety of prophylactic onabotulinumtoxinA in patients with chronic migraine and comorbid depressive symptoms. Methods This was a prospective, open-label, multicenter pilot study. Eligible patients met International Classification of Headache Disorders 2nd edition Revision criteria for chronic migraine and had associated depressive symptoms, including Patient Health Questionnaire depression module scores of 5–19. Eligible participants received 155 units of onabotulinumtoxinA, according to the PREEMPT protocol, at baseline and week 12. Assessments included headache frequency, the Headache Impact Test™, the Migraine Disability Assessment, the Beck Depression Inventory®-II, the nine-item Patient Health Questionnaire depression module, and the seven-item Generalized Anxiety Disorder questionnaire. Adverse events were also monitored. Results Overall, 32 participants received treatment. At week 24, there were statistically significant mean (standard deviation [SD]) improvements relative to baseline in the number of headache/migraine-free days (+8.2 [5.8]) (P<0.0001) and in the number of headache/migraine days (−8.2 [5.8]) (P<0.0001) per 30-day period. In addition, there were significant improvements in Headache Impact Test scores (−6.3 [6.9]) (P=0.0001) and Migraine Disability Assessment scores (−44.2 [67.5]) (P=0.0058). From baseline to week 24, statistically significant improvements were also seen in Beck Depression Inventory-II (−7.9 [6.0]) (P<0.0001), Patient Health Questionnaire depression module (−4.3 [4.7]) (P<0.0001), and Generalized Anxiety Disorder questionnaire (−3.5 [5.0]) (P=0.0002) scores. No serious adverse events were reported. Adverse events

  3. Genetics Home Reference: sporadic hemiplegic migraine

    MedlinePlus

    ... Home Health Conditions sporadic hemiplegic migraine sporadic hemiplegic migraine Enable Javascript to view the expand/collapse boxes. ... PDF Open All Close All Description Sporadic hemiplegic migraine is a rare form of migraine headache. Migraines ...

  4. The Face of Chronic Migraine Which Has Started to be Clarified

    PubMed Central

    AYDIN ÖZEMİR, Zeynep; BAYKAN, Betül

    2013-01-01

    Recently, information about migraine which is generally characterized with attacks has gradually increased. In some patients with migraine, progression may be observed such that the frequency and time of the attacks are increased and an attack lasts for days. This condition is called chronic migraine (CM). According to the last classification, chronic migraine is defined as headache which occurs 15 days a month or more frequently at least 8 of which show the characteristic properties of migraine or response to migraine-specific treatment. The diagnostic cirteria of chronic migraine, its differences from other chronic daily headaches and the question if it is a migraine form with a high frequency which transforms from episodic migraine or a completely different pathophysiological picture are still contradictory. Clarifying these issues is possible with clinical studies as well as increasing the studies directed to investigate the pathophysiological mechanisms.

  5. Oral contraceptives in women with migraine: balancing risks and benefits.

    PubMed

    Allais, G; De Lorenzo, C; Mana, O; Benedetto, C

    2004-10-01

    Oral contraceptives (OCs) are a safe and highly effective method of birth control, but can also be associated with some risks, mainly a potential thrombotic risk. OCs may condition the course of headache and sometimes start it, but their influence on the clinical evolution of migraine is not easily assessable. The last Classification of Headache Disorders of the International Headache Society clearly identifies an "exogenous hormone-induced headache" that could be triggered by intake of OCs. Old high-dose OCs could effectively worsen headache in a significant proportion of patients, but the newest formulations influence headache course to a lesser extent. In any case, while an increase in migraine frequency or intensity do not oblige the cessation of OCs, experiencing a migraine aura for the first time, or even a clear worsening of a preexistent aura suggest discontinuation of OCs. Even if both migraine and OCs intake are associated with an increased risk of ischaemic stroke, migraine per se is not a contraindication for OCs use; however, patients suffering from migraine with aura generally show a greater thrombotic risk than women with migraine without aura. Other risk factors (patient's age, tobacco use, hypertension, hyperlipidaemia, obesity and diabetes) must be carefully considered when prescribing OCs in migraine patients. Furthermore, all OCs, even those with low oestrogen content, are a major risk for venous thrombosis, particularly in women with hereditary thrombophilia. A thorough laboratory control of the genetics of prothrombotic factors and coagulative parameters should precede any decision of OCs prescription in migraine patients.

  6. Symptomatic or prophylactic treatment of weekend migraine: an open-label, nonrandomized, comparison study of frovatriptan versus naproxen sodium versus no therapy

    PubMed Central

    Guidotti, Mario; Barrilà, Caterina; Leva, Serena; De Piazza, Claudio; Omboni, Stefano

    2013-01-01

    Background Migraine often occurs during weekends. The efficacy of frovatriptan, naproxen sodium, or no therapy for the acute or prophylactic treatment of weekend migraineurs was tested in an open-label, nonrandomized pilot study. Methods Twenty-eight subjects (mean age 36 ± 12 years, including 18 females) suffering from migraine without aura were followed up for six consecutive weekends. No treatment was administered during the first two weekends. On the third and fourth weekends, patients were given frovatriptan 2.5 mg and on the fifth and sixth weekends naproxen sodium 500 mg. Treatment was taken on Saturday and Sunday morning, regardless of the occurrence of migraine. Efficacy was evaluated through a diary, where patients reported the severity of migraine on a scale from 0 (no migraine) to 10 (severe migraine) and use of rescue medication. Results The migraine severity score was significantly lower with frovatriptan (4.8 [95% confidence interval (CI) 3.8–5.9]) than with naproxen sodium (5.7 [CI 5.1–6.4], P< 0.05 versus frovatriptan) or no therapy (6.6 [6.2–7.0], P< 0.01 versus frovatriptan). The difference in favor of frovatriptan was more striking in patients not taking rescue medication (frovatriptan, 1.9 [1.5–2.3]) versus naproxen sodium 3.6 [3.0–4.2], P< 0.001) and versus no therapy (5.1 [4.4–5.8], P< 0.001) and on the second day of treatment. The rate of use of rescue medication was significantly (P< 0.05) lower on frovatriptan (12.5%) than on naproxen sodium (31.3%) or no therapy (56.3%). Conclusion This pilot study provides the first evidence of the efficacy of a second-generation triptan as symptomatic or prophylactic treatment for weekend migraine. PMID:23355779

  7. Episodic and chronic migraine headache: breaking down barriers to optimal treatment and prevention.

    PubMed

    Lipton, Richard B; Silberstein, Stephen D

    2015-03-01

    Migraine is a common disabling primary headache disorder that affects an estimated 36 million Americans. Migraine headaches often occur over many years or over an individual's lifetime. By definition, episodic migraine is characterized by headaches that occur on fewer than 15 days per month. According to the recent International Classification of Headache Disorders (third revision) beta diagnostic criteria, chronic migraine is defined as "headaches on at least 15 days per month for at least 3 months, with the features of migraine on at least 8 days per month." However, diagnostic criteria distinguishing episodic from chronic migraine continue to evolve. Persons with episodic migraine can remit, not change, or progress to high-frequency episodic or chronic migraine over time. Chronic migraine is associated with a substantially greater personal and societal burden, more frequent comorbidities, and possibly with persistent and progressive brain abnormalities. Many patients are poorly responsive to, or noncompliant with, conventional preventive therapies. The primary goals of migraine treatment include relieving pain, restoring function, and reducing headache frequency; an additional goal may be preventing progression to chronic migraine. Although all migraineurs require abortive treatment, and all patients with chronic migraine require preventive treatment, there are no definitive guidelines delineating which persons with episodic migraine would benefit from preventive therapy. Five US Food and Drug Association strategies are approved for preventing episodic migraine, but only injections with onabotulinumtoxinA are approved for preventing chronic migraine. Identifying persons who require migraine prophylaxis and selecting and initiating the most appropriate treatment strategy may prevent progression from episodic to chronic migraine and alleviate the pain and suffering associated with frequent migraine.

  8. The Cerebellum and Migraine

    PubMed Central

    Vincent, Maurice; Hadjikhani, Nouchine

    2013-01-01

    Clinical and pathophysiological evidences connect migraine and the cerebellum. Literature on documented cerebellar abnormalities in migraine, however, is relatively sparse. Cerebellar involvement may be observed in 4 types of migraines: in the widespread migraine with aura (MWA) and migraine without aura (MWoA) forms; in particular subtypes of migraine such as basilar-type migraine (BTM); and in the genetically driven autosomal dominant familial hemiplegic migraine (FHM) forms. Cerebellar dysfunction in migraineurs varies largely in severity, and may be subclinical. Purkinje cells express calcium channels that are related to the pathophysiology of both inherited forms of migraine and primary ataxias, mostly spinal cerebellar ataxia type 6 (SCA-6) and episodic ataxia type 2 (EA-2). Genetically driven ion channels dysfunction leads to hyperexcitability in the brain and cerebellum, possibly facilitating spreading depression waves in both locations. This review focuses on the cerebellar involvement in migraine, the relevant ataxias and their association with this primary headache, and discusses some of the pathophysiological processes putatively underlying these diseases. PMID:17578530

  9. Reversible hypohidrosis with topiramate therapy for chronic migraine.

    PubMed

    Markowitz, Shira Y; Robbins, Matthew S; Cascella, Clair; Sheikh, Huma U; Grosberg, Brian M

    2010-04-01

    Topiramate is an anticonvulsant medication that is widely used for migraine prophylaxis. Hypohidrosis and hyperthermia are 2 rare adverse effects of topiramate treatment, which have mainly occurred in pediatric epilepsy patients. Herein, we describe the first case of reversible hypohidrosis in an adult patient treated with topiramate for chronic migraine.

  10. Limb pain in migraine and cluster headache.

    PubMed Central

    Guiloff, R J; Fruns, M

    1988-01-01

    Upper limb pain occurred in close temporal association with attacks of migraine, cluster headache and cluster-migraine in 22 cases. Seven had also lower limb pain. Limb pain was usually ipsilateral to the headache but could alternate sides and behaved like other accepted migraine accompaniments. It was always ipsilateral to the associated paraesthesiae/numbness (9 cases) and weakness (6 cases). The distribution and restricted localisations of limb pain were similar to those of the sensory symptoms and could not be accounted for by primary dysfunction of the peripheral or autonomic nervous systems. A central origin for limb pain is postulated. A temporary dysfunction in the somatosensory cortex, and/or its thalamic connections, during migraine or cluster headache attacks, might mediate such pain in a number of patients. PMID:3216204

  11. Migraine madness: recurrent psychosis after migraine.

    PubMed Central

    Fuller, G N; Marshall, A; Flint, J; Lewis, S; Wise, R J

    1993-01-01

    A 69 year old man with longstanding migraine with aura had four episodes of psychosis lasting 7-28 days during a 17 year period. During attacks he had formed visual hallucination and delusions, including reduplicative paramnesia. His mother was similarly affected. His EEG showed symmetrical frontal delta waves. The time course and EEG changes are similar to acute confusional migraine. The reduplicative paramnesia suggests a focal non-dominant hemisphere dysfunction. PMID:8482964

  12. Calcium channels and migraine.

    PubMed

    Pietrobon, Daniela

    2013-07-01

    Missense mutations in CACNA1A, the gene that encodes the pore-forming α1 subunit of human voltage-gated Ca(V)2.1 (P/Q-type) calcium channels, cause a rare form of migraine with aura (familial hemiplegic migraine type 1: FHM1). Migraine is a common disabling brain disorder whose key manifestations are recurrent attacks of unilateral headache that may be preceded by transient neurological aura symptoms. This review, first, briefly summarizes current understanding of the pathophysiological mechanisms that are believed to underlie migraine headache, migraine aura and the onset of a migraine attack, and briefly describes the localization and function of neuronal Ca(V)2.1 channels in the brain regions that have been implicated in migraine pathogenesis. Then, the review describes and discusses i) the functional consequences of FHM1 mutations on the biophysical properties of recombinant human Ca(V)2.1 channels and native Ca(V)2.1 channels in neurons of knockin mouse models carrying the mild R192Q or severe S218L mutations in the orthologous gene, and ii) the functional consequences of these mutations on neurophysiological processes in the cerebral cortex and trigeminovascular system thought to be involved in the pathophysiology of migraine, and the insights into migraine mechanisms obtained from the functional analysis of these processes in FHM1 knockin mice. This article is part of a Special Issue entitled: Calcium channels.

  13. [Antiepileptic drugs for the prevention of pediatric migraine].

    PubMed

    Cuvellier, J-C

    2009-12-01

    Migraine, according to the criteria of the International Headache Society, occurs in about 5 to 10% of children and adolescents. Pediatric migraine can cause a significant impact on quality of life. As stated by the American Academy of Neurology and Child Neurology Society's migraine guidelines, situations for prophylaxis consideration include recurring migraines that significantly interfere with daily activities, despite acute therapy; frequent headaches; contraindication, overuse, or failure of acute therapy; adverse reactions to acute therapy; cost of acute and preventive therapies; patient preferences; and presence of uncommon migraine conditions. Preventive therapy may be warranted in as many as 30% of young patients with migraine seen in tertiary headache centers. Headache related disability can be measured by scoring systems such as the Pediatric Migraine Disability Assessment Scale. Numerous medications have been studied to prevent migraines in children, including antihistamines, antidepressants, and antihypertensive agents. However, few high quality clinical trials actually demonstrate efficacy in this population. Recently, many studies dealt with the use of antiepileptic drugs in this indication but there is a paucity of placebo controlled studies. Both topiramate (TPM) and divalproex sodium have been studied in a randomized-controlled study. Only TPM showed efficacy, though, clearly, further controlled trials are needed to confirm these data. Besides unproven efficacy, adverse effects of valproic acid, such as weight gain, somnolence, and alopecia may limit its use. Additional studies are warranted before recommending levetiracetam (LVT), zonisamide (ZNS) and gabapentin (GBP) agents for migraine prophylaxis in children and adolescents.

  14. Migraine in pregnancy.

    PubMed

    Aubé, M

    1999-01-01

    Migraine does not increase the risk for complications of pregnancy for the mother or for the fetus: the incidences of toxemia, miscarriages, abnormal labour, congenital anomalies, and stillbirths are comparable to those of the general population. Several retrospective studies have shown a tendency for migraine to improve with pregnancy. Between 60 and 70% of women either go into remission or improve significantly, mainly during the second and third trimesters. Women with migraine onset at menarche and those with perimenstrual migraine are more likely to go into remission during pregnancy. The migraine type does not seem to be a significant prognostic factor for improvement. However, in the small number of women (4-8%) whose migraines worsen with pregnancy, migraine with aura appears to be overrepresented. In a small number of cases (1.3-16.5%), migraine appears to start with pregnancy, often in the first trimester; these headaches involve a higher proportion of migraine with aura. Management of migraine during pregnancy should first focus on avoiding potential triggers. Consideration should also be given to nonpharmacologic therapies. If pharmacologic treatment becomes necessary, acetaminophen and codeine can be used safely as abortive agents; ASA and NSAIDs (ibuprofen, naproxen) can be used as a second choice, but not for long periods of time, and they should be avoided during the last trimester. For treatment of severe attacks of migraine, chlorpromazine, dimenhydrinate, and diphenhydramine can be used; metoclopramide should be restricted to the third trimester. According to the United States FDA risk categories, meperidine and morphine show no evidence of risk in humans but should not be used at the end of the third trimester. In some refractory cases, dexamethasone or prednisone can be considered. Should prophylactic treatment become indicated, the beta-adrenergic receptor antagonists (e.g., propranolol) can be used.

  15. Acute migraine: Current treatment and emerging therapies

    PubMed Central

    Kalra, Arun A; Elliott, Debra

    2007-01-01

    Migraine is a common disabling primary headache disorder. Despite the need for a perfect treatment of this debilitating condition, the ideal “cure” eludes us. In 1992, the first triptan was released in the US for use in acute migraine. Triptans are more specific for the serotonin receptor 5-hydroxy triptamine (5-HT) 1 than previously prescribed drugs, such as ergotamines, with fewer side effects. This was an important first step in specific acute migraine therapy. Today however, triptans continue to be underutilized. There remains a concern, among practitioners and patients, about possible cardiovascular safety issues, despite the lack of strong evidence of serious adverse events. In fact, triptans now have a safe track record over more than a decade of use. Other perceived downfalls to use, include cost and variable efficacy. The more we learn about the clinical features and pathophysiology of migraine, the closer we are to finding a satisfactory monotherapy. Until then, recognizing that mixed mechanisms underlie migraine symptoms, rational polytherapy can be useful. Research on the roles of serotonin, calcitonin gene related peptide, glutamine and N-methyl-D-aspartate in the trigeminovascular system holds promise for those searching for the perfect migraine headache cure. PMID:18488069

  16. Can ID Migraine be used as a screening test for adolescent migraine?

    PubMed

    Zarifoğlu, M; Karli, N; Taşkapilioğlu, O

    2008-01-01

    Although the ID Migraine has been developed and used for adults, it can also be used in adolescents. We aimed to investigate the validity of the ID Migraine in the adolescent student population. The study was performed on 1064 adolescents aged 12-17 years. A face-to-face semistructured interview was conducted with students after they had answered a 17-item questionnaire on sociodemographics and headache. Students who had had two or more headache attacks during the last 3 months then answered the ID Migraine. The sensitivity and specificity of the ID Migraine were 62.1% and 71.1%, respectively. The sensitivity was higher for patients with migraine with aura (71.1%), for girls (71.3%) and for younger adolescents (69.1%). The specificity was higher for boys (77.9%) and for older adolescents (73.3%). The kappa value was 0.316 (P < 0.001). Although the kappa value of the ID Migraine is low, the test may be a useful tool in screening adolescent migraine after some changes are made.

  17. Gastrointestinal disorders associated with migraine: A comprehensive review

    PubMed Central

    Cámara-Lemarroy, Carlos R; Rodriguez-Gutierrez, Rene; Monreal-Robles, Roberto; Marfil-Rivera, Alejandro

    2016-01-01

    Migraine is a recurrent and commonly disabling primary headache disorder that affects over 17% of women and 5%-8% of men. Migraine susceptibility is multifactorial with genetic, hormonal and environmental factors all playing an important role. The physiopathology of migraine is complex and still not fully understood. Many different neuropeptides, neurotransmitters and brain pathways have been implicated. In connection with the myriad mechanisms and pathways implicated in migraine, a variety of multisystemic comorbidities (e.g., cardiovascular, psychiatric and other neurological conditions) have been found to be closely associated with migraine. Recent reports demonstrate an increased frequency of gastrointestinal (GI) disorders in patients with migraine compared with the general population. Helicobacter pylori infection, irritable bowel syndrome, gastroparesis, hepatobiliary disorders, celiac disease and alterations in the microbiota have been linked to the occurrence of migraine. Several mechanisms involving the gut-brain axis, such as a chronic inflammatory response with inflammatory and vasoactive mediators passing to the circulatory system, intestinal microbiota modulation of the enteric immunological milieu and dysfunction of the autonomic and enteric nervous system, have been postulated to explain these associations. However, the precise mechanisms and pathways related to the gut-brain axis in migraine need to be fully elucidated. In this review, we survey the available literature linking migraine with GI disorders. We discuss the possible physiopathological mechanisms, and clinical implications as well as several future areas of interest for research. PMID:27688656

  18. [Use of antiepileptic drugs for the preventive treatment of migraine].

    PubMed

    Hamada, Junichi

    2009-10-01

    Migraine and epilepsy share several common characteristic clinical features, and epilepsy is a comorbid disorder of migraine. Clinical studies have shown that some antiepileptic drugs are effective for the preventive treatment of migraine. The rationale for the use of these antiepileptic drugs in migraine prophylaxis is the hypothesis that migraine and epilepsy have several common pathophysiological mechanisms. It has been suggested that in these 2 pathological conditions, an imbalance exists between excitatory glutamate-mediated transmission and inhibitory GABA-mediated transmission in cerebral tissues, mainly in specific brain areas. Moreover, it has been postulated that abnormal activation of some kinds of voltage-gated ionic channels has been postulated to have a key role in both migraine and epilepsy, especially when caused by a genetic abnormality. It has been found that cortical spreading depression is involved in the pathophysiological mechanism of epilepsy, in addition to the generation of migraine aura. Preventive antiepileptic drugs can be chosen for treatment after considering clinical efficacy- scientific evidence, side effects, and patients' specific personal conditions. Recently, scientific evidence was found to demonstrate efficacy of valproic acid and topiramate in the preventive treatment of migraine. These drugs can reduce the incidence of migraine attacks in the large clinical studies. Other new antiepileptic drugs can be tried in future clinical study.

  19. Migraine and the presidency.

    PubMed

    Evans, Randolph W

    2011-10-01

    The disclosure that 2012 presidential candidate Michele Bachmann has migraines resulted in intense public and physician interest in the migraine of presidents, migraine and potential presidential disability, and the politics of migraine that are reviewed in this article. Jefferson had severe headaches that may have been a migraine variant. Lincoln, Grant, and Wilson were, John Adams and Eisenhower might have been, and Truman and Kennedy may have been migraineurs. First Ladies Abigail Adams, Lincoln, Eisenhower, and Kennedy all suffered from migraines. Although migraines can usually be effectively treated, disabling attacks could occur because of the accentuated triggers of office that could prevent a future president from being temporarily able to discharge the duties of office. The 25th amendment is available to voluntarily transfer powers of office to the vice president even for a short period of time. The current $13 million per year in research funding provided by the National Institutes of Health is clearly inadequate to the task of improving treatment for such a pervasive, disabling disease that so profoundly affects so many Americans including presidential candidates, presidents, and first ladies. A survey of the Southern Headache Society on migraine and presidential disability is also presented.

  20. [Migraine and epilepsy].

    PubMed

    Tsuji, Sadatoshi

    2014-01-01

    Migraine and epilepsy are both common episodic disorders that share many clinical features and underlying pathophysiological mechanisms. The comorbidity of these two conditions is well known. However, the temporal association between migraine and epilepsy is a controversial issue, since these two conditions may occur in numerous ways. Four types of association between headache and epileptic seizure are recognized: pre-ictal headache, headache as the expression of an epileptic manifestation, post-ictal headache, and inter-ictal headache. The classification of epilepsy by the International League Against Epilepsy did not refer to the epileptic headache. On the other hand, the International Classification of Headache Disorders, 3rd edition (ICHD-3) defines three entities: migraine aura-triggered seizure which sometimes referred to as migralepsy, hemicrania epileptica, and post-ictal headache. However, ICHD-3 mentions that there is a complex and bidirectional association between migraine and epilepsy. Most of the previous reports of migralepsy corresponded to occipital seizures that mimic migraine with aura. The term migralepsy has recently been criticized. Migraine and epilepsy share several pathophysiological mechanisms which involve neurotransmitters and iron channel dysfunctions. There is the hypothesis of a shared genetic susceptibility to migraine and epilepsy. Strong support of a shared genetic basis comes from familial hemiplegic migraine.

  1. Migraines: What a Pain!

    MedlinePlus

    ... after age 12, during and after puberty, migraines affect girls three times more often than boys. Migraines aren't contagious, ... Answer all the questions in the diary each time you have a headache. The ... which can help you to go to sleep and get rid of the headache medicines to ...

  2. [Antidepressants in migraine prophylaxis].

    PubMed

    Nagata, Eiichiro

    2009-10-01

    The initiation of a prophylactic treatment for migraine depends on the frequency of migraine attacks and the extent of the function disability associated with these attacks. Antidepressants have good evidence of efficacy in the prophylactic treatment for migraine. In general, among the antidepressants, amitriptyline is the most frequently prescribed by headache specialists. Several clinical trials on this drug have also evidenced the remarkable benefits of amitriptyline in the prophylactic treatment of migraine attack. In evidence-based guidelines developed by Japanese Headache Society and American Neurological Association, it is classified as a Group 1 drugs (effective drug for the prevention of migraine attack). Moreover, these drugs are more useful in cases where there is comorbidity with conditions such as depression. The side-effects of these drugs are sleepiness and dry mouth. Administration of amytriptyline at low dose can reduce the frequency of side effects such as sleepiness.

  3. Vertigo as a migraine phenomenon.

    PubMed

    Cherian, Neil

    2013-04-01

    Migraine is a complex disorder with many different manifestations. There has been an increasing interest in the association of migraine and vertigo. Many different terms have been developed to describe this concept, the more popular being vestibular migraine, migrainous vertigo, and migraine-associated vertigo. The most commonly cited diagnostic criteria are that of Neuhauser though this has yet to be included in the International Classification of Headache Disorders (2nd edition). At this time, there is a lack of consensus regarding migraine-related vertigo and its pathomechanism. Regardless, a few randomized controlled prospective studies have been performed to evaluate the efficacy of various medications. Topiramate has been shown to be effective for migraine-related vertigo. At this time there is no specific treatment for migraine-related dizziness outside of conventional migraine management. The genetics have yet to be fully realized though an autosomal dominant familial migraine vertigo disorder has been identified.

  4. Brain imaging with sup 123 I-IMP-SPECT in migraine between attacks

    SciTech Connect

    Schlake, H.P.; Boettger, I.G.G.; Grotemeyer, K.H.; Husstedt, I.W.

    1989-06-01

    {sup 123}I-IMP-SPECT brain imaging was performed in patients with classic migraine (n = 5) and migraine accompagnee (n = 18) during the headache-free interval. A regional reduction of tracer uptake into brain was observed in all patients with migraine accompagnee, while in patients with classic migraine only one case showed an area of decreased activity. The most marked alteration was found in a patient with persisting neurological symptoms (complicated migraine). In most cases the areas of decreased tracer uptake corresponded to headache localization as well as to topography of neurologic symptoms during migraine attacks. It may be concluded that migraine attacks occur in connection with exacerbations of preexisting changes of cerebral autoregulation due to endogenous or exogenous factors.

  5. Genetic risk score analysis indicates migraine with and without comorbid depression are genetically different disorders.

    PubMed

    Ligthart, Lannie; Hottenga, Jouke-Jan; Lewis, Cathryn M; Farmer, Anne E; Craig, Ian W; Breen, Gerome; Willemsen, Gonneke; Vink, Jacqueline M; Middeldorp, Christel M; Byrne, Enda M; Heath, Andrew C; Madden, Pamela A F; Pergadia, Michele L; Montgomery, Grant W; Martin, Nicholas G; Penninx, Brenda W J H; McGuffin, Peter; Boomsma, Dorret I; Nyholt, Dale R

    2014-02-01

    Migraine and major depressive disorder (MDD) are comorbid, moderately heritable and to some extent influenced by the same genes. In a previous paper, we suggested the possibility of causality (one trait causing the other) underlying this comorbidity. We present a new application of polygenic (genetic risk) score analysis to investigate the mechanisms underlying the genetic overlap of migraine and MDD. Genetic risk scores were constructed based on data from two discovery samples in which genome-wide association analyses (GWA) were performed for migraine and MDD, respectively. The Australian Twin Migraine GWA study (N = 6,350) included 2,825 migraine cases and 3,525 controls, 805 of whom met the diagnostic criteria for MDD. The RADIANT GWA study (N = 3,230) included 1,636 MDD cases and 1,594 controls. Genetic risk scores for migraine and for MDD were used to predict pure and comorbid forms of migraine and MDD in an independent Dutch target sample (NTR-NESDA, N = 2,966), which included 1,476 MDD cases and 1,058 migraine cases (723 of these individuals had both disorders concurrently). The observed patterns of prediction suggest that the 'pure' forms of migraine and MDD are genetically distinct disorders. The subgroup of individuals with comorbid MDD and migraine were genetically most similar to MDD patients. These results indicate that in at least a subset of migraine patients with MDD, migraine may be a symptom or consequence of MDD.

  6. Involvement of BDNF/TrkB and ERK/CREB axes in nitroglycerin-induced rat migraine and effects of estrogen on these signals in the migraine

    PubMed Central

    Guo, Jiu-Qing; Deng, Hui-Hui; Bo, Xiao

    2017-01-01

    ABSTRACT Migraine is a highly prevalent headache disorder, especially in women. Brain-derived neurotrophic factor (BDNF) and its receptor tropomyosin receptor kinases (TrkB), as well as extracellular signal-regulated kinase (ERK) and its downstream target c-AMP-responsive element binding protein (CREB) are strongly associated with the transmission of nociceptive information. However, the involvement of these substances in migraine has rarely been examined. In the present study, intraperitoneal injection of nitroglycerin (NTC) successfully induced rat migraine attack, as evidenced by behavioral testing. The location and abundance of these substances in the migraine model were determined by immunohistochemistry, real-time polymerase chain reaction (RT-PCR), western blot and enzyme-linked immunosorbant assays (ELISA). Results showed that BDNF, TrkB, phosphor(p)-ERK and p-CREB were up-regulated in the brain neurons of both male and female rats with NTG-induced migraine compared to non-migraine control, whereas their expression levels were decreased in headache-free intervals of the migraine compared to migraine attacks. Estrogen is an important contributor to migraine. Female ovariectomized rats showed significant reduction in the expression of BDNF, TrkB, p-CREB and p-ERK in both attacks and intervals of NTG-induced migraine, relative to rats that have their ovaries. But, intraperitoneal administration of exogenous estrogen recovered their expression in ovariectomized rats. Collectively, this study unveiled a positive correlation of BDNF/TrkB and ERK/CREB axes in NTG-induced migraine and promoting effects of estrogen on their signals in the migraine. These findings contribute to further understanding the pathogenesis of migraine in the molecular basis. PMID:27875242

  7. Superior mentalizing abilities of female patients with schizophrenia.

    PubMed

    Abu-Akel, Ahmad; Bo, Sune

    2013-12-30

    Mentalizing abilities are severely disrupted in patients with schizophrenia, but gender-related differences in this domain are virtually unexplored. Given the importance of these abilities in understanding psychopathology, social functioning and outcome, this study aimed to examine the mentalizing abilities of male and female patients with schizophrenia. The cognitive and affective mentalizing abilities of self and other of clinically stable male and female patients with schizophrenia were analyzed using the abbreviated version of the Metacognitive Assessment Scale (MAS-A). Compared to their male counterparts, the female patients demonstrated superior overall mentalizing abilities. This advantage was also evident when mentalizing about the Self or the Other. When examining cognitive versus affective mentalizing, women were significantly better in their ability to attribute and understand the affective mental states of others. These differences were unrelated to intelligence or psychopathology. The superior mentalizing abilities of female patients extend gender-related differences in schizophrenia to include social cognition. This suggests that our current knowledge of socio-cognitive abilities in schizophrenia is generalizable to male but not to female patients. The findings also provide important insights to understanding how etiological differences affect social cognition. Awareness to such differences has important implications for diagnosis and clinical treatment.

  8. OnabotulinumtoxinA for chronic migraine: efficacy, safety, and tolerability in patients who received all five treatment cycles in the PREEMPT clinical program

    PubMed Central

    Aurora, SK; Dodick, DW; Diener, H-C; DeGryse, RE; Turkel, CC; Lipton, RB; Silberstein, SD

    2014-01-01

    Objective Chronic migraine (CM) is a prevalent and disabling neurological disorder. Phase III REsearch Evaluating Migraine Prophylaxis Therapy (PREEMPT) clinical program assessed efficacy and safety of onabotulinumtoxinA (BOTOX®) for prophylaxis of headaches in adults with CM. This secondary analysis assessed patients who received all five treatment cycles and completed the study. Materials and methods PREEMPT (two phase III studies: 24-week double-blind, placebo-controlled [DBPC], parallel-group phase, followed by 32-week open-label [OL] phase) evaluated the efficacy and safety of onabotulinumtoxinA in CM (≥15 days/month with headache lasting ≥4 h a day). Patients were randomized (1:1) to onabotulinumtoxinA or placebo every 12 weeks for two cycles, followed by onabotulinumtoxinA for three cycles. Multiple headache symptom measures were evaluated. Results for the completer (five cycles) subgroup of patients are reported. Results Of 1384 total PREEMPT patients, 1005 received all five treatment cycles (513 received onabotulinumtoxinA only [onabotulinumtoxinA/onabotulinumtoxinA (O/O)] and 492 received two cycles of placebo then three cycles of onabotulinumtoxinA [placebo/onabotulinumtoxinA (P/O)]). Demographics were similar between treatment groups. At Week 56, after all patients were treated with onabotulinumtoxinA, there continued to be significant between-group differences favoring the O/O vs P/O group for the following headache symptom measures: LS mean change from baseline in frequencies of headache days (−12.0 O/O, −11.1 P/O; P = 0.035), migraine days (−11.6 O/O, −10.7 P/O; P = 0.038), and moderate/severe headache days (−11.0 O/O, −10.1 P/O; P = 0.042). For other measures (cumulative hours of headache on headache days, frequency of headache episodes, and percentage with severe Headache Impact Test (HIT)-6 score, and total HIT-6 and Migraine-Specific Quality of Life Questionnaire scores), there were also large mean improvements from

  9. Genetics Home Reference: familial hemiplegic migraine

    MedlinePlus

    ... Home Health Conditions familial hemiplegic migraine familial hemiplegic migraine Enable Javascript to view the expand/collapse boxes. ... PDF Open All Close All Description Familial hemiplegic migraine is a form of migraine headache that runs ...

  10. [Migraine: ignition of the brain].

    PubMed

    Sánchez-del-Río González, Margarita

    2013-12-01

    Although our knowledge of which systems are activated during migraine is reasonably complete, why the system is activated remains unknown. Incorporating the findings obtained in studies on pain in general has allowed a more integrated model to be generated. According to this new model, there is an anatomical substrate consisting in a complex framework of pain that is made up not only of the trigeminovascular system (end pathway) but of a number of networks that are in turn connected to one another, like the neurolimbic, the ascending and descending modulatory system. This complex network is responsible for modulating and conveying nociceptive signals. In patients with migraine, hyperexcitability of this framework is conditioned by genetic and epigenetic alterations. Epigenetic changes are chemical modifications affecting chromatin, which modulates the activity of genes without modifying the DNA sequence, and which are capable of modulating the expression of genes involved in a number of different aspects, such as plasticity, system excitability, memory of pain or moods. In turn, the presence of external factors (such as environmental changes or alcohol) and internal factors (such as hormones or sleep disorders) contribute to activate this loaded anatomical substrate, resulting in the attack of migraine.

  11. Chocolate and migraine: the history of an ambiguous association.

    PubMed

    Lippi, Giuseppe; Mattiuzzi, Camilla; Cervellin, Gianfranco

    2014-12-17

    Migraine is a highly prevalent condition and an important cause of disability. Although the pathogenesis of this condition is complex and multifaceted, several environmental factors have been associated with development and aggravation of headache attacks. Among the various foods that have been implicated in migraine, chocolate has been regarded as detrimental on the basis of old and mostly anecdotal evidence. Therefore, this article is aimed to provide an overview on the current scientific evidence about the relationship between chocolate and migraine. Taken together, the information gathered from epidemiological and provocative studies attests that the potential causal association between chocolate and migraine remains largely enigmatic. The analysis of epidemiological surveys reveals a highly heterogeneous picture, with frequency of migraine episodes attributable to chocolate ranging from 0 to 22.5%. Even in those studies reporting a more convincing association, the risk of migraine after chocolate ingestion was found to be 2- to 3-fold lower than that reported for exposure to other conventional triggers such as stress, fasting, lack of sleep and alcohol beverages. The results of the double-blind studies are instead unequivocal, and clearly demonstrate that the risk of developing a headache attack after ingestion of chocolate is as likely as administering placebo in patients with migraine. It can hence be concluded that the widespread belief that chocolate and cocoacontaining foods should be absolutely avoided by migraine patients lacks of a reliable scientific basis.

  12. Revision Stapedectomy in a Female Patient with Inner Ear Malformation

    PubMed Central

    Patel, Tirth R.; Moberly, Aaron C.

    2016-01-01

    Objectives. We describe an unusual case of surgical management of congenital mixed hearing loss in a female patient with inner ear malformation. This report outlines the role of temporal bone imaging and previous surgical history in evaluating a patient's risk of perilymph gusher during stapes surgery. Methods. A 68-year-old female patient with a history of profound bilateral mixed hearing loss due to ossicular and cochlear malformation presented to our otology clinic. She had undergone multiple unsuccessful previous ear surgeries. Computed tomography revealed bilateral inner ear malformations. She elected to proceed with revision stapedectomy. Results. The patient received modest benefit to hearing, and no operative complications occurred. Conclusions. Although stapedectomy has been shown to improve hearing in patients with stapes fixation, there is risk of perilymph gusher in patients with inner ear abnormalities. Evaluation and counseling of the risk of gusher during stapes surgery should be done on a case-by-case basis. PMID:27144044

  13. Pathogenesis and surgical therapy of migraine attacks caused by weather (Foehn) and menstruation.

    PubMed

    Novak, V J

    1984-09-01

    This work reports for the first time on the pathological background and the successful definitive surgical treatment of migraine attacks caused by weather (Foehn) changes, menstruation, nutrition (cheese, chocolates, red wines etc), and psychophysical stress. Forty-two patients between the ages of 13 and 48, who were subdivided into an earlier and later treatment group, were surgically treated for migraines caused by the factors mentioned above. In the first group of 15 female patients that was treated, the surgical technique consisted of subperichondral septum correction crushing and partial or total resection of the middle concha and ethmoidal opening. In four of the patients where no septum deviation was observed, a resection of the middle nasal concha and a transnasal opening of the ethmoidal cells in the area of the middle nasal passage was performed. In the later group consisting of 27 patients, the surgical technique was simplified so that only subperichondral septum correction and crushing of the middle concha was performed, without total resection of the concha and ethmoidal cell opening. Up to the present all the 42 patients operated on have been free from migraine attacks, the first operation having been performed seven years ago and the last eight months ago.

  14. Electroencephalogram variations in pediatric migraines and tension-type headaches.

    PubMed

    Ozkan, Mehpare; Teber, Serap T; Deda, Gülhis

    2012-03-01

    This study evaluates specific electroencephalogram abnormalities in pediatric migraine and tension-type headaches, and demonstrates the clinical value of these abnormalities. We studied 50 migraine patients and 50 tension-type headache patients. Their mean age ± SD was 10.62 ± 3.21 (range, 5-16) years in the migraine group, and 13.00 ± 2.37 (7-16) years in the tension-type headache group. Diagnoses were rendered according to the International Classification of Headache Disorders, 2nd Edition, First Revision, of the International Headache Society. All patients underwent two waking-state electroencephalograms, one during a headache, and the other when headache-free. Thirty-six percent (18/50) of migraine patients and 12% (6/50) of tension-type headache patients revealed specific electroencephalogram abnormalities in headache attack electroencephalograms (P < 0.05). In headache-free period electroencephalograms, 16% (8/50) of the migraine group and 2% (1/50) of the tension-type headache group revealed abnormalities (P < 0.05). Our results indicate that electroencephalogram abnormalities are particularly prevalent in migraines, especially during headache attacks. This study is the first, to the best of our knowledge, on electroencephalographic evaluation of pediatric migraine and tension-type headache patients during both headache attacks and headache-free periods.

  15. Reduction in perceived stress as a migraine trigger

    PubMed Central

    Lipton, Richard B.; Hall, Charles B.; Tennen, Howard; DeFreitas, Tiffani A.; Borkowski, Thomas M.; Grosberg, Brian M.; Haut, Sheryl R.

    2014-01-01

    Objective: To test whether level of perceived stress and reductions in levels of perceived stress (i.e., “let-down”) are associated with the onset of migraine attacks in persons with migraine. Methods: Patients with migraine from a tertiary headache center were invited to participate in a 3-month electronic diary study. Participants entered data daily regarding migraine attack experience, subjective stress ratings, and other data. Stress was assessed using 2 measures: the Perceived Stress Scale and the Self-Reported Stress Scale. Logit-normal, random-effects models were used to estimate the odds ratio for migraine occurrence as a function of level of stress over several time frames. Results: Of 22 enrolled participants, 17 (median age 43.8 years) completed >30 days of diaries, yielding 2,011 diary entries including 110 eligible migraine attacks (median 5 attacks per person). Level of stress was not generally associated with migraine occurrence. However, decline in stress from one evening diary to the next was associated with increased migraine onset over the subsequent 6, 12, and 18 hours, with odds ratios ranging from 1.5 to 1.9 (all p values < 0.05) for the Perceived Stress Scale. Decline in stress was associated with migraine onset after controlling for level of stress for all time points. Findings were similar using the Self-Reported Stress Scale. Conclusions: Reduction in stress from one day to the next is associated with migraine onset the next day. Decline in stress may be a marker for an impending migraine attack and may create opportunities for preemptive pharmacologic or behavioral interventions. PMID:24670889

  16. Migraine and metaphor.

    PubMed

    Haan, Joost

    2013-01-01

    The metaphors of migraine make it a challenging source of inspiration for writers of fiction. The visual aura is a hallucination, the outside world - the so-called 'reality' - is distorted. The excruciating pain can stand for horror, punishment, and fate. Photophobia, phonophobia, and osmophobia underline visual, acoustic, and olfactoric stimuli. The protagonist sees, hears, and smells more, but not always better. Paradoxically, this increased awareness of 'reality' results in a need to seek isolation. Often, the end of a migraine attack is like a rescue. Immediately after an attack the fear of the next one begins. As migraine is hereditary, there are also aspects of solidarity, but shame and blame are nearby.

  17. Mitochondrial dysfunction in migraine.

    PubMed

    Yorns, William R; Hardison, H Huntley

    2013-09-01

    Migraine is the most frequent type of headache in children. In the 1980s, scientists first hypothesized a connection between migraine and mitochondrial (mt) disorders. More recent studies have suggested that at least some subtypes of migraine may be related to a mt defect. Different types of evidence support a relationship between mitochondria (mt) and migraine: (1) Biochemical evidence: Abnormal mt function translates into high intracellular penetration of Ca(2+), excessive production of free radicals, and deficient oxidative phosphorylation, which ultimately causes energy failure in neurons and astrocytes, thus triggering migraine mechanisms, including spreading depression. The mt markers of these events are low activity of superoxide dismutase, activation of cytochrome-c oxidase and nitric oxide, high levels of lactate and pyruvate, and low ratios of phosphocreatine-inorganic phosphate and N-acetylaspartate-choline. (2) Morphologic evidence: mt abnormalities have been shown in migraine sufferers, the most characteristic ones being direct observation in muscle biopsy of ragged red and cytochrome-c oxidase-negative fibers, accumulation of subsarcolemmal mt, and demonstration of giant mt with paracrystalline inclusions. (3) Genetic evidence: Recent studies have identified specific mutations responsible for migraine susceptibility. However, the investigation of the mtDNA mutations found in classic mt disorders (mt encephalomyopathy with lactic acidosis and stroke-like episodes, myoclonus epilepsy with ragged red fibers, Kearns-Sayre syndrome, and Leber hereditary optic neuropathy) has not demonstrated any association. Recently, 2 common mtDNA polymorphisms (16519C→T and 3010G→A) have been associated with pediatric cyclic vomiting syndrome and migraine. Also, POLG mutations (eg, p.T851 A, p.N468D, p.Y831C, p.G517V, and p.P163S) can cause disease through impaired replication of mtDNA, including migraine. Further studies to investigate the relationship between mt

  18. Chronic Migraine: An Update on Physiology, Imaging, and the Mechanism of Action of Two Available Pharmacologic Therapies.

    PubMed

    Aurora, Sheena K; Brin, Mitchell F

    2017-01-01

    Several lines of research support the hypothesis that migraine is a spectrum of illness, with clinical symptoms that vary along a continuum from episodic migraine to chronic migraine. Physiologic changes may result in episodic migraine evolving into chronic migraine over months to years in susceptible individuals. With chronification, headache frequency increases, becoming more disabling and less responsive to therapy. Neurophysiologic and functional imaging research has reported that chronic migraine may be associated with severity-specific metabolic, functional, and structural abnormalities in the brainstem. Without longitudinal studies, it is unclear whether these changes may represent a continuum of individual progression and/or are reversible. Furthermore, chronic migraine is associated with larger impairments in cortical processing of sensory stimuli when compared with episodic migraine, possibly caused by more pronounced cortical hyperexcitability. Progressive changes in nociceptive thresholds and subsequent central sensitization due to recurrent migraine attacks in vulnerable individuals contribute to the chronic migraine state. This may result in changes to baseline neurologic function between headache attacks, evident in both electrophysiological and functional imaging research. Patients experiencing migraine chronification may report increased non-headache pain, fatigue, psychiatric disorders (eg, depression, anxiety), gastrointestinal complaints, and other somatic conditions associated with their long-term experience with migraine pain. Recent research provides a foundation for differentiating episodic and chronic migraine based on neurophysiologic and neuroimaging tools. In this literature review, we consider these findings in the context of models designed to explain the physiology and progression of episodic migraine into chronic migraine, and consider treatment of chronic migraine in susceptible individuals. Advances in pharmacotherapy provide

  19. The effect of migraine prophylaxis on migraine-related resource use and productivity.

    PubMed

    Láinez, Miguel J A

    2009-09-01

    In the US, it is estimated that up to 10% of men and 25% of women, particularly those aged 25-55 years, experience debilitating migraines, such that the condition presents an enormous economic burden for patients, health systems, employers and society. Migraine headache is a particularly prevalent condition associated with major reductions in patients' quality of life. From a payer perspective, the implementation of relevant programmes of migraine prophylaxis is highly desirable. Consistent evidence exists, from several randomized, controlled studies, of the efficacy of amitriptyline, divalproex sodium, propranolol, timolol and topiramate in migraine prophylaxis. Considering resource utilization, various studies suggest that migraine prophylaxis with antiepileptics, antidepressants, beta-blockers or calcium channel antagonists markedly reduces triptan use and visits to physician offices and emergency departments (EDs), without compromising quality of care or treatment outcomes. Over recent years, the effects of topiramate in reducing resource utilization in patients with migraine have been relatively widely studied. In US claims database analyses involving >4000 patients with migraine, topiramate significantly reduced triptan use by up to 20% in the 12-month period after starting treatment. Reductions were also noted in the numbers of ED visits, diagnostic procedures, hospital admissions and migraine-related hospitalization days. These long-term benefits of topiramate manifested without any increase in overall headache-related costs. Furthermore, in detailed modelling analyses based on UK and US data, topiramate-induced savings in acute medical services were estimated to offset about one-quarter of the monthly per patient cost of the topiramate regimen, which was shown to be a dominant cost-effective intervention relative to no preventive therapy: cost-effectiveness ratios were calculated as pound 5728 per quality-adjusted life-year (QALY) [2005 costings] and $US10

  20. Exacerbation of migraine attacks during treatment with the selective serotonin reuptake inhibitor sertraline. A case report.

    PubMed

    Bickel, A; Kornhuber, J; Maihöfner, C; Ropohl, A

    2005-11-01

    Abnormal signal transmission in central serotonergic pathways is supposed to play an important role in the pathogenesis of migraine and major depression. We report on a patient, who was treated during an episode of depression with the selective serotonin reuptake inhibitor (SSRI) sertraline and developed frequent migraine attacks under this therapeutical regime. Single migraine attacks were treated successfully with triptanes. Although SSRIs may be beneficial for migraine prophylaxis at long term administration, this case suggests that acute administration of SSRIs in migraineurs may include the risk of worsening migraine.

  1. Diet restriction in migraine, based on IgG against foods: A clinical double-blind, randomised, cross-over trial

    PubMed Central

    Alpay, Kadriye; Ertaş, Mustafa; Orhan, Elif Kocasoy; Üstay, Didem Kanca; Lieners, Camille; Baykan, Betül

    2010-01-01

    Introduction: It is well-known that specific foods trigger migraine attacks in some patients. We aimed to investigate the effect of diet restriction, based on IgG antibodies against food antigens on the course of migraine attacks in this randomised, double blind, cross-over, headache-diary based trial on 30 patients diagnosed with migraine without aura. Methods: Following a 6-week baseline, IgG antibodies against 266 food antigens were detected by ELISA. Then, the patients were randomised to a 6-week diet either excluding or including specific foods with raised IgG antibodies, individually. Following a 2-week diet-free interval after the first diet period, the same patients were given the opposite 6-week diet (provocation diet following elimination diet or vice versa). Patients and their physicians were blinded to IgG test results and the type of diet (provocation or elimination). Primary parameters were number of headache days and migraine attack count. Of 30 patients, 28 were female and 2 were male, aged 19–52 years (mean, 35 ± 10 years). Results: The average count of reactions with abnormally high titre was 24 ± 11 against 266 foods. Compared to baseline, there was a statistically significant reduction in the number of headache days (from 10.5 ± 4.4 to 7.5 ± 3.7; P < 0.001) and number of migraine attacks (from 9.0 ± 4.4 to 6.2 ± 3.8; P < 0.001) in the elimination diet period. Conclusion: This is the first randomised, cross-over study in migraineurs, showing that diet restriction based on IgG antibodies is an effective strategy in reducing the frequency of migraine attacks. PMID:20647174

  2. Functional imaging in chronic migraine.

    PubMed

    Maniyar, Farooq H; Goadsby, Peter J

    2013-05-01

    Chronic migraine is a relatively common disorder in neurological terms that causes very significant disability at a high cost. The precise mechanisms behind the progression of episodic migraine to chronic migraine are not well understood. Functional neuro-imaging works on the basis that neuronal activations are associated with changes in regional cerebral blood flow, and it can help us answer some of these questions. In this review, we discuss important recent studies in chronic migraine or studies relating to increasing frequency of migraine attacks. The findings show that increasing frequency of migraine attacks is associated with changes in key brainstem areas, basal ganglia and various cortical areas involved in pain.

  3. Migraine aura and related phenomena: beyond scotomata and scintillations

    PubMed Central

    Vincent, MB; Hadjikhani, N

    2013-01-01

    Migraine affects the cortical physiology and may induce dysfunction both ictally and interictally. Although visual symptoms predominate during aura, other contiguous cortical areas related to less impressive symptoms are also impaired in migraine. Answers from 72.2% migraine with aura and 48.6% of migraine without aura patients on human faces and objects recognition, colour perception, proper names recalling and memory in general showed dysfunctions suggestive of prosopagnosia, dyschromatopsia, ideational apraxia, alien hand syndrome, proper name anomia or aphasia, varying in duration and severity. Symptoms frequently occurred in a successively building-up pattern fitting with the geographical distribution of the various cortical functions. When specifically inquired, migraineurs reveal less evident symptoms that are not usually considered during routine examination. Spreading depression most likely underlies the aura symptoms progression. Interictal involvement indicates that MWA and MWoA are not completely silent outside attacks, and that both subforms of migraine may share common mechanisms. PMID:17944958

  4. Migraine and neurogenetic disorders.

    PubMed

    Sathe, Swati

    2013-09-01

    In the current classification of headache disorders, headache attributable to genetic disorders is not classified separately, rather as headache attributed to cranial or cervical vascular disorder. The classification thus implies that a vascular pathology causes headache in these genetic disorders. Unquestionably, migraine is one of the prominent presenting features of several genetic cerebral small vessel diseases such as cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy, retinal vasculopathy with cerebral leukodystrophy, and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty. Shared genetic features, increased susceptibility, and/or vascular endothelial dysfunction may play a role in pathogenesis of migraine. Common or overlapping pathways involving the responsible genes may provide insight regarding the pathophysiological mechanisms that can explain their comorbidity with migraine. This review focuses on clinical features of genetic vasculopathies. An independent category-migraine related to genetic disorders-should be considered to classify these disorders.

  5. [Migraine - established concepts and new developments].

    PubMed

    Speck, V; Maihöfner, C

    2013-06-01

    Migraine is a very common primary headache disorder associated with intermittent attacks and great suffering. Despite extensive research efforts in the recent years, many pathophysiological aspects remain unclear. An altered cortical adaptability and the brainstem as a migraine generator are probably involved in the initiation of a (silent) cortical spreading depression and other processes that lead to neurogenic inflammation of the meninges causing the headache. Numerous studies in the last years have examined somatic, especially cerebrovascular and also psychological comorbidities. For attack therapy, CGRP antagonists have emerged as promising non-vasoconstrictive acting alternatives for triptans. However, they were so far not approved due to liver enzyme elevations in safety studies. Another new approach without vasoconstrictive action are the selective 5-HT1F agonists (especially Lasmiditan). Large placebo-controlled and triptan-controlled trials need to be awaited. For migraine prophylaxis, a comparable effect of sports and pharmacological prophylaxis using topiramate could be found. Particularly the combination of drug and non-drug therapies (such as the combination of stress management training with a beta-blocker treatment) achieves high efficacy. Also interdisciplinary, multimodal treatment approaches are important options. Two large multicentre studies have demonstrated the efficacy of botulinum toxin A as a prophylactic treatment for chronic migraine. Neuromodulative and neurostimulative procedures are promising but still experimental treatment options for patients with refractory migraine.

  6. Hypothalamic involvement in chronic migraine

    PubMed Central

    Peres, M; del Rio, M S.; Seabra, M; Tufik, S; Abucham, J; Cipolla-Neto, J; Silberstein, S; Zukerman, E

    2001-01-01

    OBJECTIVES—Chronic migraine (CM), previously called transformed migraine, is a frequent headache disorder that affects 2%-3% of the general population. Analgesic overuse, insomnia, depression, and anxiety are disorders that are often comorbid with CM. Hypothalamic dysfunction has been implicated in its pathogenesis, but it has never been studied in patients with CM. The aim was to analyze hypothalamic involvement in CM by measurement of melatonin, prolactin, growth hormone, and cortisol nocturnal secretion.
METHODS—A total of 338 blood samples (13/patient) from 17 patients with CM and nine age and sex matched healthy volunteers were taken. Melatonin, prolactin, growth hormone, and cortisol concentrations were determined every hour for 12 hours. The presence of comorbid disorders was also evaluated.
RESULTS—An abnormal pattern of hypothalamic hormonal secretion was found in CM. This included: (1) a decreased nocturnal prolactin peak, (2) increased cortisol concentrations, (3) a delayed nocturnal melatonin peak in patients with CM, and (4) lower melatonin concentrations in patients with CM with insomnia. Growth hormone secretion did not differ from controls.
CONCLUSION—These results support hypothalamic involvement in CM, shown by a chronobiologic dysregulation, and a possible hyperdopaminergic state in patients with CM. Insomnia might be an important variable in the study findings.

 PMID:11723194

  7. CADASIL: Migraine, Encephalopathy, Stroke and Their Inter-Relationships

    PubMed Central

    Markus, Hugh Stephen

    2016-01-01

    Background Migraine is common in Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) but its treatment responses are not well described, and its relationship to stroke risk unknown. Encephalopathy is a less common presentation; it has been suggested it is related to migraine. We characterised migraine patterns and treatment responses in CADASIL, and examined associations between migraine and both stroke risk and encephalopathy. Methods 300 symptomatic CADASIL patients were prospectively recruited from a national referral clinic over a nineteen year period, from 1996 to 2015. Data was collected using a standardised questionnaire. Migraine was classified according to the International Classification of Headache Disorders, 3rd edition (beta version). A cross-sectional analysis was carried out on the data collected. Results Migraine was present in 226 (75.3%), and the presenting feature in 203 (67.7%). It was usually accompanied by aura (89.8%). Patients showed variable responses to a variety of drugs for migraine. Of 24 given triptans, 45.5% had consistent or partial responses. None had complications following triptans. Thirty-three (11.0%) patients experienced encephalopathy lasting on average 8.1 ± 3.4 days. Patients with migraine with aura had higher odds of encephalopathy (OR = 5.4; 95%CI 1.6–28.4; p = 0.002). Patients with confusional aura had higher odds of encephalopathy than those with other aura types (OR = 2.5, 95%CI = 1.0–5.8, p = 0.04). There was also no increase in risk of encephalopathy with sex or age at onset of migraine. Migraineurs had a lower stroke risk than non-migraineurs (HR = 0.46, 95%CI 0.3–0.6, p = 2.1x10-6). Conclusions Migraine with aura is a prominent feature of CADASIL. Treatment responses are similar to those seen in the general migraine population and no complications were observed with triptans. Migraine with aura was associated with increased risk of encephalopathy suggesting

  8. [Domestic violence against women and health care demands. Results of a female emergency department patient survey].

    PubMed

    Brzank, P; Hellbernd, H; Maschewsky-Schneider, U; Kallischnigg, G

    2005-03-01

    Domestic violence (DV) is a serious risk for women's health. So far, little attention has been paid to this area in research and medical care in Germany. Acknowledging this deficit, the S.I.G.N.A.L.-Intervention Project has started to develop a program to improve the medical care for victimized women. For the first time in Germany, data on the health care needs of victimized women have been collected within the S.I.G.N.A.L.-Evaluation Research Project. This article presents the results of a female patient survey (n=806) on DV conducted in the emergency department (ED) of a university hospital in Berlin. The results demonstrate that 36.6% of women reported at least one episode of DV after the age of 16. A total of 4.6% were victims of DV over the past year, and 1.5% of women came to the ED for treatment of injuries caused by violence. A total of 57% of the victims of at least one episode of DV in their lifetime after the age of 16 described a negative impact on their health. The most frequently reported sequelae were head injuries, haematomas and fractures, gastrointestinal disorders, headache/migraine and heart disease. The psychological symptoms were anxiety, depression and suicide/self-mutilation attempts. Some 52% of the victims who reported health consequences had received medical care. In case of DV occurring, 67% of all women said that they would discuss it with their physicians. Approximately 80% of all respondents favoured a routine inquiry for DV as part of the medical history protocol of the ED.

  9. Psychological aspects of migraine in childhood.

    PubMed

    Lanzi, G; Balottin, U; Gamba, N; Fazzi, E

    1983-08-01

    Experimental data indicate that certain unconscious emotions cause modifications of the brain stem neurotransmitters, inducing neurohumoral and vascular changes which underlie the migraine attack in biologically predisposed subjects. The present study investigates, with patient interviews, psychodiagnostic tests (Rorschach, Blacky pictures, Thematic Apperception test, drawings, Wechsler) and parental interviews in 20 pediatric migraine subjects. In 85% of the cases, a condition of repressed anger preceding the attack is seen. In 40% of the subjects, events such as a death in the family, separations, angry quarrels among parents, and scholastic problems, are seen just before onset of the disease. In conclusion, migraine may be considered a psychosomatic disorder, with the phenomenon of pain as a somatic extrinsication of psychological distress.

  10. Roller coaster migraine: an underreported injury?

    PubMed

    McBeath, J G; Nanda, A

    2000-10-01

    A 28-year-old woman presented with severe headache, sleep problems, memory problems, and irritability 2 months after a violent roller coaster ride. She was diagnosed with posttraumatic migraine, and intravenous dihydroergotamine resolved her symptoms. Imaging studies, electroencephalogram, and visual and auditory evoked responses were normal. Imipramine, divalproex sodium, and propranolol were prescribed to prevent the headaches from recurring and dihydroergotamine nasal spray was prescribed for breakthrough headaches. We consider the many short but significant brain insults delivered during the roller coaster ride a critical factor in triggering this instance of posttraumatic migraine, which while unmanaged was a source of significant disability for the patient.

  11. What Is an Ocular Migraine?

    MedlinePlus

    ... When to seek help What is an ocular migraine? Is it a sign of something serious? Answers ... the other which might have more–serious complications. Migraine aura involving your vision In some cases, ocular ...

  12. Morphologic differences of occipital region in patients with schizophrenia and migraine headache using magnetic resonance imaging (MRI) and visual evoked potentials (VEPs).

    PubMed

    Sulejmanpašić, Gorana; Fišeković, Saida; Drnda, Senad

    2017-02-01

    Aim To compare morphologic variations of occipital sulci patterns in patients with schizophrenia and migraine headache regarding gender and laterality using magnetic resonance imaging (MRI) and visual evoked potentials (VEPs) as well as damage of visual pathway in patients with schizophrenia. Methods This study included 80 patients. Brain scans and visual evoked potential responses recorded over the occipital cortex were performed to analyze the occipital region of both hemispheres. Average total volumes of both hemispheres and average values of latency of the healthy population were used for comparison. Results There was statistically significant difference between subjects considering gender (p=0.012). Parameters of body of the calcarine sulcus (p=0.0325) showed statistically significant positive correlation with P100 latency (p=0.0449), inferior sagittal sulcus (p=0.0443) had significant positive correlation with P100 latency (p=0,0413), lateral occipital sulcus (p=0.0411) and P100 latency (p=0.0321) showed statistically significant difference only of left hemisphere in male patients with schizophrenia with shallower depth of the sulcus and P100 latency prolongation. Conclusion The consistency of the findings reveals distinct multiple brain regions, which show changes in the gray matter of patients with chronic forms of schizophrenia. The neurocognitive deficits of schizophrenia show highly consistent cross-sectional relationships to each type of functional outcome.

  13. Intractable migraine headaches during pregnancy under chiropractic care.

    PubMed

    Alcantara, Joel; Cossette, Martine

    2009-11-01

    The absence of hormone fluctuations and/or the analgesic effects of increased beta-endorphins are thought to confer improvements in headache symptoms during pregnancy. However, for a number of pregnant patients, they continue to suffer or have worsening headache symptoms. The use of pharmacotherapy for palliative care is a concern for both the mother and the developing fetus and alternative/complementary care options are sought. We present a 24-year-old gravid female with chronic migraine headaches since age 12years. Previous unsuccessful care included osteopathy, physical therapy, massage and medication. Non-steroidal anti-inflammatory medication with codeine provided minor and temporary relief. Chiropractic care involving spinal manipulative therapy (SMT) and adjunctive therapies resulted in symptom improvement and independence from medication. This document provides supporting evidence on the safety and possible effectiveness of chiropractic care for patients with headaches during pregnancy.

  14. Migraine Linked to Higher Stroke Risk After Surgery

    MedlinePlus

    ... https://medlineplus.gov/news/fullstory_162999.html Migraine Linked to Higher Stroke Risk After Surgery The risk ... said. For the study, Eikermann and colleagues collected data on nearly 125,000 surgical patients at Massachusetts ...

  15. Acne in the adult female patient: a practical approach.

    PubMed

    Kamangar, Faranak; Shinkai, Kanade

    2012-10-01

    Acne vulgaris is a common reason why adult women present to dermatologists and can be a clinical challenge to treat. It may also be an important sign of an underlying endocrine disease such as Polycystic Ovary Syndrome (PCOS). Although standard acne therapies can be successfully used to treat acne in adult female patients, hormonal treatment is a safe and effective therapeutic option that may provide an opportunity to better target acne in this population, even when other systemic therapies have failed. In this article, a practical approach to the adult female patient with acne will be reviewed to enhance the dermatologist's ability to use hormonal acne therapies and to better identify and evaluate patients with acne in the setting of a possible endocrine disorder.

  16. Rapid cycling as a feature of bipolar disorder and comorbid migraine

    PubMed Central

    Gordon-Smith, K.; Forty, L.; Chan, C.; Knott, S.; Jones, I.; Craddock, N.; Jones, L.A.

    2015-01-01

    Background Previous research has suggested the clinical profile of individuals with bipolar disorder (BD) differs according to the presence or absence of comorbid migraine. We aimed to determine the clinical characteristics that differentiate individuals with BD with and without comorbid migraine in a large, representative, clinically well-characterised UK sample. Methods The lifetime clinical characteristics of 1488 individuals with BD (BPI n=1120, BPII n=368) with and without comorbid migraine were compared (n=375 vs. n=1113 respectively). Results Individuals with BD and comorbid migraine had a distinctive set of lifetime clinical characteristics. A multivariate model showed that consistent with previous studies those with comorbid migraine were significantly more likely to be female (OR=2.099, p=0.005) and have comorbid panic attacks (OR=1.842, p=0.004). A novel finding was that even after controlling for other differences, the individuals with BD and comorbid migraine were more likely to have a rapid cycling illness course (OR=1.888, p=0.002). Limitations Presence of migraine was assessed using self report measures. Cross-sectional study design limits investigations of bidirectional associations between migraine and bipolar disorder. Conclusions Comorbid migraine in BD may represent a more homogenous subtype of BD with an unstable rapid cycling course. Identifying individuals with BD and comorbid migraine may be of use in a clinical setting and this subgroup could be the focus of future aetiological studies. PMID:25661398

  17. The Role of Home Practice in the Thermal Biofeedback Treatment of Migraine Headache.

    ERIC Educational Resources Information Center

    Gauthier, Janel; And Others

    1994-01-01

    Examined role of home practice of hand warming in thermal biofeedback treatment of migraine headache. Seventeen female migraine sufferers were assigned to thermal biofeedback with or without regular home practice. Subjects on home practice group experienced decreases in headache activity and medication intake that were both statistically and…

  18. High incidence of endogenous depression in migraine: confirmation by tyramine test.

    PubMed Central

    Jarman, J; Fernandez, M; Davies, P T; Glover, V; Steiner, T J; Thompson, C; Rose, F C; Sandler, M

    1990-01-01

    Forty patients with migraine who were attending a specialist clinic were interviewed with the Schedule for Affective Disorders and Schizophrenia--Lifetime version. Sixteen (40%) had a history of major depression which was of endogenous type in 15, according to Research Diagnostic Criteria. The tyramine test, a previously established trait marker for endogenous depression, showed that the migraine group as a whole had significantly low values compared with 14 normal controls, due almost entirely to low values in the endogenous depressive subgroup; there were no differences between diet-sensitive and non-diet-sensitive migraine patients. Thus depression in patients with migraine seems unlikely to be secondary to migraine per se. A substantial subgroup of patients with migraine may possess an inherent predisposition to endogenous depression. PMID:2391520

  19. Resilience in migraine brains: decrease of coherence after photic stimulation

    PubMed Central

    Mendonça-de-Souza, Mayara; Monteiro, Ubirakitan M.; Bezerra, Amana S.; Silva-de-Oliveira, Ana P.; Ventura-da-Silva, Belvânia R.; Barbosa, Marcelo S.; de Souza, Josiane A.; Criado, Elisângela C.; Ferrarezi, Maria C. M.; Alencar, Giselly de A.; Lins, Otávio G.; Coriolano, Maria das G. W. S.; Costa, Belmira L. S. A.; Rodrigues, Marcelo C. A.

    2012-01-01

    Background: During migraine attacks, patients generally have photophobia and phonophobia and seek for environments with less sensorial stimulation. Present work aimed to quantify cortical partial directed coherence (PDC) of electroencephalographic (EEG) recordings from migraine patients and controls in occipital, parietal, and frontal areas with or without photic stimulation. Our hypothesis is that migraine patients with visual aura might have neuronal networks with higher coherence than controls even in interictal periods due to a predisposition in sensory cortical processing. Methods: Eleven adult women with migraine with visual aura (at least 48 h without previous attacks) and seven healthy adult woman were submitted to EEG recording in basal state and during photic stimulation. Results: When compared to healthy volunteers, migraine patients show different coherence profiles. Migraine patients had greater coherence than controls during the basal period (without photic stimulation), showing predisposition for sensory processing in many frequency ranges. After photic stimulation, patients showed a decrease in cortical coherence while controls had an increase. Conclusions: When compared to healty subjects, migraineurs show increased cortical coherence before photic stimulation, but a decrease when stimulation starts. This may be the expression of a resilience mechanism that allows migraineurs the interictal period. The PDC analysis permits to address a patient coherence profile, or “coherence map,” that can be utilized for management of the headache disorder or following up treatments. PMID:22837743

  20. [Current approaches to treatment of migraine during pregnancy].

    PubMed

    Ekusheva, E V; Damulin, I V

    2015-01-01

    Migraine is one of the most common complaints in the majority of pregnant women. Migraine without aura is the most frequent cause of headache. Improvement of this disease is reported in 50-80% of patient. However, about one third of pregnant women have severe prolonged attacks with marked concomitant symptoms and maladaptation that necessarily need treatment. Authors consider the issues of differential diagnosis and principles of management of these patients.

  1. Role of dexamethasone in the prevention of migraine recurrence in the acute care setting: a review.

    PubMed

    Giuliano, Christopher; Smalligan, Roger D; Mitchon, Greg; Chua, Matt

    2012-05-01

    Patients with migraine headaches are commonly encountered by clinicians both in the clinic and in the emergency department. Migraines impose a significant financial burden on patients, caregivers, and society. Up to 49% of patients treated acutely for migraine headache will have a recurrence within 72 hours. Recurrence of migraines is dependent on a number of factors, including the choice of abortive agent, age, sex, and initial severity of the migraine. Dexamethasone has been proposed and studied as a medication that may decrease the frequency of such recurrences of migraine headaches in affected patients. Dexamethasone is a corticosteroid that has been proposed to prevent recurrence of migraines through its prevention of neurogenic inflammation. Initial trials, with less-than-ideal methodology, showed large decreases in the number of patients experiencing recurrent migraines. Later randomized controlled trials revealed mixed results, with subsequent meta-analyses showing an overall benefit in the prevention of recurrence of migraines. These meta-analyses suggest that dexamethasone will prevent recurrence in about 10% of patients, although trials that used higher doses of dexamethasone and followed patients for ≥ 72 hours showed a larger benefit. Very few adverse events were reported in the randomized controlled trials following a single dose of dexamethasone. Given the benign side effect profile and wide tolerability to a single high dose of dexamethasone, it appears to be a safe and modestly effective addition to standard migraine abortive therapy for the prevention of migraine recurrence. Dexamethasone should not be used in patients with non-migraine headaches or contraindications to steroids. Further studies should help delineate if dexamethasone can be tailored to specific patient populations and hence enhance its therapeutic effectiveness.

  2. Opioid Treatment of Migraine: Risk Factors and Behavioral Issues.

    PubMed

    Stone, Melissa T; Weed, Valerie; Kulich, Ronald J

    2016-09-01

    Migraine can impact every aspect of a person's functioning. Psychological comorbidities, cognitive constructs, and behavioral responses to pain greatly impact the perception of migraine pain, treatment efficacy and outcome, and overall quality of life and functioning. Current considerations for migraine treatment emphasize the utility of the biopsychosocial model in understanding and treating migraine, noting both the importance of addressing psychological factors such as cognitive beliefs as well as psychiatric comorbidities. The guidelines for migraine treatment implicate opioid therapy as a second or third tier treatment. Guidelines and recommendations for the safe use of opioid medications among patients with chronic pain emphasize the importance of screening prior to prescribing opioid medications. Chronic opioid therapy has been shown to further levels of disability, decrease quality of life, and correlate to psychiatric comorbidities, concerns that are already present in migraine patients. While opioid treatment provides an alternative for persons with contraindications for alternative migraine treatments, it is critical that opioids be used sparingly and exclusively in conjunction with comprehensive assessment and integration of psychological treatment.

  3. Recent Advances in the Understanding of Vestibular Migraine

    PubMed Central

    2016-01-01

    Approximately 1% of the general population and 10% of patients with migraine suffer from vestibular migraine (VM). However, this condition remains relatively unknown; therefore, it is often underdiagnosed despite the recent adoption of international diagnostic criteria for VM. The diagnosis of VM is based on the symptoms, degree, frequency, and duration of the vestibular episodes, a history of migraine, the temporal association of migraine symptoms with vestibular episodes in at least 50% of cases, and the exclusion of other causes. Physical examination and laboratory findings are usually normal in patients with VM but can be used to rule out other vestibular disorders with similar symptoms. The pathophysiology of VM remains incompletely understood; however, several mechanisms link the trigeminal system, which is activated during migraine attacks, and the vestibular system. Because few controlled trials have specifically investigated VM, the treatment options for this order are largely the same as those for migraine and include antiemetics for severe acute attacks, pharmacological migraine prophylaxis, and lifestyle changes. PMID:27821976

  4. Autograft Choice in Young Female Patients: Patella Tendon versus Hamstring.

    PubMed

    Shakked, Rachel; Weinberg, Maxwell; Capo, Jason; Jazrawi, Laith; Strauss, Eric

    2017-03-01

    With the increasing incidence of anterior cruciate ligament (ACL) reconstruction in women and younger patients, the optimal graft choice in the young female patient has become the subject of much debate. This study aimed to evaluate patient-reported outcomes, objective knee stability, complication rates, and the incidence of failure after ACL reconstruction using bone-patellar tendon-bone (BPTB) autograft compared with hamstring (HS) autograft in young female patients. Female patients who underwent primary ACL reconstruction with BPTB or HS autograft between ages 15 and 25 years were identified. Medical records were reviewed for postoperative complications and subsequent procedures on the operative knee. Patients were evaluated with functional surveys, physical examination including Lachman and pivot-shift tests, and arthrometric testing with a KT-1000 arthrometer. There were 37 patients in the BPTB group and 28 patients in the HS group. For patients who did not undergo revision, significant differences were not found in visual analog score (p = 0.94), Lysholm score (p = 0.81), Kujala score (p = 0.85), or Tegner level (p = 0.81). No difference was detected in the rate of return to a level of activity at or above the same level prior to injury (p = 0.31). Significantly more patients in the BPTB group were graded 1a Lachman and negative pivot shift compared with the HS group (p < 0.001). There was a significant difference in mean side-to-side manual maximum arthrometric testing (p < 0.001). There were significantly fewer subsequent procedures and a lower rate of graft failures in the BPTB group. We detected no difference in subjective functional outcomes following ACL reconstruction. However, a higher failure rate in the HS reconstructions and greater laxity by arthrometric testing may indicate increased objective stability with the use of BPTB autograft in the young female patient population. The level of evidence for this article is

  5. Female sexual dysfunction in patients with endometriosis: Indian scenario

    PubMed Central

    Mishra, Vineet V.; Nanda, Sakshi; Gandhi, Khushali; Aggarwal, Rohina; Choudhary, Sumesh; Gondhali, Raveendra

    2016-01-01

    BACKGROUND: Female sexual dysfunction (FSD) in Indian women is often overlooked due to cultural beliefs and considered as social taboos. Sexuality is an important and integral part of life. There are many causes of sexual dysfunction, but the prevalence of FSD in endometriotic patients is still underdiagnosed. MATERIALS AND METHODS: Study design - Cross-sectional observational study conducted at tertiary care center, from June 2015 to March 2016. Sample size - Fifty-one patients in reproductive age group (18–47 years) who were diagnosed with endometriosis on diagnostic laparoscopy were included. Methods - FSD was assessed with a detailed 19-item female sexual function index questionnaire. All six domains of sexual dysfunction, i.e., desire, arousal, lubrication, orgasm, satisfaction, and pain were studied. Exclusion - Patients with other gynecological, medical or surgical history were excluded. RESULTS: Out of 51 patients with endometriosis, 47.06% of patients had sexual dysfunction. With the increase in staging of endometriosis, sexual dysfunction prevalence is also rising. FSD was 100% in patients with severe endometriosis as compared to 33.33% in minimal endometriosis. CONCLUSION: Every individual deserves good sexual life. The sexual dysfunction associated with endometriosis should also be taken into consideration while managing these patients. PMID:28216913

  6. Childhood onset of migraine, gender, parental social class, and trait neuroticism as predictors of the prevalence of migraine in adulthood.

    PubMed

    Cheng, Helen; Treglown, Luke; Green, Andy; Chapman, Benjamin P; Κornilaki, Ekaterina N; Furnham, Adrian

    2016-09-01

    This study investigated the effects of socio-demographic and psychological factors in childhood and adulthood on the prevalence of migraine in adulthood using data from The National Child Development Studies (NCDS), a birth cohort in the UK. The analytical sample comprises 5799 participants with complete data. Logistic regression analysis showed that higher professional parental social class (OR=2.0: 1.05, 3.86, p<0.05), female sex (OR=2.24: 1.68-2.99, p<0.001), migraine in childhood diagnosed by physicians (OR=1.76: 1.23-2.50, p<0.01), and higher trait neuroticism (OR=1.17:1.26-1.06, p<0.01):<0 were all significantly associated with the prevalence of migraine in adulthood. Both socio-demographic and personality factors were significantly associated with the prevalence of migraine in adulthood.

  7. X-chromosome inactivation in female patients with Fabry disease.

    PubMed

    Echevarria, L; Benistan, K; Toussaint, A; Dubourg, O; Hagege, A A; Eladari, D; Jabbour, F; Beldjord, C; De Mazancourt, P; Germain, D P

    2016-01-01

    Fabry disease (FD) is an X-linked genetic disorder caused by the deficient activity of lysosomal α-galactosidase (α-Gal). While males are usually severely affected, clinical presentation in female patients may be more variable ranging from asymptomatic to, occasionally, as severely affected as male patients. The aim of this study was to evaluate the existence of skewed X-chromosome inactivation (XCI) in females with FD, its concordance between tissues, and its contribution to the phenotype. Fifty-six females with FD were enrolled. Clinical and biological work-up included two global scores [Mainz Severity Score Index (MSSI) and DS3], cardiac magnetic resonance imaging, measured glomerular filtration rate, and measurement of α-Gal activity. XCI was analyzed in four tissues using DNA methylation studies. Skewed XCI was found in 29% of the study population. A correlation was found in XCI patterns between blood and the other analyzed tissues although some punctual variability was detected. Significant differences in residual α-Gal levels, severity scores, progression of cardiomyopathy and deterioration of kidney function, depending on the direction and degree of skewing of XCI were evidenced. XCI significantly impacts the phenotype and natural history of FD in females.

  8. Body Image and the Female Adolescent Oncology Patient.

    PubMed

    Burg, Alison Joy

    2016-01-01

    Female adolescent oncology patients undergo many physical changes throughout treatment that have challenging psychological, emotional, and social implications. Body image for this population is a subject that tends to be overlooked in the midst of the cancer experience. This article will examine the complex concept of body image and discuss why female adolescent patients are at such high risk for negative body image. Assessment and care strategies are needed to foster a positive body image, resiliency, and overall well-being. Although survivorship studies may offer insightful information about the effects of the cancer journey on long-term body image, focus should be on prevention and holistic care as part of the treatment itself. The health care team, especially nursing professionals, should acknowledge, recognize, and address this vital issue as a critical part of oncology care.

  9. The metaphysical art of Giorgio de Chirico. Migraine or epilepsy?

    PubMed

    Blanke, Olaf; Landis, Theodor

    2003-01-01

    It has been suggested that the great Italian painter Giorgio de Chirico (1888-1978), who developed the unique style of 'metaphysical art', suffered from migraine and used some of his morbid manifestations as a source of inspiration for his paintings. Yet, whereas many of the symptoms that de Chirico described are rare in migraine, they are frequently encountered in patients with temporal lobe epilepsy. Here we rediscuss de Chirico's symptoms critically and suggest that, if his symptoms were of neurological origin, they rather relate to temporal lobe epilepsy than migraine.

  10. Migraine and risk of perioperative ischemic stroke and hospital readmission: hospital based registry study

    PubMed Central

    Timm, Fanny P; Houle, Timothy T; Grabitz, Stephanie D; Lihn, Anne-Louise; Stokholm, Janne B; Eikermann-Haerter, Katharina; Nozari, Ala; Kurth, Tobias

    2017-01-01

    Objective To evaluate whether patients with migraine are at increased risk of perioperative ischemic stroke and whether this may lead to an increased hospital readmission rate. Design Prospective hospital registry study. Setting Massachusetts General Hospital and two satellite campuses between January 2007 and August 2014. Participants 124 558 surgical patients (mean age 52.6 years; 54.5% women). Main outcome measures The primary outcome was perioperative ischemic stroke occurring within 30 days after surgery in patients with and without migraine and migraine aura. The secondary outcome was hospital readmission within 30 days of surgery. Exploratory outcomes included post-discharge stroke and strata of neuroanatomical stroke location. Results 10 179 (8.2%) patients had any migraine diagnosis, of whom 1278 (12.6%) had migraine with aura and 8901 (87.4%) had migraine without aura. 771 (0.6%) perioperative ischemic strokes occurred within 30 days of surgery. Patients with migraine were at increased risk of perioperative ischemic stroke (adjusted odds ratio 1.75, 95% confidence interval 1.39 to 2.21) compared with patients without migraine. The risk was higher in patients with migraine with aura (adjusted odds ratio 2.61, 1.59 to 4.29) than in those with migraine without aura (1.62, 1.26 to 2.09). The predicted absolute risk is 2.4 (2.1 to 2.8) perioperative ischemic strokes for every 1000 surgical patients. This increases to 4.3 (3.2 to 5.3) for every 1000 patients with any migraine diagnosis, 3.9 (2.9 to 5.0) for migraine without aura, and 6.3 (3.2 to 9.5) for migraine with aura.Patients with migraine had a higher rate of readmission to hospital within 30 days of discharge (adjusted odds ratio 1.31, 1.22 to 1.41). Conclusions Surgical patients with a history of migraine are at increased risk of perioperative ischemic stroke and have an increased 30 day hospital readmission rate. Migraine should be considered in the risk assessment for perioperative

  11. Animal models of monogenic migraine.

    PubMed

    Chen, Shih-Pin; Tolner, Else A; Eikermann-Haerter, Katharina

    2016-06-01

    Migraine is a highly prevalent and disabling neurological disorder with a strong genetic component. Rare monogenic forms of migraine, or syndromes in which migraine frequently occurs, help scientists to unravel pathogenetic mechanisms of migraine and its comorbidities. Transgenic mouse models for rare monogenic mutations causing familial hemiplegic migraine (FHM), cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL), and familial advanced sleep-phase syndrome (FASPS), have been created. Here, we review the current state of research using these mutant mice. We also discuss how currently available experimental approaches, including epigenetic studies, biomolecular analysis and optogenetic technologies, can be used for characterization of migraine genes to further unravel the functional and molecular pathways involved in migraine.

  12. Animal models of chronic migraine.

    PubMed

    Storer, Robin James; Supronsinchai, Weera; Srikiatkhachorn, Anan

    2015-01-01

    Many animal models of migraine have been described. Some of them have been useful in the development of new therapies. All of them have their shortcomings. Animal models of chronic migraine have been relatively less frequently described. Whether a rigid distinction between episodic and chronic migraine is useful when their underlying pathophysiology is likely to be the same and that migraine frequency probably depends on complex polygenic influences remains to be determined. Any model of chronic migraine must reflect the chronicity of the disorder and be reliable and validated with pharmacological interventions. Future animal models of chronic migraine are likely to involve recurrent activation of the trigeminal nociceptive system. Valid models would provide a means for investigating pathophysiological mechanism of the transformation from episodic to chronic migraine and may also be used to test the efficacy of potential preventive medications.

  13. Prophylaxis of migraine in children and adolescents.

    PubMed

    Kacperski, Joanne

    2015-06-01

    While it has been established that headaches in the pediatric age group are relatively common, the characterization of headache disorders and their treatment in this group has historically been limited. Due to the paucity of controlled studies on prophylaxis of the primary headache disorders in children, the diagnosis of migraine often rests on criteria similar to those used in adults. Data from adult studies are often extrapolated and applied to the pediatric patient. Although it appears that many prophylactic agents are safe, well tolerated and efficacious in children, currently only topiramate is FDA-approved for use in patients 12 years and over. As a result, despite often experiencing significant disability, many children who present to their physician with migraines do not receive preventive therapy. One-third of adolescents meet the criteria for warranting prophylactic therapy, yet few are offered a preventative medication. Moreover, controlled clinical trials investigating the use of both abortive and prophylactic medications in children have suffered from high placebo response rates. A diverse group of medications are used to prevent migraine attacks, including antidepressants, antiepileptics, antihistamines and antihypertensive agents, yet there still remains a serious lack of controlled studies on the pharmacological treatment of pediatric migraine.

  14. The effect of 17β-estradiol on gene expression of calcitonin gene-related peptide and some pro-inflammatory mediators in peripheral blood mononuclear cells from patients with pure menstrual migraine

    PubMed Central

    Karkhaneh, Azam; Ansari, Mohammad; Emamgholipour, Solaleh; Rafiee, Mohammad Hessam

    2015-01-01

    Objective(s): The neuropeptide calcitonin gene-related peptide (CGRP) has long been postulated to play an integral role in the pathophysiology of migraine. Earlier studies showed that CGRP can stimulate the synthesis and release of nitric oxide (NO) and cytokines from trigeminal ganglion glial cells. The purpose of this study was to determine the effect of 17β-estradiol in regulation of CGRP expression, inducible nitric oxide synthase (iNOS) activity, and NO and interleukin-1beta (IL-1β) release in cultured peripheral blood mononuclear cells (PBMCs) from patients with pure menstrual migraine and healthy individuals. Materials and Methods: This study was performed on twelve patients with pure menstrual migraine and twelve age-and sex-matched healthy individuals. PBMCs treated with 17β-estradiol for 24 hr at physiological and pharmacological doses. Gene expression was evaluated by real time-PCR. CGRP and IL-1β proteins in culture supernatant were determined by ELISA method. Activity of iNOS in PBMCs and total nitrite in the culture supernatant were measured by colorimetric assays. Results: Treatment with 17β-estradiol had a biphasic effect on expression of CGRP. We found that 17β-estradiol treatment at pharmacological dose significantly increases mRNA expression of CGRP in both groups (P<0.001), whereas at physiological dose it could significantly decrease CGRP mRNA expression (P<0.001), CGRP protein levels, IL-1β release, NO production and iNOS activity only in patient groups (P<0.05). Conclusion: Collectively, it appears that 17β-estradiol can exert protective effect on decrease of inflammation in migraine via decrease in levels of CGRP, IL-1β and iNOS activity; however, more studies are necessary in this regard. PMID:26526225

  15. Interictal lack of habituation of mismatch negativity in migraine.

    PubMed

    de Tommaso, M; Guido, M; Libro, G; Losito, L; Difruscolo, O; Sardaro, M; Puca, F M

    2004-08-01

    The aim was to study mismatch negativity features and habituation during the interictal phase of migraine. In migraine patients, a strong negative correlation has been found between the initial amplitude of long latency auditory-evoked potentials and their amplitude increase during subsequent averaging. We studied 12 outpatients with a diagnosis of migraine without aura recorded in a headache-free interval and 10 gender- and age-matched healthy volunteers not suffering from any recurrent headache. The experiment consisted of two sequential blocks of 2000 stimulations, during which 1800 (90%) recordings for standard tones and 200 (10%) for target tones were selected for averaging. The latency of the N1 component was significantly increased in migraine patients in respect of controls in both the first and second repetitions; the MMN latency was increased in the second repetition. In the control group the MMN amplitude decreased on average by 3.2 +/- 1.4 microV in the second trial, whereas in migraine patients it showed a slight increase of 0.21 +/- 0.11 microV in the second repetition. The MMN latency relieved in the second trial was significantly correlated with the duration of illness in the migraine patients (Spearman correlation coefficient: 0.69; P < 0.05). The increases in N1 latency and MMN latency and amplitude, the latter correlated with duration of illness, seemed to be due to a reduced anticipatory effect of stimulus repetition in migraine patients. This suggests that such hypo-activity of automatic cortical processes, subtending the discrimination of acoustic stimuli, may be a basic abnormality in migraine, developing in the course of the disease.

  16. Formulation and evaluation of diclofenac potassium fast-disintegrating tablets and their clinical application in migraine patients.

    PubMed

    Comoglu, Tansel; Dogan, Aysegul; Comoglu, Selcuk; Basci, Nursabah

    2011-03-01

    The aim of this study was to prepare fast-disintegrating tablets (FDTs) of diclofenac potassium with sufficient integrity as well as a pleasant taste, using two different fillers and binders: Tablettose 70(®) and Di-Pac(®). Tablets were made with direct compression method. Tablet properties such as porosity, hardness, and disintegration time were determined. Diclofenac potassium determinations were carried out using a validated spectrophotometric method for the analysis of drug. Furthermore, in vivo experiments were carried out to compare the analgesic effect and the time to relieve migraine headache between the commercial tablets and FDTs of diclofenac potassium against placebo. Results showed that FDTs of diclofenac potassium with durable structure and desirable taste can be prepared using both fillers and binders but tablets prepared with Di-Pac had a better taste so the tablet formulation containing Di-Pac was chosen for in vivo experiments. Placebo controlled in vivo trial demonstrated that 50 mg diclofenac potassium, administered as a single dose of FDTs or commercial tablets, was effective in relieving the pain and both of them were superior to placebo.

  17. Efficacy of feverfew as prophylactic treatment of migraine.

    PubMed Central

    Johnson, E S; Kadam, N P; Hylands, D M; Hylands, P J

    1985-01-01

    Seventeen patients who ate fresh leaves of feverfew daily as prophylaxis against migraine participated in a double blind placebo controlled trial of the herb: eight patients received capsules containing freeze dried feverfew powder and nine placebo. Those who received placebo had a significant increase in the frequency and severity of headache, nausea, and vomiting with the emergence of untoward effects during the early months of treatment. The group given capsules of feverfew showed no change in the frequency or severity of symptoms of migraine. This provides evidence that feverfew taken prophylactically prevents attacks of migraine, and confirmatory studies are now indicated, preferably with a formulation controlled for sesquiterpene lactone content, in migraine sufferers who have never treated themselves with this herb. PMID:3929876

  18. Hypovitaminosis D in female patients with chronic low back pain.

    PubMed

    Lotfi, Ahmed; Abdel-Nasser, Ahmed M; Hamdy, Ahmed; Omran, Ahmed A; El-Rehany, Mahmoud A

    2007-11-01

    Chronic low back pain (LBP) is an extremely common problem in practice, where it is often labeled idiopathic. No sufficient studies have been conducted to analyze the contribution of hypovitaminosis D to the etiology of chronic LBP in populations wherein vitamin D deficiency is endemic. The present study was, therefore, carried out to examine hypovitaminosis D and its determinants in female patients with chronic LBP during the childbearing period. Sixty female patients complaining of LBP lasting more than 3 months were clinically studied rheumatologically and neurologically. Questionnaires and indices quantifying risk factors associated with vitamin D deficiency were utilized. Biochemical assays of serum calcium, phosphorus, alkaline phosphatase (ALP), parathormone (PTH), and 25-hydroxyvitamin D (25 OHD) were performed and compared to those of 20 matched healthy controls. The determinants of vitamin D levels in patients were examined by stepwise regression. Patients with LBP had significantly lower 25 OHD levels (p < 0.05) and significantly higher PTH (p < 0.05) and ALP (p < 0.001) than controls, although there were no significant group differences in calcium and phosphorus. Hypovitaminosis D (25 OHD < 40 ng/ml) was found in 49/60 patients (81%) and 12/20 (60%) of controls, with an odds ratio of 2.97. Although many risk factors related to sun exposure, clothing, diet, and pregnancy were significantly correlated with vitamin D levels in patients, only limited duration of sun exposure, contributing 55% to the variance of 25 OHD, limited areas of skin exposed (13%), and increased number of pregnancies (2%), were significant determinants of vitamin D levels in patients. Despite the sunny climate, hypovitaminosis D is prevalent among Egyptian women in the childbearing period, especially those presenting with chronic LBP, where it is associated with hyperphosphatasia and hyperparathyroidism, without alterations in serum calcium. The major determinant of hypovitaminosis D

  19. A Narrative Review of Evidence-Based Preventive Options for Chronic Migraine.

    PubMed

    Starling, Amaal J; Vargas, Bert B

    2015-10-01

    Chronic migraine is a debilitating disorder that affects 2 % of the global population and imparts a significant societal and economic impact. The cornerstones of chronic migraine management include making an accurate diagnosis, patient education, treatment of comorbid conditions, and selection of an appropriate, evidence-based acute and preventive treatment regimen. Although it is common to treat chronic migraine with preventive medications effective for episodic migraine, a number of treatment options exist with specific evidence for effectiveness in chronic migraine. Currently, onabotulinumtoxinA injections are the only FDA-approved preventive treatment for chronic migraine. A number of non-medication treatment options including occipital nerve and supraorbital nerve stimulation have shown promise as effective prevention for patients either unable to tolerate or unable to obtain relief from oral medications, but more research is necessary.

  20. "Alice in Wonderland syndrome" associated with topiramate for migraine prevention.

    PubMed

    Jürgens, T P; Ihle, K; Stork, J-H; May, A

    2011-02-01

    Various visual and sensory phenomena have been described in migraine with aura. Among those, the 'Alice in Wonderland' syndrome is defined as a distortion of the body image with the patient being aware of its unreal nature. Here, the case of a 17-year-old girl with migraine without aura who developed an 'Alice in Wonderland' syndrome repeatedly on topiramate treatment was presented and potential pathophysiological concepts were discussed.

  1. Migraines with and without aura and their response to preventive therapy with topiramate.

    PubMed

    Reuter, U; Del Rio, M S; Diener, H-C; Allais, G; Davies, B; Gendolla, A; Pfeil, J; Schwalen, S; Schäuble, B; van Oene, J

    2010-05-01

    Data from the Prolonged Migraine Prevention (PROMPT) with Topiramate trial were evaluated post hoc to determine whether topiramate could prevent migraine auras, and whether its efficacy in preventing migraine headaches was similar in patients with (MA; n = 269) and without (MoA; n = 542) aura. Migraines and auras were recorded during prospective baseline, 6-month open-label (OL) topiramate and 6-month double-blind (DB), placebo-controlled phases. In the last 28 OL days, migraines without aura and migraine auras decreased by 43.1% and 54.1%, respectively, in MA patients. MoA patients experienced a 44.3% reduction in migraines. In the DB phase, increases in migraines with placebo vs. topiramate were similar to the full study, but were generally not statistically significant, probably due to lack of power in the subgroup analysis. Similarly, there were no statistically significant changes in number of auras between groups. Thus, topiramate appears to reduce migraine auras in parallel with headache reductions, which are similar in patients with and without aura.

  2. Evidence-based guideline update: NSAIDs and other complementary treatments for episodic migraine prevention in adults

    PubMed Central

    Holland, S.; Silberstein, S.D.; Freitag, F.; Dodick, D.W.; Argoff, C.; Ashman, E.

    2012-01-01

    Objective: To provide updated evidence-based recommendations for the preventive treatment of migraine headache. The clinical question addressed was: Are nonsteroidal anti-inflammatory drugs (NSAIDs) or other complementary treatments effective for migraine prevention? Methods: The authors analyzed published studies from June 1999 to May 2009 using a structured review process to classify the evidence relative to the efficacy of various medications for migraine prevention. Results: The author panel reviewed 284 abstracts, which ultimately yielded 49 Class I or Class II articles on migraine prevention; of these 49, 15 were classified as involving nontraditional therapies, NSAIDs, and other complementary therapies that are reviewed herein. Recommendations: Petasites (butterbur) is effective for migraine prevention and should be offered to patients with migraine to reduce the frequency and severity of migraine attacks (Level A). Fenoprofen, ibuprofen, ketoprofen, naproxen, naproxen sodium, MIG-99 (feverfew), magnesium, riboflavin, and subcutaneous histamine are probably effective for migraine prevention (Level B). Treatments considered possibly effective are cyproheptadine, Co-Q10, estrogen, mefenamic acid, and flurbiprofen (Level C). Data are conflicting or inadequate to support or refute use of aspirin, indomethacin, omega-3, or hyperbaric oxygen for migraine prevention. Montelukast is established as probably ineffective for migraine prevention (Level B). PMID:22529203

  3. Genetic analysis for a shared biological basis between migraine and coronary artery disease

    PubMed Central

    Winsvold, Bendik S.; Nelson, Christopher P.; Malik, Rainer; Gormley, Padhraig; Anttila, Verneri; Vander Heiden, Jason; Elliott, Katherine S.; Jacobsen, Line M.; Palta, Priit; Amin, Najaf; de Vries, Boukje; Hämäläinen, Eija; Freilinger, Tobias; Ikram, M. Arfan; Kessler, Thorsten; Koiranen, Markku; Ligthart, Lannie; McMahon, George; Pedersen, Linda M.; Willenborg, Christina; Won, Hong-Hee; Olesen, Jes; Artto, Ville; Assimes, Themistocles L.; Blankenberg, Stefan; Boomsma, Dorret I.; Cherkas, Lynn; Davey Smith, George; Epstein, Stephen E.; Erdmann, Jeanette; Ferrari, Michel D.; Göbel, Hartmut; Hall, Alistair S.; Jarvelin, Marjo-Riitta; Kallela, Mikko; Kaprio, Jaakko; Kathiresan, Sekar; Lehtimäki, Terho; McPherson, Ruth; März, Winfried; Nyholt, Dale R.; O'Donnell, Christopher J.; Quaye, Lydia; Rader, Daniel J.; Raitakari, Olli; Roberts, Robert; Schunkert, Heribert; Schürks, Markus; Stewart, Alexandre F.R.; Terwindt, Gisela M.; Thorsteinsdottir, Unnur; van den Maagdenberg, Arn M.J.M.; van Duijn, Cornelia; Wessman, Maija; Kurth, Tobias; Kubisch, Christian; Dichgans, Martin; Chasman, Daniel I.; Cotsapas, Chris; Zwart, John-Anker; Samani, Nilesh J.

    2015-01-01

    Objective: To apply genetic analysis of genome-wide association data to study the extent and nature of a shared biological basis between migraine and coronary artery disease (CAD). Methods: Four separate methods for cross-phenotype genetic analysis were applied on data from 2 large-scale genome-wide association studies of migraine (19,981 cases, 56,667 controls) and CAD (21,076 cases, 63,014 controls). The first 2 methods quantified the extent of overlapping risk variants and assessed the load of CAD risk loci in migraineurs. Genomic regions of shared risk were then identified by analysis of covariance patterns between the 2 phenotypes and by querying known genome-wide significant loci. Results: We found a significant overlap of genetic risk loci for migraine and CAD. When stratified by migraine subtype, this was limited to migraine without aura, and the overlap was protective in that patients with migraine had a lower load of CAD risk alleles than controls. Genes indicated by 16 shared risk loci point to mechanisms with potential roles in migraine pathogenesis and CAD, including endothelial dysfunction (PHACTR1) and insulin homeostasis (GIP). Conclusions: The results suggest that shared biological processes contribute to risk of migraine and CAD, but surprisingly this commonality is restricted to migraine without aura and the impact is in opposite directions. Understanding the mechanisms underlying these processes and their opposite relationship to migraine and CAD may improve our understanding of both disorders. PMID:27066539

  4. Characteristic Headaches with Cervical Migraine (O Kharakteristike Golovnoi Boli pri Sheinoi Migreni),

    DTIC Science & Technology

    Headache is the leading symptom of cervical migraine. The localization and irradiation of pains, the characteristic gesture of the patients, the...characteristics of cervical migraine. It must be assumed that knowledge through further studies of the clinical aspects and diagnosis of this...widespread disease will eventually reach all practicing physicians, and that in time ’ cervical migraine’ will become a common diagnosis at any polyclinic. (Author)

  5. The association between abdominal obesity and characteristics of migraine attacks in Iranian adults

    PubMed Central

    Sadeghi, Omid; Askari, Gholamreza; Maghsoudi, Zahra; Ghiasvand, Reza; Khorvash, Fariborz

    2016-01-01

    Background: Migraine is a primary headache disorder that affects the neurovascular system. Recent studies have shown that migraine patients with general obesity have higher characteristics of migraine attacks compared with normal weight patients, but data on central obesity are scarce. This study was done to assess the relationship between central obesity and the characteristics of migraine attacks in migraine patients. Materials and Methods: This cross-sectional study was conducted on 129 migraine patients (28 men and 101 women), aged 15–67 years, in Isfahan, Iran. Anthropometric measurements such as waist circumference (WC), hip circumference (HC), waist–hip ratio (WHR) and waist–height ratio (WHtR), as well as characteristics of migraine attacks such as severity, frequency, duration, and headache diary result (HDR) was determined for each participant. Linear regression was used to examine the association between anthropometric measurements and characteristics of migraine attacks. P value less than 0.05 was considered significant. Results: WC, WHR, and WHtR were positively associated with the severity (P-value: WC: 0.002, WHR: 0.002, WHtR: 0.001) and frequency (P-value: WC: 0.006, WHR: 0.01, WHtR: 0.002) of migraine attacks. Moreover, we found a significant association between WC (P = 0.001), WHR (P = 0.004), and WHtR (P < 0.001) with HDR. No significant relationship was observed between central obesity indicators and duration of migraine attacks. Conclusions: Central obesity indicators were positively associated with the severity and frequency of migraine attacks as well as HDR, but not with duration of attacks. Based on our findings, it can be concluded that weight loss may decrease the characteristics of migraine attacks. PMID:27186204

  6. Daily Migraine Prevention and Its Influence on Resource Utilization in the Military Health System

    DTIC Science & Technology

    2006-08-01

    of migraine and the evolution of treatment. One of the earliest known references comes from a historical Mesopotamian text dated around 3000 B.C...care resource utilization. b. Economic Impact and Resource Utilization Associated with Migraine The Natio t for 3.5 million ambulatory visits...prom aine patients who met one or more of th . T ily Migraine Prevention by the International Headache Consortium oted the use of daily

  7. Prevalence and characteristics of migraine in medical students and its impact on their daily activities

    PubMed Central

    Menon, Bindu; Kinnera, Neeharika

    2013-01-01

    Background: Migraine is a common neurological disorder with significant impact on quality of life. The aim of this study was to investigate the prevalence and characteristics of migraine headaches in medical students, to measure its impact on their life, and to assess their knowledge about the ailment. Information about lifestyle variables was also collected. Materials and Methods: All medical students who confirmed of having headache for more than 1 year formed the study group. Students filled a detailed questionnaire focusing on demographics, pain characteristics, accompanying factors, triggers, and family history of migraine. Lifestyle variables were enquired and migraine associated disability was assessed by MIDAS (Migraine Disability Assessment). The diagnosis of migraine was made according to the International Headache Society criteria. Results are expressed in n = numbers and percentage. Results: Sixty-eight percent of medical students had headache. The prevalence of migraine in the whole cohort was 28%; however, of the headache group, migraine constituted 42%. There was a female preponderance. One-fourth of the students had weekly or daily attacks with 31% students reporting increase in their headache intensity and frequency. Forty-four percent of students had severe headaches. Dizziness, allodynia, and neck stiffness were reported as accompanying symptoms. Trigger factors were identified in 99% students, predominant of which were poor sleep hygiene, environmental changes, head movements, and mental stress. Only 4% of students did regular exercise. Twenty-seven percent of students reported self-medication use of analgesics. One-fourth of the students had migraine-associated disability but only 6% realized that they had migraine. Conclusion: Our study found a high prevalence of headache with migraine in medical students. The students’ awareness of the disease was very low with one-fourth of the students resorting to self-medication. Our study identified

  8. Female sexual dysfunction in patients with substance-related disorders

    PubMed Central

    Diehl, Alessandra; da Silva, Rosiane Lopes; Laranjeira, Ronaldo

    2013-01-01

    OBJECTIVE: To estimate the prevalence of female sexual dysfunction symptoms and the associated risk factors in a sample of patients with substance-related disorders admitted to a specialized in-patient care unit. METHODS: This study used a cross-section design, with eight months of data collection, conducted with substance-dependent women using structured questionnaires to collect socio-demographic data and identify their drug of choice. The Drug Abuse Screening Test, Short Alcohol Dependence Data questionnaire, Fagerström Test for Nicotine Dependence, and Arizona Sexual Experience Scale were also administered. RESULTS: The sample consisted of 105 women who had a mean age of 34.8 years (SD = 12.1, range = 18-65) and were predominantly heterosexual (74.3%), single (47.6%), Caucasian (50.5%), catholic (36.2%), and educated only to the level of primary education (40%), with a monthly family income of up to one minimum salary (37.5%). In 42.9% of the patients, crack was the drug of choice; 47.6% of the sample qualified for the Drug Abuse Screening Test (substantial problems related to drugs), 43.8% exhibited Short Alcohol Dependence Data (moderate or severe dependency), 47.6% exhibited Fagerström Test for Nicotine Dependence (high or very high nicotine dependence). The prevalence of sexual dysfunction symptoms was 34.2% (95% CI = [25.3, 44.1]), and a high level of nicotine dependence and low income increased the chances of having sexual dysfunction by 2.72-fold and 2.54 fold, respectively. An association was also observed between female sexual dysfunction symptoms and schooling and levels of drug dependence. CONCLUSIONS: Female sexual dysfunction symptoms were common among this sample and primarily associated with high levels of nicotine use. PMID:23525317

  9. The impact of migraine: a case study.

    PubMed

    Jung, Sharon

    2007-08-01

    Migraine headaches are common and among the most disabling nonfatal conditions of humankind. They are frequently misdiagnosed, which may lead to undertreatment. Patients often self-diagnose and self-medicate, resulting in inadequate treatment. Consequently, patients may take additional doses, trying to gain relief with inappropriate medications. Rebound can ensue. With adequate treatment, a patient's condition and quality of life may improve considerably. Patient education is extremely important to help patients identify appropriate self-care measures, such as identification of triggering events and coping with the chronic nature of their condition. This case study presents a patient who began experiencing migraines following a neck injury. His headaches became more frequent, and ergotamine and caffeine (Cafergot) suppositories were prescribed. When he presented, he was experiencing daily headaches and using daily ergotamine and caffeine suppositories. He was using the emergency department (ED) frequently because of severe headaches. Cervical spasm was recognized as his trigger, and the ergotamine and caffeine suppositories were discontinued. After 3 days of severe headaches, his rebound ceased. He reverted back to episodic migraines, which he treated with zolmitriptan (Zomig) nasal spray, which was effective. His cervical spasm was treated with botulinum toxin type A (Botox), with excellent results. He has maintained reasonable headache control for 2 years.

  10. Habituation of single CO2 laser-evoked responses during interictal phase of migraine.

    PubMed

    de Tommaso, Marina; Libro, Giuseppe; Guido, Marco; Losito, Luciana; Lamberti, Paolo; Livrea, Paolo

    2005-09-01

    A reduced habituation of averaged laser-evoked potential (LEP) amplitudes was previously found in migraine patients. The aim of the present study was to assess the habituation of single LEP responses and pain sensation during the interictal phase in migraine patients. Fourteen migraine patients were compared with ten control subjects. The pain stimulus was laser pulses, generated by CO2 laser, delivered to right supraorbital zone. Patients were evaluated during attack-free conditions. The LEP habituation was studied by measuring the changes of LEP amplitudes across and within three consecutive repetitions of 21 non-averaged trials. In migraine patients the N2-P2 wave amplitudes did not show a tendency toward habituation across and, above all, within the three repetitions. Anomalous behaviour of nociceptive cortex during the interictal phase of migraine may predispose patients to headache occurrence and persistence.

  11. Height velocity curves in female patients with idiopathic scoliosis.

    PubMed

    Chazono, Masaaki; Soshi, Sigeru; Kida, Yoshikuni; Hashimoto, Kurando; Inoue, Takeshi; Nakamura, Yousuke; Shinohara, Akira; Marumo, Keishi; Kono, Katsuki; Suzuki, Nobumasa

    2012-01-01

    Following identification of peak height velocity (PHV) by a recent study as a possible prognostic factor for curve progression in patients with idiopathic scoliosis (IS), the aim of this study was to investigate PHV curves in Japanese female patients with IS. The study subjects were 20 skeletally immature IS patients who were followed until maturity. The mean age and the mean pubertal status at the initial visit were 9.8 years and 24 months before menarche, respectively, with a follow-up period of 5.2 years. Height measurements were recorded at each visit, and HV was calculated as the change in height (cm) divided by the time interval (yr.) between visits of 6 to 12 months. The PHV, age at PHV (APHV), height at PHV (HPHV), and final height (FH) were determined. Patient HV curves were plotted using their HV data, and growth periods (GPs) were calculated from the curves. PHVs and GPs of study patients were compared to standard data from unaffected girls. The median values and interquartile ranges in PHV, APHV, HPHV, and FH were 8.5 cm/yr. (7.9-9.7), 11.8 yr. (11.2-12.1), 153.2 cm (150.1-155.8), and 160.1 cm (157.4-162.4), respectively. The median GP was 27 months. The PHV and GP values in IS female patients were higher and shorter than those in unaffected girls. These findings indicate that the patterns of height velocity curves in IS patients are different from those in unaffected girls, suggesting that curve progression in IS patients is associated with the magnitude of PHV and duration of GP. Recently, we have developed an HV reader to easily and quickly identify the present HV in patients with scoliosis, applicable for the clinical setting or school screening. We conclude that risk assessments of curve progression in patients with IS should include HV along with measures of skeletal maturity such as the Risser sign and/or digital skeletal age using hand X-rays.

  12. Cognitive functioning in female patients with 21-hydroxylase deficiency.

    PubMed

    Dittmann, R W; Kappes, M H; Kappes, M E

    1993-01-01

    The cognitive functioning of 27 female patients with congenital adrenal hyperplasia (CAH) (aged 11-41 yrs) and 13 of their healthy sisters (13-31 yrs) was compared using short versions of age-appropriate Wechsler scales. In contrast to other studies, neither a higher than average IQ level for CAH patients (mean: 99.0) nor for their sisters (97.7) was found. Unexpectedly, and in contrast to other reports, the subgroup of salt-wasting (SW) patients>16 yrs (N=6; mean score: 111.5) differed from their sisters as well as from simple-virilizing (SV) patients in "full IQ" (p<0.05) and subtest scorings for "Information", "Similarities", and "Picture Completion" (p<0.05-<0.10). SW patients displayed "more masculine" behaviour (vs. SV patients and sisters) which, in turn, was related to differential prenatal hormonal influences. No clear-cut relationships between IQ/cognitive (subtest) findings and gender-role behaviour were found.

  13. New therapeutic approaches for the prevention and treatment of migraine.

    PubMed

    Diener, Hans-Christoph; Charles, Andrew; Goadsby, Peter J; Holle, Dagny

    2015-10-01

    The management of patients with migraine is often unsatisfactory because available acute and preventive therapies are either ineffective or poorly tolerated. The acute treatment of migraine attacks has been limited to the use of analgesics, combinations of analgesics with caffeine, ergotamines, and the triptans. Successful new approaches for the treatment of acute migraine target calcitonin gene-related peptide (CGRP) and serotonin (5-hydroxytryptamine, 5-HT1F) receptors. Other approaches targeting the transient receptor potential vanilloid (TRPV1) receptor, glutamate, GABAA receptors, or a combination of 5-HT1B/1D receptors and neuronal nitric oxide synthesis have been investigated but have not been successful in clinical trials thus far. In migraine prevention, the most promising new approaches are humanised antibodies against CGRP or the CGRP receptor. Non-invasive and invasive neuromodulation approaches also show promise as both acute and preventive therapies, although further studies are needed to define appropriate candidates for these therapies and optimum protocols for their use.

  14. Efficacy and mechanism of anticonvulsant drugs in migraine.

    PubMed

    Hoffmann, Jan; Akerman, Simon; Goadsby, Peter J

    2014-03-01

    Anticonvulsants represent one of the main substance classes used for the preventive treatment of migraine. Efficacy has been demonstrated in randomized placebo-controlled trials for topiramate and valproic acid including divalproex sodium. In the case of topiramate, efficacy has recently been proven for chronic migraine and even medication overuse headache, questioning the established concept of medication withdrawal. However, preventive treatment with anticonvulsants is frequently hampered by side effects that occasionally require treatment discontinuation. In addition, these data indicate that some anticonvulsant drugs are effective in migraine, while a number are clearly not useful. Effective anticonvulsants, such as topiramate and valproate, target nociceptive trigeminovascular and trigeminothalamic dural pathways or mechanisms involved in cortical spreading depression. Dissecting out how the anticonvulsants that do not work differ mechanistically from those that do will almost certainly provide avenues through which one can develop new treatments to bring to patients with migraine.

  15. Considerations for management of migraine symptoms in the primary care setting.

    PubMed

    Silberstein, Stephen D

    2016-06-01

    Migraine is a common disabling brain disorder that affects one in seven US citizens annually. The burden of migraine is substantial, both in economic terms and for individual patients and their close family members. Initial medical consultations for migraine are usually with a primary care physician (PCP), and it is predominantly managed in a primary care setting; therefore, PCPs need a thorough understanding of migraine and the treatment options. This review provides an overview of the prevalence, symptoms, burden, and diagnosis of migraine with a focus on adults. Important aspects of migraine management, such as medication overuse and chronic migraine, are highlighted and insight is provided into factors for consideration when prescribing acute/abortive treatment for migraine to ensure that individual patients receive optimal pharmaceutical management. The effects of associated symptoms, e.g. nausea/vomiting, on treatment efficacy are pertinent in migraine; however, many therapy options, including alternative delivery systems, are available, thus facilitating the selection of optimal treatment for an individual patient.

  16. Inhaled corticosteroids can reduce osteoporosis in female patients with COPD

    PubMed Central

    Liu, Shih-Feng; Kuo, Ho-Chang; Liu, Guan-Heng; Ho, Shu-Chen; Chang, Huang-Chih; Huang, Hung-Tu; Chen, Yu-Mu; Huang, Kuo-Tung; Chen, Kuan-Yi; Fang, Wen-Feng; Lin, Meng-Chih

    2016-01-01

    Background Whether the use of inhaled corticosteroids (ICSs) in patients with COPD can protect from osteoporosis remains undetermined. The aim of this study is to assess the incidence of osteoporosis in patients with COPD with ICS use and without. Patients and methods This is a retrospective cohort and population-based study in which we extracted newly diagnosed female patients with COPD between 1997 and 2009 from Taiwan’s National Health Insurance (TNHI) database between 1996 and 2011 (International Classification of Diseases, Ninth Revision – Clinical Modification [ICD-9-CM] 491, 492, 496). The patients with COPD were defined by the presence of two or more diagnostic codes for COPD within 12 months on either inpatient or outpatient service claims submitted to TNHI. Patients were excluded if they were younger than 40 years or if osteoporosis had been diagnosed prior to the diagnosis of COPD and cases of asthma (ICD-9 CM code 493.X) before the index date. These enrolled patients were followed up till 2011, and the incidence of osteoporosis was determined. The Cox proportional hazards regression model was also used to estimate hazard ratios (HRs) for incidences of lung cancer. Results Totally, 10,723 patients with COPD, including ICS users (n=812) and nonusers (n=9,911), were enrolled. The incidence rate of osteoporosis per 100,000 person years is 4,395 in nonusers and 2,709 in ICS users (HR: 0.73, 95% confidence interval [CI]: 0.63–084). The higher ICS dose is associated with lower risk of osteoporosis (0 mg to ≤20 mg, HR: 0.84, 95% CI: 0.69–1.04; >20 mg to ≤60 mg, HR: 0.78, 95% CI: 0.59–1.04; and >60 mg, HR: 0.72, 95% CI: 0.55–0.96; P for trend =0.0023) after adjusting for age, income, and medications. The cumulative osteoporosis probability significantly decreased among the ICS users when compared with the nonusers (P<0.001). Conclusion Female patients with COPD using ICS have a dose–response protective effect for osteoporosis. PMID:27478374

  17. Obesity and headache/migraine: the importance of weight reduction through lifestyle modifications.

    PubMed

    Verrotti, Alberto; Di Fonzo, Alessia; Penta, Laura; Agostinelli, Sergio; Parisi, Pasquale

    2014-01-01

    The aim of this study is to determine a possible relationship between prevalence, frequency, and severity of migraine and obesity. All pertinent data from the literature have been critically examined and reviewed in order to assess the possible relationship between obesity and migraine, in particular migraine frequency and disability in children, as well as in adult population studies. Prevalence, frequency, and severity of migraine appear to increase in relation to the body mass index, although this evidence is not supported by all the studies examined. Data from literature suggest that obesity can be linked with migraine prevalence, frequency, and disability both in pediatric and adult subjects. These data have important clinical implications and suggest that clinicians should have a special interest for weight reduction of obese children suffering from migraine, prescribing and supporting intensive lifestyle modifications (dietary, physical activities, and behavioral) for the patient and the entire family.

  18. Obesity and Headache/Migraine: The Importance of Weight Reduction through Lifestyle Modifications

    PubMed Central

    Verrotti, Alberto; Di Fonzo, Alessia; Agostinelli, Sergio

    2014-01-01

    The aim of this study is to determine a possible relationship between prevalence, frequency, and severity of migraine and obesity. All pertinent data from the literature have been critically examined and reviewed in order to assess the possible relationship between obesity and migraine, in particular migraine frequency and disability in children, as well as in adult population studies. Prevalence, frequency, and severity of migraine appear to increase in relation to the body mass index, although this evidence is not supported by all the studies examined. Data from literature suggest that obesity can be linked with migraine prevalence, frequency, and disability both in pediatric and adult subjects. These data have important clinical implications and suggest that clinicians should have a special interest for weight reduction of obese children suffering from migraine, prescribing and supporting intensive lifestyle modifications (dietary, physical activities, and behavioral) for the patient and the entire family. PMID:24800223

  19. Arterial hypertension in migraine: Role of familial history and cardiovascular phenotype.

    PubMed

    Babayan, Laura; Mamontov, Oleg V; Amelin, Alexander V; Bogachev, Mikhail; Kamshilin, Alexei A

    2017-03-01

    Recent studies indicate that migraine is associated with increased risk of cardiovascular diseases. However, links between autonomic cardiovascular regulation, arterial hypertension (AH) and migraine are still little explored. In this study, we evaluated autonomic regulation in migraine patients with and without hypertension. We studied 104 patients with migraine, aged 34±10 y, including 28 with and 76 without hypertension (M+AH and M-AH groups, respectively). The control group consisted of 88 healthy volunteers matched by age and sex. The autonomic regulation of circulation was examined with the tilt-table test, deep-breathing and Valsalva Maneuver, handgrip test, cold-stress induced vasoconstriction, arterial baroreflex, and blood pressure variability measurements. We found that migraine patients with concomitant hypertension demonstrated reduced arterial baroreflex, whereas other parameters of cardiac autonomic regulation were unchanged. In contrast, most indicators of vasomotor reactivity (blood pressure response to the hand-grip, Valsalva maneuver and cold vasoconstriction) were enhanced in migraine patients with no significant differences between migraine patients with and without hypertension. Patients from both M+AH and M-AH groups more commonly had a family history of cardiovascular disorders. Our data revealed increased vasomotor reactivity in migraine patients, with or without concomitant hypertension. This was associated with the family history of cardiovascular diseases.

  20. Caring for female patients: The experiences of male nurses.

    PubMed

    Keogh, Brian; Gleeson, Madeline

    This article presents the results of two small qualitative studies, which examined the experiences of six male registered psychiatric nurses (RPN) and five male registered general nurses (RGN) when caring for patients of the opposite sex. Semi-structured interviews were used to collect the data. The focus of the interviews was an attempt to describe the male nurses' experiences of caring for women with a particular emphasis on interventions that involved physical touch. Themes were generated from both studies and the common themes are presented here. Male nurses in this study were often apprehensive about using physical touch and they used coping strategies in response to their fears of being accused of using touch inappropriately. Several factors also influenced the male nurses when using physical touch as an intervention. These findings suggest that learning about caring for female patients needs to be included in the undergraduate curriculum and that further research on the experience of men as nurses is required.

  1. Treatment of Osteitis Pubis in Non-Athlete Female Patients

    PubMed Central

    Kavroudakis, E; Karampinas, P.K; Evangelopoulos, D.S; Vlamis, J

    2011-01-01

    Background: Osteitis pubis represents a non-infectious inflammation of the pubic symphysis causing varying degrees of lower abdominal and pelvic pain. Although, the disease is believed to affect mainly young athletic patients, it is also encountered in other specific patient groups. Both conservative and surgical treatment options are available. While for elite athletes surgical treatment is indicated, leading to fast pain relief and mobilization, for non-athletic patients no clear indication can be established. Methods: Eight non-athletic women with osteitis pubis, referred to our Department for treatment, were evaluated. All were initially treated conservatively with bed rest, per os non steroidal anti-inflammatory drugs and physical therapy. Results: Seven patients improved significantly with conservative treatment while one displayed no improvement and was treated surgically with arthrodesis. Conclusion: We conclude that, for non-athletic female patients suffering from osteitis pubis, surgery is rarely required and that conservative treatment by means of non steroidal anti inflammatory drugs and physical modalities represents a fair option regarding pain and limitation of everyday activity. PMID:21966337

  2. Endothelial dysfunction state in migraine headache and neutrally mediated syncope in children and young adults

    PubMed Central

    Sabri, Mohammad Reza; Dehghan, Bahar; Yaghini, Omid; Nasiri, Jafar; Mansourian, Marjan; Khalifehsoltani, Shiva

    2015-01-01

    Background: Recent evidences have supported migraine headache and neurally mediated syncope as the especial types of endotheliopathies. To determine endothelial function in patients with migraine headache or those with neurally mediated syncope, the present study was conducted. Materials and Methods: This cross-sectional study was performed on 93 consecutive patients aged 5-20 years in four groups; neurally mediated syncope, migraine, both neurally mediated syncope and migraine, and control groups. All subjects were tested for basic biophysical and biochemical features including age, gender, body mass index, systolic, and diastolic blood pressures, intima-media thickness (IMT) and flow-mediated dilation (FMD), blood hemoglobin, fasting blood glucose, lipid profile, intercellular adhesion molecule (ICAM), vascular cell adhesion molecule (VCAM), and E-selectin. Results: The mean levels of VCAM and ICAM were significantly higher in all groups when compared to control group (P < 0.05). FMD was significantly higher in syncope, migraine, and syncope and migraine groups than in the control group (P < 0.05). Furthermore, mean IMT was significantly lower in migraine and also in syncope and migraine groups than in syncope group and control group (P < 0.05). Examining the association between IMT and other baseline parameters showed positive association of IMT with systolic and diastolic blood pressures. Conclusion: Endothelial dysfunction is seen in both migraine headache and neurally mediated syncope. Changes in endothelial functional indices are also dependent on the blood pressure. PMID:26664425

  3. Functional Connectivity of EEG Signals Under Laser Stimulation in Migraine

    PubMed Central

    de Tommaso, Marina; Trotta, Gabriele; Vecchio, Eleonora; Ricci, Katia; Van de Steen, Frederik; Montemurno, Anna; Lorenzo, Marta; Marinazzo, Daniele; Bellotti, Roberto; Stramaglia, Sebastiano

    2015-01-01

    In previous studies, migraine patients showed abnormalities in pain-related evoked responses, as reduced habituation to repetitive stimulation. In this study, we aimed to apply a novel analysis of EEG bands synchronization and directed dynamical influences under painful stimuli in migraine patients compared to non-migraine healthy volunteers. Thirty-one migraine without aura outpatients (MIGR) were evaluated and compared to 19 controls (CONT). The right hand was stimulated by means of 30 consecutive CO2 laser stimuli. EEG signal was examined by means of Morlet wavelet, synchronization entropy (SE), and Granger causality (GC), and the statistically validated results were mapped on the corresponding scalp locations. The vertex complex of averaged laser-evoked responses (LEPs) showed reduced habituation compared to CONT. In the prestimulus phase, enhanced SE in the 0, 5–30 Hz range was present in MIGR and CONT between the bilateral temporal–parietal and the frontal regions around the midline. Migraine patients showed an anticipation of EEG changes preceding the painful stimulation compared to CONT. In the poststimulus phase, the same cortical areas were more connected in MIGR vs CONT. In both groups of patients and CONT, the habituation index was negatively correlated with the GC scores. A different pattern of cortical activation after painful stimulation was present in migraine. The increase in cortical connections during repetitive painful stimulation may subtend the phenomenon of LEPs reduced habituation. Brain network analysis may give an aid in understanding subtle changes of pain processing under laser stimuli in migraine patients. PMID:26635589

  4. Cluster Headache: Special Considerations for Treatment of Female Patients of Reproductive Age and Pediatric Patients.

    PubMed

    VanderPluym, Juliana

    2016-01-01

    Cluster headache is a rare disorder that is more common in adult male patients. It has a unique phenotype of unilateral, severe, to very severe headaches lasting 15 to 180 min with ipsilateral autonomic symptoms. Time to correct diagnosis can be protracted. A number of treatment options exist for the standard cluster headache patient, but special considerations must be made for female patients of reproductive age and pediatric patients. The objective of this article is to explore the current literature pertaining to special considerations in cluster headache management, including treatment of pregnant or breastfeeding patients and pediatric patients.

  5. Inducible nitric oxide synthase haplotype associated with migraine and aura.

    PubMed

    de O S Mansur, Thiago; Gonçalves, Flavia M; Martins-Oliveira, Alisson; Speciali, Jose G; Dach, Fabiola; Lacchini, Riccardo; Tanus-Santos, Jose E

    2012-05-01

    Migraine is a complex neurological disorder with a clear neurogenic inflammatory component apparently including enhanced nitric oxide (NO) formation. Excessive NO amounts possibly contributing to migraine are derived from increased expression and activity of inducible NO synthase (iNOS). We tested the hypothesis that two functional, clinically relevant iNOS genetic polymorphisms (C(-1026)A-rs2779249 and G2087A-rs2297518) are associated with migraine with or without aura. We studied 142 healthy women without migraine (control group) and 200 women with migraine divided into two groups: 148 with migraine without aura (MWA) and 52 with aura (MA). Genotypes were determined by real-time polymerase chain reaction using the Taqman(®) allele discrimination assays. The PHASE 2.1 software was used to estimate the haplotypes. The A allele for the G2087A polymorphism was more commonly found in the MA group than in the MWA group (28 vs. 18%; P < 0.05). No other significant differences in the alleles or genotypes distributions were found (P > 0.05). The haplotype combining both A alleles for the two polymorphisms was more commonly found in the MA group than in the control group or in the MWA group (19 vs. 10 or 8%; P = 0.0245 or 0.0027, respectively). Our findings indicate that the G2087A and the C(-1026)A polymorphism in the iNOS gene affect the susceptibility to migraine with aura when their effects are combined within haplotypes, whereas the G2087A affects the susceptibility to aura in migraine patients. These finding may have therapeutic implications when examining the effects of selective iNOS inhibitors.

  6. Humanistic and economic burden of nausea and vomiting among migraine sufferers

    PubMed Central

    Gajria, Kavita; Lee, Lulu K; Flores, Natalia M; Aycardi, Ernesto; Gandhi, Sanjay K

    2017-01-01

    Background While studies have demonstrated the economic burden of migraines in terms of quality of life, health care resource use (HRU), and costs, there exists a notable paucity of data comparing such outcomes among migraineurs with nausea and vomiting (N/V) and those without. The current study aimed to address this gap. Methods This was a retrospective study using data from the 2013 US National Health and Wellness Survey, a cross-sectional, internet-based survey. Respondents self-reported their migraine with or without N/V along with demographics and outcomes including depression (Patient Health Questionnaire total score; PHQ-9), sleep problems (11-item total score of sleep problems), HRU (number of physician visits, emergency room [ER] visits, and hospitalizations) and Work Productivity and Activity Impairment-General Health Scale (WPAI-GH), and associated mean annual costs. Generalized linear models, adjusting for covariates, assessed the burden of N/V on all outcomes. Results Among all migraineurs (N=7,855), 73.4% were female, mean age was 41.82 years old, and 57.6% reported experiencing N/V. Adjusting for covariates, migraineurs with N/V vs without N/V had higher mean PHQ-9 scores (7.91 vs 7.02, p<0.001) and mean sleep problems (3.29 vs 2.64, p<0.001). Mean ER visits were more frequent among migraineurs with N/V than those without N/V (0.48 vs 0.38, p=0.001). This difference translated into a 26.3% increase in estimated mean ER costs (N/V=US$1,499 vs without N/V=US$1,187, p=0.002). Mean percentage activity impairment was higher in migraineurs with N/V than in those without N/V (37.73% vs 35.12%, p=0.002) and migraineurs with N/V had higher work productivity loss costs (N/V=US$10,344 vs without N/V=US$9,218, p=0.016). Conclusion Migraine patients with N/V reported worse depression, sleep problems, and activity impairment, and higher ER visits than those without N/V. Migraine with N/V was also associated with an increase in mean annual ER visit costs and work

  7. Central auditory processing and migraine: a controlled study

    PubMed Central

    2014-01-01

    Background This study aimed to verify and compare central auditory processing (CAP) performance in migraine with and without aura patients and healthy controls. Methods Forty-one volunteers of both genders, aged between 18 and 40 years, diagnosed with migraine with and without aura by the criteria of “The International Classification of Headache Disorders” (ICDH-3 beta) and a control group of the same age range and with no headache history, were included. Gaps-in-noise (GIN), Duration Pattern test (DPT) and Dichotic Digits Test (DDT) tests were used to assess central auditory processing performance. Results The volunteers were divided into 3 groups: Migraine with aura (11), migraine without aura (15), and control group (15), matched by age and schooling. Subjects with aura and without aura performed significantly worse in GIN test for right ear (p = .006), for left ear (p = .005) and for DPT test (p < .001) when compared with controls without headache, however no significant differences were found in the DDT test for the right ear (p = .362) and for the left ear (p = .190). Conclusions Subjects with migraine performed worsened in auditory gap detection, in the discrimination of short and long duration. They also presented impairment in the physiological mechanism of temporal processing, especially in temporal resolution and temporal ordering when compared with controls. Migraine could be related to an impaired central auditory processing. Clinical trial registration Research Ethics Committee (CEP 0480.10) – UNIFESP PMID:25380661

  8. QEEG-guided neurofeedback for recurrent migraine headaches.

    PubMed

    Walker, Jonathan E

    2011-01-01

    Seventy-one patients with recurrent migraine headaches, aged 17-62, from one neurological practice, completed a quantitative electroencephalogram (QEEG) procedure. All QEEG results indicated an excess of high-frequency beta activity (21-30 Hz) in 1-4 cortical areas. Forty-six of the 71 patients selected neurofeedback training while the remaining 25 chose to continue on drug therapy. Neurofeedback protocols consisted of reducing 21-30 Hz activity and increasing 10 Hz activity (5 sessions for each affected site). All the patients were classified as migraine without aura. For the neurofeedback group the majority (54%) experienced complete cessation of their migraines, and many others (39%) experienced a reduction in migraine frequency of greater than 50%. Four percent experienced a decrease in headache frequency of < 50%. Only one patient did not experience a reduction in headache frequency. The control group of subjects who chose to continue drug therapy as opposed to neurofeedback experienced no change in headache frequency (68%), a reduction of less than 50% (20%), or a reduction greater than 50% (8%). QEEG-guided neurofeedback appears to be dramatically effective in abolishing or significantly reducing headache frequency in patients with recurrent migraine.

  9. Investigation of polymorphisms in genes involved in estrogen metabolism in menstrual migraine.

    PubMed

    Sutherland, Heidi G; Champion, Morgane; Plays, Amelie; Stuart, Shani; Haupt, Larisa M; Frith, Alison; MacGregor, E Anne; Griffiths, Lyn R

    2017-04-05

    Migraine is a common, disabling headache disorder, which is influenced by multiple genes and environmental triggers. After puberty, the prevalence of migraine in women is three times higher than in men and >50% of females suffering from migraine report a menstrual association, suggesting hormonal fluctuations can influence the risk of migraine attacks. It has been hypothesized that the drop in estrogen during menses is an important trigger for menstrual migraine. Catechol-O-methyltransferase (COMT) and Cytochrome P450 (CYP) enzymes are involved in estrogen synthesis and metabolism. Functional polymorphisms in these genes can influence estrogen levels and therefore may be associated with risk of menstrual migraine. In this study we investigated four single nucleotide polymorphisms in three genes involved in estrogen metabolism that have been reported to impact enzyme levels or function, in a specific menstrual migraine cohort. 268 menstrual migraine cases and 142 controls were genotyped for rs4680 in COMT (Val158Met), rs4646903 and rs1048943 in CYP1A1 (T3801C and Ile462Val) and rs700519 in CYP19A1 (Cys264Arg). Neither genotype nor allele frequencies for the COMT and CYP SNPs genotyped were found to be significantly different between menstrual migraineurs and controls by chi-square analysis (P>0.05). Therefore we did not find association of functional polymorphisms in the estrogen metabolism genes COMT, CYP1A1 or CYP19A1 with menstrual migraine. Further studies are required to assess whether menstrual migraine is genetically distinct from the common migraine subtypes and identify genes that influence risk.

  10. A Nutrition Screening Form for Female Infertility Patients.

    PubMed

    Langley, Susie

    2014-12-01

    A Nutrition Screening Form (NSF) was designed to identify lifestyle risk factors that negatively impact fertility and to provide a descriptive profile of 300 female infertility patients in a private urban infertility clinic. The NSF was mailed to all new patients prior to the initial physician's visit and self-reported data were assessed using specific criteria to determine if a nutrition referral was warranted. This observational study revealed that 43% of the women had a body mass index (BMI) <20 or ≥25 kg/m(2), known risks for infertility. Almost half reported a history of "dieting" and unrealistic weight goals potentially limiting energy and essential nutrients. A high number reported eating disorders, vegetarianism, low fat or low cholesterol diets, and dietary supplement use. Fourteen percent appeared not to supplement with folic acid, 13% rated exercise as "extremely" or "very active", and 28% reported a "high" perceived level of stress. This preliminary research demonstrated that a NSF can be a useful tool to identify nutrition-related lifestyle factors that may negatively impact fertility and identified weight, BMI, diet, exercise, and stress as modifiable risk factors deserving future research. NSF information can help increase awareness among health professionals and patients about the important link between nutrition, fertility, and successful reproductive outcomes.

  11. Autoantibody studies of female patients with reproductive failure.

    PubMed

    Reimand, K; Talja, I; Metsküla, K; Kadastik, U; Matt, K; Uibo, R

    2001-08-01

    The aim of this study was to investigate the prevalence and character of autoimmune derangements in women with reproductive failure. A total of 108 females (age range 17-43, mean 27.5 years), including 16 with primary menstrual cycle disturbances and polycystic ovaries (PCO), 20 with polycystic ovary syndrome (PCOS), 38 with endometriosis (E), and 34 with chronic anovulation, luteal phase insufficiency, subfertility or unexplained infertility (INF) were investigated. A control group of 392 women was formed from an unselected population sample (age range 17-43, mean 31.0 years). All sera were tested by indirect immunofluorescence method to assess common autoantibodies: nuclear (ANA), smooth muscle (SMA), parietal cell (PCA), thyroid microsomal (TMA), reticulin (ARA), mitochondrial (AMA) and liver/kidney microsomal autoantibodies (LKMA). Enzyme-linked immunosorbent assay was used to detect antibodies against beta2-glycoprotein I (anti-beta 2GPI) and carbonic anhydrase (anti-CA). Our results showed that 40.7% of patients' sera and 14.8% of control sera contained one or more common autoantibodies, ANA and SMA were most frequently detected (difference between two groups P<0.005). Anti-beta 2GPI were found in eight cases (7.4%), including two patients with INF but without other autoantibodies. Anti-CA were revealed in nine cases (8.3%) including patients' PCOS, E and INF. A comparison of patients' clinical data with antibody assay results did not reveal any significant associations. Our results indicate a high prevalence of autoimmune reactions in women with reproductive failure due to the most common causes PCO, PCOS and E as well as in unexplained infertility. This might reflect the propensity to develop autoimmune reactions in such patients, including pathogenic autoimmune reactions to specific target antigens.

  12. The relationship between different fatty acids intake and frequency of migraine attacks

    PubMed Central

    Sadeghi, Omid; Maghsoudi, Zahra; Khorvash, Fariborz; Ghiasvand, Reza; Askari, Gholamreza

    2015-01-01

    Background: Migraine is a primary headache disorder that affects the neurovascular system. Recent studies have shown that consumption of some fatty acids such as omega-3 fatty acids improves migraine symptoms. The aim of the present study is to assess the association between usual intake of fatty acids such as eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and saturated fatty acids (SFA) with the frequency of migraine attacks. Materials and Methods: 105 migraine patients with age ranging from 15 to 50 years participated in this cross-sectional study. Usual dietary consumption was assessed by using a semi-quantitative food frequency questionnaire (FFQ). Moreover, frequency of migraine attacks during 1 month period was determined in all participants. Data had been analyzed using independent sample t-test and linear regression test with adjustment of confounding variables. Results: In this study, we found that lower intake of EPA (β = −335.07, P = 0.006) and DHA (β = −142.51, P = 0.001) was associated with higher frequency of migraine attacks. In addition, we observed similar relationship either in men or women. No significant association was found between dietary intake of SFA and the frequency of migraine attacks (β = −0.032, P = 0.85). Conclusions: Frequency of migraine attacks was negatively associated with dietary intake of omega-3 polyunsaturated fatty acids. No significant relationship was found between SFA intake and migraine frequency. Further studies are required to shed light on our findings. PMID:26120333

  13. The lesson of chronic migraine.

    PubMed

    Bonavita, V; De Simone, R

    2015-05-01

    The hypothesis that central sensitization/allodynia is the common final mechanism responsible for the progression of migraine pain is supported by the possibility of tracing back to allodynic mechanisms the action of the main risk factors for chronic migraine validated by the recent literature. The comorbidity between migraine and idiopathic intracranial hypertension without papilledema is emerging as a new, commonly overlooked risk factor for migraine progression whose putative mechanism might also converge on the sensitization of central pain pathways. If headache progression always occurs at the end of a pathogenetic sequence typical of an individual susceptibility to allodynia, then the primary character of chronic migraine might be debated. Allodynia is not specific to migraine but is implied in the progressive amplification of pain after repeated stimuli, a universal adaptive phenomenon. Being largely conditioned by the individual comorbidity profile, allodynia may only in part be defined as primary in itself. Many migraine comorbid conditions, including a hidden idiopathic intracranial hypertension without papilledema, may emphasize susceptibility to allodynia and promote chronic migraine. These factors and comorbid conditions require to be individually assessed and adequately treated to optimize the therapeutic response.

  14. Stroke-like migraine attack after cranial radiation therapy: the SMART syndrome.

    PubMed

    Lim, Sue Yin; Brooke, Jonathan; Dineen, Robert; O'Donoghue, Michael

    2016-10-01

    We describe a patient who experienced a prolonged episode of headache, drowsiness, seizure, unilateral weakness, delusion and hallucination due to a stroke-like migraine attack after cranial radiation therapy. Stroke-like migraine attack after radiation therapy (SMART) syndrome is a rare complication of therapeutic brain irradiation.

  15. Importance of the Radicular Syndrome in Cervical Migraine (O Znachenii Radikulyarnogo Sindroma pri Sheinoi Migreni),

    DTIC Science & Technology

    The direct causes of cerebral disorders in cervical migraine are compression of the vertebral artery and irritation of the vertebral nerve by... cervical osteophytes, deformed uncinate processes, as well as the pathological afferentation which occurs here. One hundred ten patients suffering from... cervical migraine were observed. The most characteristic symptoms are constant dull, frequently unilateral headaches with typical irradiation from the

  16. Association of COX-2 Promoter Polymorphisms -765G/C and -1195A/G with Migraine

    PubMed Central

    MOZAFFARI, Elahe; DOOSTI, Abbas; ARSHI, Asghar; FAGHANI, Mostafa

    2016-01-01

    Background: Migraine is a common debilitating primary headache disorder with current head pain attacks, which contributes to physical activity dysfunctions in chronic pain phase. PGE2 and PGI2 are two important prostaglandins synthesised by COX-2 enzymes, involved in migraine pain signals. COX-2 modulation is essential in treatment and pathogenesis of migraine. This study aimed to investigating the association between COX-2 gene polymorphisms with the risk of migraine susceptibility in migraine patients with related and unrelated parents. Methods: This case- control study was based on 100 migraine patients and 100 non-migraine subjects in Bushehr province, Iran in 2013. Genomic DNA of blood samples was extracted and genotyping of COX-2-765G>C (rs20417) and COX-2-1195A>G (rs689466) gene variants was investigated by PCR-RFLP method. Statistical analyses were accomplished using the SPSS software package. Results: There was a significant differences in the frequencies of the COX-2-765G>C and COX-2-1195A>G genotypes between migraine patients and controls (P≤0.05). Conclusion: COX-2-765CC, COX-2-765CG, COX-2-1195GG and COX-2-1195AG genotypes can increase the risk of migraine significantly. As the first study in Iran, we are hopeful to achieve greater results about the relevancy of COX-2 gene, migraine and pain signals pathway by repeating these experiments on more samples. PMID:28053929

  17. A Randomized Controlled Trial of a Comprehensive Migraine Intervention Prior to Discharge From an Emergency Department

    PubMed Central

    Friedman, Benjamin W.; Solorzano, Clemencia; Norton, Jennifer; Adewumni, Victoria; Campbell, Caron M.; Esses, David; Bijur, Polly E.; Solomon, Seymour; Lipton, Richard B.; Gallagher, E. John

    2012-01-01

    Objectives Patients who use an emergency department (ED) for acute migraine headaches have higher migraine disability scores and lower socioeconomic status and are unlikely to have used a migraine-specific medication prior to presentation to the ED. The objective was to determine if a comprehensive migraine intervention, delivered just prior to ED discharge, could improve migraine impact scores 1 month after the ED visit. Methods This was a randomized controlled trial of a comprehensive migraine intervention versus typical care among patients who presented to an ED for management of acute migraine. At the time of discharge, for patients randomized to comprehensive care, the authors’ protocol reinforced their diagnosis, shared a migraine education presentation from the National Library of Medicine, provided them with six tablets of sumatriptan 100 mg and 14 tablets of naproxen 500 mg, and if they wished, provided them with an expedited free appointment to our institution's headache clinic. Patients randomized to typical care received the care their attending emergency physicians (EPs) felt was appropriate. The primary outcome was a between-group comparison of the Headache Impact Test (HIT-6) score, a validated headache assessment instrument, 1 month after ED discharge. Secondary outcomes included an assessment of satisfaction with headache care and frequency of use of migraine-specific medication within that 1-month period. Results Over a 19-month period, 50 migraine patients were enrolled. One-month follow-up was successfully obtained in 92% of patients. Baseline characteristics were comparable. One-month HIT-6 scores in the two groups were nearly identical (59 vs. 56, 95% confidence interval [CI] for difference of 3 = –5 to 11), as was dissatisfaction with overall headache care (17% vs. 18%, 95% CI for difference of 1% = –22% to 24%). Patients randomized to the comprehensive intervention were more likely to be using triptans or migraine-specific therapy (43

  18. Modulation of trigeminal reflex excitability in migraine: effects of attention and habituation on the blink reflex.

    PubMed

    de Tommaso, Marina; Murasecco, Donatella; Libro, Giuseppe; Guido, Marco; Sciruicchio, Vittorio; Specchio, Luigi Maria; Gallai, Virgilio; Puca, Francomichele

    2002-06-01

    The modulation of trigeminal reflex excitability in migraine patients was evaluated during the asymptomatic phase by studying the effects of attention, habituation and preconditioning stimulus on the R2 and R3 components of the blink reflex (BR). Fifty patients suffering from migraine without aura, 20 affected by migraine with aura and 35 sex- and age-matched controls were selected. In subgroups of migraine with-aura and without-aura patients, and normal controls, the blink reflex was elicited during different cognitive situations: (a) spontaneous mental activity; (b) stimulus anticipation; (c) recognition of target numbers. In the remaining subjects, R2 and R3 habituation was evaluated by repetitive stimulation at 1, 5, 10, 15, 20, 25 and 30 s intervals. The R2 and R3 recovery curves were also computed. A reduced R3 threshold with a normal pain threshold was found in migraine with-aura and without-aura patients; the R3 component was not significantly correlated with the pain thresholds in patients and controls. The R2 and R3 components were less influenced by the warning of the stimulus in migraine without-aura and migraine with-aura patients, in comparison with the control group. A slight increase of both R2 and R3 recovery after preconditioning stimulus was also observed in migraine patients, probably caused by a phenomenon of trigeminal hyperexcitability persisting after the last attack. The abnormal BR modulation by alerting expresses in migraine a dysfunction of adaptation capacity to environmental conditions, probably predisposing to migraine.

  19. Prevalence of bruxism in children with episodic migraine - a case–control study with polysomnography

    PubMed Central

    2014-01-01

    Background Parents of children with migraine have described a higher prevalence of sleep bruxism and other sleep disturbances in their children. The objective of this study was to use polysomnography to investigate the prevalence of bruxism during sleep in children with episodic migraine relative to controls. Findings Controls and patients were matched by sex, age, years of formal education, presence of snoring, arousals per hour, and respiratory events per hour. A total of 20 controls, between 6 and 12 years old, with no history of headache, recruited from public schools in Sao Paulo between 2009 and 2012, and 20 patients with episodic migraine recruited from the Headache Clinic at the Federal University of Sao Paulo between 2009 and 2012 underwent polysomnography. No intervention was performed before sleep studies. Among migraine patients, 27.5% experienced aura prior to migraine onset. The sleep efficiency, sleep latency, REM sleep latency, arousals per hour, percentage of sleep stages, and breathing events per hour were similar between groups. Five children (25%) with episodic migraine exhibited bruxism during the sleep study while this finding was not observed in any control (p = 0.045). Conclusions Our data demonstrate that bruxism during sleep is more prevalent in children with episodic migraine. Further prospective studies will help elucidate the underlying shared pathogenesis between bruxism and episodic migraine in children. PMID:24886343

  20. Systems pharmacology to decipher the combinational anti-migraine effects of Tianshu formula.

    PubMed

    Li, Yan; Zhang, Jingxiao; Zhang, Lilei; Chen, Xuetong; Pan, Yanqiu; Chen, Su-Shing; Zhang, Shuwei; Wang, Zhenzhong; Xiao, Wei; Yang, Ling; Wang, Yonghua

    2015-11-04

    Migraine is the most common neurovascular disorder that imparts a considerable burden to health care system around the world. However, currently there are still no effective and widely applicable pharmacotherapies for migraine patients. Herbal formulae, characterized as multiple herbs, constituents and targets, have been acknowledged with clinical effects in treating migraine, which attract more and more researchers' attention although their exact molecular mechanisms are still unclear. In this work, a novel systems pharmacology-based method which integrates pharmacokinetic filtering, target fishing and network analysis was developed and exemplified by a probe, i.e. Tianshu formula, a widely clinically used anti-migraine herbal formula in China which comprises of Rhizoma chuanxiong and Gastrodia elata. The results exhibit that 20 active ingredients of Tianshu formula possess favorable pharmacokinetic profiles, which have interactions with 48 migraine-related targets to provide potential synergistic therapeutic effects. Additionally, from systematic analysis, we speculate that R. chuanxiong as the monarch herb mediates the major targets like PTGS2, ESR1, NOS2, HTR1B and NOS3 to regulate the vascular and nervous systems, as well as the inflammation and pain-related pathways to benefit migraine patients. Meanwhile, as an adjuvant herb, G. elata may not only assist the monarch herb to improve the outcome of migraine patients, but also regulate multiple targets like ABAT, HTR1D, ALOX15 and KCND3 to modify migraine accompanying symptoms like vomiting, vertigo and gastrointestinal disorders.

  1. Migraine management: How do the adult and paediatric migraines differ?

    PubMed Central

    Sonal Sekhar, M.; Sasidharan, Shalini; Joseph, Siby; Kumar, Anand

    2011-01-01

    Migraine is one of the common causes of severe and recurring headache. It may be difficult to manage in primary care settings, where it is under diagnosed and medically treated. Migraine can occur in children as well as in adults and it is three times more common in women than in men. Migraine in children is different from adults in various ways. Migraine management depends on the various factors like duration and severity of pain, associated symptoms, degree of disability, and initial response to treatment. The therapy of children and adolescents with migraines includes treatment modalities for acute attacks, prophylactic medications when the attacks are frequent, and biobehavioural modes of treatment to aid long-term management of the disorder. The long lasting outcome of childhood headaches and progression into adult headaches remains largely unknown. However, it has been suggested that adult migraine may represent a progressive disorder. In children, the progressive nature is uncertain and further investigations into longitudinal outcome and phenotypic changes in childhood headaches have yet to be recognized. Even though paediatric and adult migraines seem to be slightly different from one another, but not enough to categorize either as sole. PMID:23960771

  2. Gynaecological Prolapse Surgery in Very Old Female Patients

    PubMed Central

    Mothes, A. R.; Lehmann, T.; Kwetkat, A.; Radosa, M. P.; Runnebaum, I. B.

    2016-01-01

    Background: The aim of this study is to compare very elderly female patients with a younger control group after prolapse surgery with regard to co-morbidity and complications. Method: In a case-control design, the consecutive data of patients after prolapse surgery at the age of over 80 years and those of a control group were analysed by means of the Clavien-Dindo (CD) classification of surgical complications, the Charlson Comorbidity Index and the Cumulative Illness Rating Scale Geriatrics (CIRS-G). Statistics: Studentʼs t, Fisherʼs exact and Mann-Whitney U tests. Results: The analysis comprised n = 57 vs. n = 60 operations. In the very elderly patients there was often a grade IV prolapse (p < 0.001), apical fixations were more frequent (p < 0.001), but the operating times were not different. In the very elderly patients 21 % CD II+III complications were observed, in the control group 6.6 % (p = 0.031). No CD IV and V complications occurred in either group, the duration of inpatient stay amounted to 5 (± 1) vs. 4.1 (± 0.8; p < 0.001) days, the very elderly patients needed an inpatient follow-up more frequently (p < 0.001). The co-morbidities of the very elderly patients differed from those of the control group in number (median 2.0 vs. 1.5; p < 0.001), in CIRS-G (4.1 ± 2.2 vs. 2.4 ± 1.7; p < 0.01) and in Charlson Index (1.6 ± 1.6 vs. 0.5 ± 0.7; p < 0.001). Conclusions: A prolapse in very elderly women can be safely managed by surgery. In no case did the complications require intensive care treatment nor were they life-threatening, but they did lead to a longer duration of hospital stay and more frequently to further treatment geriatric or inpatient internal medicine facilities. PMID:27582580

  3. Patient-Centered Mental Health Care for Female Veterans

    PubMed Central

    Kimerling, Rachel; Bastian, Lori A.; Bean-Mayberry, Bevanne A.; Bucossi, Meggan M.; Carney, Diane V.; Goldstein, Karen M.; Phibbs, Ciaran S.; Pomernacki, Alyssa; Sadler, Anne G.; Yano, Elizabeth M.; Frayne, Susan M.

    2016-01-01

    Objective Mental health services for women vary widely across the Veterans Health Administration (VHA) system, without consensus on the need for, or organization of, specialized services for women. Understanding women’s needs and priorities is essential to guide the implementation of patient-centered behavioral health services. Methods In a cross-sectional, multisite survey of female veterans using primary care, potential stakeholders were identified for VHA mental health services by assessing perceived or observed need for mental health services. These stakeholders (N=484) ranked priorities for mental health care among a wide range of possible services. The investigators then quantified the importance of having designated women’s mental health services for each of the mental health services that emerged as key priorities. Results Treatment for depression, pain management, coping with chronic general medical conditions, sleep problems, weight management, and posttraumatic stress disorder (PTSD) emerged as women’s key priorities. Having mental health services specialized for women was rated as extremely important to substantial proportions of women for each of the six prioritized services. Preference for primary care colocation was strongly associated with higher importance ratings for designated women’s mental health services. For specific types of services, race, ethnicity, sexual orientation, PTSD symptoms, and psychiatric comorbidity were also associated with higher importance ratings for designated women’s services. Conclusions Female veterans are a diverse population whose needs and preferences for mental health services vary along demographic and clinical factors. These stakeholder perspectives can help prioritize structural and clinical aspects of designated women’s mental health care in the VHA. PMID:25642611

  4. Are Episodic and Chronic Migraine One Disease or Two?

    PubMed

    Burshtein, Reuben; Burshtein, Aaron; Burshtein, Joshua; Rosen, Noah

    2015-12-01

    Migraine is a debilitating headache disorder that has a significant impact on the world population, in both economic and sociologic capacities. Migraine has two main categories: (1) chronic migraine (CM), defined as the patient having 15 or more headache days per month, with at least five attacks fulfilling measures for EM with aura or EM without aura, and (2) episodic migraine (EM), defined as less than 15 headache days per month. With this definition, CM can only exist in the presence of EM, and it questions whether the two are separate diseases. Migraine has a significant impact on the population, as each year, about 2.5 % of patients with EM develop new-onset CM (Manack et al., Curr Pain Headache Rep 15:70-78, 2011) (Loder et al. Headache 55:214-228, 2015), with certain risk factors being evident only with CM. In addition, there are comorbid diseases that are only associated with CM, suggesting two separate diseases rather than one. Differentiation in response to treatments, both preventive and abortive, demonstrates both a similarity and a difference in EM versus CM. Also, comparing the two processes based upon functional imaging has been a recent development, beginning to show a physiological difference in regional cortical thickness, cortical surface area, and regional volumes in patients with EM and CM. Evidence regarding whether EM and CM demonstrate one disease with a significant level of complication or if two independent processes is inconclusive, and additional research must be performed to further characterize their relationship.

  5. [The clinical features of migraine-associated vertigo].

    PubMed

    Goto, Fumiyuki; Tsutsumi, Tomoko; Ogawa, Kaoru

    2013-08-01

    Migraine-associated vertigo (MAV) is proposed as a new clinical entity on the basis of the assumption that the typical migraine and vertigo or dizziness have a common pathophysiology. Some of the patients with recurrent vertigo syndromes with unknown pathology may have MAV. We performed a retrospective study to clarify the clinical characteristics of MAV in the Japanese population. The following were considered as diagnostic criteria: (1) recurrent vestibular symptoms, (2) migraine headache as defined by the International Headache Society (IHS) criteria, (3) at least one instance of synchronization of a vertiginous attack with a migraine headache, (4) no associated unilateral hearing loss, and (5) absence of other diseases that may have caused vertiginous attacks. Of 552 patients with dizziness or vertigo, 46 (8.3%) were diagnosed as having MAV. A typical feature of this clinical entity is that migraine occurs before the onset of vertigo in women aged 30-40 years. Usually the attacks occur once in a year for 1 to 10 years. An attack lasts for 1-24 h and presents as vertigo and unsteadiness with simultaneous headache. The presence of hearing loss presents an important clinical dilemma. Whether the condition in patients experiencing hearing loss should be defined as MAV or not is still a matter for discussion.

  6. Mandibular tori, migraine and temporomandibular disorders.

    PubMed

    Clifford, T; Lamey, P J; Fartash, L

    1996-05-25

    In this study the presence of mandibular tori was related to conditions associated with parafunctional activity. Parafunction in the form of tooth clenching or grinding has been associated with temporomandibular disorders (TMD) and recently migraine. Patients attending a facial pain clinic in Belfast were assessed for the presence of tori and results compared to age and gender matched controls. The findings were that mandibular tori were present significantly more commonly in both migraineurs and TMD patients. The results support an association with parafunction in the aetiology of mandibular tori and suggest that tori are a useful marker of past or present parafunction in some patients.

  7. High Frequency Migraine Is Associated with Lower Acute Pain Sensitivity and Abnormal Insula Activity Related to Migraine Pain Intensity, Attack Frequency, and Pain Catastrophizing

    PubMed Central

    Mathur, Vani A.; Moayedi, Massieh; Keaser, Michael L.; Khan, Shariq A.; Hubbard, Catherine S.; Goyal, Madhav; Seminowicz, David A.

    2016-01-01

    Migraine is a pain disorder associated with abnormal brain structure and function, yet the effect of migraine on acute pain processing remains unclear. It also remains unclear whether altered pain-related brain responses and related structural changes are associated with clinical migraine characteristics. Using fMRI and three levels of thermal stimuli (non-painful, mildly painful, and moderately painful), we compared whole-brain activity between 14 migraine patients and 14 matched controls. Although, there were no significant differences in pain thresholds nor in pre-scan pain ratings to mildly painful thermal stimuli, patients did have aberrant suprathreshold nociceptive processing. Brain imaging showed that, compared to controls, patients had reduced activity in pain modulatory regions including left dorsolateral prefrontal, posterior parietal, and middle temporal cortices and, at a lower-threshold, greater activation in the right mid-insula to moderate pain vs. mild pain. We also found that pain-related activity in the insula was associated with clinical variables in patients, including associations between: bilateral anterior insula and pain catastrophizing (PCS); bilateral anterior insula and contralateral posterior insula and migraine pain intensity; and bilateral posterior insula and migraine frequency at a lower-threshold. PCS and migraine pain intensity were also negatively associated with activity in midline regions including posterior cingulate and medial prefrontal cortices. Diffusion tensor imaging revealed a negative correlation between fractional anisotropy (a measure of white matter integrity; FA) and migraine duration in the right mid-insula and a positive correlation between left mid-insula FA and PCS. In sum, while patients showed lower sensitivity to acute noxious stimuli, the neuroimaging findings suggest enhanced nociceptive processing and significantly disrupted modulatory networks, particularly involving the insula, associated with indices

  8. Onabotulinum toxin A (Botox) for chronic migraine treatment: an Italian experience.

    PubMed

    Grazzi, L; Usai, S

    2015-05-01

    Chronic migraine is a common and debilitating headache syndrome. Botulinum neurotoxin, a potent toxin produced by the anaerobic bacterium clostridium botulinum, used largely for treatment of disorders associated with increased muscle tone and hyperhidrosis, is used for patients suffering from chronic migraine. In this study, a group of patients suffering from chronic migraine with medication overuse was treated with onabotulinum toxin A (Botox) to verify its efficacy for chronic migraine. The results confirmed the efficacy of onabotulinum toxin A (Botox) when used at the dosage of 155 UI according to the PREEMPT protocol. Although these results are preliminary, they led to intense efforts to evaluate the analgesic properties of onabotulinum toxin A (Botox) and to assess its use in clinical practice, in particular in migraine field.

  9. Efficacy and Tolerability of STOPAIN for a Migraine Attack

    PubMed Central

    St. Cyr, Andrea; Chen, Ashley; Bradley, Kathleen C.; Yuan, Hsiangkuo; Silberstein, Stephen D.; Young, William B.

    2015-01-01

    Objective: To determine whether topical menthol 6% gel will relieve a migraine attack. Materials and Methods: A single-center, open-label pilot trial of 25 patients with at least 1 year of diagnosed episodic migraine and <15 headache days per month. Patients treated one migraine attack with STOPAIN topical menthol 6% gel to skull base within 2 h of headache onset. Headache pain severity was assessed prior to and after gel application. Results: Thirty-two patients enrolled and 25 completed the study. Prior to treatment, 7 patients had mild pain, 13 moderate pain, and 5 severe pain. Two hours following gel application, 7 (28%) patients had no pain, 7 (28%) mild pain, 6 (25%) moderate pain, and 5 (20%) severe pain. The majority of patients had similar pain intensity (8; 32%) or improvement (13; 52%). At 24-h, only two non-rescued patients still had mild headache. Of the 25 completers, 2 patients took rescue medication prior to the 2-h period, and an additional 10 patients rescued between 2 and 24 h. Conclusion: Study results showed a significant improvement in headache intensity by 2 h after gel application. This pilot study shows STOPAIN gel may be effective in treating an acute migraine attack. PMID:25699012

  10. Comparison of acute non-haemolytic transfusion reactions in female and male patients receiving female or male blood components

    PubMed Central

    Imoto, S; Araki, N; Shimada, E; Saigo, K; Nishimura, K; Nose, Y; Bouike, Y; Hashimoto, M; Mito, H; Okazaki, H

    2007-01-01

    To study the relationship between antibodies detected in patients’ and/or donors’ sera and the clinical features of acute non-haemolytic transfusion reactions (ANHTRs), and to determine any gender-related difference. ANHTRs range from urticaria to transfusion-related acute lung injury (TRALI). Antibodies to human leukocyte antigen (HLA), granulocytes, platelets, and/or plasma proteins are implicated in some of the ANHTRs. A higher antibody positivity is expected for females than for males. A comparative study of ANHTRs for antibody positivity and their clinical features between females and males for both patients and donors is helpful for characterizing ANHTRs including TRALI more clearly, but such studies are few and outdated. Two hundred and twenty-three ANHTR cases reported by 45 hospitals between October 2000 and July 2005 were analysed. The patients and 196 donors of suspect blood products were screened for antibodies to HLA Class I, HLA Class II, granulocytes, and platelets. The patients were also screened for anti-plasma protein antibodies. The types and severity of ANHTR did not differ significantly between female and male patients. The frequency of the anti-HLA antibodies, but not that of the non-HLA antibodies, was significantly higher in females. Non-HLA antibodies were significantly associated with severe reactions in females. All the TRALI cases had predisposing risk factors for acute lung injury, and 60% of the cases showed anti-leucocyte antibodies. Although the anti-HLA antibodies were detected more frequently in females than males, no significant association of ANHTRs including TRALI with gender, not only for patients, but also for donors, could be shown in this study. PMID:18067650

  11. Peripheral vascular dysfunction in migraine: a review

    PubMed Central

    2013-01-01

    Numerous studies have indicated an increased risk of vascular disease among migraineurs. Alterations in endothelial and arterial function, which predispose to atherosclerosis and cardiovascular diseases, have been suggested as an important link between migraine and vascular disease. However, the available evidence is inconsistent. We aimed to review and summarize the published evidence about the peripheral vascular dysfunction of migraineurs. We systematically searched in BIOSIS, the Cochrane database, Embase, Google scholar, ISI Web of Science, and Medline to identify articles, published up to April 2013, evaluating the endothelial and arterial function of migraineurs. Several lines of evidence for vascular dysfunction were reported in migraineurs. Findings regarding endothelial function are particularly controversial since studies variously indicated the presence of endothelial dysfunction in migraineurs, the absence of any difference in endothelial function between migraineurs and non-migraineurs, and even an enhanced endothelial function in migraineurs. Reports on arterial function are more consistent and suggest that functional properties of large arteries are altered in migraineurs. Peripheral vascular function, particularly arterial function, is a promising non-invasive indicator of the vascular health of subjects with migraine. However, further targeted research is needed to understand whether altered arterial function explains the increased risk of vascular disease among patients with migraine. PMID:24083826

  12. Antidromic vasodilatation and the migraine mechanism.

    PubMed

    Geppetti, Pierangelo; Rossi, Eleonora; Chiarugi, Alberto; Benemei, Silvia

    2012-03-01

    Despite the fact that an unprecedented series of new discoveries in neurochemistry, neuroimaging, genetics and clinical pharmacology accumulated over the last 20 years has significantly increased our current knowledge, the underlying mechanism of the migraine headache remains elusive. The present review article addresses, from early evidence that emerged at the end of the nineteenth century, the role of 'antidromic vasodilatation' as part of the more general phenomenon, currently defined as neurogenic inflammation, in the unique type of pain reported by patients suffering from migraine headaches. The present paper describes distinctive orthodromic and antidromic properties of a subset of somatosensory neurons, the vascular- and neurobiology of peptides contained in these neurons, and the clinical-pharmacological data obtained in recent investigations using provocation tests in experimental animals and human beings. Altogether, previous and recent data underscore that antidromic vasodilatation, originating from the activation of peptidergic somatosensory neurons, cannot yet be discarded as a major contributing mechanism of the throbbing head pain and hyperalgesia of migraine.

  13. Migraine in women with chronic pelvic pain with and without endometriosis

    PubMed Central

    Karp, Barbara Illowsky; Sinaii, Ninet; Nieman, Lynnette K.; Silberstein, Stephen D.; Stratton, Pamela

    2012-01-01

    Objective To examine the prevalence of migraine in women with chronic pelvic pain with and without endometriosis. Design Prospective study of headache, pelvic pain, and quality of life before laparoscopic surgery for pelvic pain. Endometriosis was diagnosed pathologically. Headaches were classified as migraine or non-migraine using International Headache Society criteria. Setting Clinical research hospital. Patient(s) 108 women in a clinical trial for chronic pelvic pain (NCT00001848). Intervention(s) Laparoscopy to diagnose endometriosis, assessment by neurologist to assess headaches. Main Outcome Measure(s) Prevalence of migraine and other headaches in women with chronic pelvic pain with or without endometriosis. Headache frequency, severity and relationship to pelvic pain and endometriosis. Result(s) Lifetime prevalence of definite or possible migraine was 67% of women with chronic pelvic pain. An additional 8% met criteria for possible migraine. Migraine was no more likely in women with endometriosis than those without. Women with the most severe headaches had a lower quality of life compared with those with pelvic pain alone. Conclusion(s) Migraine headache is common in women with chronic pelvic pain, regardless of endometriosis, and contributes to disability in those with both conditions. The strong association suggests a common pathophysiology. PMID:21145540

  14. Venous Thoracic Outlet Syndrome as a Cause of Intractable Migraines.

    PubMed

    Chahwala, Veer; Tashiro, Jun; Li, Xiaoyi; Baqai, Atif; Rey, Jorge; Robinson, Handel R

    2017-02-01

    Thoracic outlet syndrome (TOS) refers to the compression of the neurovascular bundle within the thoracic outlet. Cases are classified by primary etiology-arterial, neurogenic, or venous. In addition to the typical symptoms of arm swelling and paresthesias, headaches have been reported as a potential symptom of TOS. In this report, we describe a patient with debilitating migraines, which were consistently preceded by unilateral arm swelling. Resolution of symptoms occurred only after thoracic outlet decompression. Patients with migraines and concomitant swelling and/or paresthesias, especially related to provocative arm maneuvers, should be considered a possible atypical presentation of TOS and evaluated in more detail.

  15. Vestibular migraine: the most frequent entity of episodic vertigo.

    PubMed

    Dieterich, Marianne; Obermann, Mark; Celebisoy, Nese

    2016-04-01

    Vestibular migraine (VM) is the most common cause of episodic vertigo in adults as well as in children. The diagnostic criteria of the consensus document of the International Bárány Society for Neuro-Otology and the International Headache Society (2012) combine the typical signs and symptoms of migraine with the vestibular symptoms lasting 5 min to 72 h and exclusion criteria. Although VM accounts for 7% of patients seen in dizziness clinics and 9% of patients seen in headache clinics it is still underdiagnosed. This review provides an actual overview on the pathophysiology, the clinical characteristics to establish the diagnosis, the differential diagnosis, and the treatment of VM.

  16. [Differential diagnosis of visual aura in migraine and epilepsy].

    PubMed

    Schulze-Bonhage, A

    2001-09-01

    Visual phenomena like lightnings, disturbed contours of objects, or skotoma, can be due to ophthalmological diseases, but can also occur as symptoms generated by the central nervous system ("aura") in migraine or epilepsy. A subsequent hemicrania is considered as a hallmark of migraine, but in many cases does not allow for a certain distinction from postictal headaches in patients with focal epilepsy. A detailed analysis of the aura does, however, provide sufficient information for classifying the disorder as an aura in migraine or as a simple partial epileptic seizure in most cases. The higher degree of differentiation of visual phenomena including colour, movement, and complex visual phenomena, is characteristic of the activation of neuronal circuits during an epileptic aura. The higher speed of transsynaptic propagation of epileptic discharges and postictal inactivation causes a more rapid time-course of the epileptic aura as compared to a migraine aura resulting from a depolarization spreading by diffusion. Clinically, the diagnosis of epilepsy is supported by additional positive motor phenomena or by a transition into a complex partial seizure, e. g. when epileptic activity spreads into a temporal lobe. Secondarily generalized seizures, however, may also occur in patients with migraine. Interictal and ictal EEG recordings can be important to prove an epileptic origin, but their sensitivity is low if ictal discharges remain limited to a small brain area. In rare cases, measurements of ictal cerebral perfusion can contribute to the differential diagnosis.

  17. The Impact of Migraine on Posterior Ocular Structures

    PubMed Central

    Demircan, Süleyman; Ataş, Mustafa; Arık Yüksel, Sevgi; Ulusoy, Melek D.; Yuvacı, İsa; Arifoğlu, Hasan Basri; Başkan, Burhan; Zararsız, Gökmen

    2015-01-01

    Purpose. To investigate the thickness of the retinal nerve fiber layer (RNFL) and choroid in patients who have migraines in comparison to healthy controls. Methods. This study included 76 eyes and patients in the migraine group, 36 with aura (MWA group) and 40 without (MWoA group), and 38 eyes as control subjects. The RNFL and macular thicknesses were analysed with standard OCT protocol while choroidal thickness was analysed with EDI protocol in all subjects. Choroidal thickness was measured at the fovea, 1500 µm nasal and 1500 µm temporal to the fovea in a horizontal section. Results. The mean RNFL thickness for nasal and nasal inferior sectors was significantly thinner (P ≤ 0.018) in the migraineurs' eyes than in those of the controls, as was the mean choroid thickness at the fovea and measured points (P < 0.0001). However, the mean macular thickness was not significantly different between the groups. Conclusions. This study suggests that migraine leads to a reduction in the peripapillary RNFL thickness and to thinning in choroidal structures. These findings can be explained by a chronic ischemic insult related to migraine pathogenic mechanisms and these findings are considered supportive of the relationship between glaucoma and migraine. PMID:25767720

  18. Effects of calcium antagonists on serotonin-dependent aggregation and serotonin transport in platelets of patients with migraine.

    PubMed

    Pukhal'skaya, T G; Kolosova, O A; Men'shikov, M Y; Vein, A M

    2000-07-01

    Flunarizine and cinnarizine (IC50 6.8x10(-6) and 2.8x10(-5) M, respectively) inhibited 3H-serotonin uptake by platelets. In higher doses, they blocked serotonin-induced platelet aggregation and stimulated 3H-serotonin release from these cells. Imipramine did not affect serotonin-releasing effects of preparations. In all patients cinnarizine was more potent in inhibiting serotonin uptake, and in half of the patients cinnarizine displayed higher activity as an inductor of serotonin release.

  19. Modelling headache and migraine and its pharmacological manipulation

    PubMed Central

    Erdener, S E; Dalkara, T

    2014-01-01

    Similarities between laboratory animals and humans in anatomy and physiology of the cephalic nociceptive pathways have allowed scientists to create successful models that have significantly contributed to our understanding of headache. They have also been instrumental in the development of novel anti-migraine drugs different from classical pain killers. Nevertheless, modelling the mechanisms underlying primary headache disorders like migraine has been challenging due to limitations in testing the postulated hypotheses in humans. Recent developments in imaging techniques have begun to fill this translational gap. The unambiguous demonstration of cortical spreading depolarization (CSD) during migraine aura in patients has reawakened interest in studying CSD in animals as a noxious brain event that can activate the trigeminovascular system. CSD-based models, including transgenics and optogenetics, may more realistically simulate pain generation in migraine, which is thought to originate within the brain. The realization that behavioural correlates of headache and migrainous symptoms like photophobia can be assessed quantitatively in laboratory animals, has created an opportunity to directly study the headache in intact animals without the confounding effects of anaesthetics. Headache and migraine-like episodes induced by administration of glyceryltrinitrate and CGRP to humans and parallel behavioural and biological changes observed in rodents create interesting possibilities for translational research. Not unexpectedly, species differences and model-specific observations have also led to controversies as well as disappointments in clinical trials, which, in return, has helped us improve the models and advance our understanding of headache. Here, we review commonly used headache and migraine models with an emphasis on recent developments. Linked Articles This article is part of a themed section on Animal Models in Psychiatry Research. To view the other articles in this

  20. Headaches and Migraines: Understanding Headaches, From Mild to Migraine

    MedlinePlus

    ... through them was to lie down in a dark room and just suffer through it." "For us, ... and Migraine pages on MedlinePlus (medlineplus.gov) The Web site for the National Institute for Neurological Disorders: ...

  1. Critical analysis of the use of onabotulinumtoxinA (botulinum toxin type A) in migraine

    PubMed Central

    Robertson, Carrie E; Garza, Ivan

    2012-01-01

    OnabotulinumtoxinA, a neurotoxin, has been studied in numerous trials as a novel preventive therapy for migraine headache. The data would support that it may be effective at reducing headache days in patients suffering from chronic migraine (≥15 headache days/month, with eight or more of those migraine headache days). The mechanism by which onabotulinumtoxinA exerts its effects on migraine is not yet understood. It is known to inhibit acetylcholine release at the neuromuscular junction, but this probably does not explain the observed antinociceptive properties noted in preclinical and clinical trials. This review will discuss the known mechanisms of action of botulinum toxin type A, and will review the available randomized, placebo-controlled trials that have looked at its efficacy as a migraine preventative. We also describe the onabotulinumtoxinA injection sites used at our institution. PMID:22275844

  2. NSAIDs in the Acute Treatment of Migraine: A Review of Clinical and Experimental Data

    PubMed Central

    Pardutz, Arpad; Schoenen, Jean

    2010-01-01

    Migraine is a common disabling neurological disorder with a serious socio-economical burden. By blocking cyclooxygenase nonsteroidal anti-inflammatory drugs (NSAIDs) decrease the synthesis of prostaglandins, which are involved in the pathophysiology of migraine headaches. Despite the introduction more than a decade ago of a new class of migraine-specific drugs with superior efficacy, the triptans, NSAIDs remain the most commonly used therapies for the migraine attack. This is in part due to their wide availability as over-the-counter drugs and their pharmaco-economic advantages, but also to a favorable efficacy/side effect profile at least in attacks of mild and moderate intensity. We summarize here both the experimental data showing that NSAIDs are able to influence several pathophysiological facets of the migraine headache and the clinical studies providing evidence for the therapeutic efficacy of various subclasses of NSAIDs in migraine therapy. Taken together these data indicate that there are several targets for NSAIDs in migraine pathophysiology and that on the spectrum of clinical potency acetaminophen is at the lower end while ibuprofen is among the most effective drugs. Acetaminophen and aspirin excluded, comparative trials between the other NSAIDs are missing. Since evidence-based criteria are scarce, the selection of an NSAID should take into account proof and degree of efficacy, rapid GI absorption, gastric ulcer risk and previous experience of each individual patient. If selected and prescribed wisely, NSAIDs are precious, safe and cost-efficient drugs for the treatment of migraine attacks. PMID:27713337

  3. PRRT2 mutation causes paroxysmal kinesigenic dyskinesia and hemiplegic migraine in monozygotic twins.

    PubMed

    Castiglioni, Claudia; López, Isabel; Riant, Florence; Bertini, Enrico; Terracciano, Alessandra

    2013-05-01

    PRRT2 gene mutations have recently been identified as a causative gene of Paroxysmal kinesigenic dyskinesia (PKD), a rare movement disorder characterised by the occurrence of chorea, dystonia or athetosis triggered by sudden action. Some patients have additional intermittent neurologic disorders like infantile convulsions. The association with migraine has been rarely reported in this condition. Here we report the coexistence of PKD and hemiplegic migraine in twins harbouring a heterozygous mutation in PRRT2. Two monozygotic twins manifesting PKD together with repeated episodes of migraine with some severe attacks of hemiplegic migraine have been followed and treated for more than 10 years. Molecular genetic analysis disclosed the c.649_650insC, p.R217Pfs*8 heterozygous mutation in both twins. This mutation was segregating from the mother who likewise harboured the same mutation c.649dupC although she had never manifested PKD but complained of rare common migraine attacks in her past history. The association of PKD and hemiplegic migraine has been previously reported in one large family, associated to febrile convulsions and afebrile seizures in some individuals, but our report relates this association of symptoms to a mutation in PRRT2. The co-occurrence of both hemiplegic migraine and PKD in monozygotic twins expands the phenotypic spectrum of intermittent manifestations related to PRRT2 and perhaps suggests an additional causing gene for hemiplegic migraine.

  4. Increased risk of essential tremor in migraine: A population-based retrospective cohort study

    PubMed Central

    Lau, Chi-Ieong; Lin, Che-Chen; Chen, Hsuan-Ju; Wang, Han-Cheng; Chen, Wei-Hung

    2017-01-01

    Purpose To examine the long-term risk of essential tremor (ET) in migraine. Methods Using population-based administrative data from a subset of the National Health Insurance Research Database (NHIRD) of Taiwan, we identified 22,696 newly diagnosed migraineurs (mean age 44.5 years) and a matched migraine-free cohort of 90,784 individuals in the period 2000–2008. Multivariable Cox proportional hazards regression analysis was conducted for assessing the ET risk for the migraine cohort compared to the migraine-free cohort. Results After adjusting for covariates, the migraine cohort had a 1.83-fold increased risk (95% CI 1.50–2.23) of subsequent ET in comparison to the migraine-free cohort (8.97 vs. 4.81 per 10,000 person-years). In the subgroup analysis, patients with migraine were associated with higher risks of ET, regardless of gender, age or the existence of comorbidities. Conclusion Our findings demonstrated an association between migraine and ET, suggesting a possible shared pathophysiology underpinning both disorders. PMID:28288163

  5. Cyclical changes of cortical excitability and metaplasticity in migraine: evidence from a repetitive transcranial magnetic stimulation study.

    PubMed

    Cosentino, Giuseppe; Fierro, Brigida; Vigneri, Simone; Talamanca, Simona; Paladino, Piera; Baschi, Roberta; Indovino, Serena; Maccora, Simona; Valentino, Francesca; Fileccia, Enrico; Giglia, Giuseppe; Brighina, Filippo

    2014-06-01

    The primary brain dysfunctions leading to the onset of a migraine attack remain largely unknown. Other important open questions concern the mechanisms of initiation, continuation, and termination of migraine pain, and the changes in brain function underlying migraine transformation. Brief trains of high-frequency repetitive transcranial magnetic stimulation (rTMS), when applied to the primary motor cortex at suprathreshold intensity (⩾120% of resting motor threshold [RMT]), elicit in healthy subjects a progressive, glutamate-dependent facilitation of the motor evoked potentials (MEP). Conversely, in conditions of increased cortical excitability, the rTMS trains induce inhibitory MEP responses likely mediated by cortical homeostatic mechanisms. We enrolled 66 migraine-without-aura patients, 48 migraine-with-aura patients, 14 patients affected by chronic migraine (CM), and 20 healthy controls. We assessed motor cortical response to 5-Hz rTMS trains of 10 stimuli given at 120% RMT. Patients with episodic migraine were studied in different phases of the migraine cycle: interictal, preictal, ictal, and postictal states. Results showed a facilitatory MEP response during the trains in patients evaluated in the preictal phase, whereas inhibitory responses were observed during and after a migraine attack, as well as in CM patients. In the interictal phase, different responses were observed, depending on attack frequency: facilitation in patients with low and inhibition in those with high attack recurrence. Our findings suggest that changes in cortical excitability and fluctuations in the threshold for inhibitory metaplasticity underlie the migraine attack recurrence, and could be involved in the process of migraine transformation.

  6. Effect of juggling therapy on anxiety disorders in female patients

    PubMed Central

    Nakahara, Toshihiro; Nakahara, Kazuhiko; Uehara, Miho; Koyama, Ken-ichiro; Li, Kouha; Harada, Toshiro; Yasuhara, Daisuke; Taguchi, Hikaru; Kojima, Sinya; Sagiyama, Ken-ichiro; Inui, Akio

    2007-01-01

    Aims The aim of this study was to investigate the effect of juggling therapy for anxiety disorder patients. Design and Method Subjects were 17 female outpatients who met the DSM-IV diagnostic criteria for anxiety disorders. Subjects were treated with standard psychotherapy, medication and counseling for 6 months. For the last 3 months of treatment, subjects were randomized into either a non-juggling group (n = 9) or a juggling therapy group (juggling group: n = 8). The juggling group gradually acquired juggling skills by practicing juggling beanbags (otedama in Japan) with both hands. The therapeutic effect was evaluated using scores of psychological testing (STAI: State and Trate Anxiety Inventry, POMS: Profile of Mood Status) and of ADL (FAI: Franchay Activity Index) collected before treatment, 3 months after treatment (before juggling therapy), and at the end of both treatments. Results After 6 months, an analysis of variance revealed that scores on the state anxiety, trait anxiety subscales of STAI and tension-anxiety (T-A) score of POMS were significantly lower in the juggling group than in the non-juggling group (p < 0.01). Depression, anger-hostility scores of POMS were improved more than non-jugglers. In the juggling group, activity scores on the vigor subscale of POMS and FAI score were significantly higher than those in the non juggling group (p < 0.01). Other mood scores of POMS did not differ between the two groups. Conclusion These findings suggest that juggling therapy may be effective for the treatment of anxiety disorders. PMID:17470298

  7. The diet factor in pediatric and adolescent migraine.

    PubMed

    Millichap, J Gordon; Yee, Michelle M

    2003-01-01

    Diet can play an important role in the precipitation of headaches in children and adolescents with migraine. The diet factor in pediatric migraine is frequently neglected in favor of preventive drug therapy. The list of foods, beverages, and additives that trigger migraine includes cheese, chocolate, citrus fruits, hot dogs, monosodium glutamate, aspartame, fatty foods, ice cream, caffeine withdrawal, and alcoholic drinks, especially red wine and beer. Underage drinking is a significant potential cause of recurrent headache in today's adolescent patients. Tyramine, phenylethylamine, histamine, nitrites, and sulfites are involved in the mechanism of food intolerance headache. Immunoglobulin E-mediated food allergy is an infrequent cause. Dietary triggers affect phases of the migraine process by influencing release of serotonin and norepinephrine, causing vasoconstriction or vasodilatation, or by direct stimulation of trigeminal ganglia, brainstem, and cortical neuronal pathways. Treatment begins with a headache and diet diary and the selective avoidance of foods presumed to trigger attacks. A universal migraine diet with simultaneous elimination of all potential food triggers is generally not advised in practice. A well-balanced diet is encouraged, with avoidance of fasting or skipped meals. Long-term prophylactic drug therapy is appropriate only after exclusion of headache-precipitating trigger factors, including dietary factors.

  8. Migraine: a review and future directions for treatment.

    PubMed

    Linde, M

    2006-08-01

    Migraine is a chronic, neurological disorder generally manifesting itself in attacks with severe headache, nausea and an increased reactivity to sensory stimuli. A low migraine threshold is set by genetic factors, although the phenotype also modulates the manifestations. The 1-year prevalence is approximately 13% and is higher among women. Patients usually experience neuropsychological dysfunction, and sometimes also reversible focal neurological symptoms. The trajectories of the characteristic symptoms of acute migraine usually follow a similar time course, indicating a reciprocal underlying mechanism. A central nervous system hyperexcitability has been demonstrated in neurophysiological studies. The dibilitating effects of migraine are not confined to the attacks per se. Many individuals do not recover completely between the attacks and most report a negative impact on the most important life domains, and an interest in testing other treatments. Young persons have a higher frequency of attacks. Acute treatment should routinely be initiated with an analgesic plus a prokinetic anti-emetic. Triptans must not be provided early during the attack to ensure their efficacy. The natural course of attacks is commonly only temporarily altered by acute treatment. Non-pharmacological treatment and drugs may be equally viable in prophylaxis for migraine. In more complicated cases, conjoint therapy should be considered. New strategies to improve adherence with existing therapeutic regimens might yield greater benefits than will new pharmacological agents.

  9. Update on the Pharmacological Treatment of Chronic Migraine.

    PubMed

    Sun-Edelstein, Christina; Rapoport, Alan M

    2016-01-01

    Chronic migraine (CM) is a common and disabling disorder that remains underdiagnosed and poorly treated. Significant unmet therapeutic needs add to the burden of this disorder; even when CM is recognized, effective treatment options are limited and randomized controlled trials supporting the use of various preventive medications are sparse. In this review, we discuss the available options for CM treatment. Currently the only FDA-approved treatment for CM prevention is onabotulinumtoxinA. Two double-blind studies have demonstrated the efficacy of topiramate for CM prevention, but it is not FDA-approved for this indication. Treatments in development for migraine will also be reviewed. Advancements in the understanding of migraine pathogenesis have identified new targets for both acute and preventive treatment and have engendered the development of targeted and mechanism-based therapies. The need for more effective treatment for CM patients, which has long since been identified, is now being addressed. Several of the emerging treatments for migraine prevention are under investigation specifically for CM or high-frequency episodic migraine.

  10. Associations Between Sleep Quality and Migraine Frequency: A Cross-Sectional Case-Control Study.

    PubMed

    Lin, Yu-Kai; Lin, Guan-Yu; Lee, Jiunn-Tay; Lee, Meei-Shyuan; Tsai, Chia-Kuang; Hsu, Yu-Wei; Lin, Yu-Zhen; Tsai, Yi-Chien; Yang, Fu-Chi

    2016-04-01

    Migraine has been associated with sleep disturbances. Relationship between sleep quality and migraine frequency is yet to be determined. The present study aimed to investigate sleep disturbances among low-frequency, moderate-frequency, high-frequency, and chronic migraineurs, with and without auras, with well-controlled confounding variables.This cross-sectional controlled study included 357 subjects from an outpatient headache clinic in Taiwan. Standardized questionnaires were utilized to collect demographic, migraine, sleep, depression, anxiety, and restless leg syndrome characteristics in all participants. According to frequency of migraine attacks, patients were divided into 4 groups: with 1 to 4 migraine days per month, 5 to 8 migraine days in a month, 9 to 14 migraine days in a month, and >14 migraine days per month. The Pittsburgh Sleep Quality Index (PSQI) and subgroup items were used to evaluate sleep quality. The association between migraine frequency and sleep quality was investigated using multivariable linear regression and logistic regression.The PSQI total score was highest in patients with high frequent migraine (10.0 ± 3.4) and lowest in controls (7.0 ± 3.4) with a significant trend analysis (P for trend = 0.006). Migraine frequency had an independent effect on the items "Cannot get to sleep within 30 minutes" (P < 0.001), "Wake up in the middle of the night or early morning" (P < 0.001), "Bad dreams" (P = 0.001), "Pain" (P = 0.004), and "Quality of sleep" (P < 0.001). The result showed the effect of migraine frequency in both the aura-present (P for trend = 0.008) and the aura-absent subgroups (P for trend = 0.011).High migraine frequency correlates with poor sleep quality and a higher prevalence of poor sleepers. These associations occur in migraine with aura and without aura.

  11. A Nationwide Population-Based Cohort Study of Migraine and Organic-Psychogenic Erectile Dysfunction

    PubMed Central

    Wu, Szu-Hsien; Chuang, Eric; Chuang, Tien-Yow; Lin, Cheng-Li; Lin, Ming-Chia; Yen, Der-Jen; Kao, Chia-Hung

    2016-01-01

    Abstract As chronic illnesses and chronic pain are related to erectile dysfunction (ED), migraine as a prevalent chronic disorder affecting lots of people all over the world may negatively affect quality of life as well as sexual function. However, a large-scale population-based study of erectile dysfunction and other different comorbidities in patients with migraine is quite limited. This cohort longitudinal study aimed to estimate the association between migraine and ED using a nationwide population-based database in Taiwan. The data used for this cohort study were retrieved from the Longitudinal Health Insurance Database 2000 in Taiwan. We identified 5015 patients with migraine and frequency matched 20,060 controls without migraine from 2000 to 2011. The occurrence of ED was followed up until the end of 2011. We used Cox proportional hazard regression models to analyze the risks of ED. The overall incidence of ED was 1.78-fold greater in the migraine cohort than in the comparison cohort (23.3 vs 10.5 per 10,000 person-years; 95% confidence interval [CI] = 1.31–2.41). Furthermore, patients with migraine were 1.75-fold more likely to develop organic ED (95% CI = 1.27–2.41) than were the comparison cohort. The migraine patients with anxiety had a 3.6-fold higher HR of having been diagnosed with ED than the comparison cohort without anxiety (95% CI, 2.10–6.18). The results support that patients with migraine have a higher incidence of being diagnosed with ED, particularly in the patient with the comorbidity of anxiety. PMID:26962838

  12. Utility and preliminary effects of online digital assistance (ODA) for behavioral attack prevention in migraine.

    PubMed

    Kleiboer, Annet; Sorbi, Marjolijn; Mérelle, Saskia; Passchier, Jan; van Doornen, Lorenz

    2009-09-01

    There were two objectives of this research. First was to establish the utility of online digital assistance (ODA), a generic software-based method designed to support behavioral training (BT) in migraine. The second was to test whether ODA can produce additional effects in BT. Utility (feasibility and acceptability) was based on 44 patients with migraine who received ODA as an adjuvant to BT delivered to small groups by lay trainers with migraine at home. ODA tracking files were used to determine ODA feasibility. Acceptability was assessed by a structured interview. To examine ODA effects, 31 patients with migraine who received ODA during BT and at 6 months' follow-up were compared with a matched group of 31 participants who received BT only. Feasibility was established based on minimal technical problems, good compliance, and successful execution of ODA. Acceptability was confirmed by positive participant responses concerning usefulness, supportiveness, and low burden. Finally, ODA participants did not mark better improvements considering migraine attack frequency, internal control, and migraine-specific quality of life compared to those that underwent BT only. ODA is feasible, well-accepted, and perceived to support self-care in 44 patients with migraine. The method is currently designed for these patients, but it can be easily adapted for other health settings. Whether ODA can induce higher gains remains to be established.

  13. Prevalence and risk of migraine headaches in adult fragile X premutation carriers.

    PubMed

    Au, J; Akins, R S; Berkowitz-Sutherland, L; Tang, H-T; Chen, Y; Boyd, A; Tassone, F; Nguyen, D V; Hagerman, R

    2013-12-01

    FMR1 premutation carriers are common in the general population (1/130-260 females and 1/250-810 males) and can be affected by fragile X-associated tremor ataxia syndrome, fragile X-associated primary ovarian insufficiency, anxiety, depression, hypertension, sleep apnea, fibromyalgia, and hypothyroidism. Here we report the results of a pilot study to assess the prevalence and risk of migraine in FMR1 premutation carriers. Three hundred fifteen carriers (203 females; 112 males) and 154 controls (83 females; 71 males) were seen sequentially as part of a family study. A standardized medical history, physical examination and confirmation of diagnosis of migraine headaches were performed by a physician. The prevalence of migraine was 54.2% in female carriers (mean age/SD: 49.60/13.73) and 26.79% in male carriers (mean age/SD: 59.94/14.27). This prevalence was higher compared to female (25.3%; mean age/SD: 47.60/15.21; p =  0.0001) and male controls (15.5%; mean age/SD; 53.88/13.31; p =  0.0406) who underwent the same protocol and were confirmed to be negative for the FMR1 mutation by DNA testing. We hypothesize that the increased prevalence of migraine headaches in FMR1 premutation carriers is likely related to the mitochondrial abnormalities that have recently been reported. Screening for migraine should be considered when evaluating FMR1 premutation carriers in the future.

  14. The role of genetics on migraine induction triggered by CGRP and PACAP38.

    PubMed

    Guo, Song

    2017-03-01

    Migraine has a strong genetic component and is characterized by multiphasic events including an initial premonitory phase with premonitory symptoms (PS). Calcitonin gene-related peptide (CGRP) and pituitary adenylate cyclase-activating peptide-38 (PACAP38) are endogenous neuropeptides that can trigger migraine attacks and have in recent years gained considerable interest in the migraine field. Yet, the exact pathophysiological mechanisms underlying CGRP- and PACAP38-induced attacks are not fully clarified. Human provocation models have shown that these peptides induce attacks in only two- thirds of migraine patients. Whether this diverse migraine response after CGRP or PACAP38 may be explained by genetic factors is unknown. The present thesis includes four studies that explore different factors that may be associated with the CGRP- and PACAP38-induced migraine response. In study I and II we investigated the role of familial predisposition (family load) and number of risk conferring gene variants on migraine attacks induced by CGRP or PA-CAP38. In study III, we investigated biochemical changes of CGRP, vasoactive intestinal peptide (VIP), S100B and TNF-alpha in the blood after PACAP38. Finally in study IV, we studied whether CGRP or PACAP38 may induce PS. Study I and II demonstrated that PACAP38 and CGRP induce migraine attacks in 63% and 72% of the patients, respectively. Moreover, we showed that patients with high family load or a high number of migraine associated gene variants did not report more migraine attacks after CGRP or PACAP38 than those with no familial predisposition or few gene variants. Study III showed that PACAP38 infusion caused changes in plasma concentrations for VIP and S100B, but not CGRP and TNF-alpha, suggesting activation of parasympathetic nerve endings. Study IV showed absence of PS after CGRP and lack of statistical difference in PS between patients who reported and not reported attacks after PACAP38 suggesting peripheral mechanisms of

  15. Topiramate: the evidence for its therapeutic value in the prevention of migraine

    PubMed Central

    Nadin, Carole

    2005-01-01

    Introduction: Preventive therapy is recommended in patients with migraines frequent and/or severe enough to interfere with daily life, and/or with an inadequate response to acute therapy (26–43% of patients with migraine in a recent US survey). Preventive treatments include beta blockers, amitriptyline, and antiepileptics (sodium valproate, gabapentin), but these may have significant adverse effects and are contraindicated in some patients. Topiramate is an antiepileptic recently approved for prevention of migraine. Aims: To assess the evidence on the therapeutic value of topiramate as preventive treatment for migraine in adults. Evidence review: All identified outcomes were patient-oriented. Strong evidence shows that topiramate 100 or 200 mg/day is more effective than placebo in reducing mean monthly migraine frequency, and further evidence shows better effectiveness than placebo on responder rate, rescue medication use, migraine severity, and migraine duration. The 100 mg/day dose appears generally better tolerated than 200 mg/day. Evidence shows that topiramate is associated with weight loss rather than weight gain. Limited evidence suggests that topiramate can improve health-related quality of life and reduce days with disability. Uncontrolled studies indicate effectiveness in refractory migraine. Limited evidence indicates broadly similar efficacy and tolerability for topiramate 100 mg/day and propranolol 160 mg/day, though more comparative trials are required. There is insufficient economic evidence to assess the cost effectiveness of topiramate. Place in therapy: Topiramate 100 mg/day is the dose with the best balance between efficacy and tolerability, and offers therapeutic value in patients in whom propranolol or other preventive migraine therapies are contraindicated, poorly tolerated, or ineffective. PMID:22500148

  16. Migraine Medications and Antidepressants: A Risky Mix?

    MedlinePlus

    ... are the health risks associated with taking migraine medications and antidepressants at the same time? Answers from ... Swanson, M.D. Reports suggest that combining migraine medications called triptans with certain antidepressants — including selective serotonin ...

  17. Impact of Migraine on School Performance

    MedlinePlus

    ... Spencer, MD Steven Karceski, MD The impact of migraine on school performance Daniel Kantor, MD e168 WHAT ... this study tackle an often overlooked problem: how migraine headache affects the school performance of children. 1 ...

  18. Migraines and perimenopause: helping women in midlife manage and treat migraine.

    PubMed

    Hauser, Lise

    2012-01-01

    Migraine is more common in women than men, with lifetime prevalence rates between 15 percent and 26 percent for women. The World Health Organization ranks migraine as 12th among all causes of years lived with disability in women. This article reviews diagnostic criteria for migraine with and without aura, the impact of fluctuating hormones in perimenopause on the experience of migraine and medication and nonmedication approaches to managing migraine.

  19. New paradigms in the recognition and acute treatment of migraine.

    PubMed

    Sheftell, Fred D; Tepper, Stewart J

    2002-01-01

    It would be ideal if clinical decisions regarding acute migraine treatment could be made on the basis of three parameters: a critical appraisal of available scientific evidence, clinical experience (including knowledge of the individual patient and his/her attack characteristics), and, of course, patient preferences. Patients are likely to prefer agents that offer rapid relief, pain-free status within 2 hours, no recurrence or need for rescue medication, extended time to recurrence (if present), consistency of therapeutic effect over multiple attacks, oral administration. good tolerability, safety, and minimal drug interactions. Fortunately, a number of specific therapies now are available which place these objectives within the patient's reach. Ongoing barriers to optimal migraine care include underrecognition, underconsultation, undertreatment, restrictions imposed by insurance companies, and exaggerated concerns regarding the safety of the triptans. Overcoming these barriers is likely to prove a more important contribution to patient care than endeavoring to establish the relative merits of one triptan over another. We have described in detail a number of strategies for improving recognition and treatment of migraine. Many headache specialists now believe that recurrent episodes of disabling headache, with a stable pattern over years, should be viewed as migraine until proven otherwise. In the end, this may represent the most useful paradigm in the primary care setting, where time is of the essence. Studies to validate this approach are needed. Acute treatment intervention that is based on scientific evidence, clinical experience, and patients' needs and desires will provide better outcomes than those presently obtained. Preliminary evidence favors early intervention with oral triptans, and randomized, prospective, double-blind, placebo-controlled studies, ideally employing a crossover design, are required to confirm this. The US Consortium's evidence

  20. Classification of spontaneous EEG signals in migraine

    NASA Astrophysics Data System (ADS)

    Bellotti, R.; De Carlo, F.; de Tommaso, M.; Lucente, M.

    2007-08-01

    We set up a classification system able to detect patients affected by migraine without aura, through the analysis of their spontaneous EEG patterns. First, the signals are characterized by means of wavelet-based features, than a supervised neural network is used to classify the multichannel data. For the feature extraction, scale-dependent and scale-independent methods are considered with a variety of wavelet functions. Both the approaches provide very high and almost comparable classification performances. A complete separation of the two groups is obtained when the data are plotted in the plane spanned by two suitable neural outputs.

  1. Migraine: pharmacotherapy in the emergency department

    PubMed Central

    Kelly, A.

    2000-01-01

    Migraine can be a disabling condition for the sufferer. For the small number of patients who fail home therapy and seek treatment in an emergency department, there are a number of therapeutic options. This paper reviews the evidence regarding the effectiveness and safety of the following therapies: the phenothiazines, lignocaine (lidocaine), ketorolac, the ergot alkaloids, metoclopramide, the "triptans", haloperidol, pethidine and magnesium. Based on available evidence, the most effective agents seem to be prochlorperazine, chlorpromazine and sumatriptan, each of which have achieved greater then 70% efficacy in a number of studies. PMID:10921808

  2. Does Migraine Increase the Risk of Glaucoma?: A Population-Based Cohort Study.

    PubMed

    Chen, Hsin-Yi; Lin, Cheng-Li; Kao, Chia-Hung

    2016-05-01

    This study investigated whether migraine influences the risk of primary open-angle glaucoma (POAG) and primary angle-closure glaucoma (PACG) in Taiwan.We retrieved the data analyzed in this study from the National Health Insurance Research Database in Taiwan. We included 17,606 newly diagnosed migraine patients without preexisting glaucoma and randomly selected and matched 70,423 subjects without migraine as the comparison cohort. The same exclusion criteria were also applied to comparison subjects. Multivariate Cox proportion-hazards regression model was used to assess the effects of migraines on the risk of glaucoma after adjusting for demographic characteristics and comorbidities.The cumulative incidence of POAG was higher in the migraine cohort than that in the comparison cohort (log-rank P = 0.04). The overall incidence of POAG (per 10,000 person-years) was 9.62 and 7.69, respectively, for migraine cohort and nonmigraine cohort (crude hazard ratio [HR] = 1.24, 95% confidence interval [CI] = 1.01-1.54). After adjusting the covariates, the risk of POAG was not significantly higher in the migraine cohort than in the comparison cohort (adjusted HR [aHR] = 1.15, 95% CI = 0.93-1.42). The cumulative incidence of PACG did not differ between the migraine cohort and the comparison cohort (log-rank test P = 0.53). The overall incidence of PACG was not significantly higher in the migraine cohort than that in the comparison cohort (7.42 vs 6.84 per 10,000 person-years), with an aHR of 1.04 (95% CI = 0.82-1.32).This study shows that migraines are not associated with a higher risk either in POAG or in PACG.

  3. Becker's Nevus Syndrome in a Pediatric Female Patient

    PubMed Central

    Hernandez-Quiceno, Sara; Ramírez-Jiménez, Juan Jose; Lopera-Cañaveral, Maria Victoria; Toro-Ramos, Martin; Usuga-Arcila, Yuri; Correa-Londoño, Luis; Martinez, Juan Camilo; Monroy, Jennifer; Alfaro, Juan Manuel

    2016-01-01

    Becker's nevus syndrome is part of the epidermal nevus syndromes and has been described with a phenotype that includes Becker's nevus, ipsilateral breast hypoplasia, and variable skeletal malformations. It is more frequent in males than in females (5 : 1) but is more relevant in females. The diagnosis is clinically based and the skin lesion must be present and no other numbered criteria have been established, but with more criteria being present the possibility of the diagnosis is higher. Regarding the treatment of breast hypoplasia, the use of antiandrogen medication has demonstrated adequate clinical response in a dose of 50 mg/day of spironolactone. PMID:27891278

  4. [Mental disorders and migraine: epidemiologic studies].

    PubMed

    Guillem, E; Pelissolo, A; Lepine, J P

    1999-01-01

    Epidemiologic studies in the general population, taking into account certain bias inherent to the clinical observation have confirmed the clinical impression reporting a higher psychiatric comorbidity with persons suffering from migraine than in persons without migraine. Persons with migraine are at increased risk for affective and anxiety disorders, personality traits disorders (neuroticism), suicide attempts, but not for alcohol or illicit drug abuse. The comorbidity is more important in migraine with aura than in migraine without aura. Concerning affective disorders, the lifetime prevalence of major depression is 34.4% in persons with migraine and 10.4% in persons without migraine. For bipolar I disorder, prevalence is 6.8% in migraine with aura versus 0.9% when no migraine. Compared to no migraine, the lifetime prevalence of anxiety disorders in migraine is significantly increased in: panic disorder (10.9% vs 1.8%); generalized anxiety disorder (10.2% vs 1.9%); obsessive-compulsive disorder (8.6% vs 1.8%); phobic disorder (39.8% vs 20.6%). In addition, no psychopathological, biological or genetic explanation seems to be meaningful for the comprehension of this comorbidity pattern. These results remain primarily descriptive but they justify a clinical investigation of affective and anxiety disorders, and suicide attempts, in all person with migraine, and it also justifies the treatment of pain associated with the treatment of eventual affective or anxiety disorders.

  5. [The use of drugs in migraine].

    PubMed

    Wilkinson, M

    1976-06-02

    Drugs may be given either for treatment of the acute attack or as prophylaxis. Those most commonly used for the acute attack are analgesics, anti-emetics and ergotamine tartrate. A recent work (Volans, 1974) has shown that absorption may be impaired during a migraine attack. It is important therefore that not only is the analgesic given in an easily absorbed form but that a drug such as metaclopromide should be given to help restore the normal activity of the gastro-intestinal tract. Patients having one or more attacks of migraine a week may need prophylactic treatment. The drugs now used include: Methysergide, should only be used for severe cases when no other treatment has been found helpful. Dihydroergotamine, the vasoconstrictor activity is less than in ergotamine tartrate and can therefore be used prophylactically. Pizotifen, possesses powerful anti-serotonin properties. It also has marked antihistamine and antitryptamine properties as well as being a central sedative and anti-depressant. Clonidine, in doses of 1 mugm/Kg renders the blood vessels less sensitive to circulating amines and seems to be effective in about one third of patients with classical or common migraine. Sympathetic Blocking Agents: alpha-blockers: indoramine has recently given some good results; beta-blockers: such as propanolol and pindolol have also been used. Full trials of all the substances are now in progress. Tranquilisers and anti-depressants, two of those commonly used are diazepam and amitryptiline. In either cases a small dose only should be used. Anticonvulsants, phenytoin in doses of 50-100 mgs per day is sometimes helpful particularly in children or in those who have abnormal electroencephalograms.

  6. [Gap junctional intercellular communication: a new mechanism in pathophysiology of migraine with aura. Therapeutic applications].

    PubMed

    Sarrouilhe, D; Dejean, C

    2012-12-01

    Migraine is a common, recurrent and disabling primary headache disorder, which affects up to 20% of the population. About a third of patients with migraine have attacks with aura, a focal neurological disturbance that manifests itself as visual, sensitive or motor symptoms. Cortical spreading depression, a wave of electrical activity that moves across the cerebral cortex through neuronal-glial cell gap junctions, would be involved in the triggering of migraine aura. Moreover, cortical spreading depression activates perivascular trigeminal afferents in the neocortex, that through central and peripheral reflex, cause inflammatory reaction in the meninges to generate the headache. Tonabersat, a novel benzopyran compound, was selected for clinical trial on the basis of its inhibitory activity on cortical spreading depression and neurogenic inflammation in animal models of migraine. Moreover, tonabersat inhibited trigeminal ganglion neuronal-glial cell gap junctions, suggesting that this compound could prevent peripheral sensitization within the ganglion. In clinical trial, tonabersat showed a preventive effect on attacks of migraine with aura but had no efficacy on non-aura attacks and in the acute treatment of migraine. In conclusion, neuronal-glial cell gap junctional intercellular communication seems to be involved in the pathophysiology of migraine with aura and is emerging as a new promising therapeutic target for prophylactic treatment of patients with chronic attacks.

  7. Female Migraineurs Show Lack of Insular Thinning with Age

    PubMed Central

    Maleki, Nasim; Barmettler, Gabi; Moulton, Eric A.; Scrivani, Steven; Veggeberg, Rosanna; Spierings, Egilius L.H.; Burstein, Rami; Becerra, Lino; Borsook, David

    2015-01-01

    Gray matter loss in cortical regions is a normal ageing process for the healthy brain. There have been few studies on the process of ageing of the brain in chronic neurological disorders. In this study, we evaluated changes in the cortical thickness by age in 92 female subjects (46 migraine patients, and 46 healthy controls) using high field MRI. The results indicate that in contrast to healthy subjects migraineurs show lack of thinning in the insula by age. The functional significance of the lack of thinning is unknown, but may contribute to the overall cortical hyperexcitability of the migraine brain since the region is tightly involved in a number of majo brain networks involved in interoception, salience, nociception, and autonomic function, including the default mode network. PMID:25775358

  8. Pathophysiology of Migraine: A Disorder of Sensory Processing.

    PubMed

    Goadsby, Peter J; Holland, Philip R; Martins-Oliveira, Margarida; Hoffmann, Jan; Schankin, Christoph; Akerman, Simon

    2017-04-01

    Plaguing humans for more than two millennia, manifest on every continent studied, and with more than one billion patients having an attack in any year, migraine stands as the sixth most common cause of disability on the planet. The pathophysiology of migraine has emerged from a historical consideration of the "humors" through mid-20th century distraction of the now defunct Vascular Theory to a clear place as a neurological disorder. It could be said there are three questions: why, how, and when? Why: migraine is largely accepted to be an inherited tendency for the brain to lose control of its inputs. How: the now classical trigeminal durovascular afferent pathway has been explored in laboratory and clinic; interrogated with immunohistochemistry to functional brain imaging to offer a roadmap of the attack. When: migraine attacks emerge due to a disorder of brain sensory processing that itself likely cycles, influenced by genetics and the environment. In the first, premonitory, phase that precedes headache, brain stem and diencephalic systems modulating afferent signals, light-photophobia or sound-phonophobia, begin to dysfunction and eventually to evolve to the pain phase and with time the resolution or postdromal phase. Understanding the biology of migraine through careful bench-based research has led to major classes of therapeutics being identified: triptans, serotonin 5-HT1B/1D receptor agonists; gepants, calcitonin gene-related peptide (CGRP) receptor antagonists; ditans, 5-HT1F receptor agonists, CGRP mechanisms monoclonal antibodies; and glurants, mGlu5 modulators; with the promise of more to come. Investment in understanding migraine has been very successful and leaves us at a new dawn, able to transform its impact on a global scale, as well as understand fundamental aspects of human biology.

  9. Association analysis of the functional monoamine oxidase A gene promotor polymorphism in migraine.

    PubMed

    Marziniak, M; Mössner, R; Benninghoff, J; Syagailo, Y V; Lesch, K-P; Sommer, C

    2004-05-01

    Migraine affects about 15% of the adult population. Serotonergic and dopaminergic systems are believed to be involved in its pathophysiology. One of the key enzymes in the degradation of serotonin and to a lesser extent of dopamine is monoamine oxidase A (MAO-A). In this study we investigated a functionally relevant gene-linked polymorphic repetitive sequence (LPR) located approximately 1.2 kb upstream of the ATG codon in the MAO-A-promotor gene. 119 patients with migraine and 229 controls were tested. The allelic distribution of the controls and the migraine patients did not show significant differences with respect to the low- and high-activity alleles. Moreover, effectiveness of the potent serotonergic antimigraine agents, triptans, which are metabolized by MAO-A, was clinically not affected by the MAO-A-LPR in our patients. These findings thus indicate that there is no association between the functional MAO-A-LPR and susceptibility to migraine.

  10. Migraine with Aura or Sports-Related Concussion: Case Report, Pathophysiology, and Multidisciplinary Approach to Management.

    PubMed

    Ellis, Michael J; Cordingley, Dean; Girardin, Richard; Ritchie, Lesley; Johnston, Janine

    The evaluation and management of athletes presenting with clinical features of migraine headache with aura in the setting of sports-related head trauma is challenging. We present a case report of a 15-yr-old boy with a history of migraine with visual aura that developed acute visual disturbance and headache after a head injury during an ice hockey game. The patient underwent comprehensive assessment at a multidisciplinary concussion program, including neuro-ophthalmological examination, neurocognitive testing, and graded aerobic treadmill testing. Clinical history and multidisciplinary assessment was consistent with the diagnosis of coexisting sports-related concussion and migraine with brainstem aura. The authors discuss the pearls and pitfalls of managing patients who develop migraine headache with visual aura after sports-related head injury and the value of a comprehensive multidisciplinary approach to this unique patient population.

  11. Hyperammonemia crisis following parturition in a female patient with ornithine transcarbamylase deficiency

    PubMed Central

    Kido, Jun; Kawasaki, Tatsuya; Mitsubuchi, Hiroshi; Kamohara, Hidenobu; Ohba, Takashi; Matsumoto, Shirou; Endo, Fumio; Nakamura, Kimitoshi

    2017-01-01

    Ornithine transcarbamylase deficiency (OTCD) is an X-linked disorder, with an estimated prevalence of 1 per 80000 live births. Female patients with OTCD develop metabolic crises that are easily provoked by non-predictable common disorders, such as genetic (private mutations and lyonization) and external factors; however, the outcomes of these conditions may differ. We resuscitated a female patient with OTCD from hyperammonemic crisis after she gave birth. Hyperammonemia after parturition in a female patient with OTCD can be fatal, and this type of hyperammonemia persists for an extended period of time. Here, we describe the cause and treatment of hyperammonemia in a female patient with OTCD after parturition. Once hyperammonemia crisis occurs after giving birth, it is difficult to improve the metabolic state. Therefore, it is important to perform an early intervention before hyperammonemia occurs in patients with OTCD or in carriers after parturition. PMID:28293384

  12. Hyperammonemia crisis following parturition in a female patient with ornithine transcarbamylase deficiency.

    PubMed

    Kido, Jun; Kawasaki, Tatsuya; Mitsubuchi, Hiroshi; Kamohara, Hidenobu; Ohba, Takashi; Matsumoto, Shirou; Endo, Fumio; Nakamura, Kimitoshi

    2017-02-28

    Ornithine transcarbamylase deficiency (OTCD) is an X-linked disorder, with an estimated prevalence of 1 per 80000 live births. Female patients with OTCD develop metabolic crises that are easily provoked by non-predictable common disorders, such as genetic (private mutations and lyonization) and external factors; however, the outcomes of these conditions may differ. We resuscitated a female patient with OTCD from hyperammonemic crisis after she gave birth. Hyperammonemia after parturition in a female patient with OTCD can be fatal, and this type of hyperammonemia persists for an extended period of time. Here, we describe the cause and treatment of hyperammonemia in a female patient with OTCD after parturition. Once hyperammonemia crisis occurs after giving birth, it is difficult to improve the metabolic state. Therefore, it is important to perform an early intervention before hyperammonemia occurs in patients with OTCD or in carriers after parturition.

  13. Comparison between the efficacy of ginger and sumatriptan in the ablative treatment of the common migraine.

    PubMed

    Maghbooli, Mehdi; Golipour, Farhad; Moghimi Esfandabadi, Alireza; Yousefi, Mehran

    2014-03-01

    Frequency and torment caused by migraines direct patients toward a variety of remedies. Few studies to date have proposed ginger derivates for migraine relief. This study aims to evaluate the efficacy of ginger in the ablation of common migraine attack in comparison to sumatriptan therapy. In this double-blinded randomized clinical trial, 100 patients who had acute migraine without aura were randomly allocated to receive either ginger powder or sumatriptan. Time of headache onset, its severity, time interval from headache beginning to taking drug and patient self-estimation about response for five subsequent migraine attacks were recorded by patients. Patients(,) satisfaction from treatment efficacy and their willingness to continue it was also evaluated after 1 month following intervention. Two hours after using either drug, mean headaches severity decreased significantly. Efficacy of ginger powder and sumatriptan was similar. Clinical adverse effects of ginger powder were less than sumatriptan. Patients' satisfaction and willingness to continue did not differ. The effectiveness of ginger powder in the treatment of common migraine attacks is statistically comparable to sumatriptan. Ginger also poses a better side effect profile than sumatriptan.

  14. 47,XYY karyotype and normal SRY in a patient with a female phenotype.

    PubMed

    Benasayag, S; Rittler, M; Nieto, F; Torres de Aguirre, N; Reyes, M; Copelli, S

    2001-06-01

    A rare case of a female patient with a 47,XYY karyotype is described. She had normal female external genitalia, bilateral testes, rudimentary Fallopian tubes and no uterus. Molecular analysis revealed a normal SRY encoding sequence. The possible events in the etiology of this sex reversal entity are discussed.

  15. Botulinum Toxin in Migraine Treatment

    PubMed Central

    ILGAZ AYDINLAR, Elif; YALINAY DİKMEN, Pınar; SAĞDUYU KOCAMAN, Ayşe

    2013-01-01

    Since botulinum toxin might have a therapeutic effect on pain, many studies investigating the efficiency of botulinum toxin in headache treatment have been done. The most satisfying results were achieved by botulinum toxin type A (BoNT/A) in the treatment of chronic migraine. In this paper, we reviewed the clinical effectiveness of BoNT/A in migraine and included our clinical experience. In our ongoing pilot study, where we have repeated BoNT/A injections every 12 weeks, The difference in the Migraine Disability Assessment (MIDAS) scores between the first and the second injections was 61.1%; and between the first and the 3rd injections was found to be 65.72%.

  16. Psychiatric comorbidities of episodic and chronic migraine.

    PubMed

    Buse, Dawn C; Silberstein, Stephen D; Manack, Aubrey N; Papapetropoulos, Spyros; Lipton, Richard B

    2013-08-01

    Migraine is a prevalent disabling neurological disorder associated with a wide range of medical and psychiatric comorbidities. Population- and clinic-based studies suggest that psychiatric comorbidities, particularly mood and anxiety disorders, are more common among persons with chronic migraine than among those with episodic migraine. Additional studies suggest that psychiatric comorbidities may be a risk factor for migraine chronification (i.e., progression from episodic to chronic migraine). It is important to identify and appropriately treat comorbid psychiatric conditions in persons with migraine, as these conditions may contribute to increased migraine-related disability and impact, diminished health-related quality of life, and poor treatment outcomes. Here, we review the current literature on the rates of several psychiatric comorbidities, including depression, anxiety, and post-traumatic stress disorder, among persons with migraine in clinic- and population-based studies. We also review the link between physical, emotional, and substance abuse, psychiatric disorders, and migraine. Finally, we review the data on psychiatric risk factors for migraine chronification and explore theories and evidence underlying the comorbidity between migraine and these psychiatric disorders.

  17. Painful heat reveals hyperexcitability of the temporal pole in interictal and ictal migraine States.

    PubMed

    Moulton, E A; Becerra, L; Maleki, N; Pendse, G; Tully, S; Hargreaves, R; Burstein, R; Borsook, D

    2011-02-01

    During migraine attacks, alterations in sensation accompanying headache may manifest as allodynia and enhanced sensitivity to light, sound, and odors. Our objective was to identify physiological changes in cortical regions in migraine patients using painful heat and functional magnetic resonance imaging (fMRI) and the structural basis for such changes using diffusion tensor imaging (DTI). In 11 interictal patients, painful heat threshold + 1°C was applied unilaterally to the forehead during fMRI scanning. Significantly greater activation was identified in the medial temporal lobe in patients relative to healthy subjects, specifically in the anterior temporal pole (TP). In patients, TP showed significantly increased functional connectivity in several brain regions relative to controls, suggesting that TP hyperexcitability may contribute to functional abnormalities in migraine. In 9 healthy subjects, DTI identified white matter connectivity between TP and pulvinar nucleus, which has been related to migraine. In 8 patients, fMRI activation in TP with painful heat was exacerbated during migraine, suggesting that repeated migraines may sensitize TP. This article investigates a nonclassical role of TP in migraineurs. Observed temporal lobe abnormalities may provide a basis for many of the perceptual changes in migraineurs and may serve as a potential interictal biomarker for drug efficacy.

  18. Current Treatment Options in Vestibular Migraine

    PubMed Central

    Obermann, Mark; Strupp, Michael

    2014-01-01

    Approximately 1% of the general population in western industrialized countries suffers from vestibular migraine. However, it remains widely unknown and often under diagnosed despite the recently published diagnostic criteria for vestibular migraine. Treatment trials that specialize on vestibular migraine are scarce and systematic randomized controlled clinical trials are now only emerging. This review summarizes the knowledge on the currently available treatment options that were tested specifically for vestibular migraine and gives an evidence-based, informed treatment recommendation with all its limitations. To date only two randomized controlled treatment trials provide limited evidence for the use of rizatriptan and zolmitriptan for the treatment of vestibular migraine attacks because of methodological shortcomings. There is an ongoing multicenter randomized placebo-controlled trial testing metoprolol 95 mg vs. placebo (PROVEMIG-trial). Therefore, the therapeutic recommendations for the prophylactic treatment of vestibular migraine are currently widely based on the guidelines of migraine with and without aura as well as expert opinion. PMID:25538676

  19. Frovatriptan: A Review of Pharmacology, Pharmacokinetics and Clinical Potential in the Treatment of Menstrual Migraine

    PubMed Central

    Balbisi, Ebrahim A

    2006-01-01

    Frovatriptan is an orally active 5-hydroxytryptamine (5-HT) receptor agonist which binds with high affinity to 5-HT1B and 5-HT1D receptors. Earlier clinical trials demonstrated that frovatriptan 2.5 mg is significantly more effective than placebo in the acute management of migraine and its associated symptoms. More recently, frovatriptan was shown to be effective in the management of menstrual migraine. The incidence of menstrual migraine in subjects receiving frovatriptan 2.5 mg twice daily during the six day perimenstrual period was 41% compared with 67% with placebo. Frovatriptan treatment is generally well tolerated. The most commonly reported adverse effects were dizziness, paresthesia, dry mouth, and fatigue. Pharmacologic studies demonstrated that frovatriptan is cerebroselective. Its selectivity for cerebral vessels lessens the potential for undesirable peripheral effects. Frovatriptan has a terminal deposition half-life of approximately 26 hours, which appears to be independent of age, gender, and renal function. This imparts that frovatriptan may be particularly well suited to patients with prolonged migraines and those who suffer migraine recurrence. Frovatriptan does not alter cytochrome P450 (CYP450) isoenzymes, as such it is unlikely to affect the metabolism of other drugs. No dosage adjustments are necessary based on age, renal, or mild to moderate hepatic impairment. Apart from its efficacy in the acute management of migraine, frovatriptan is an effective agent when used as either acute therapy or as intermittent prophylaxis therapy of menstrual migraines, particularly in women who do not respond to conventional therapies. PMID:18360605

  20. [Recommendations guide for the treatment of migraine in the clinical practice].

    PubMed

    Láinez, J M; Castillo, J; González, V M; Otero, M; Mateos, V; Leira, R; Pascual, J

    2007-04-01

    Migraine is the most frequent neurological reason for consultation. The differences regarding health care system, type of professional seeing these patients and therapeutic armamentarium available in the different countries are important, which makes it very recommendable to have an action guide that reflects the local clinical practice. Following the year 2005 WHO recommendations in its "Global Campaign" against migraine, the coordinators of the Headache Study Groups of the Spanish Society of Neurology, the Spanish Society of Family and Community Medicine, the Spanish Society of Rural and General Medicine, the Spanish Society of General Medicine and the Global Campaign decided to jointly make this guide. To do so, they made a search in MEDLINE, using the terms "migraine", "migraine treatment" and "headache guidelines" and "migraine guidelines". The most relevant articles were analyzed, including the references that we considered to be of interest. Furthermore, we reviewed the most important textbooks on headache and migraine. In this paper, we detail the recommendations agreed on, according to the evidence grade, on symptomatic and preventive treatment of migraine.

  1. 46,XX patients with congenital adrenal hyperplasia: initial assignment as male, reassigned female.

    PubMed

    Lee, Peter A; Witchel, Selma F

    2005-02-01

    Six 46,XX patients with congenital adrenal hyperplasia (CAH) presented with genital ambiguity, five so severe that initial gender assignment was male. Once diagnosis was realized, parents were involved in evaluation and chose sex re-assignment as female. To date, these girls and their parents all indicate satisfaction with their decision for a female sex of rearing. The girls have a female gender identity with behavior characteristics known for females with CAH. Thus, while outcome is satisfactory, it is realized that for most, expression of sexual orientation and adult life adjustments have not yet occurred.

  2. Assessment of the female patient with urinary incontinence.

    PubMed

    Bates, Frankie

    2002-10-01

    Understanding the pelvic floor anatomy and all of its components is crucial when performing pelvic floor examination and assessing patients suffering from urinary incontinence. It is important for urology nurses to understand the pelvic floor, including the muscle, nerve, and fascia involved; external and internal examination of the vulva; and global assessment of the patient.

  3. Killing two birds with one stone: successful opioid monotherapy in intractable migraine-triggered epilepsy, a case series.

    PubMed

    Derakhshan, Iraj

    2017-01-01

    The novel concept explored in this case series is the primacy of headaches in generating seizures in those patients who suffer from migraine-triggered epilepsy. In this series, once the migraine headaches were fully suppressed, via daily scheduled opioid therapy, the seizures also stopped. Seizures returned, however, after the patients stopped the opiate regimen for any reason. The above pharmacological scenario is reminiscent of a similar but naturalistic course of events reported on the salutary effects of ketogenic diet, or changes in life style, in similar cases of migraine-triggered epilepsy. The primacy of migraine in treating what has been named 'seizure headaches' is seen in two other scenarios (i.e. the salutary effect of ketogenic diet and lifestyle changes resulting in restoration of one's sleeping pattern) thus stopping the migraine as well as the seizures associated with the same. This case series recounts the same phenomenon via utilizing around-the-clock maintenance opioid therapy.

  4. Primary intracranial angiomatoid fibrous histiocytoma presenting with anaemia and migraine-like headaches and aura as early clinical features.

    PubMed

    Hansen, Jakob Møller; Larsen, Vibeke Andrée; Scheie, David; Perry, Arie; Skjøth-Rasmussen, Jane

    2015-12-01

    A 17-year-old female with migraine with aura complained of fatigue and was diagnosed with anemia. Three years later, changes in her headache pattern prompted hospital referral. Brain MRI showed a bi-lobed extra-axial intracerebral tumor encroaching both parieto-occipital regions. The resection specimen yielded a rare diagnosis of primary intracranial angiomatoid fibrous histiocytoma (AFH). Tumor removal resulted in cessation of her migraine and anemia. AFH may cause systemic symptoms--in this case fatigue and anemia--long before focal neurological symptoms are present. This is the first report of an intracranial AFH presenting as migraine with visual aura and anemia.

  5. Can migraine aura be provoked experimentally? A systematic review of potential methods for the provocation of migraine aura.

    PubMed

    Lindblad, Marianne; Hougaard, Anders; Amin, Faisal Mohammad; Ashina, Messoud

    2017-01-01

    Background The nature of the migraine aura and its role in migraine pathophysiology is incompletely understood. In particular, the mechanisms underlying aura initiation and the causal relation between aura and headache are unknown. The scientific investigation of aura in patients is only possible if aura can be triggered. This paper reviews potential methods for the experimental provocation of migraine aura. Methods We systematically searched PubMed for studies of experimental migraine provocation, including case reports of patients with aura and reports of the occurrence of aura following exposure to any kind of suspected trigger. Results We identified 21 provocation studies, using 13 different prospective provocation methods, and 34 case reports. In the prospective studies, aura were reported following the administration of intravenous and sublingual glyceryl trinitrate, visual stimulation, physical activity, calcitonin gene-related peptide infusion, chocolate ingestion, and the intravenous injection of insulin. In addition, carotid artery puncture has consistently been reported as a trigger of aura. Conclusions No safe and efficient method for aura provocation exists at present, but several approaches could prove useful for this purpose.

  6. Migraine with brainstem aura presenting as recurrent hypersomnia (Kleine-Levin syndrome).

    PubMed

    Nesbitt, Alexander D; Leschziner, Guy D

    2016-10-01

    Recurrent hypersomnia, or Kleine-Levin syndrome, is rare and frequently causes substantial diagnostic anxiety and delay. Patients often undergo multiple investigations to rule out other causes of encephalopathy. The treatment options are unsatisfactory. Migraine with brainstem aura has not previously been widely considered in the medical literature as a differential diagnosis. We describe two patients referred to a tertiary sleep neurology service with a putative diagnosis of Kleine-Levin syndrome. Each described attacks of hypersomnia with elements of migraine with brainstem aura, in addition to having a history of migraine with aura. Simple acute migraine treatment clearly attenuated further attacks. These cases generate discussion as to the common features and potential mechanisms underlying both disorders. Furthermore, they highlight a hitherto underexplored alternative diagnosis of Kleine-Levin syndrome. This provides scope for offering established and effective migraine treatment options to patients who with a potential misdiagnosis of Kleine-Levin syndrome, providing scope for offering established and effective migraine treatment to some patients originally diagnosed with a rare condition for which there is no current consistently effective therapeutic options.

  7. Skewed X-inactivation in a tumor tissue from a female patient with leiomyomatosis

    SciTech Connect

    Kishino, T.; Jinno, Y.; Niikawa, N.

    1995-07-17

    Leiomyomatosis (multiple leiomyomas) is characterized by benign smooth muscle cell proliferations in the esophagus, tracheobronchial tree, and female genital tract. At least 3 genetically different hereditary leiomyomatoses have been identified. Among them, an X-linked leiomyomatosis is often associated with an Alport syndrome-like nephropathy. It has remained obscure whether the leiomyomata occur monoclonally or polyclonally. The clonality of various malignancies has been examined by analysis of X-inactivation patterns in female patients heterozygous for polymorphic alleles of X-linked genes. We examined the clonality of a leiomyoma in a female patient by a polymerase chain reaction (PCR)-based X-inactivation assay. 6 refs., 1 fig.

  8. The effect of office based flexible and rigid cystoscopy on pain experience in female patients

    PubMed Central

    Vriesema, Jessica L.; Stomps, Saskia P.; van Balen, Olav L.W.B.; Cornel, Erik B.

    2017-01-01

    Purpose Rigid and flexible cystoscopies are both routinely used in female patients. Literature is conflicting whether flexible cystoscopy is less painful compared to rigid cystoscopy. The aim of this study was therefore to investigate whether using flexible cystoscopy leads to less discomfort and pain compared to rigid cystoscopy in female patients who underwent first time cystoscopy. Materials and Methods One hundred eighty-nine female patients, who never had undergone cystoscopy, were randomized into 2 groups: 92 patients underwent rigid cystoscopy and 97 patients flexible cystoscopy. Directly after the cystoscopy procedure all patients were asked to fill out their pain experience on a 100-mm visual analogue pain scale (VAS). Results Median VAS score was significantly lower for women undergoing flexible cystoscopy (0 [0–20]) compared to rigid cystoscopy (15 [0–38], p<0.001). In addition, age was inversely associated with VAS score, indicating that younger females experienced more pain (R=−0.30, p=0.001). The use of flexible cystoscopy was associated with a decrease in VAS score and remained significant after adjustment for age, sex of urologist, performing urologist and indication (standardized β=−0.17, p=0.048). Conclusions The use of flexible cystoscopy resulted in a significantly lower pain experience compared to rigid cystoscopy. Based on patient's pain experience during cystoscopy, this study implicates to use flexible cystoscopy in female patients who undergo first time cystoscopy. PMID:28097268

  9. Migraine: possible role of platelet insensitivity to prostaglandin E1 (PGE1).

    PubMed

    Cerneca, F; de Luyk, S; Radillo, O; Simeone, R; Mangiarotti, M

    1993-01-01

    Platelet aggregation inhibition, induced by prostaglandin E1 (PGE1), was evaluated in 38 patients affected by migraine. Our data indicate a complete insensitivity to PGE1 in these subjects. The insensitivity to PGE1 leads to decreased cyclic-AMP (cAMP) levels, determining an imbalance in the inhibitory mechanism. From this observation we can suppose that the decreased affinity of PGE1-receptors, causing decreased cAMP levels, may be involved in pathogenesis of migraine.

  10. Comparison of dynamic (brush) and static (pressure) mechanical allodynia in migraine.

    PubMed

    LoPinto, C; Young, W B; Ashkenazi, A

    2006-07-01

    Allodynia has been described in migraine but has not been fully investigated for the different sensory modalities. The aim of this study was to compare the prevalence of dynamic (brush) and static (pressure) mechanical allodynia in migraine patients and to suggest a practical method of testing them in a clinical setting. Patients with International Headache Society-defined episodic migraine (EM) or with transformed migraine (TM) as defined by Silberstein and Lipton were prospectively recruited from the Jefferson Headache Center out-patient clinic. A questionnaire of migraine features and symptoms of allodynia was administered. Brush allodynia (BA) was tested by cutaneous stimulation with a gauze pad and pressure allodynia (PA) was tested using von Frey hairs (VFH). The prevalence of BA and PA in all patients and in the different subgroups was calculated and correlated with migraine features. We recruited 55 migraine patients. Twenty-five had EM and 30 had TM. BA was present in 18 (32.7%) patients and PA in 18-24 (32.7-43.6%). Allodynia to both brush and pressure was found in 13-17 (23.6-30.9%) patients. If a patient had allodynia to one modality only, it was more likely to be PA than BA. Both BA and PA were more common in patients with TM compared with those with EM [BA 46.7% vs. 16.0%; PA (differences significant for the medium and thick VFHs) 50% vs. 20% and 50% vs. 12%, respectively]. Both types of allodynia were also more common in patients with migraine with aura compared with those with migraine without aura (BA 57.1% vs. 17.6%; PA 57.1-61.9% vs. 17.6-32.7%). There was a positive correlation between allodynia score (as obtained by examination) and allodynia index (as obtained by history) for both BA and PA. The incomplete, although considerable, overlap between BA and PA suggests that allodynia to different sensory modalities is associated with sensitization of different neuronal populations. Because PA was more common than BA, it may be a more sensitive

  11. Survival Outcomes and Predictive Factors for Female Urethral Cancer: Long-term Experience with Korean Patients.

    PubMed

    Kang, Minyong; Jeong, Chang Wook; Kwak, Cheol; Kim, Hyeon Hoe; Ku, Ja Hyeon

    2015-08-01

    The aim of this study was to evaluate female urethral cancer (UCa) patients treated and followed-up during a time period spanning more than 20 yr at single institution in Korea. We reviewed medical records of 21 consecutive patients diagnosed with female UCa at our institution between 1991 and 2012. After exclusion of two patients due to undefined histology, we examined clinicopathological variables, as well as survival outcomes of 19 patients with female UCa. A Cox proportional hazards ratio model was used to identify significant predictors of prognosis according to variables. The median age at diagnosis was 59 yr, and the median follow-up duration was 87.0 months. The most common initial symptoms were voiding symptoms and blood spotting. The median tumor size was 3.4 cm, and 55% of patients had lesions involving the entire urethra. The most common histologic type was adenocarcinoma, and the second most common type was urothelial carcinoma. Fourteen patients underwent surgery, and 7 of these patients received adjuvant radiation or systemic chemotherapy. Eleven patients experienced tumor recurrence after primary therapy. Patients with high stage disease, advanced T stage (≥T3), and positive lymph nodes had worse survival outcomes compared to their counterparts. Particularly, lymph node positivity and advanced T stage were significant predictive factors for all survival outcomes. Tumor location was the only significant predictor for recurrence-free survival. Although our study included a small number of patients, it conveys valuable information about this rare female urologic malignancy in a Korean population.

  12. Evaluation of Migraine Surgery Outcomes through Social Media

    PubMed Central

    Egan, Katie G.; Israel, Jacqueline S.; Ghasemzadeh, Rezvaneh

    2016-01-01

    Background: Social media have been used to study many aspects of health and human behavior. Although social media present a unique opportunity to obtain unsolicited patient-reported outcomes, its use has been limited in plastic and reconstructive surgical procedures, including migraine nerve surgery. The goal of this study was to utilize the most popular social media site, Facebook, to evaluate patients’ experience with migraine surgery. Methods: Six months of data regarding nerve surgery, nerve stimulators, and radiofrequency nerve ablation were collected from posts and comments written by members of 2 Facebook groups. Outcomes were classified by degree of resolution of symptoms. Results: A total of 639 posts related to migraine surgery. Of 304 posts commenting on postoperative success of nerve surgery, 16% reported elimination of headaches and 65% significant improvement (81% with complete or significant improvement), 5% partial improvement, 11% no change, and 3% worsening symptoms. Nerve surgery had a higher success rate than nerve stimulators and radiofrequency ablation. Nerve surgery was recommended by 90% of users. Conclusions: The 81% rate of complete or significant improvement of symptoms in this study is close to the 79% to 84% shown in current literature. Similar to the findings of a recent systematic review, surgery is more efficacious compared with nerve stimulators and ablation. This study adds to evidence favoring migraine surgery by removing evaluator bias and demonstrates that surgical outcomes and satisfaction data may be obtained from social media. PMID:27826478

  13. Evaluation of carotid intima-media thickness in children with migraine: a marker of subclinical atherosclerosis.

    PubMed

    Poyrazoglu, Hatice Gamze; Vurdem, Umit Erkan; Arslan, Alev; Uytun, Salih

    2016-10-01

    Migraine is a commonly seen neurovascular disorder during childhood. Inflammation induced by the activation of cytokines and neuropeptides is implied in its pathophysiology. There is an association between inflammation and atherosclerosis in patients with migraine. In addition, there is a strong correlation between early atherosclerotic wall lesions and carotid intima-media thickness (CIMT). The study population consisted of 57 migraine patients aged 5-17 years, as well as 47 healthy children who served as the control group. Those migraine patients who were not receiving any medications at the interictal period were compared to healthy controls in terms of their measured lipid levels, thyroid function, vitamin B12 levels, serum iron levels, iron binding capacity, complete blood count, C-reactive protein (CRP) levels, and carotid intima-media thickness (CIMT) scores, which may comprise risk factors for atherosclerosis. When children in the migraine and control groups were compared in terms of those risk factors that are known to be related to vascular changes, no significant differences were found. However, a significant difference was detected in CIMT values (P < 0.05). Atherosclerosis commences in childhood, and there is a long period of time before the onset of ischemic symptoms occurs. In children with migraine, an evaluation of CIMT can be used as a non-invasive imaging modality to detect atherosclerosis, which develops in the context of chronic inflammation. In this way, measures to reduce morbidity and mortality, which may result from cardiovascular diseases, can be implemented.

  14. Contribution of intravestibular sensory conflict to motion sickness and dizziness in migraine disorders.

    PubMed

    Wang, Joanne; Lewis, Richard F

    2016-10-01

    Migraine is associated with enhanced motion sickness susceptibility and can cause episodic vertigo [vestibular migraine (VM)], but the mechanisms relating migraine to these vestibular symptoms remain uncertain. We tested the hypothesis that the central integration of rotational cues (from the semicircular canals) and gravitational cues (from the otolith organs) is abnormal in migraine patients. A postrotational tilt paradigm generated a conflict between canal cues (which indicate the head is rotating) and otolith cues (which indicate the head is tilted and stationary), and eye movements were measured to quantify two behaviors that are thought to minimize this conflict: suppression and reorientation of the central angular velocity signal, evidenced by attenuation ("dumping") of the vestibuloocular reflex and shifting of the rotational axis of the vestibuloocular reflex toward the earth vertical. We found that normal and migraine subjects, but not VM patients, displayed an inverse correlation between the extent of dumping and the size of the axis shift such that the net "conflict resolution" mediated through these two mechanisms approached an optimal value and that the residual sensory conflict in VM patients (but not migraine or normal subjects) correlated with motion sickness susceptibility. Our findings suggest that the brain normally controls the dynamic and spatial characteristics of central vestibular signals to minimize intravestibular sensory conflict and that this process is disrupted in VM, which may be responsible for the enhance motion intolerance and episodic vertigo that characterize this disorder.

  15. Sexual Concerns of Male Spouses of Female Alzheimer's Disease Patients.

    ERIC Educational Resources Information Center

    Litz, Brett T.; And Others

    1990-01-01

    Presents case study which highlights attendant cognitive changes that occur in Alzheimer's patient, presenting caregiver with challenges to couple's sexual functioning. Describes man who reported erectile dysfunction directly stemming from stressful changes that had occurred in his relationship to his wife who had Alzheimer's disease. General…

  16. Anthroposophic Therapy for Migraine: A Two-Year Prospective Cohort Study in Routine Outpatient Settings

    PubMed Central

    Hamre, Harald J; Witt, Claudia M; Kienle, Gunver S; Glockmann, Anja; Ziegler, Renatus; Rivoir, Andreas; Willich, Stefan N; Kiene, Helmut

    2010-01-01

    Background and Methods: Anthroposophic treatment for migraine is provided by physicians and includes special artistic and physical therapies and special medications. We conducted a prospective cohort study of 45 consecutive adult outpatients (89% women) starting anthroposophic treatment for migraine under routine conditions. Main outcomes were Average Migraine Severity (physician and patient ratings 0-10, primary outcome), Symptom Score (patient rating, 0-10), and quality of life (SF-36); main follow-up time point was after six months. Results: The anthroposophic treatment modalities used were medications (67% of patients), eurythmy therapy (38%), art therapy (18%), and rhythmical massage therapy (13%). Median therapy duration was 105 days. In months 0-6, conventional prophylactic antimigraine medications were used by 14% (n=5/36) of evaluable patients. From baseline to six-month follow-up, physician-rated Average Migraine Severity improved by 3.14 points (95% confidence interval 2.40-3.87, p<0.001); patient-rated Average Migraine Severity improved by 2.82 points (2.05-3.64, p<0.001); and Symptom Score improved by 2.32 points (1.68-2.95, p<0.001). In addition, three SF-36 scales (Social Functioning, Bodily Pain, Vitality), the SF-36 Physical Component summary measure, and the SF-36 Health Change item improved significantly. All improvements were maintained at last follow-up after 24 months. Patients not using conventional prophylactic antimigraine medications had improvements similar to the whole cohort. Conclusions: Patients with migraine under anthroposophic treatment had long-term improvement of symptoms and quality of life. Although the pre-post design of the present study does not allow for conclusions about comparative effectiveness, study findings suggest that anthroposophic therapies may be useful in the long-term care of patients with migraine. PMID:21673981

  17. Bulbocavernosus Reflex Test for Diagnosis of Pudendal Nerve Injury in Female Patients with Diabetic Neurogenic Bladder

    PubMed Central

    Niu, Xiaoting; Wang, Xun; Huang, Huanjie; Ni, Peiqi; Lin, Yuanshao; Shao, Bei

    2016-01-01

    The study was designed to investigate the clinical application and significance of the bulbocavernosus reflex (BCR) test for diagnosing diabetic neurogenic bladder (DNB) in female subjects. In this study, 68 female patients with DNB and 40 female normal controls were subjected to a nerve conduction study (NCS) of all four limbs and the BCR test. The data were analyzed and compared, and the corresponding diagnostic sensitivities were discussed. Mean BCR latency for female DNB patients was significantly prolonged, compared to that of the control group, suggesting pudendal nerve injuries in female DNB patients. Moreover, DNB patients were categorized according to the diabetes course. Compared to that of Group A (diabetes course < 5 y), the mean BCR latency was significantly prolonged in Group B (diabetes course between 5 and 10 y) and then further prolonged in Group C (diabetes course > 10 y), which were all longer than the control group. Furthermore, compared with that of the controls, the mean BCR latency was prolonged in DNB patients with or without NCS abnormalities in limbs. Nevertheless, no significant difference was observed in BCR latency between DNB patients with and without NCS abnormalities. Significantly increasing trends were also observed in the NCS and BCR abnormality rates along with increased diabetes course. Most importantly, compared with the NCS of limbs, the BCR test was more sensitive in diagnosing DNB in the female subjects. Overall, our findings suggest that the BCR test would help to assess the pudendal nerve injury in female DNB patients, which might be a potential diagnostic tool in the clinic. PMID:28053822

  18. Survey of Migraine Sufferers with Dogs to Evaluate for Canine Migraine-Alerting Behaviors

    PubMed Central

    Bhowmick, Amrita

    2013-01-01

    Abstract Objectives Anecdotal reports suggest that changes in dog behavior might be used to predict impending migraine episodes. This survey was designed to investigate how companion dogs react to migraines that occur in their owners. Design Online survey was available from January 4–31, 2012. Settings/location Survey was conducted through SurveyMonkey, with links to the survey posted at Migraine.com and promoted through social media. Subjects Adults ≥18 years old who experience migraine episodes and live with a dog were eligible to participate. Interventions and outcome measures Participants completed an 18-question online survey that asked about participant demographics, migraines, and their dog's behavior before or during migraine episodes. Results The survey was completed by 1029 adult migraineurs (94.9% women), with migraines typically occurring ≤8 days per month in 63.4% of participants. A recognized change in the dog's behavior prior to or during the initial phase of migraine was endorsed by 552 participants (53.7%), most commonly unusual attentiveness to the owner (39.9%). Among the 466 participants providing details about their dog's behavior with their migraines, 57.3% were able to identify dog alerting behavior before symptoms of a migraine attack would typically begin, with changes usually noticed within 2 hours before the onset of initial migraine symptoms. The dog's behavior was considered to be often or usually linked with the development of a migraine for 59.2% of migraineurs, and 35.8% of migraineurs endorsed beginning migraine treatments after the dog's behavior was recognized and before migraine symptoms had started. Participant demographics, migraine frequency, and breed of dog in the home were similar between the 470 participants with no alerting behavior endorsed and the 466 participants providing detailed alerting information. Conclusions About one in four migraineurs living with a companion dog endorsed recognizing a change in their

  19. Migraine-like episodic pain behavior in a dog: can dogs suffer from migraines?

    PubMed

    Plessas, I N; Volk, H A; Kenny, P J

    2013-01-01

    Migraines and other primary headache disorders commonly affect people. There is evidence to suggest that migraines can occur in dogs. In this review, we present a dog with paroxysmal episodes that have a striking resemblance to human migraine, and we give an overview of migraine in people. The current classification, clinical signs, and diagnosis in people are discussed, as well as the anatomy of head pain, pathophysiology, pharmacology, and treatment options.

  20. Female gender lost protective effect against disease progression in elderly patients with chronic hepatitis B

    PubMed Central

    You, Hong; Kong, Yuanyuan; Hou, Jinlin; Wei, Lai; Zhang, Yuexin; Niu, Junqi; Han, Tao; Ou, Xiaojuan; Dou, Xiaoguang; Shang, Jia; Tang, Hong; Xie, Qing; Ding, Huiguo; Ren, Hong; Xu, Xiaoyuan; Xie, Wen; Liu, Xiaoqing; Xu, Youqing; Li, Yujie; Li, Jie; Chow, Shein-Chung; Zhuang, Hui; Jia, Jidong

    2016-01-01

    Female gender and younger age are protective factors against disease progression in chronic hepatitis B (CHB). However, it is not clear whether the disease progression still remains slow in elderly females. This study investigated the interaction of female gender and older age on the development of cirrhosis in patients recorded in China Registry of Hepatitis B. A total of 17,809 CHB patients were enrolled in this multi-center cross-sectional study. The prevalence of cirrhosis in female CHB patients increased faster than that in male CHB patients over 50 years old. Multivariate analysis showed that the increase of adjusted ORs for developing cirrhosis in females started to accelerate after 50 years old: 11.19 (95% CI: 5.93–21.11) in women versus 14.75 (95% CI: 8.35–26.07) in men at ages of 50–59 years, 21.67 (95% CI: 11.05–42.47) versus 24.4 (95% CI: 13.00–45.80) at ages 60–69 years, and 18.78 (95% CI: 6.61–53.36) versus 12.09 (95% CI: 4.35–33.61) in those over 70 years. In conclusion, the protective effect of female gender against cirrhosis gradually lost with increasing age, therefore disease progression should be monitored more closely in elderly women with CHB. PMID:27892487

  1. A fe/male transsexual patient in psychoanalysis.

    PubMed

    Quinodoz, D

    1998-02-01

    The author describes the analysis of a transsexual who had undergone a vaginoplasty as a young man and had since been living as a woman. The complexity of the psychic reality is epitomised by the analyst's difficulty in deciding whether to use masculine or feminine grammatical forms to refer to this patient. The author tells how she assumed the fantasy role of parents expecting a baby whose sex they did not yet know. She discusses at length her hesitation about accepting a transsexual patient into analysis and reports how she overcame her misgivings after analysing her own countertransference and consulting the literature. Noting that this borderline analysand resorted to both psychotic and neurotic mechanisms, the analyst decided to rely on the capacity for symbolisation and mental representation evinced in the latter. On the psychotic level, the delusional neo-reality of the appearance of a woman sought to replace the unbearable reality of being a man, whereas the neurotic part was aware that s/he could never really be a woman. The author observes that in this analysand sexualisation served to conceal a fundamental narcissistic fault. She also describes how she worked with her own madness to help the patient emerge from a situation of paradoxical fusion with the mother in madness.

  2. The Impact of Migraine and the Effect of Migraine Treatment on Workplace Productivity in the United States and Suggestions for Future Research

    PubMed Central

    Burton, Wayne N.; Landy, Stephen H.; Downs, Kristen E.; Runken, M. Chris

    2009-01-01

    Evidence suggests that migraine is associated with decreased productivity. This article describes the results of a systematic literature review of peer-reviewed publications that measured the impact of migraine on workplace productivity in the United States and provides recommendations for future research. A MEDLINE search was conducted from January 1, 1990 to July 31, 2008. Articles were included if the results were from a prospective or retrospective study that reported work-specific productivity outcomes in adults with migraine in the United States. Twenty-six studies were included. Nine studies found that diagnosed and/or undiagnosed migraine had a negative impact on worker productivity. Although one migraine prophylactic study found a statistically significant improvement in worker productivity for topiramate-treated patients, another found an insignificant difference in lisinopril-treated patients. Fifteen studies compared the impact of triptan therapy with a control group. The control groups in these studies differed with regard to recall periods, time to follow-up, and types of questionnaires used. Almost all studies found that triptan therapy was associated with a statistically significant improvement in loss in worker productivity vs the control group. Health care professionals can reduce the impact of migraine on worker productivity with appropriate therapy. Researchers should collect presenteeism and absenteeism data, report results in units of time, use a validated instrument, carefully consider recall periods, and report worker productivity separately. In addition, patients with undiagnosed migraine should be included in disease burden studies. When evaluating effects of treatment on productivity, researchers should target well-controlled, double-blind studies and conduct productivity research for new treatments. PMID:19411440

  3. Atypical nummular headache or circumscribed migraine: The utility of pressure algometry

    PubMed Central

    Barón, Johanna; Rodríguez, Cristina; Ruiz, Marina; Pedraza, María Isabel; Guerrero, Ángel Luis; Madeleine, Pascal; Cuadrado, María Luz; Fernández-de-las-Peñas, César

    2015-01-01

    A peripheral mechanism has been proposed for nummular headache; however, there have been descriptions of atypical features resembling migraine. The authors describe a case in which algometry assessment facilitated the discrimination between atypical nummular headache and circumscribed migraine. A 21-year-old woman presented with a history of focal episodic pain in a circumscribed area on the left frontal region. The algometry study showed a unilateral and diffuse decrease of the pain pressure thresholds with frontal predominance, as has been proposed for migraine patients. This result led the authors to introduce a more specific preventive therapy with topiramate, with significant relief. In conclusion, cartographic investigation of pressure pain sensitivity is a simple tool that can help to differentiate between nummular headache and migraine. Further confirmatory investigations are needed. PMID:25647287

  4. Antiphospholipid syndrome (APS) revisited: Would migraine headaches be included in future classification criteria?

    PubMed

    Noureldine, Mohammad Hassan A; Haydar, Ali A; Berjawi, Ahmad; Elnawar, Rody; Sweid, Ahmad; Khamashta, Munther A; Hughes, Graham R V; Uthman, Imad

    2016-07-16

    Headaches have been extensively reported in Antiphospholipid syndrome (APS)/Antiphospholipid antibodies (aPL)-positive patients. The aim of this study was to highlight the prevalence of headaches among APS/aPL-positive patients and discuss its association with laboratory, clinical and imaging findings. We searched the literature through Google Scholar and PubMed for publications on the epidemiology, pathogenesis, laboratory, imaging and clinical findings, and management of headaches in APS/aPL-positive patients. The following keywords were used: Antiphospholipid, Hughes syndrome, anticardiolipin, lupus anticoagulant, anti-β2 glycoprotein I, headache, migraine, tension, and cluster. All reports published between 1969 and 2015 were included. Migraine is the most commonly reported type of headache in APS/aPL-positive patients. Thrombotic and platelet dysfunction hypotheses have been studied to uncover the pathogenic role of aPL in the development of headaches. Several studies are reporting higher levels of aPL in primary and secondary APS migraineurs, but only few reached statistical significance. Migraine patients without clinical signs/symptoms of cerebral infarction rarely show positive imaging findings. Digital subtraction angiography shows promise in demonstrating small vascular lesions otherwise not detected on computed tomography, magnetic resonance imaging, or cerebral angiograms. Although it may be solitary and harmless in many cases, the deleterious effect of migraine on the quality of life of APS patients prompts rapid diagnosis and proper management. An anticoagulation trial is advisable in APS patients with migraine as many cases of severe, refractory migraine resolved with anticoagulation therapy. The profile of migraine headaches discussed in this study permits its candidacy for inclusion in future APS classification criteria.

  5. Comparison of the effectiveness of topiramate and sodium valproate in pediatric migraine.

    PubMed

    Unalp, Aycan; Uran, Nedret; Oztürk, Aysel

    2008-12-01

    Frequent migraine headaches can have a significant impact on disability, prompting the need for early recognition and treatment. The objective of this study is to compare the efficacy of topiramate and sodium valproate for the prevention of pediatric migraine, retrospectively. Mean monthly migraine frequency, intensity, and duration in the 28 patients treated with topiramate decreased from 15.3 +/- 10.1 to 4.4 +/- 5.5 episode, from 6.8 +/- 1 to 3.2 +/- 1, and from 10.2 +/- 9.4 to 2.4 +/- 3.1 hours, respectively. Headache disability improved with a reduction of Pediatric Migraine Disability Assessment score from 36 +/- 29.5 to 4.6 +/- 6.5 (P < .05). Similarly, mean monthly headache frequency, headache intensity, headache duration, and Pediatric Migraine Disability Assessment score in the 20 patients treated with sodium valproate decreased from 20.1 +/- 10.2 to 6.6 +/- 8.6, from 7.1 +/- 1 to 3.4 +/- 2.1, from 7 +/- 12 to 1.4 +/- 2.5 hours, and from 20.5 +/- 16.1 to 5.5 +/- 9.2, respectively (P < .05). In conclusion, valproate and topiramate seem to be able to manage successfully childhood migraine without substantial differences in efficacy.

  6. Novel Therapeutic Targets for Chronic Migraine

    DTIC Science & Technology

    2012-09-01

    AWARD NUMBER: W81XWH-11-1-0646 TITLE: Novel Therapeutic Targets for Chronic Migraine ...COVERED 1 Sep 2011 – 31 Aug 2012 4. TITLE AND SUBTITLE 5a. CONTRACT NUMBER Novel Therapeutic Targets for Chronic Migraine 5b. GRANT NUMBER W81XWH...AVAILABILITY STATEMENT Approved for Public Release; Distribution Unlimited 13. SUPPLEMENTARY NOTES 14. ABSTRACT Chronic migraine is a disabling disorder

  7. Novel Therapeutic Targets for Chronic Migraine

    DTIC Science & Technology

    2014-11-01

    NTG. However, previous work has shown that the locomotor stimulants, morphine and cocaine, both showed enhanced conditioned place preference in state...hydrocodone, oxycodone, meperidine and morphine , are commonly used in North America as ‘rescue’ therapy for migraine (Bigal and Lipton, 2009). In Europe... morphine and naltrexone in mice. Psychopharmacology (Berl) 141: 118–122. Bigal ME, Lipton RB (2008). Excessive acute migraine medication use and migraine

  8. Effects of Coriandrum sativum Syrup on Migraine: A Randomized, Triple-Blind, Placebo-Controlled Trial

    PubMed Central

    Delavar Kasmaei, Hosein; Ghorbanifar, Zahra; Zayeri, Farid; Minaei, Bagher; Kamali, Seyed Hamid; Rezaeizadeh, Hossein; Amin, Gholamreza; Ghobadi, Ali; Mirzaei, Zohreh

    2016-01-01

    Background: Migraine is one of the most common and debilitating neurological problems. Although numerous preventive drugs are used to treat migraine, their complications are unavoidable. Application of herbal medicine, especially well-known medicinal plants, to treatment of chronic diseases, like migraine, could be effective. Coriandrum sativum L. (C. sativum) fruit is one of the most commonly prescribed herbs in Persian medicine, which has been used to treat headache. Objectives: This study was designed to evaluate the effects of C. sativum syrup on duration, severity and frequency of migraine. Patients and Methods: A total of 68 migraineurs, who had the eligibility criteria, according to international headache society diagnostic criteria, were randomly assigned to intervention group (n = 34) or control group (n = 34). In addition to 500 mg of sodium valproate per day, in intervention group, they received 15 mL of Coriander fruit syrup and 15 mL of placebo syrup, in control group, three times a day, during a month. The subjects were followed for clinical efficacy at weeks 1, 2, 3 and 4. The number of migraine attacks per week, as well as the duration and severity of attacks, were evaluated. Results: Of 68 patients randomized, 66 were included in analysis. The generalized estimating equations analysis showed that the Coriander fruit syrup decreased duration, severity and frequency of migraine, in the intervention group (P < 0.001). To be more precise, the mean migraine duration, severity and frequency, in the intervention group, were 5.7 hours, 3.65 units and about 50% less than control group, respectively. Conclusions: Results of this study showed that C. sativum fruit is efficient in reduction of the duration and frequency of migraine attacks and in diminishing pain degree. PMID:26889386

  9. Female Genital Dialogues: Female Genital Self-Image, Sexual Dysfunction, and Quality of Life in Patients With Vitiligo With and Without Genital Affection.

    PubMed

    Sarhan, Deena; Mohammed, Ghada F A; Gomaa, Amal H A; Eyada, Moustafa M K

    2016-01-01

    Vitiligo has a major effect on sexual health because of the disfiguring skin lesions affecting self-image and self-esteem. However, this topic has not explored. This article aimed to assess the effect of vitiligo on genital self-image, sexual function, and quality of life in female patients. This cross-sectional study included 50 sexually active women with vitiligo and 25 women without vitiligo. All participants subjected to full history taking and examination. Extent of vitiligo was assessed with the Vitiligo Area Scoring Index score, sexual function with the Female Sexual Function Index, genital self-image with Female Genital Self-Image Score and quality of life with the Dermatology Life Quality Index questionnaires. The main outcome measures were correlation between Vitiligo Area Scoring Index, Female Genital Self-Image Score, Female Sexual Function Index, and Dermatology Life Quality Index domains was determined using t test and Pearson correlation. This study revealed a negative correlation between the Vitiligo Area Scoring Index score and sexual satisfaction. Vitiligo Area Scoring Index and Dermatology Life Quality Index score was significantly correlated with Arabic Version of the Female Genital Self-Image Score alone and with Arabic Version of the Female Sexual Functioning Index alone and with both the Arabic Version of the Female Genital Self-Image Score and the Arabic Version of the Female Sexual Functioning Index (p <.05). Sexual and psychological assessment of patients with vitiligo is imperative to improve outcomes and increase patients' compliance with treatment.

  10. Quality of life, depression, and sexual dysfunction in spouses of female patients with fibromyalgia.

    PubMed

    Tutoglu, Ahmet; Boyaci, Ahmet; Koca, Irfan; Celen, Esra; Korkmaz, Nurdan

    2014-08-01

    The aim of this study was to investigate the effects of the quality of life and psychological condition of female patients with fibromyalgia and their spouses on sexual function. A total of 32 female patients diagnosed with fibromyalgia and their spouses were analyzed. Thirty married couples were included in the study as the control group. The demographic data of the fibromyalgia patients were recorded, a visual analog scale was used to evaluate the level of pain, and the Fibromyalgia Impact Questionnaire was used to evaluate the impact of the symptoms on the quality of life of the patients. The quality of life of both the patients and the control group were evaluated using the Short Form 36 (SF-36), and psychological variables were evaluated using the Beck Depression Inventory (BDI) and Beck Anxiety Inventory. Sexual function was assessed using the Female Sexual Function Index for female participants and the International Index of Erectile Function (IIEF) for male participants. The IIEF erectile dysfunction scores were significantly lower in the spouses of female patients with fibromyalgia than in the control group (p < 0.05), and the BDI scores were significantly higher in the spouses of the female patients with fibromyalgia (p < 0.05). Among the SF-36 scores, the emotional and physical roles were significantly lower in the spouses of the female patients with fibromyalgia (p = 0.003 and p = 0.004, respectively). In all spouses of FMS patients and controls, there was a significantly negative correlation between erectile function, the BDI score, and to be married with FMS patient and positive correlations between erectile function and emotional role, social function, mental health, SF-36 pain score, and general health (p < 0.05 for all). In a linear regression model, BDI, to be married with FMS patient and general health were found to affect erectile function (beta regression coefficient = -0.572, SE = 0.082, p = 0.001; beta regression coefficient = -0.332, SE = 1

  11. Fertility preservation in female cancer patients: An overview

    PubMed Central

    Mahajan, Nalini

    2015-01-01

    Fertility preservation is becoming increasingly important to improve the quality of life in cancer survivors. Despite guidelines suggesting that discussion of fertility preservation should be done prior to starting cancer therapies, there is a lack of implementation in this area. A number of techniques are available for fertility preservation, and they can be used individually or together in the same patient to maximize efficiency. Oocyte and embryo cryopreservation are now established techniques but have their limitations. Ovarian tissue cryopreservation though considered experimental at present, has a wider clinical application and the advantage of keeping the fertility window open for a longer time. Both chemotherapy and radiotherapy have a major impact on reproductive potential and fertility preservation procedures should be carried out prior to these treatments. The need for fertility preservation has to be weighed against morbidity and mortality associated with cancer. There is thus a need for a multidisciplinary collaboration between oncologists and reproductive specialists to improve awareness and availability. PMID:25838742

  12. Dietary Intake In Adult Female Coeliac Disease Patients In Slovenia

    PubMed Central

    Mičetić-Turk, Dušanka

    2016-01-01

    Abstract Objectives The aim of the study was to assess dietary intake of coeliac disease (CD) patients and to determine if they are meeting the dietary reference values for a balanced diet. Subjects/Methods 40 women with CD, aged from 23 to 76 participated in our study. Total daily intake was assessed by a three-day food diary. Resting metabolic rate (RMR) was calculated using Harris-Benedict equation. Considering physical activity level (PAL) 1.4, the recommended total energy expenditure (TEE) value was determined. The data was evaluated with professional evaluation software Prodi and statistically analysed. Results 40 participants returned the food diary. The average energy intake was significantly too low to ensure the meeting of all-day energy needs (p<0.05). The meals contained a recommended proportion of protein, but a statistically significantly higher proportion of fat (p<0.05), lower proportion of carbohydrates and a significantly lower intake of dietary fibre (p<0.05). Regarding macro-, micro- elements and vitamins, there was a significant lack in the intake of calcium and iodine, folic acid, vitamin D and vitamin A (p<0.05), meanwhile iron intake was at the lower limit of the recommended intake, whereas zinc, potassium and vitamin K intake were significantly higher according to the recommended values, but were comparable with the intake of the general population in the Central European area. Conclusion Even in subjects with adequate or low daily energy intake, their meals contained too much fat, too few carbohydrates and dietary fibre as well as inorganic substances. The patients with CD should get regular nutritional monitoring and education on the quality and balance of a gluten-free diet. PMID:27284377

  13. Chronic Migraine in Children and Adolescents.

    PubMed

    Özge, Aynur; Yalin, Osman Özgür

    2016-02-01

    Chronic migraine is defined as having more than 15 headache days in a month, half of these showing migraine features, for at least 3 months. It is a chronic painful syndrome with aspects such as psychiatric comorbid, decreased quality of life, and environmental and intrinsic psychological factors that make face-to-face treatment difficult. Children and adolescent migraine differ from adults as a result of growing brain and evolving disorder. In this paper, we will emphasize the definition, diagnosis, epidemiology, burden of life, and management of chronic migraine in children and adolescent.

  14. Adipokines and Migraine: A Systematic Review

    PubMed Central

    Peterlin, B. Lee; Sacco, Simona; Bernecker, Claudia; Scher, Ann I.

    2016-01-01

    Background Migraine is comorbid with obesity. Recent research suggests an association between migraine and adipocytokines, proteins that are predominantly secreted from adipose tissue and which participate in energy homeostasis and inflammatory processes. Objectives In this review, we first briefly discuss the association between migraine and obesity and the importance of adipose tissue as a neuroendocrine organ. We then present a systematic review of the extant literature evaluating circulating levels of adiponectin and leptin in those with migraine. Methods A search of the PubMed database was conducted using the keywords “migraine,” “adiponectin,” and “leptin.” In addition reference lists of relevant articles were reviewed for possible inclusion. English language studies published between 2005 and 2015 evaluating circulating blood concentration of adiponectin or leptin in those with migraine were included. Conclusions While the existing data are suggestive that adipokines may be associated with migraine, substantial study design differences and conflicting results limit definitive conclusions. Future research utilizing carefully considered designs and methodology is warranted. In particular careful and systematic characterization of pain states at the time of samples, as well as systematic consideration of demographic (eg, age, sex) and other vital covariates (eg, obesity status, lipids) are needed to determine if adipokines play a role in migraine pathophysiology and if any adipokine represents a viable, novel migraine biomarker, or drug target. PMID:27012149

  15. Identification of Intellectual Disability Genes in Female Patients with a Skewed X-Inactivation Pattern.

    PubMed

    Fieremans, Nathalie; Van Esch, Hilde; Holvoet, Maureen; Van Goethem, Gert; Devriendt, Koenraad; Rosello, Monica; Mayo, Sonia; Martinez, Francisco; Jhangiani, Shalini; Muzny, Donna M; Gibbs, Richard A; Lupski, James R; Vermeesch, Joris R; Marynen, Peter; Froyen, Guy

    2016-08-01

    Intellectual disability (ID) is a heterogeneous disorder with an unknown molecular etiology in many cases. Previously, X-linked ID (XLID) studies focused on males because of the hemizygous state of their X chromosome. Carrier females are generally unaffected because of the presence of a second normal allele, or inactivation of the mutant X chromosome in most of their cells (skewing). However, in female ID patients, we hypothesized that the presence of skewing of X-inactivation would be an indicator for an X chromosomal ID cause. We analyzed the X-inactivation patterns of 288 females with ID, and found that 22 (7.6%) had extreme skewing (>90%), which is significantly higher than observed in the general population (3.6%; P = 0.029). Whole-exome sequencing of 19 females with extreme skewing revealed causal variants in six females in the XLID genes DDX3X, NHS, WDR45, MECP2, and SMC1A. Interestingly, variants in genes escaping X-inactivation presumably cause both XLID and skewing of X-inactivation in three of these patients. Moreover, variants likely accounting for skewing only were detected in MED12, HDAC8, and TAF9B. All tested candidate causative variants were de novo events. Hence, extreme skewing is a good indicator for the presence of X-linked variants in female patients.

  16. CDKL5 mutations cause infantile spasms, early onset seizures, and severe mental retardation in female patients

    PubMed Central

    Archer, H L; Evans, J; Edwards, S; Colley, J; Newbury‐Ecob, R; O'Callaghan, F; Huyton, M; O'Regan, M; Tolmie, J; Sampson, J; Clarke, A; Osborne, J

    2006-01-01

    Objective To determine the frequency of mutations in CDKL5 in both male and female patients with infantile spasms or early onset epilepsy of unknown cause, and to consider whether the breadth of the reported phenotype would be extended by studying a different patient group. Methods Two groups of patients were investigated for CDKL5 mutations. Group 1 comprised 73 patients (57 female, 16 male) referred to Cardiff for CDKL5 analysis, of whom 49 (42 female, 7 male) had epileptic seizure onset in the first six months of life. Group 2 comprised 26 patients (11 female, 15 male) with infantile spasms previously recruited to a clinical trial, the UK Infantile Spasms Study. Where a likely pathogenic mutation was identified, further clinical data were reviewed. Results Seven likely pathogenic mutations were found among female patients from group 1 with epileptic seizure onset in the first six months of life, accounting for seven of the 42 in this group (17%). No mutations other than the already published mutation were found in female patients from group 2, or in any male patient from either study group. All patients with mutations had early signs of developmental delay and most had made little developmental progress. Further clinical information was available for six patients: autistic features and tactile hypersensitivity were common but only one had suggestive Rett‐like features. All had a severe epileptic seizure disorder, all but one of whom had myoclonic jerks. The EEG showed focal or generalised changes and in those with infantile spasms, hypsarrhythmia. Slow frequencies were seen frequently with a frontal or fronto‐temporal predominance and high amplitudes. Conclusions The spectrum of the epileptic seizure disorder, and associated EEG changes, in those with CDKL5 mutations is broader than previously reported. CDKL5 mutations are a significant cause of infantile spasms and early epileptic seizures in female patients, and of a later intractable seizure disorder

  17. When does chronic migraine strike? A clinical comparison of migraine according to the headache days suffered per month.

    PubMed

    Torres-Ferrús, M; Quintana, M; Fernandez-Morales, J; Alvarez-Sabin, J; Pozo-Rosich, P

    2017-02-01

    Introduction According to the IHCD-3β classification, chronic migraine (CM) is headache occurring on 15 or more days/month. Episodic migraine (EM) can be divided into low frequency (LFEM) and high frequency (HFEM) depending on the headache days suffered per month. Methods We performed a clinical comparison of migraine characteristics according to monthly headache days suffered. Patients were divided into three groups: LFEM (1-9 headache days/month), HFEM (10-14 headache days/month) and CM (≥15 headache days/month). Results The analysis included 1109 patients. Previously reported differences between EM and CM were replicated. However, there were three times more clinical differences between LFEM and HFEM than between HFEM and CM (15 vs. 6). A new model that takes 10 headache days as a cut-off value for CM would have a minimally higher predictive capacity (72.8%) and no statistical differences (71.8%) when comparing it to the current classification. Conclusions HFEM patients have few clinical differences compared with CM patients. This includes the poor outcomes regarding headache-related disability and impact on daily life. According to these findings, neurologists and headache specialists should consider that the emotional and functional impact in HFEM patients could be as disabling as in those with CM.

  18. Catastrophic antiphospholipid antibody syndrome presenting as acute vascular occlusion in a young female patient.

    PubMed

    Alonso, Joaquín Valle; Del Pozo, Francisco Javier Fonseca; Álvarez, Manuel Vaquero; Pedraza, Jorge; Aguayo, Miguel Angel; Sanchez, Almudena

    2016-10-10

    Acquired thrombotic and thromboembolic disorders may be presented initially with symptoms and signs of acute ischaemia or organ dysfunction that will lead many of these patients to seek care in the emergency department. We report a case of a 19-year-old female patient who developed catastrophic antiphospholipid syndrome (CAPS syndrome or Asherson syndrome) 6 weeks post stillbirth with an initial presentation of acute vascular occlusion. The patient was immediately operated and anticoagulated with significant improvement.

  19. Psychopathology and quality of life burden in chronic daily headache: influence of migraine symptoms.

    PubMed

    Autret, A; Roux, S; Rimbaux-Lepage, S; Valade, D; Debiais, S

    2010-06-01

    The aim of this study is to compare the psychopathology and the quality of life of chronic daily headache patients between those with migraine headache and those with tension-type headache. We enrolled 106 adults with chronic daily headache (CDH) who consulted for the first time in specialised centres. The patients were classified according to the IHS 2004 criteria and the propositions of the Headache Classification Committee (2006) with a computed algorithm: 8 had chronic migraine (without medication overuse), 18 had chronic tension-type headache (without medication overuse), 80 had medication overuse headache and among them, 43 fulfilled the criteria for the sub-group of migraine (m) MOH, and 37 the subgroup for tension-type (tt) MOH. We tested five variables: MADRS global score, HAMA psychic and somatic sub-scales, SF-36 psychic, and somatic summary components. We compared patients with migraine symptoms (CM and mMOH) to those with tension-type symptoms (CTTH and ttMOH) and neutralised pain intensity with an ANCOVA which is a priori higher in the migraine group. We failed to find any difference between migraine and tension-type groups in the MADRS global score, the HAMA psychological sub-score and the SF36 physical component summary. The HAMA somatic anxiety subscale was higher in the migraine group than in the tension-type group (F(1,103) = 10.10, p = 0.001). The SF36 mental component summary was significantly worse in the migraine as compared with the tension-type subgroup (F(1,103) = 5.758, p = 0.018). In the four CDH subgroups, all the SF36 dimension scores except one (Physical Functioning) showed a more than 20 point difference from those seen in the adjusted historical controls. Furthermore, two sub-scores were significantly more affected in the migraine group as compared to the tension-type group, the physical health bodily pain (F(1,103) = 4.51, p = 0.036) and the mental health (F(1,103) = 8.17, p = 0.005). Considering that the statistic procedure

  20. Outcome of Chronic Daily Headache or Chronic Migraine.

    PubMed

    Cho, Soo-Jin; Song, Tae-Jin; Chu, Min Kyung

    2016-01-01

    Chronic daily headache (CDH) is a common neurological condition that affects 1-4% of the general population. Recent epidemiological studies have shown that CDH is mainly represented by chronic migraine (CM). Owing to the frequent headaches, associated symptoms, and comorbid conditions associated with CDH/CM, disability, quality of life (QoL), economic burden, and treatment outcome have become important personal and social issues. There have been several studies assessing the disability, QoL, and economic burden associated with CDH/CM. These studies, conducted in different settings, consistently reported significantly higher disability and economic burden and lower QoL among CDH/CM patients compared to patients with episodic headache (EH) or episodic migraine (EM). Treatment outcome of CDH/CM is often poor. In this review, we describe and summarize the results of relevant studies performed to date.

  1. [What benefits does the preventive treatment of migraine have?].

    PubMed

    Pozo-Rosich, Patricia

    2014-03-10

    The preventive treatment of migraine is under-used. Moreover, treatment compliance and persistence rates are low. Yet, it is crucial to be able to control the frequency, intensity and duration of the attacks of migraine, which enables patients to resort to painkillers less often. All this plays a key role in improving the associated quality of life and disability. It is important to have a clear idea of the goals of preventive treatment, as well as the indications for starting it, its ideal duration and compliance. Enhancing and completing the knowledge we have about preventive treatment will probably improve its prescription and provide tools that allow an increase in patient compliance to be achieved.

  2. Association of autoimmune diseases with lichen sclerosus in 532 male and female patients.

    PubMed

    Kreuter, Alexander; Kryvosheyeva, Yulia; Terras, Sarah; Moritz, Rose; Möllenhoff, Katrin; Altmeyer, Peter; Scola, Nina; Gambichler, Thilo

    2013-03-27

    Lichen sclerosus is a relatively common chronic inflammatory skin disease that predominantly affects the anogenital area. Accumulating evidence indicates that lichen sclerosus in women may be associated with other autoimmune disease, whereas this association seems to lack in male patients. We retrospectively evaluated the prevalence of autoimmune diseases and serological parameters indicative for autoimmunity in male and female patients with lichen sclerosus. Of the 532 patients (396 women, 136 men; 500 adults, 32 children; mean age: 49 years; range 1-89 years; female:male ratio 3:1), 452 (85%) had genital and 80 (15%) had extragenital disease. In women, lichen sclerosus was significantly more often associated with at least one autoimmune disease as compared to men (odds ratio [OR] 4.3, 95% confidence interval [CI] 1.9-9.6; p<0.0001). Moreover, female patients with lichen sclerosus had sinificantly more often associated autoimmune thyroid diseases (OR 4.7, 95% CI 1.8-11.9; p<0.0002), antithyroid-antibodies (OR 2.7, 95% CI 1.1-6.5; p=0.023), and elevated autoantibodies (OR 4.1, 95% CI 1.9-9.3; p<0.0001) as compared to male patients. This observation is suggestive for a different pathogenetic background in male and female patients.

  3. Migraine treatment and placebo effect.

    PubMed

    Speciali, José G; Peres, Mário; Bigal, Marcelo E

    2010-03-01

    Placebos are typically defined as physiologically inactive substances that elicit a therapeutic response. The antipode of the placebo effect is the nocebo effect, or the negative effects of placebo, where unpleasant symptoms (e.g., adverse events) emerge after the administration of placebo. Placebo analgesia is one of the most striking examples of the cognitive modulation of pain perception. Herein we focus on the importance of placebo in headache research. We first review the mechanisms of the placebo effect. We then focus on the importance of placebo in the acute treatment of migraine. We follow by discussing the importance of placebo on the preventive treatment of migraine and our perspectives for the 5 years to come regarding the study of the placebos.

  4. Source localization of intermittent rhythmic delta activity in a patient with acute confusional migraine: cross-spectral analysis using standardized low-resolution brain electromagnetic tomography (sLORETA).

    PubMed

    Kim, Dae-Eun; Shin, Jung-Hyun; Kim, Young-Hoon; Eom, Tae-Hoon; Kim, Sung-Hun; Kim, Jung-Min

    2016-01-01

    Acute confusional migraine (ACM) shows typical electroencephalography (EEG) patterns of diffuse delta slowing and frontal intermittent rhythmic delta activity (FIRDA). The pathophysiology of ACM is still unclear but these patterns suggest neuronal dysfunction in specific brain areas. We performed source localization analysis of IRDA (in the frequency band of 1-3.5 Hz) to better understand the ACM mechanism. Typical IRDA EEG patterns were recorded in a patient with ACM during the acute stage. A second EEG was obtained after recovery from ACM. To identify source localization of IRDA, statistical non-parametric mapping using standardized low-resolution brain electromagnetic tomography was performed for the delta frequency band comparisons between ACM attack and non-attack periods. A difference in the current density maximum was found in the dorsal anterior cingulated cortex (ACC). The significant differences were widely distributed over the frontal, parietal, temporal and limbic lobe, paracentral lobule and insula and were predominant in the left hemisphere. Dorsal ACC dysfunction was demonstrated for the first time in a patient with ACM in this source localization analysis of IRDA. The ACC plays an important role in the frontal attentional control system and acute confusion. This dysfunction of the dorsal ACC might represent an important ACM pathophysiology.

  5. Heart Rate Variability in Sleep-Related Migraine without Aura

    PubMed Central

    Vollono, Catello; Gnoni, Valentina; Testani, Elisa; Dittoni, Serena; Losurdo, Anna; Colicchio, Salvatore; Di Blasi, Chiara; Mazza, Salvatore; Farina, Benedetto; Della Marca, Giacomo

    2013-01-01

    Objectives: This is an observational study aimed to investigate the activity of autonomic nervous system during sleep in patients with sleep-related migraine. Methods: Eight consecutive migraineurs without aura were enrolled (6 women and 2 men), aged 30 to 62 years (mean 48.1 ± 9.3 years). Inclusion criteria were: high frequency of attacks (> 5 per month) and occurrence of more than 75% of the attacks during sleep causing an awakening. Patients were compared with a control group of 55 healthy subjects (23 men and 32 women, mean age 54.2 ± 13.0 years), and with a further control group of 8 age- and gender-matched healthy controls. Patient and controls underwent polysomnography and heart rate variability analysis. Results: A significant reduction of the LF/HF ratio during N2 and N3 sleep stages was observed in migraineurs compared with controls. No differences in sleep macrostructure were observed; cyclic alternating pattern (CAP) time and CAP rate were lower in migraineurs than in controls. Conclusions: These findings indicate a peculiar modification of the autonomic balance during sleep in sleep-related migraine. The reduction of LF/HF ratio in NREM sleep was observed in controls, but it was quantitatively much more evident in migraineurs. Changes in LF/HF could be consequent to an autonomic unbalance which could manifest selectively (or alternatively become more evident) during sleep. These findings, together with the reduction in CAP rate, could be an expression of reduced arousability during sleep in patients with sleep-related migraine. The simultaneous involvement of the autonomic, arousal, and pain systems might suggest involvement of the hypothalamic pathways. Citation: Vollono C; Gnoni V; Testani E; Dittoni S; Losurdo A; Colicchio S; Di Blasi C; Mazza S; Farina B; Della Marca G. Heart rate variability in sleep-related migraine without aura. J Clin Sleep Med 2013;9(7):707-714. PMID:23853566

  6. The effects of magnesium, L-carnitine, and concurrent magnesium-L-carnitine supplementation in migraine prophylaxis.

    PubMed

    Tarighat Esfanjani, Ali; Mahdavi, Reza; Ebrahimi Mameghani, Mehrangiz; Talebi, Mahnaz; Nikniaz, Zeinab; Safaiyan, Abdolrasool

    2012-12-01

    Given the conflicting results about the positive effects of magnesium and L-carnitine and as there is no report concerning concurrent supplementation of magnesium and L-carnitine on migraine prophylaxis, the effects of magnesium, L-carnitine, and concurrent magnesium-L-carnitine supplementation on migraine indicators were assessed. In this clinical trial, 133 migrainous patients were randomly assigned into three intervention groups: magnesium oxide (500 mg/day), L-carnitine (500 mg/day), and Mg-L-carnitine (500 mg/day magnesium and 500 mg/day L-carnitine), and a control group. After 12 weeks of supplementation, the checklist of migraine indicators including migraine attacks/month, migraine days/month, and headache severity was completed, and serum concentrations of magnesium and L-carnitine were measured by atomic absorption spectrophotometry and enzymatic UV test, respectively. The results showed a significant reduction in all migraine indicators in all studied groups (p < 0.05). The ANOVA results showed a significant reduction in migraine frequency across various supplemented and control groups (p = 0.008). By separating the effects of magnesium supplementation from other confounding factors such as routine treatments using the repeated measures and nested model, it was clarified that magnesium supplementation had a significant effect on all migraine indicators. Oral supplementation with magnesium oxide and L-carnitine and concurrent supplementation of Mg-L-carnitine besides routine treatments could be effective in migraine prophylaxis; however, larger trials are needed to confirm these preliminary findings.

  7. The efficacy of Kiko exercises on the prevention of migraine headaches: a pilot study.

    PubMed

    Elinoff, Victor; Lynn, Steven Jay; Ochiai, Hidy; Hallquist, Michael

    2009-01-01

    Migraine headaches, a common chronic medical problem, require prophylactic treatment when they are frequent and severe. This is the first study to investigate the efficacy of Kiko, a Japanese practice of Qigong that uses repetitive coordinated breathing and movement as a prophylactic treatment of migraine headaches. This pilot study, a single arm, non-randomized 4-month trial, investigated whether 3 months of Kiko training would reduce the severity and/or frequency of migraine and/or MIDAS scores. The baseline migraine data were collected from participants in the first month and then participants were taught Kiko exercises in 3 monthly sessions. Participants practiced at home and had the opportunity to utilize a Kiko DVD. The participants were instructed by Washin-Ryu style martial arts Master, Hidy Ochiai. Subjects completed monthly diaries that recorded the frequency and severity of their migraines, as well as the frequency and duration of their home Kiko practice. Six of the original 13 subjects completed the trial. All the individuals who completed the study had measurable improvement in their migraines. All participants reported a positive experience in learning the technique, and there were no reported adverse effects. Although the results of this study need to be confirmed in a larger clinical trial with adequate controls for placebo effects, these preliminary results are consistent with other trials that have documented the potential benefits of mind-body practices in controlling symptoms and improving the quality of life of patients suffering from chronic medical illness.

  8. Prospective analysis of factors related to migraine attacks: the PAMINA study.

    PubMed

    Wöber, C; Brannath, W; Schmidt, K; Kapitan, M; Rudel, E; Wessely, P; Wöber-Bingöl, C

    2007-04-01

    Migraine is related to numerous factors such as hormones, stress or nutrition, but information about their actual importance is limited. Therefore, we analysed prospectively a wide spectrum of factors related to headache in migraineurs. We examined 327 migraineurs recruited via newspapers who kept a comprehensive diary for 3 months. Statistical analysis comprising 28 325 patient days and 116 dichotomous variables was based on the interval between two successive headache attacks. We calculated univariate Cox regression analyses and included covariables with a P-value of <0.05 in two stepwise multivariate Cox regression analyses, the first accounting for a correlation of the event times within a subject, the second stratified by the number of headache-free intervals. We performed similar analyses for the occurrence of migraine attacks and for the persistence of headache and migraine. Menstruation had the most prominent effect, increasing the hazard of occurrence or persistence of headache and migraine by up to 96%. All other factors changed the hazard by <35%. The two days before menstruation and muscle tension in the neck, psychic tension, tiredness, noise and odours on days before headache onset increased the hazard of headache or migraine, whereas days off, a divorced marriage, relaxation after stress, and consumption of beer decreased the hazard. In addition, three meteorological factors increased and two others decreased the hazard. In conclusion, menstruation is most important in increasing the risk of occurrence and persistence of headache and migraine. Other factors increase the risk less markedly or decrease the risk.

  9. Differences in the treatment of male and female patients with end-stage renal disease.

    PubMed Central

    Florakas, C; Wilson, R; Toffelmire, E; Godwin, M; Morton, R

    1994-01-01

    OBJECTIVE: To determine whether there is a difference in the allocation of types of dialysis to male and female patients with end-stage renal disease (ESRD). DESIGN: Descriptive study. SETTING: Canada. PATIENTS: All patients registered with the Canadian Organ Replacement Register (CORR) whose treatment began between 1981 and 1991. Data were obtained for 19,732 patients, of whom 18,010 had sufficiently complete data and were being treated with either peritoneal dialysis or hemodialysis 3 months after the diagnosis of ESRD. OUTCOME MEASURES: Proportions of patients receiving peritoneal dialysis and hemodialysis according to sex. RESULTS: Significantly more male (58.1%) than female (50.8%) patients were receiving hemodialysis 3 months after diagnosis (p < 0.00001). Multivariate analysis to control for the possible confounding effects of age, province of treatment, diagnosis, concurrent illness and year of diagnosis did not explain the difference. CONCLUSIONS: In Canada from 1981 to 1991 male patients were more likely than female patients to receive hemodialysis for the treatment of ESRD. Additional research is needed to explain this finding. PMID:7954176

  10. Proinflammatory proteins in female and male patients with primary antiphospholipid syndrome: preliminary data.

    PubMed

    Bećarević, Mirjana; Ignjatović, Svetlana

    2016-10-01

    The latest classification criteria for the diagnosis of the antiphospholipid syndrome (APS, an autoimmune disease characterized by thromboses, miscarriages and presence of antiphospholipid antibodies (Abs)) emphasized that thrombotic manifestations of APS should be without any signs of an inflammatory process. However, atherosclerosis (a chronic inflammatory response to the accumulation of lipoproteins in the walls of arteries) and APS are characterized by some similar features. We evaluated whether proinflammatory proteins were associated with the features of the primary APS (PAPS). PAPS patients without obstetric complications and with impaired lipid profile were included in the study. Antiphospholipid antibodies, TNF-alpha, and apo(a) were determined by ELISA. Complement components and hsCRP were measured by immunonephelometry. Decreased C3c was observed in female patients with increased titers of IgG anti-β2gpI (χ(2) = 3.939, P = 0.047) and in male patients with increased IgM anticardiolipin Abs (χ(2) = 4.286, P = 0.038). Pulmonary emboli were associated with interleukin (IL)-6 in male (χ(2) = 6.519, P = 0.011) and in female (χ(2) = 10.405, P = 0.001) patients. Cerebrovascular insults were associated with LDL-cholesterol (P = 0.05, 95 % CI: 1.003 - 12.739) in female and with apo(a) (P = 0.016, 95 % CI: 0.000-0.003) in male patients. Older female patients had increased LDL-cholesterol levels and frequency of myocardial infarctions. Proinflammatory proteins were associated with features of primary APS. No real gender differences in regard to proinflammatory protein levels were observed. Premenopausal state of female PAPS patients confers lower cardiovascular risk.

  11. Acetazolamide in vestibular migraine prophylaxis: a retrospective study.

    PubMed

    Çelebisoy, Neşe; Gökçay, Figen; Karahan, Ceyda; Bilgen, Cem; Kirazlı, Tayfun; Karapolat, Hale; Köse, Timur

    2016-10-01

    The aim of this study is to check the efficacy of acetazolamide in the prophylaxis of vestibular migraine (VM). Treatment options in VM are mainly based on migraine guidelines. We tried to assess the efficacy of acetazolamide in these patients depending on clinical similarities with episodic ataxia type 2 and familial hemiplegic migraine responding to the drug. This is a retrospective cohort study. Among 50 patients with VM and prescribed acetazolamide 500 mg/day, 39 patients were studied as five had been lost on follow-up and six had stopped taking the drug due to side effects. Vertigo and headache frequency determined by number of attacks per month, and the severity determined by visual analog scales measured in centimeters from 0 to 10 were collected from the records. Initial reported figures for frequency and severity were compared with the results gathered after 3 months of treatment. The results were compared. Acetazolamide was effective in reducing both the frequency and severity of vertigo and headache attacks and this effect was more prominent for vertigo frequency and severity.

  12. Atrial Fibrillation is Associated With Morphine Treatment in Female Breast Cancer Patients

    PubMed Central

    Lee, Cynthia Wei-Sheng; Muo, Chih-Hsin; Liang, Ji-An; Lin, Ming-Chia; Kao, Chia-Hung

    2016-01-01

    Abstract We investigated the relationship between morphine treatment and the risk of atrial fibrillation (AF) in female patients with breast cancer. We identified a malignancy cohort of 73,917 female breast cancer patients without an AF history before the date of breast cancer diagnosis between 2000 and 2010 by using the Longitudinal Health Insurance Database for Catastrophic Illness Patients in Taiwan. This malignancy cohort was divided into morphine and comparison cohorts comprising 18,671 and 55,246 patients, respectively, and the incidences of newly diagnosed AF were calculated. We used the Cox proportional hazard model with time-dependent exposure covariates to estimate the risk of AF. The effect of morphine was assessed through multivariable Cox proportional hazard regression controlling for age, the Charlson comorbidity index (CCI) score, and the use of bisphosphonates and paclitaxel. Compared with nonmorphine users, patients who received morphine exhibited a 4.37-fold (95% CI = 3.56–5.36) increase in the risk of developing AF. The risk of AF increased as the CCI score increased, but decreased in patients with tamoxifen treatment. This risk is especially significant in current morphine users of all ages and with low CCI score. AF risk increased as the duration of morphine use lengthened (P for trend <0.0001). The incidence of AF in female breast cancer patients in Taiwan is associated with morphine, but prevented by tamoxifen treatment. PMID:26986153

  13. Formaldehyde, aspartame, and migraines: a possible connection.

    PubMed

    Jacob, Sharon E; Stechschulte, Sarah

    2008-01-01

    Aspartame is a widely used artificial sweetener that has been linked to pediatric and adolescent migraines. Upon ingestion, aspartame is broken, converted, and oxidized into formaldehyde in various tissues. We present the first case series of aspartame-associated migraines related to clinically relevant positive reactions to formaldehyde on patch testing.

  14. Psychosocial Precursors and Correlates of Migraine Headache.

    ERIC Educational Resources Information Center

    Levor, Robert M.; And Others

    1986-01-01

    Tested the interactions of migraine headache cycles and sufferers' daily experiences of stressful events, emotional arousal, and physical activity. Results support a model of migraine characterized by parallel physiological and psychosocial instability during a 4-day cycle and by an interaction of personality and behavioral (self-reported stress)…

  15. An epidemiological survey of hemiplegic migraine.

    PubMed

    Lykke Thomsen, L; Kirchmann Eriksen, M; Faerch Romer, S; Andersen, I; Ostergaard, E; Keiding, N; Olesen, J; Russell, M B

    2002-06-01

    The objective of the present study was to use systematic nation-wide case-finding methods to establish the prevalence and sex ratio of hemiplegic migraine (HM) in the entire Danish population of 5.2 million inhabitants. Affected patients were identified from three different recruitment sources: the National Patient Register, case records from private practising neurologists and advertisements. Based on the observed number of affected patients from each case-finding method, it was attempted to estimate the total number of affected patients by means of the statistical method known as capture-recapture. Two hundred and ninety-one affected patients were identified; 147 were familial HM from 44 different families, 105 were sporadic HM and 39 were unclassifiable HM. The HM sex ratio (M:F) was 1:3. Based on the identified number of affected patients the prevalence of HM at the end of 1999 was estimated to be 0.01% in Denmark, where the familial and sporadic form were equally frequent.

  16. Ischemia may be the primary cause of the neurologic deficits in classic migraine

    SciTech Connect

    Skyhoj Olsen, T.; Friberg, L.; Lassen, N.A.

    1987-02-01

    This study investigates whether the cerebral blood flow reduction occurring in attacks of classic migraine is sufficient to cause neurologic deficits. Regional cerebral blood flow measured with the xenon 133 intracarotid injection technique was analyzed in 11 patients in whom a low-flow area developed during attacks of classic migraine. When measured with this technique, regional cerebral blood flow in focal low-flow areas will be overestimated because of the effect of scattered radiation (Compton scatter) on the recordings. In this study, this effect was particularly taken into account when evaluating the degree of blood flow reduction. During attacks of classic migraine, cerebral blood flow reductions averaging 52% were observed focally in the 11 patients. Cerebral blood flow levels known to be insufficient for normal cortical function (less than 16 to 23 mL/100 g/min) were measured in seven patients during the attacks. This was probably also the case in the remaining four patients, but the effect of scattered radiation made a reliable evaluation of blood flow impossible. It is concluded that the blood flow reduction that occurs during attacks of classic migraine is sufficient to cause ischemia and neurologic deficits. Hence, this study suggests a vascular origin of the prodromal neurologic deficits that may accompany attacks of classic migraine.

  17. Scent of aura? Clinical features of olfactory hallucinations during a migraine attack (OHM).

    PubMed

    Mainardi, Federico; Rapoport, Alan; Zanchin, Giorgio; Maggioni, Ferdinando

    2017-02-01

    Introduction Olfactory hallucination during a migraine attack (OHM) is a rare phenomenon. At present, it is not considered a manifestation of migraine aura. Material and methods The clinical features of OHM were collected in 11 patients. Results Of the 11 patients, 10 had migraine without aura and one migraine with aura associated with OHM. Mean age at onset of headache and at appearance of OHM were respectively 17.8 and 32.3 years. Migraine average frequency was 3.9 attacks/month, 19% of them being associated with OHM. The temporal pattern of OHM maintained the same characteristics in the different attacks. O