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Sample records for female migraine patients

  1. Quality of Life and Migraine Disability among Female Migraine Patients in a Tertiary Hospital in Malaysia

    PubMed Central

    Shaik, Munvar Miya; Hassan, Norul Badriah; Gan, Siew Hua

    2015-01-01

    Background. Disability caused by migraine may be one of the main causes of burden contributing to poor quality of life (QOL) among migraine patients. Thus, this study aimed to measure QOL among migraine sufferers in comparison with healthy controls. Methods. Female diagnosed migraine patients (n= 100) and healthy controls (n=100) completed the Malay version of the World Health Organization QOL Brief (WHOQOL-BREF) questionnaire. Only migraine patients completed the Malay version of the Migraine Disability Assessment questionnaire. Results. Females with migraines had significantly lower total WHOQOL-BREF scores (84.3) than did healthy controls (91.9, P<0.001). Similarly, physical health (23.4 versus 27.7, P<0.001) and psychological health scores (21.7 versus 23.2, P< 0.001) were significantly lower than those for healthy controls. Seventy-three percent of patients experienced severe disability, with significantly higher number of days with headaches (13.8 days/3 months, P< 0.001) and pain scores (7.4, P< 0.013). Furthermore, migraine patients with lower total QOL scores had 1.2 times higher odds of having disability than patients with higher total QOL scores. Conclusions. The present study showed that migraine sufferers experienced significantly lower QOL than the control group from a similar population. Disability was severe and frequent and was associated with lower QOL among the migraine patients. PMID:25632394

  2. 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. Copyright © 2015 Elsevier B.V. All rights reserved.

  3. Metabolic syndrome in female migraine patients is associated with medication overuse headache: a clinic-based study in China.

    PubMed

    He, Z; Dong, L; Zhang, Y; Kong, Q; Tan, G; Zhou, J

    2015-08-01

    Migraine and metabolic syndrome have been reported to coexist to a marked degree, especially in women migraine patients, but the relationship between these two conditions is still unclear. This study was performed to evaluate the association of headache characteristics and its comorbidities with metabolic syndrome (MetS) and its components in female migraine patients. A total of 142 women with migraine who fulfilled the criteria of the International Classification of Headache Disorders 2nd edition were recruited in a neurological outpatient department in China. The characteristics of migraine and its comorbidities (analgesic use, psychiatric disorders and disability) were assessed with a detailed questionnaire. Anthropometrics, blood biochemistry and transcranial Doppler sonography were used for metabolic measurements and vascular function. Of 142 participants, 70.4% had one or more metabolic abnormalities and 12.0% had MetS. After adjustment for age, residence, body mass index, waist-to-height ratio, smoking and drinking history, chronic migraine in women patients was associated with MetS [odds ratio (OR) = 5.342, P = 0.032], but when the chronic migraine patients were comorbid with medication overuse headache (MOH), the risk for MetS increased significantly (OR = 12.68, P = 0.007). In addition, MOH was associated with abdominal obesity and hypertension amongst the components of MetS (OR = 4.205 and 3.234, P = 0.043 and 0.039, respectively). Our study may suggest that chronic migraine is associated with MetS, especially when it is comorbid with analgesic overuse. MOH may be the risk factor for MetS in female migraine patients and associated with abdominal obesity and hypertension. © 2015 EAN.

  4. The effect of 1 mg folic acid supplementation on clinical outcomes in female migraine with aura patients.

    PubMed

    Menon, Saras; Nasir, Bushra; Avgan, Nesli; Ghassabian, Sussan; Oliver, Christopher; Lea, Rodney; Smith, Maree; Griffiths, Lyn

    2016-12-01

    Migraine is a common neurovascular condition that may be linked to hyperhomocysteinemia. We have previously provided evidence that reduction of homocysteine with a vitamin supplementation can reduce the occurrence of migraine in women. The current study examined the occurrence of migraine in response to vitamin supplementation with a lower dose of folic acid. This was a 6 month randomised, double blinded placebo controlled trial of daily vitamin supplementation containing 1 mg of folic acid, 25 mg of Vitamin B6 and Vitamin B12, on reduction of homocysteine and the occurrence of migraine in 300 female patients diagnosed with migraine with aura. Vitamin supplementation with 1 mg of folic acid, did not significantly decrease homocysteine levels (P = 0.2). The treatment group did not show a significant decrease in the percentage of participants with high migraine disability, severity or frequency at the end of the 6 month intervention (P > 0.1). 1 mg of folic acid in combination with vitamin B6 and B12 is less effective in reducing migraine associated symptoms compared to the previously tested dosage of 2 mg folic acid in combination with 25 mg of vitamin B6 and 400 μg of vitamin B12.

  5. 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.

  6. 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

  7. Migraine features in patients with Meniere's disease.

    PubMed

    Ghavami, Yaser; Mahboubi, Hossein; Yau, Amy Y; Maducdoc, Marlon; Djalilian, Hamid R

    2016-01-01

    To better understand the features of migraine in Meniere's disease (MD). Retrospective review of prospectively obtained surveys in an outpatient clinic of a tertiary medical center. Detailed questionnaires on headaches and dizziness were given to consecutive patients presenting with dizziness. The responses were verified by the clinician with the patient. The data, in addition to the clinical history and audiogram, were used to diagnose patients with migraine headaches and MD using criteria set by the International Headache Society (IHS) and the American Academy of Otolaryngology-Head and Neck Surgery, respectively. The prevalence of migraine-like symptoms in those patients with MD, who did not fit the diagnostic criteria for migraine, was evaluated. Thirty-seven patients with definite MD were included. There was a predominance of females (female/male:26/11). Mean age of patients was 52 ± 14 years. Nineteen patients (51%) had migraine headaches. Fifteen patients fulfilled the criteria for definite vestibular migraine. Of those who did not fulfill the IHS migraine criteria, a majority had characteristics such as a family history of migraine, visual motion sensitivity, or lifelong motion sickness that were highly suggestive of a migraine disorder. A majority of patients with MD have migraine headaches as defined by the IHS. Sensitivity to visual motion, light and sound, head motion, smells, weather changes, or medication was present in 95% of all patients with definite MD and 82% of non-IHS migraine MD patients. This may suggest that MD may be an atypical variant of migraine. © 2015 The American Laryngological, Rhinological and Otological Society, Inc.

  8. Managing migraine by patient profile: role of frovatriptan.

    PubMed

    Cady, Roger K; Farmer, Kathleen

    2016-01-01

    For the last quarter of a century, triptans have been available for acute treatment of migraine but with little guidance on which of the different triptan products to use for which patient or which attack of migraine. In this article, we propose a structured approach to analysis of individual migraine attacks and patient characteristics as a means of defining and optimizing acute intervention. Assessment of patient and attack profiles includes the "5-Ps": pattern, phenotype, patient, pharmacology, and precipitants. Attending to these five components of information can assist in developing an individualized behavioral, pharmacological, and nonpharmacological comprehensive treatment plan for most migraine patients. This clinical approach is then focused on frovatriptan because of its unique molecular signature and potential novel clinical applications. Frovatriptan like all triptans is indicated for acute treatment of migraine but its role has been explored in management of several unique migraine phenotypes. Frovatriptan has the longest half-life of any triptan and consequently is often promoted for acute treatment of migraine of longer duration. It has also been studied as a short-term preventive treatment in women with menstrual-related migraine. Given that 60% of female migraineurs suffer from menstrual-related migraine, this population is the obvious group for continued study. Small studies have also explored frovatriptan's use in treating migraine predicted by premonitory symptoms as a preventive for the headache phase of migraine. By identifying patient and attack profiles, clinicians may effectively determine the viability of frovatriptan as an effective pharmacological intervention for migraine.

  9. Living with chronic migraine: a qualitative study on female patients' perspectives from a specialised headache clinic in Spain.

    PubMed

    Palacios-Ceña, Domingo; Neira-Martín, Beatriz; Silva-Hernández, Lorenzo; Mayo-Canalejo, Diego; Florencio, Lidiane Lima; Fernández-de-Las-Peñas, César; García-Moreno, Héctor; García-Azorín, David; Cuadrado, María Luz

    2017-08-21

    The aim of this study was to explore the views and experiences of a group of Spanish women suffering from chronic migraine (CM). Headache clinic at a university hospital in Madrid (Spain). Purposeful sampling of patients that attended a specialised headache clinic for the first time between June 2016 and February 2017 was performed. The patients included were females aged 18-65 and with positive diagnoses of CM according to the International Classification of Headache disorders (third edition, beta version), with or without medication overuse. Accordingly, 20 patients participated in the study with a mean age of 38.65 years (SD 13.85). Qualitative phenomenological study. Data were collected through in-depth interviews, researchers' field notes and patients' drawings. A thematic analysis was performed following appropriate guidelines for qualitative research. Five main themes describing the significance of suffering emerged: (a) the shame of suffering from an invisible condition; (b) treatment: between need, scepticism and fear; (c) looking for physicians' support and sincerity and fighting misconceptions; (d) limiting the impact on daily life through self-control; and (e) family and work: between understanding and disbelief. The disease is experienced as an invisible process, and the journey to diagnosis can be a long and tortuous one. Drug prescription by the physician is greeted with distrust and scepticism. Patients expect sincerity, support and the involvement of their doctors in relation to their disease. Pain becomes the main focus of the patient's life, and it requires considerable self-control. The disease has a strong impact in the work and family environment, where the patient may feel misunderstood. Qualitative research offers insight into the way patients with CM experience their disease and it may be helpful in establishing a more fruitful relationship with these patients. © Article author(s) (or their employer(s) unless otherwise stated in the text

  10. Managing migraine by patient profile: role of frovatriptan

    PubMed Central

    Cady, Roger K; Farmer, Kathleen

    2016-01-01

    For the last quarter of a century, triptans have been available for acute treatment of migraine but with little guidance on which of the different triptan products to use for which patient or which attack of migraine. In this article, we propose a structured approach to analysis of individual migraine attacks and patient characteristics as a means of defining and optimizing acute intervention. Assessment of patient and attack profiles includes the “5-Ps”: pattern, phenotype, patient, pharmacology, and precipitants. Attending to these five components of information can assist in developing an individualized behavioral, pharmacological, and nonpharmacological comprehensive treatment plan for most migraine patients. This clinical approach is then focused on frovatriptan because of its unique molecular signature and potential novel clinical applications. Frovatriptan like all triptans is indicated for acute treatment of migraine but its role has been explored in management of several unique migraine phenotypes. Frovatriptan has the longest half-life of any triptan and consequently is often promoted for acute treatment of migraine of longer duration. It has also been studied as a short-term preventive treatment in women with menstrual-related migraine. Given that 60% of female migraineurs suffer from menstrual-related migraine, this population is the obvious group for continued study. Small studies have also explored frovatriptan’s use in treating migraine predicted by premonitory symptoms as a preventive for the headache phase of migraine. By identifying patient and attack profiles, clinicians may effectively determine the viability of frovatriptan as an effective pharmacological intervention for migraine. PMID:27103792

  11. 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

  12. Clinical profile and functional disability of patients with migraine.

    PubMed

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

    2016-01-01

    Migraine is a common disabling primary headache disorder. Globally, migraine was ranked as the seventh highest cause of disability. The aim of the study was to explore the clinical profile and functional disability of patients with migraine. A cross-sectional survey was conducted at the neurology outpatient department of a tertiary care hospital in Karnataka. Using a consecutive sampling technique, 60 patients were recruited for the study. Descriptive and inferential statistics were used to analyze the data. 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. 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.

  13. 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

  14. 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.

  15. Handedness, eyedness, and crossed hand-eye dominance in male and female patients with migraine with and without aura: a pilot study.

    PubMed

    Aygül, Recep; Dane, Senol; Ulvi, Hizir

    2005-06-01

    The possible relationships of migraine to left-handedness and left-eyedness, as well as sex and aura-related differences, were examined. 146 migraine patients (M age=32.1 yr., SD=9.5) and 141 controls (M age=30.0 yr., SD=9.3) participated. Hand preference was assessed by the modified version of the Edinburgh Handedness Inventory. Ocular dominance was measured by means of the near-far alignment test. Migraine diagnoses were made on the basis of criteria provided from the International Headache Society. In the overall sample and in women, left-handedness and left-eyedness were not significantly correlated with migraine. In men, the incidence of left-handedness and left-eyedness were significantly higher in patients than in controls. The presence of aura in patients with migraine was significantly associated with the incidence of left-eyedness and crossed hand-eye dominance, but not handedness, for the total sample and women. These results suggest that there may be a tendency towards anomalous dominance, especially left-eyedness, in migraine patients particularly those with aura.

  16. An association between migraines and heart anomalies-true or false? A heart ultrasound study using cTTE in migraine patients and control participants.

    PubMed

    Domitrz, Izabela; Styczynski, Grzegorz; Wilczko, Justyna; Marczewska, Malgorzata M; Domitrz, Wojciech; Kaminska, Anna

    2014-12-01

    A migraine is a common neurological disorder that often coexists with other illnesses including heart abnormalities, such as patent foramen ovale (PFO), atrial septal aneurysm (ASA), and mitral valve prolapse (MVP). The aim of our study was to evaluate the occurrence of some heart abnormalities in migraine patients by routine and contrast transthoracic echocardiography. We assessed the occurrence of PFO, ASA, and MVP in 96 patients with migraine without aura (87 females), in 62 patients with migraine with aura (41 females) and in 53 healthy persons (40 females). In comparison with our control group, only the prevalence of PFO was statistically higher in patients with migraine (P = 0.03) and especially with aura (P = 0.01). We did not find any statistically significant differences between the occurrence of ASA or MVP in migraine and control groups. The results of our study raise the question of the heart's role in the mechanism of migraine attacks. If the occurrence of migraine with aura had been related to some heart abnormalities, the pathophysiology of migraine attacks may have some connection to some heart dysfunction. Resolving the association between migraine and comorbid cardiac conditions might shed light on the underlying mechanisms of migraines and even result in a different treatment strategy. However, we do not find any clear connection between PFP, ASA, and MVP, and migraine occurrence. Wiley Periodicals, Inc.

  17. Raven coloured progressive matrices in migraine without aura patients.

    PubMed

    Viticchi, Giovanna; Falsetti, Lorenzo; Bartolini, Marco; Buratti, Laura; Pistelli, Lara; Provinciali, Leandro; Silvestrini, Mauro

    2017-05-01

    Conflicting results emerged from studies investigating cognitive performances in migraine patients. Based on clinical and neuroradiological aspects, the possible involvement of executive functions has been especially taken into consideration. The aim of this study was to evaluate, in a population of subjects affected by migraine without aura (MwoA), frontal lobe cognitive functions. We enrolled all the consecutive patients affected by MwoA referred to our headache centre for a first evaluation. Each patient underwent a neuropsychological evaluation including Raven coloured progressive matrices (CPM). We collected variables as age, education, years of migraine, frequency of attacks and CPM scores. Relationship between continuous variables was explored with multiple regression lines, selecting the best-fitting trendline for each relationship. We obtained a final sample of 36 subjects (females: 62.5%; mean age: 42.25 ± 10.21 years). Patients had mean length of migraine history of 12.25 ± 11.00 years and a mean frequency of attacks of 8.06 ± 7.15 per month. Linear regression underlines a progressive decrease of CPM score with the increase of the migraine history's length (R (2) = 0.8871; p < 0.001), and the frequency of migraine attacks (R (2) = 0.3122; p < 0.05). Our findings suggest that pathological CPM scores can be associated with the severity of migraine. These data seem to confirm the hypothesis of an impairment of executive functions in MwoA. Different hypotheses to explain cognitive impairment in migraine have been postulated including the impact of the typical white matter lesions and a long history of drug abuse. The possible relevant clinical consequence of a full comprehension of this particular aspect related to migraine deserves further attention and consideration.

  18. 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.

  19. 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

  20. Psychiatric comorbidities and photophobia in patients with migraine.

    PubMed

    Seidel, Stefan; Beisteiner, Roland; Manecke, Maike; Aslan, Tuna Stefan; Wöber, Christian

    2017-12-01

    Based on recent findings and our own impressions we took a closer look at the relationship between (inter)ictal photophobia and psychometric variables in migraine patients with photophobia. For this study we included 29 (27 female) migraine patients and 31 (18 female) controls with a mean age of 31.6 ± 12.5 years and 24.0 ± 4.1 years, respectively. All participants filled out the Depression Anxiety Stress Scale (DASS). Interictal photophobia in patients was significantly higher than photophobia in controls (p = .001). Patients showed statistically significantly higher levels of depressive symptoms (p < .001), anxiety symptoms (p < .001) and stress (p < .001) than controls. Among all participants, (interictal) photophobia correlated positively with age (rho = .318, p = .013) as well as with the levels of depressive symptoms (rho = .459, p < .001), anxiety symptoms (rho = .346, p = .008) and stress (rho = .368, p = .005), but not with gender. In the patients, ictal photophobia correlated positively with age (rho = .473, p = .01) and interictal photophobia (rho = .423, p = .022). Linear regression analysis revealed only a trend towards statistical significance for (interictal) photophobia as a predictor for the level of depressive symptoms (rho = .457, p = 0.056) in the whole sample. Considering higher levels of photophobia in depression and the comorbidity of migraine and depression, it might be possible that depression contributes to interictal photophobia in patients with migraine. The same may be true for anxiety and stress. Both are also related to migraine and their possible impact on photophobia in migraine may be explained by pupillary dysfunction.

  1. Frequency of Migraine Headaches in Patients With Fibromyalgia.

    PubMed

    Vij, Brinder; Whipple, Mary O; Tepper, Stewart J; Mohabbat, Arya B; Stillman, Mark; Vincent, Ann

    2015-06-01

    The purpose of this study was to evaluate the frequency of migraine headache in a large cohort of patients with fibromyalgia using a brief migraine headache-screening tool. Several studies report a high prevalence of fibromyalgia among patients with migraine headaches, but there is a dearth of research evaluating the frequency of migraine headaches in patients with fibromyalgia, despite clinical observations suggesting that migraine headaches are common in patients with fibromyalgia. This was a cross-sectional survey study. Patients (N = 3717) with a previous diagnosis of fibromyalgia who were members of the Mayo Clinic Fibromyalgia Registry were contacted by electronic survey and asked to complete a brief demographic and medical history questionnaire and the validated ID-Migraine screener. A total of 1730 patients (46.5%) completed the electronic survey. The majority of participants were white (97.2%), female (92.5%), with a mean age of 56.2 (±13.1) years. Of the respondents, 966 (55.8%) met criteria for migraine headaches. Hypertension (309 [32.3%] vs. 294 [40.1%], P = .004), asthma (312 [32.5%] vs. 189 [25.9%], P = .011), irritable bowel syndrome (520 [54.6%] vs. 348 [47.6], P = .017), chronic fatigue syndrome (486 [50.7%] vs. 271 [37.1], P < .0001), depression (634 [66.5%] vs. 413 [56.7%], P = .0002), anxiety (415 [43.5%] vs. 252 [34.7%], P = .0011), and post-traumatic stress disorder (172 [18.0%] vs. 96 [13.2%], P = .006) were all significantly more common in those who met criteria for migraine headaches than those who did not. The results of this study suggest that migraine headaches are common in patients with fibromyalgia. Clinicians who care for either population must be aware that these conditions commonly overlap and can significantly increase a patient's cumulative disease burden. © 2015 American Headache Society.

  2. Gender influences headache characteristics with increasing age in migraine patients.

    PubMed

    Bolay, Hayrunnisa; Ozge, Aynur; Saginc, Petek; Orekici, Gulhan; Uludüz, Derya; Yalın, Osman; Siva, Aksel; Bıçakçi, Şebnem; Karakurum, Başak; Öztürk, Musa

    2015-08-01

    Migraine headache is one of the most common primary headache disorders and is three times more prevalent in women than in men, especially during the reproductive ages. The neurobiological basis of the female dominance has been partly established. The present study aimed to investigate the effect of gender on the headache manifestations in migraine patients. The study group consisted of 2082 adult patients from five different hospitals' tertiary care-based headache clinics. The relationship between headache characteristics and gender was evaluated in migraine with aura (MwA) and migraine without aura (MwoA). The duration, severity, frequency of headache and associated symptoms were evaluated in both genders and age-dependent variations and analyzed in two subgroups. Women with migraine were prone to significantly longer duration and intensity of headache attacks. Nausea, phonophobia and photophobia were more prevalent in women. Median headache duration was also longer in women than in men in MwA (p = 0.013) and MwoA (p < 0.001). Median headache intensity was higher in women than in men in MwA (p = 0.010) and MwoA (p = 0.009). The frequency of nausea was significantly higher in women than in men in MwA (p = 0.049). Throbbing headache quality and associated features (nausea, photophobia, and phonophobia) were significantly more frequent in women than in men in MwoA. The gender impact varied across age groups and significant changes were seen in female migraineurs after age 30. No age-dependent variation was observed in male migraineurs. Gender has an influence on the characteristics of the headache as well as on the associated symptoms in migraine patients, and this impact varies across the age groups, particularly in women. © International Headache Society 2014.

  3. 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.

  4. 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.

  5. 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.

  6. 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

  7. Evaluation of subclinical atherosclerosis in migraine patients by ultrasound radiofrequency data technology: preliminary results.

    PubMed

    Güneş Tatar, İdil; Ergun, Onur; Çeltikçi, Pınar; Kurt, Aydın; Yavaşoğlu, Neşe; Birgi, Erdem; Tatar, Tolga; Hekimoğlu, Baki

    2016-07-01

    Migraine is a headache disorder affecting approximately 12% of the population, predominantly female individuals. Migraine has been associated with vascular events such as stroke and cardiovascular disease. The close connection between these vascular disorders and atherosclerosis is well known. Carotid artery intima-media thickness (CAIMT) is a marker for detection of subclinical atherosclerosis. The present study is an analysis of the presence of subclinical atherosclerosis in migraine patients. CAIMT was evaluated in 25 female migraine patients and 27 female controls using innovative ultrasound (US) radiofrequency (RF) data technology. Mann-Whitney U test was used to compare measurements in patient and control groups. There was a statistically significant difference between mean CAIMT of migraine patients and control group (p<0.005): mean CAIMT was 701±114 µm in migraine patients and 400±64 µm in control group. Migraine patients are more prone to atherosclerosis compared to healthy individuals. CAIMT measurement with sonography can be utilized in follow-up to detect subclinical atherosclerosis.

  8. A survey of female students with migraine: what is the influence of family history and lifestyle?

    PubMed

    Dzoljic, Eleonora; Vlajinac, Hristina; Sipetic, Sandra; Marinkovic, Jelena; Grbatinic, Ivan; Kostic, Vladimir

    2014-02-01

    To compare characteristics of migraine and some lifestyle habits in migraineurs with and without a positive family history for migraine. The prevalence study was combined with a case-control study and comprised 245 female students with migraine. Out of 245 female students with migraine, 132 (53.9%) had a positive family history for migraine. In comparison with migraineurs who had not, those with a positive family history were younger at the onset of migraine and significantly more frequently reported menstrual migraine (p < 0.001), unilateral pain (p < 0.05) and pulsate pain (p < 0.05) as well as severe headache (p < 0.01). In comparison to migraineurs with a positive family history for migraine, those who did not report a significantly higher frequency of average number of meals per day of <3 (p < 0.001), missed meals (p < 0.05) and an average sleep duration of ≤ 6 h (p < 0.05). The results of the present study are in line with literature showing a high frequency of positive family history for migraine among migraineurs. They also suggest that subjects with a positive family history have a lower "migrainous threshold" for the development of migraine and that environmental factors are more important for the occurrence of migraine in subjects without a positive family history. Accordingly, the conclusions of this study are limited to reproductive aged women.

  9. Prevalence of Pulsatile Tinnitus Among Patients With Migraine.

    PubMed

    Weinreich, Heather M; Carey, John P

    2016-03-01

    To examine the prevalence of pulsatile tinnitus (PT) among patients with a diagnosis of migraine and to determine if treatment of migraine improves symptoms. Single-institution retrospective patient review. Academic tertiary referral center. Billing data capturing ICD-9 codes 346.xx and 388.3x was used to identify patients with history of migraine and tinnitus. Patients were excluded if the symptom of PT could be attributed to an alternate diagnosis. Data were extracted from the patients' electronic medical records. Therapeutic patients were prescribed a strict migraine diet with or without migraine medication. Subjective improvement in tinnitus as documented in electronic medical records. One thousand two hundred four patients were identified with an ICD-9 code for migraine and of those patients, 12% (n = 145) had an ICD-9 code for tinnitus. After ruling out alternative causes, the prevalence of PT among all patients with migraine was 1.9%. Of migrainers with PT who underwent migraine treatment, 11 out of 16 reported resolution or improvement of their PT. PT can be observed in the context of migraine. Migraine treatment with avoidance of dietary triggers with or without medication can possibly lead to resolution of PT.

  10. Acute migraine medication adherence, migraine disability and patient satisfaction: A naturalistic daily diary study.

    PubMed

    Seng, Elizabeth K; Robbins, Matthew S; Nicholson, Robert A

    2017-09-01

    Objective To examine the influence of acute migraine medication adherence on migraine disability and acute medication satisfaction. Methods Adults with migraine completed three months of daily electronic diaries assessing headache symptoms, acute medication taken, acute medication satisfaction, and daily migraine disability. Repeated measures mixed-effects models examined the effect of initial medication type [migraine-specific medication (MSM) vs. over-the-counter analgesic (OTC) vs. an opiate/barbiturate], the severity of pain at dosing, and their interaction with daily migraine disability and satisfaction with acute medication. Results Participants (N = 337; 92.5% female; 91.1% Caucasian, non-Hispanic; 84.0% with episodic migraine) recorded 29,722 diary days. Participants took acute medication on 96.5% of 8090 migraine days. MSM was most frequently taken first (58%), followed by OTC (29.9%) and an opiate/barbiturate (12.1%). Acute medication was most frequently taken when pain was mild (41.2%), followed by moderate (37.7%) and severe pain (11.4%). Initially dosing with MSM while pain was mild was associated with the lowest daily disability [medication × pain at dosing F (4, 6336.12) = 58.73, p < .001] and highest acute medication satisfaction [medication × pain at dosing F (4, 3867.36) = 24.00, p < .001]. Conclusion Using an MSM (triptan or ergot) first was associated with the lowest migraine disability and highest acute medication satisfaction.

  11. 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.

  12. 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 ...

  13. 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

  14. Vertebral artery dissection presented as lateral medullary syndrome in a patient with migraine: a case report.

    PubMed

    Yen, Ju-Chun; Chan, Lung; Lai, Yen-Jun

    2010-12-01

    Migraine and artery dissection are both rare causes of ischemic stroke. The mechanism of migraine-related intracranial artery dissection is still unknown. It is proposed that the repeated attack of migraine would make the involved artery more vulnerable to tearing and lead to dissection. We describe a 42-year-old female suffering from basilar-type migraine for more than 20 years. The patient complained severe dizziness with hyperventilation while watching television. Initially anxiety and migraine attack were impressed in the emergency room, but dizziness accompanied with dysarthria and dysphagia was noted later. After admission, lateral medullary syndrome was suspected after a detailed neurological examination, and a brain magnetic resonance image (MRI) revealed an acute infarction on the left lateral medulla oblongata, confirming the clinical diagnosis Furthermore, cerebral angiography revealed the left distal vertebral artery dissection. The patient was reluctant to use an anticoagulant; therefore aspirin was given for secondary stroke prevention and topiramate for migraine prophylaxis. The exact mechanism of migraine-related intracranial artery dissection has yet to be proven, we propose that this may be caused by vessel wall edematous changes with repeated migraine attacks resulting in sudden or unusual stretching.

  15. Migraine headache trigger site prevalence analysis of 2590 sites in 1010 patients.

    PubMed

    Seyed Forootan, Nazilla S; Lee, Michelle; Guyuron, Bahman

    2017-02-01

    Surgical deactivation of migraine trigger sites offers an alternate treatment option for patients with recalcitrant headaches who are unresponsive to medical therapies or for those who are unable to take medications. The aim of this article is to provide a comprehensive review and a prevalence analysis of 2590 migraine surgery trigger sites in 1010 patients over a 14-year study period. This is a retrospective review of migraine patients who underwent surgical decompression of peripheral nerves. Data from the migraine surgery database maintained by the senior author were reviewed. Preoperative variables included patient demographics and migraine trigger sites, whereas intraoperative variables included specific trigger site deactivation. Overall, 825 female and 158 male patients underwent the deactivation of 2590 migraine headache trigger sites. Migraine surgery patients had an average of 2.6 trigger sites. A single trigger site was operated in 26.9% of migraine headache patients, whereas 73.1% of the patients had multiple trigger sites. The nasal trigger site (III) was the most prevalent single trigger site affecting 12.3% of patients, and overall 66.9% of patients had this site as a component of their migraine complex. Concurrent occurrence of trigger sites I, II, III, and IV was the most prevalent trigger site combination involving 21.4% of patients. This article offers the prevalence information of trigger sites and provides a simple classification for the ease of communication among surgeons and their teams. Copyright © 2016 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  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. [Migraine and interatrial septal abnormalities in patients under 55 with cryptogenic stroke].

    PubMed

    Martínez-Sánchez, Patricia; Fuentes Gimeno, Blanca; Oliver Ruiz, José María; Ortega-Casarrubios, María Angeles; Idrovo Freire, Luis; Díez-Tejedor, Exuperio

    2008-10-25

    Patent foramen ovale (PFO) is more frequent in migraine patients and is a cause of brain infarct among patients under 55 years old. Our goal was to study the association between PFO and migraine in ischemic stroke patients under 55 years old. Observational study with inclusion of consecutive stroke patients admitted to a stroke unit (1995--2005). We selected patients under 55 years of age with first-ever acute cerebral infarction of cryptogenic origin. Demographic data, vascular risk factors, stroke vascular territory, stroke severity, the presence of PFO and/or atrial septal aneurysm (ASA) in echocardiography and functional status at discharge by the modified Rankin Scale score were analysed according to previous migraine. From a total of 130 patients, 76 were males. The 13.8% had previous migraine, 3.9% among male and 27.8% among female (p < 0.001). Migraine patients were younger than non migraine ones (p = 0.041) and had a higher frequency of vascular risk factors (not significant [NS]). Stroke severity and functional status at discharge were similar in both groups. Previous history of migraine was associated with FOP (38.9% vs. 26.8%; NS) and FOP plus ASA (odds ratio = 5; 95% confidence interval, 1.422-17.580). The latter association was higher in female (33.3% vs. 0%; NS). Previous migraine is more frequently associated with double interatrial septal abnormality (PFO plus ASA) in cerebral infarct patients under 55 years of age. This association could be higher in women.

  20. 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.

  1. [Investigation of obsessive-compulsive symptoms in patients with migraine].

    PubMed

    Yetkin Özden, Selcen; Baykan, Betül; Ertekin, Erhan

    2015-01-01

    A migraine is not just a headache. Migraines are characterized by the co-occurrence of various systemic changes and known to be associated with many psychiatric disorders in the interictal period, especially major depression and anxiety disorders. Obsessive-compulsive disorder (OCD) in patients with migraines is relatively less studied. Obsessive-compulsive symptoms were investigated in consecutive patients with a diagnosis of migraine and compared with that of a control group of healthy individuals. The relationship of these symptoms with the defined clinical features of migraine was analyzed. 74 patients and 36 controls were included in this study. Patients were chosen from those admitted with headache complaints to the Istanbul University, Istanbul Faculty of Medicine, Department of Neurology, Headache Outpatient Clinics between December 2010-March 2012. A headache specialist diagnosed all patients with migraine using the International Headache Society criteria.. The Yale Brown Obsessive and Compulsive Scale (Y-BOCS) was used to score OCD symptoms in all participants. In comparing Y-BOCS total scores between the migraine patients and the control group, we found a statistically significant difference (z(109)= -3.100, p<0.05). Furthermore, both the Y-BOCS obsession and compulsion sub-scores were significantly different between the groups. The duration, frequency and side of migraine did not have any correlation with our findings. In conclusion, our study suggested that migraine sufferers tend to have higher obsessive and compulsive symptoms. These findings could be based on genetic changes and/or functional differences in the brain.

  2. Migraine education brochures and patient-perceived satisfaction.

    PubMed

    Medrano Martínez, V; Callejo-Domínguez, J M; Beltrán-Lasco, I; Pérez-Carmona, N; Abellán-Miralles, I; González-Caballero, G; Más-Sesé, G; López-Hernández, N; Pérez-Sempere, A; Moltó-Jordá, J M

    2015-10-01

    Brochures are commonly used as educational tools in daily neurological practice. They are provided to increase the general population's knowledge of a specific disease and also to combat sources of erroneous information. Surveys are the most commonly used method of ascertaining user satisfaction with services received. This study will assess patient-perceived satisfaction and provide feedback to measure the comprehensibility and overall utility of an educational brochure on migraine. Open prospective multicentre study of a group of patients diagnosed with migraine in neurology clinics in Alicante province. During the initial visit, each patient received a migraine brochure prepared by the Valencian Society of Neurology's study group for headaches (CEFALIC). During a follow-up visit, they were then asked to fill out a personal survey on the overall quality of the information in the brochure. We included a total of 257 patients diagnosed with migraine (83% episodic migraine; 17% chronic migraine); mean age was 37.6 years. Two hundred seven patients confirmed having read the brochure (80.5%); 50 patients (19.5%) either forgot to read it or had no interest in doing so. The brochure seemed interesting and easy to understand according to 90% of the patients. Seventy-six per cent of the respondents stated that reading the brochure increased their overall knowledge of migraine, while 50% of the patients found the brochure useful for improving migraine control. Patients found the migraine educational brochure to be comprehensible, a means of increasing overall knowledge of the disease, and useful for increasing control over migraines. Evaluations of the educational brochures that we provide to our patients with migraine should be studied to discover the causes of dissatisfaction, determine the level of quality of service, and investigate potential areas for improvement. Copyright © 2014 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights

  3. Patients with psychogenic nonepileptic seizures report more severe migraine than patients with epilepsy.

    PubMed

    Shepard, Morgan A; Silva, Annelise; Starling, Amaal J; Hoerth, Matthew T; Locke, Dona E C; Ziemba, Kristine; Chong, Catherine D; Schwedt, Todd J

    2016-01-01

    Clinical observations suggest that psychogenic non-epileptic seizure (PNES) patients often have severe migraine, more severe than epilepsy patients. Investigations into migraine characteristics in patients with PNES are lacking. In this study we tested the hypothesis that, compared to epilepsy patients, PNES patients have more severe migraine, with more frequent and longer duration attacks that cause greater disability. In this observational study, 633 patients with video-EEG proven epilepsy or PNES were identified from the Mayo Clinic Epilepsy Monitoring Unit database. Contacted patients were screened for migraine via a validated questionnaire, and when present, data regarding migraine characteristics were collected. Two-sample t-tests, chi square analyses, and Mann-Whitney U tests were used to compare migraine characteristics in PNES patients to those of epilepsy patients. Data from 43 PNES patients with migraine and 29 epilepsy patients with migraine were available. Compared to epilepsy patients, PNES patients reported having more frequent headaches (mean 15.1 ± 9.8 vs. 8.1 ± 6.6 headache days/month, p<.001), more frequent migraine attacks (mean 6.5 ± 6.3 vs. 3.8. ± 4.1 migraines/month, p=.028), longer duration migraines (mean 39.5 ± 28.3 vs. 27.3 ± 20.1h, p=.035), and more frequently had non-visual migraine auras (78.6% vs. 46.7% of patients with migraine auras, p=.033). Migraine-related disability scores were not different between PNES and epilepsy patients (median 39, interquartile range 89 vs. 25, interquartile range 60.6, p=.15). Compared to epilepsy patients with migraine, PNES patients with migraine report having a more severe form of migraine with more frequent and longer duration attacks that are more commonly associated with non-visual migraine auras. Copyright © 2015 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  4. Topiramate for Treatment in Patients With Migraine and Epilepsy.

    PubMed

    Spritzer, Scott D; Bravo, Thomas P; Drazkowski, Joseph F

    2016-06-01

    Antiepileptic drugs (AED) are often considered first line for monotherapy in treatment of patients with migraines, and also those with comorbid migraine and epilepsy. Topiramate, a newer generation AED, has broad mechanism of action and evidence of benefit in patients with either episodic or chronic migraine along with epilepsy, both generalized and focal. Our goal is to review the relevant mechanisms of action along with any supportive evidence published to date on the use of topiramate (TPM) in patients with both migraine headache and epilepsy. There has been very little published to date on the use of TPM in patients diagnosed with both disorders. Despite this, TPM has been adopted as first line therapy in this patient population. Future studies investigating the effectiveness of this treatment strategy are warranted in order to determine the most effective use of this medication in patients diagnosed with migraine headaches and epilepsy. © 2016 American Headache Society.

  5. Symptom dimensions of affective disorders in migraine patients.

    PubMed

    Louter, M A; Pijpers, J A; Wardenaar, K J; van Zwet, E W; van Hemert, A M; Zitman, F G; Ferrari, M D; Penninx, B W; Terwindt, G M

    2015-11-01

    A strong association has been established between migraine and depression. However, this is the first study to differentiate in a large sample of migraine patients for symptom dimensions of the affective disorder spectrum. Migraine patients (n=3174) from the LUMINA (Leiden University Medical Centre Migraine Neuro-analysis Program) study and patients with current psychopathology (n=1129), past psychopathology (n=477), and healthy controls (n=561) from the NESDA (Netherlands Study of Depression and Anxiety) study, were compared for three symptom dimensions of depression and anxiety. The dimensions -lack of positive affect (depression specific); negative affect (nonspecific); and somatic arousal (anxiety specific)- were assessed by a shortened adaptation of the Mood and Anxiety Symptom Questionnaire (MASQ-D30). Within the migraine group, the association with migraine specific determinants was established. Multivariate regression analyses were conducted. Migraine patients differed significantly (p<0.001) from healthy controls for all three dimensions: Cohen's d effect sizes were 0.37 for lack of positive affect, 0.68 for negative affect, and 0.75 for somatic arousal. For the lack of positive affect and negative affect dimensions, migraine patients were predominantly similar to the past psychopathology group. For the somatic arousal dimension, migraine patients scores were more comparable with the current psychopathology group. Migraine specific determinants for high scores on all dimensions were high frequency of attacks and cutaneous allodynia during attacks. This study shows that affective symptoms in migraine patients are especially associated with the somatic arousal component. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Bilateral Endolymphatic Hydrops in a Patient With Migraine Variant Without Vertigo: A Case Report.

    PubMed

    Liu, Isabelle Y; Ishiyama, Akira; Sepahdari, Ali R; Johnson, Kevin; Ishiyama, Gail

    2017-03-01

    To use modern high-resolution inner ear imaging modalities to evaluate for endolymphatic hydrops (EH) in a patient with migraine-associated fluctuating hearing loss without vertigo spells or dizziness. EH has been well described in patients with Meniere's disease on both human temporal bone studies and modern high-resolution imaging; however, there is no study to date, to our knowledge, that examines the presence of EH in a patient with migraine and bilateral hearing loss. We present the MRI findings using a sequence for detecting EH in a unique case of a patient experiencing migraine headaches accompanied by fluctuating hearing loss without vertigo. Magnetic resonance imaging sequences included "cisternographic" three-dimensional T2, and delayed intravenous-enhanced three-dimensional fluid-attenuation inversion recovery (DIVE-3D-FLAIR) sequences, performed with 2350 ms (bright perilymph) and 2050 ms (bright endolymph) inversion times. The bright endolymph images were subtracted from bright perilymph images to create a composite image with bright perilymph, dark endolymph, and intermediate bone signals. A 40-year-old female presented with a left-sided sensorineural hearing loss and severe migraine headaches that began at age 12. For the past year, she experienced severe migraines with right-sided fluctuating sensorineural hearing loss, tinnitus, and aural fullness. Audiometry confirmed a drop of right-sided hearing at times of migraines and increased symptom severity. Vestibular testing was within normal limits. MRI demonstrated the presence of severe bilateral vestibular and cochlear EH. EH of both the cochlea and vestibule can be present in patients without Meniere's disease or vertigo. The relationship between migraine and Meniere's disease may be complex, as demonstrated in this patient with migraine-associated bilateral hearing loss with MRI documentation of severe bilateral EH. The fact that migraine can be associated with EH is important and demonstrates a

  7. Use of a structured migraine diary improves patient and physician communication about migraine disability and treatment outcomes.

    PubMed

    Baos, V; Ester, F; Castellanos, A; Nocea, G; Caloto, M T; Gerth, W C

    2005-03-01

    Migraine is frequently undertreated, perhaps because impaired communication between patients and physicians underestimate the disability associated with migraine attacks. The purpose of this study was to evaluate the benefits of a structured migraine diary used during a prospective open-label study of triptan-naive patients in Spain for recording information on response to therapy for a pre-study migraine attack and three consecutive migraine attacks, the first and third treated with rizatriptan 10-mg wafer and the second with usual non-triptan therapy. Of 97 patients (83% women; mean age, 39 years) who completed the study, all reported moderate to severe pain, and two-thirds reported severe to total impairment during migraine attacks. At study end, 72% of patients reported that the migraine diary helped communication with their doctor about migraine, and 70% were more or much more satisfied than before the study with level of overall medical care provided by their doctor. Patients who reported the diary to be useful also reported higher overall satisfaction with medical care (p < 0.001). Most of the 22 physicians (91%) reported that the diary enabled them to better communicate with their patients about migraine, and all reported that it enabled them to assess differences in pain intensity and disability across patients. We conclude that a structured migraine diary can be a valuable aid for improving communication between physicians and patients regarding migraine disability and treatment outcomes.

  8. 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 ...

  9. Migraine

    MedlinePlus

    ... regular meals. In addition, try to control stress. Exercise regularly. Regular aerobic exercise reduces tension and can help prevent migraines. If your doctor agrees, choose any aerobic exercise you enjoy, including walking, swimming and cycling. Warm ...

  10. 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.

  11. 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.

  12. Migraine and Cerebrovascular Atherosclerosis in Patients With Ischemic Stroke.

    PubMed

    van Os, Hendrikus J A; Mulder, Inge A; Broersen, Alexander; Algra, Ale; van der Schaaf, Irene C; Kappelle, L Jaap; Velthuis, Birgitta K; Terwindt, Gisela M; Schonewille, Wouter J; Visser, Marieke C; Ferrari, Michel D; van Walderveen, Marianne A A; Wermer, Marieke J H

    2017-07-01

    Migraine is a well-established risk factor for ischemic stroke, but migraine is also related to other vascular diseases. This study aims to investigate the association between migraine and cerebrovascular atherosclerosis in patients with acute ischemic stroke. We retrieved data on patients with ischemic stroke from the DUST (Dutch Acute Stroke Study). Migraine history was assessed with a migraine screener and confirmed by telephone interview based on the ICHD criteria (International Classification of Headache Disorders). We assessed intra- and extracranial atherosclerotic changes and quantified intracranial internal carotid artery calcifications as measure of atherosclerotic burden on noncontrast computed tomography and computed tomographic angiography. We calculated risk ratios with adjustments for possible confounders with multivariable Poisson regression analyses. We included 656 patients, aged 18 to 99 years, of whom 53 had a history of migraine (29 with aura). Patients with migraine did not have more frequent atherosclerotic changes in intracranial (51% versus 74%; adjusted risk ratio, 0.82; 95% confidence interval, 0.64-1.05) or extracranial vessels (62% versus 79%; adjusted risk ratio, 0.93; 95% confidence interval, 0.77-1.12) than patients without migraine and had comparable internal carotid artery calcification volumes (largest versus medium and smallest volume tertile, 23% versus 35%; adjusted risk ratio, 0.93; 95% confidence interval, 0.57-1.52). Migraine is not associated with excess atherosclerosis in large vessels in patients with acute ischemic stroke. Our findings suggest that the biological mechanisms by which migraine results in ischemic stroke are not related to macrovascular cerebral atherosclerosis. © 2017 American Heart Association, Inc.

  13. 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.

  14. Work stress and new-onset migraine in a female employee population.

    PubMed

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

    2008-01-01

    This prospective cohort study examined whether work stress, as indicated by the job strain model and the effort-reward imbalance model, predicts new-onset migraine among 19,469 female employees with no history of migraine at study entry. A baseline survey between 2000 and 2002 assessed work stress and demographic factors. Self-reported newly diagnosed migraine was measured at follow-up between 2004 and 2005 and 1281 new cases of migraine were detected. In logistic regression analysis adjusted for age, socioeconomic position and depression at baseline, no association between job strain and migraine was found. In contrast, high effort-reward imbalance was associated with slightly increased risk of migraine at follow-up, odds ratio 1.23 (95% confidence interval 1.04, 1.45). The proportion of new migraine cases attributable to high effort-reward imbalance was 6.2%. If the observed association is causal, our findings suggest that high effort-reward imbalance might function as a modifiable risk factor for new-onset migraine.

  15. 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

  16. 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

  17. Tetra-ataxiometric Posturography in Patients with Migrainous Vertigo.

    PubMed

    Ongun, Nedim; Atalay, Nilgun S; Degirmenci, Eylem; Sahin, Fusun; Bir, Levent Sinan

    2016-01-01

    Migraine is a common disorder characterized by headache attacks frequently accompanied by vestibular symptoms like dizziness, vertigo, and balance disorders. Clinical studies support a strong link between migraine and vertigo rather than between other headache types and vertigo or nonvertiginous dizziness. There is a lack of consensus regarding the pathophysiology of migrainous vertigo. Activation of central vestibular processing during migraine attacks and vasospasm-induced ischemia of the labyrinth are reported as the probable responsible mechanisms. Because vestibular examination alone does not provide enough information for diagnosis of migrainous vertigo, posturography systems which provide objective assessment of somatosensory, vestibular, and visual information would be very helpful to show concomitant involvement of the vestibular and somato-sensorial systems. There are few posturographic studies on patients with migraine but it seems that how balance is affected in patients with migraine and/or migrainous vertigo is still not clear. We want to investigate balance function in migraineurs with and without vertigo with a tetra-ataxiometric posturography system and our study is the first study in which tetra-ataxiometric static posturography was used to evaluate postural abnormalities in a well-defined population of patients with migrainous vertigo. To investigate balance functions in migraineurs with and without vertigo with a tetra-ataxiometric posturography system. Prospective, nonrandomized, controlled study. Pamukkale University Hospital, Neurology and Physical Therapy and Rehabilitation outpatient clinics. Sixteen patients with migrainous vertigo, 16 patients with migraine without aura and no vestibular symptoms, and 16 controls were included in the study. Computerized static posturography system was performed and statistical analyses of fall, Fourier, Stability, and Weight distribution indexes were performed. The tetra-ataxiometric posturography device

  18. Prevalence and risk of migraine in patients with rosacea: A population-based cohort study.

    PubMed

    Egeberg, Alexander; Ashina, Messoud; Gaist, David; Gislason, Gunnar H; Thyssen, Jacob P

    2017-03-01

    Rosacea features increased neurovascular reactivity; migraine is a complex neurologic disorder characterized by recurrent episodes of headache associated with nausea and increased sensitivity to light and sound. We evaluated the prevalence and risk of new-onset migraine in patients with rosacea. All Danish individuals 18 years of age or older were linked in nationwide registers. Adjusted hazard ratios (HRs) were estimated by Cox regression. In the total cohort (n = 4,361,688), there were 49,475 patients with rosacea. Baseline prevalence of migraine was 7.3% and 12.1% in the reference population and in patients with rosacea, respectively. The fully adjusted HR of migraine was 1.31 (95% confidence interval 1.23-1.39) for patients with rosacea. Patients with phymatous rosacea (n = 594) had no increased risk of migraine (adjusted HR 0.45; 95% confidence interval 0.11-1.80), whereas patients with ocular rosacea (n = 6977) had a 69% increased risk (adjusted HR 1.69; 95% confidence interval 1.43-1.99). Notably, the risk was higher among patients age 50 years or older than in younger individuals, and the risk was only significant among women. We were unable to distinguish between migraine subtypes. We found a significantly higher prevalence and risk of incident migraine especially in female patients with rosacea. These data add to the accumulating evidence for a link between rosacea and the central nervous system. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

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

    PubMed

    Bond, D S; Vithiananthan, S; Nash, J M; Thomas, J G; Wing, R R

    2011-03-29

    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. 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. 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). 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.

  20. 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.

  1. 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.

  2. Odorant substances that trigger headaches in migraine patients.

    PubMed

    Silva-Néto, R P; Peres, M F P; Valença, M M

    2014-01-01

    Our objective was to determine odorants that trigger migraine attacks and the time of onset of headache after exposure. Migraine or tension-type headache patients, diagnosed according to the criteria of the International Classification of Headache Disorders-II, were interviewed about lifetime prevalence of headaches triggered by odors and time of onset of pain, after exposure of the patient to the odor. We studied 200 migraine patients and 200 tension-type headache patients. There were odor-triggered headaches after 25.5 ± 1.9 minutes of exposure in 70.0% (140/200) of migraine patients and none with tension-type headache, which ran at low sensitivity (70.0%, 95% CI 63.1-76.2) and high specificity (100.0%, 95% CI 97.6-100.0). Odor-triggered headaches are distributed in the following order of frequency: perfumes (106/140, 75.7%), paints (59/140, 42.1%), gasoline (40/140, 28.6%) and bleach (38/140, 27.1%). There was significance in the association of odor-triggered migraine, especially among perfume with cleaning (phi = -0.459), cooking (phi = 0.238), beauty products (phi = -0.213) and foul odors (phi = -0.582). Odorants, isolated or in association, especially perfume, may trigger migraine attacks after a few minutes of exposure.

  3. Influence of transcatheter closure of atrial communication on migraine headache in patients with ischemic stroke.

    PubMed

    Takaya, Yoichi; Akagi, Teiji; Kijima, Yasufumi; Nakagawa, Koji; Kono, Syoichiro; Deguchi, Kentaro; Sano, Shunji; Ito, Hiroshi

    2016-10-01

    Some types of migraine are associated with ischemic stroke. Although a right-to-left communication is linked with ischemic stroke, a causal relationship between migraine and right-to-left communication remains unclear. Furthermore, the efficacy of transcatheter closure of atrial communication on migraine is controversial. We aimed to evaluate the influence of transcatheter closure of atrial communication on migraine in patients with ischemic stroke. Thirty-eight consecutive patients with ischemic stroke who underwent transcatheter closure of atrial communication were enrolled. The prevalence, frequency, and severity of migraine were prospectively evaluated at baseline, 3 months, and >6 months after the procedure. Changes in migraine after the procedure were classified according to the frequency and severity of migraine: disappeared, improved, no-change, and worsening. Nineteen (50 %) of 38 patients suffered from migraine at baseline. No significant differences were observed in age, comorbidities, defect diameter, and atrial septal aneurysm between patients with migraine and patients without migraine. Among the 19 patients with migraine, migraine disappeared in 10 (53 %) patients and improved in 8 (42 %) patients at 3 months after transcatheter closure of atrial communication. At mean follow-up of 38 ± 28 months after the procedure, migraine disappeared in 12 (63 %) patients and improved in five (26 %) patients. No patients experienced worsening of migraine during the follow-up period. New-onset migraine was not observed in patients without migraine. Migraine is complicated in a half of patients with ischemic stroke related to atrial communication. Such migraine may disappear or improve after transcatheter closure of atrial communication.

  4. 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.

  5. Aura-like features and photophobia in sightless migraine patients.

    PubMed

    Silva, Greice Cardoso de Carvalho; Góes, Cristiana Pessoa de Queiroz Faria; Vincent, Maurice Borges

    2014-12-01

    Migraine is a central nervous system disorder frequently expressed with paroxysmal visual dysfunctions. To test the hypothesis that normal visual input is vital for the migrainous aura and photophobia. We studied the migraine-related visual disturbances in 8 sightless migraineurs identified among 200 visually impaired subjects. The main findings were the visual aura and photophobia disappearance along with blindness development, the oddness of aura - too short, colourful (e.g. blue or fire-like), auditory in nature or different in shape (round forms) - and the lack of photophobia. We propose that the aura duration should be accepted as shorter in visually impaired subjects. The changes in aura phenotype observed in our patients may be the result of both cerebral plasticity induced by the visual impairment and/or the lack of visual input per se. Integrity of visual pathways plays a key role in migraine visual aura and photophobia.

  6. Current migraine management – patient acceptability and future approaches

    PubMed Central

    Fumal, Arnaud; Schoenen, Jean

    2008-01-01

    Despite its high prevalence and individual as well as societal burden, migraine remains underdiagnosed and undertreated. In recent years, the options for the management of migraine patients have greatly expanded. A number of drugs belonging to various pharmacological classes and deliverable by several routes are now available both for the acute and the preventive treatments of migraine. Nevertheless, disability and satisfaction remain low in many subjects because treatments are not accessible, not optimized, not effective, or simply not tolerated. There is thus still considerable room for better education, for more efficient therapies and for greater support from national health systems. In spite of useful internationally accepted guidelines, anti-migraine treatment has to be individually tailored to each patient taking into account the migraine subtype, the ensuing disability, the patient’s previous history and present expectations, and the co-morbid disorders. In this article we will summarize the phenotypic presentations of migraine and review recommendations for acute and preventive treatment, highlighting recent advances which are relevant for clinical practice in terms of both diagnosis and management. PMID:19337450

  7. Pericranial nerve blockade as a preventive treatment for migraine: Experience in 60 patients.

    PubMed

    Ruiz Piñero, M; Mulero Carrillo, P; Pedraza Hueso, M I; de la Cruz Rodríguez, C; López Mesonero, L; Guerrero Peral, A L

    2016-09-01

    Anaesthetic blockade of pericranial nerves is frequently used to treat headache disorders. There is no evidence on indication of this treatment for migraine. We aim to evaluate its effectiveness as a preventive treatment for migraine using specific indication criteria. Between January 2009 and May 2013 we offered pericranial nerve blockade to migraine patients with a history of preventive drug intolerance or failure. We selected patients with tenderness to palpation of at least one greater occipital nerve (GON) or supraorbital nerve (SON). Responses at 3 months were categorised as complete response (no pain), partial response (reduction of at least 50% in severity or frequency of headache episodes), or no response. Anaesthetic blockade was performed in 60 patients (52 females, 8 males; mean age 40.6 ± 12.4 years, range 19-76). The most common procedure was blockade of GON and SON on both sides. Complete response lasting at least 2 weeks was recorded in 23 patients (38.3%), with partial response in 24 patients (40%), and no response in 13 (21.7%). In the group presenting complete response, age and length of history of migraine were significantly lower. No severe side effects were detected. Response time ranged from 2 weeks to 3 months. Pericranial nerves blockade using tenderness to palpation as an inclusion criterion is safe and potentially effective as prophylactic treatment for migraine. The best responses in our series were observed in younger patients with shorter histories of migraine. Copyright © 2014 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  8. Two Patients With Visual Aura - Migraine, Epilepsy, or Migralepsy?

    PubMed

    Hartl, Elisabeth; Rémi, Jan; Noachtar, Soheyl

    2015-09-01

    The concept of migralepsy refers to visual migraine auras that seemingly evolve into epileptic seizures. It was discussed controversially ever since and scientific proof for this entity is scarce. We report two patients with visual aura fulfilling the diagnostic criteria for migralepsy. In both patients, habitual attacks were recorded during long-term video electroencephalography (EEG) monitoring. Both patients demonstrated unilateral occipital EEG seizure patterns during their long-lasting visual aura, which eventually evolved into versive seizures. Here, we prove the epileptic origin of the visual auras, which have been misdiagnosed as migraine or migralepsy before. Additional evaluation should be considered in patients with visual aura and hints for an epileptic origin as occipital lobe epilepsy might be missed in patients diagnosed with migraine. Based on our patients, we suggest to challenge the concept of migralepsy in current classifications. © 2015 American Headache Society.

  9. 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.

  10. Clinical Trial of Subcutaneous Steroid Injection in Patients with Migraine Disorder.

    PubMed

    Nikkhah, Karim; Ghandehari, Kavian; Jouybari, Ali Ghabeli; Mirzaei, Mohammad Mousavi; Ghandehari, Kosar

    2016-01-01

    Neurologic literature on therapeutic effect of subcutaneous corticosteroids in patients with migrainous chronic daily headache is scarce. The aim of this research is to assess the therapeutic effects of this management in such patients. Consecutive patients with migrainous chronic daily headache enrolled a prospective before-after therapeutic study during 2010-2013. Methylprednisolone 40 mg was divided into four subcutaneous injection doses. Two injections were administered in the right and left suboccipital area (exactly at retromastoid cervicocranial junction) and the other two injections in the lower medial frontal area (exactly at medial right and left eyebrows). A daily headache diary was filled out by the patients before and one month after the intervention. The severity of pain was classified based on a pain intensity instrument using numeric rating scale from 0-10 point scale. Paired t-test and Chi-square test were used for statistical analysis. 504 patients (378 females, 126 males) with migrainous chronic daily headache were enrolled in the study. Dramatic, significant, moderate, mild, or no improvements respectively constituted 28.6%, 33.3%, 23.8%, and 14.3% of the post treatment courses. Therapeutic effect of intervention on mean pain scores was significant; t=7.38, df=20, P=0.000. Two cases developed subcutaneous fat atrophy in frontal injection site and three cases experienced syncope during injection. Subcutaneous corticosteroids could be used as an adjunct therapy in patients with migrainous chronic daily headache.

  11. Detecting Migraine in Patients with Mild Traumatic Brain Injury Using Three Different Headache Measures.

    PubMed

    Anderson, Kirsten; Tinawi, Simon; Lamoureux, Julie; Feyz, Mitra; de Guise, Elaine

    2015-01-01

    Posttraumatic migraine may represent an important subtype of headache among the traumatic brain injury (TBI) population and is associated with increased recovery times. However, it is underdiagnosed in patients with mild traumatic brain injury (mTBI). This study examined the effectiveness of the self-administered Nine-Item Screener (Nine-Item Screener-SA), the Headache Impact Test- 6 (HIT-6), the 3-Item Migraine Screener, and the Rivermead Post-Concussion Questionnaire (RPQ) at discriminating between mTBI patients with (n = 23) and without (n = 20) migraines. The Nine-Item Screener demonstrated significant differences between migraine patients with and without migraine on nearly every question, especially on Question 9 (disability), sensitivity: 0.95 and specificity: 0.65 (95% CI, 0.64-0.90). The HIT-6 demonstrated significant differences between migraine and no-migraine patients on disability and pain severity, with disability having a sensitivity of 0.70 and specificity of 0.75 (95% CI, 0.54-0.83). Only Question 3 of the 3-Item ID Migraine Screener (photosensitivity) showed significant differences between migraine and no-migraine patients, sensitivity: 0.84 and specificity: 0.55 (CI, 0.52-0.82). The RPQ did not reveal greater symptoms in migraine patients compared with those without. Among headache measures, the Nine-Item Screener-SA best differentiated between mTBI patients with and without migraine. Disability may best identify migraine sufferers among the TBI population.

  12. 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

  13. Elevated audiovisual temporal interaction in patients with migraine without aura.

    PubMed

    Yang, Weiping; Chu, Bingqian; Yang, Jiajia; Yu, Yinghua; Wu, Jinglong; Yu, Shengyuan

    2014-06-24

    Photophobia and phonophobia are the most prominent symptoms in patients with migraine without aura. Hypersensitivity to visual stimuli can lead to greater hypersensitivity to auditory stimuli, which suggests that the interaction between visual and auditory stimuli may play an important role in the pathogenesis of migraine. However, audiovisual temporal interactions in migraine have not been well studied. Therefore, our aim was to examine auditory and visual interactions in migraine. In this study, visual, auditory, and audiovisual stimuli with different temporal intervals between the visual and auditory stimuli were randomly presented to the left or right hemispace. During this time, the participants were asked to respond promptly to target stimuli. We used cumulative distribution functions to analyze the response times as a measure of audiovisual integration. Our results showed that audiovisual integration was significantly elevated in the migraineurs compared with the normal controls (p < 0.05); however, audiovisual suppression was weaker in the migraineurs compared with the normal controls (p < 0.05). Our findings further objectively support the notion that migraineurs without aura are hypersensitive to external visual and auditory stimuli. Our study offers a new quantitative and objective method to evaluate hypersensitivity to audio-visual stimuli in patients with migraine.

  14. Elevated audiovisual temporal interaction in patients with migraine without aura

    PubMed Central

    2014-01-01

    Background Photophobia and phonophobia are the most prominent symptoms in patients with migraine without aura. Hypersensitivity to visual stimuli can lead to greater hypersensitivity to auditory stimuli, which suggests that the interaction between visual and auditory stimuli may play an important role in the pathogenesis of migraine. However, audiovisual temporal interactions in migraine have not been well studied. Therefore, our aim was to examine auditory and visual interactions in migraine. Methods In this study, visual, auditory, and audiovisual stimuli with different temporal intervals between the visual and auditory stimuli were randomly presented to the left or right hemispace. During this time, the participants were asked to respond promptly to target stimuli. We used cumulative distribution functions to analyze the response times as a measure of audiovisual integration. Results Our results showed that audiovisual integration was significantly elevated in the migraineurs compared with the normal controls (p < 0.05); however, audiovisual suppression was weaker in the migraineurs compared with the normal controls (p < 0.05). Conclusions Our findings further objectively support the notion that migraineurs without aura are hypersensitive to external visual and auditory stimuli. Our study offers a new quantitative and objective method to evaluate hypersensitivity to audio-visual stimuli in patients with migraine. PMID:24961903

  15. Alterations of nonspecific immunity in patients with common migraine.

    PubMed

    Covelli, V; Maffione, A B; Munno, I; Jirillo, E

    1990-01-01

    In 23 patients with common migraine (CM), immune responsiveness and frequency of immunocompetent cells were investigated. In particular, phagocytosis and killing of Candida albicans by polymorphs (PMNs) and monocytes were analyzed. Also, the percentages of CD3+, CD4+, CD8+, natural killer, and CD15+ cells were evaluated by direct immunofluorescence using specific monoclonal antibodies. The results showed deficits of phagocytosis or killing exhibited by PMNs and monocytes. These immunological findings are discussed in terms of perturbation of immune status in CM patients during migraine attacks.

  16. 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.

  17. Balance Impairments in Different Subgroups of Patients With Migraine.

    PubMed

    Carvalho, Gabriela F; Bonato, Paolo; Florencio, Lidiane L; Pinheiro, Carina F; Dach, Fabiola; Bigal, Marcelo E; Bevilaqua-Grossi, Debora

    2017-03-01

    Patients with migraine often experience balance impairments. However, the relationship between clinical features - like aura and chronicity - and the severity of balance impairments is not well established. The objective of this study was to assess balance impairments in different subgroups of migraine patients. One hundred five subjects diagnosed according to the ICHD-III were recruited in the study. They were uniformly distributed among three groups: migraine with aura, migraine without aura, and chronic migraine. Thirty-five controls were also recruited in the study. Balance impairments were assessed in all subjects via the modified Sensory Organization test and the Limits of Stability test. The results in the four groups were compared using ANCOVA tests with age, BMI, presence of dizziness, level of physical activity, time of migraine onset, and medication intake as covariates. Subjects in the migraine with aura and the chronic migraine groups showed poorer balance control than control subjects in three of the four conditions tested using the modified Sensory Organization test: FirmCE: CG: 1.5 cm(2) , 95%CI 1.3 to 1.7; M: 2.1 cm(2) , 95%CI 1.6 to 2.6; MA: 4.5 cm(2) , 95%CI 3.2 to 5.8; CM: 4.5 cm(2) , 95%CI 3.0 to 6.0; P < .027; FoamOE: CG: 5.1 cm(2) , 95%CI 4.6 to 5.6; M: 5.6 cm(2) , 95%CI 5.0 to 6.1; MA: 8.8 cm(2) , 95%CI 7.3 to 10.2; CM: 8.8 cm(2) , 95%CI 7.7 to 10.0; P < .018; FoamCE: CG: 14.8 cm(2) , 95%CI 13.7 to 15.9 cm2; M: 17.3 cm(2) , 95%CI 15.4 to 19.1; MA: 21.9 cm(2) , 95%CI 19.1 to 24.7; CM: 22.4 cm(2) , 95%CI 19.9 to 24.9; P < .0001. In the FoamOE and FoamCE conditions, both groups also showed poorer postural control than subjects in the migraine without aura group (P < .01). Differences between control subjects and subjects in all the migraine groups were found in the reaction time, movement velocity, endpoint excursion, and maximal excursion parameters (P < .04) in all the directions tested during the Limits of Stability test

  18. Variability of the characteristics of a migraine attack within patients.

    PubMed

    Viana, M; Sances, G; Ghiotto, N; Guaschino, E; Allena, M; Nappi, G; Goadsby, P J; Tassorelli, C

    2016-08-01

    Migraine attacks may present different features in different patients and also within the same patient. The percentage of patients reporting stereotyped attacks and those reporting attacks with different phenotypes has not been the object of specific investigations. The objective of this article is to evaluate the percentage of migraine patients reporting the same characteristics, in terms of phenotype and response to symptomatic medications on three consecutive migraine attacks. Thirty patients with migraine without aura prospectively recorded the features of three consecutive attacks in a headache diary. Characteristics recorded were: pain intensity, presence of nausea, vomiting, photophobia, phonophophia, osmophobia, allodynia, cranial autonomic symptoms (at least one), and premonitory symptoms. Patients were allowed to take frovatriptan as symptomatic medication, whose efficacy was evaluated as the two hours pain-free status. None of the patients presented identical characteristics on the three studied attacks. This was still the case if we reduced the number of variables evaluated from 11 to seven of the eight core features indicated by the ICHD. Considering just six variables: unilaterality and quality of pain, presence/absence of nausea, vomiting, photophobia and phonophobia, only two patients (6%) had identical features on three consecutive attacks.With respect to the response to frovatriptan, 39% of patients had the same response, either positive (i.e. pain free after two hours) or negative (i.e. not pain free after two hours) on three consecutive attacks. Migraine attacks show a high variability not just among patients, but also within the same patient. Our data indicate that stereotypy of attacks is uncommon, and reinforces the underlying logic of the current operational classification system. © International Headache Society 2015.

  19. Gene-based pleiotropy across migraine with aura and migraine without aura patient groups.

    PubMed

    Zhao, Huiying; Eising, Else; de Vries, Boukje; Vijfhuizen, Lisanne S; Anttila, Verneri; Winsvold, Bendik S; Kurth, Tobias; Stefansson, Hreinn; Kallela, Mikko; Malik, Rainer; Stam, Anine H; Ikram, M Arfan; Ligthart, Lannie; Freilinger, Tobias; Alexander, Michael; Müller-Myhsok, Bertram; Schreiber, Stefan; Meitinger, Thomas; Aromas, Arpo; Eriksson, Johan G; Boomsma, Dorret I; van Duijn, Cornelia M; Zwart, John-Anker; Quaye, Lydia; Kubisch, Christian; Dichgans, Martin; Wessman, Maija; Stefansson, Kari; Chasman, Daniel I; Palotie, Aarno; Martin, Nicholas G; Montgomery, Grant W; Ferrari, Michel D; Terwindt, Gisela M; van den Maagdenberg, Arn M J M; Nyholt, Dale R

    2016-06-01

    It is unclear whether patients diagnosed according to International Classification of Headache Disorders criteria for migraine with aura (MA) and migraine without aura (MO) experience distinct disorders or whether their migraine subtypes are genetically related. Using a novel gene-based (statistical) approach, we aimed to identify individual genes and pathways associated both with MA and MO. Gene-based tests were performed using genome-wide association summary statistic results from the most recent International Headache Genetics Consortium study comparing 4505 MA cases with 34,813 controls and 4038 MO cases with 40,294 controls. After accounting for non-independence of gene-based test results, we examined the significance of the proportion of shared genes associated with MA and MO. We found a significant overlap in genes associated with MA and MO. Of the total 1514 genes with a nominally significant gene-based p value (pgene-based ≤ 0.05) in the MA subgroup, 107 also produced pgene-based ≤ 0.05 in the MO subgroup. The proportion of overlapping genes is almost double the empirically derived null expectation, producing significant evidence of gene-based overlap (pleiotropy) (pbinomial-test = 1.5 × 10(-4)). Combining results across MA and MO, six genes produced genome-wide significant gene-based p values. Four of these genes (TRPM8, UFL1, FHL5 and LRP1) were located in close proximity to previously reported genome-wide significant SNPs for migraine, while two genes, TARBP2 and NPFF separated by just 259 bp on chromosome 12q13.13, represent a novel risk locus. The genes overlapping in both migraine types were enriched for functions related to inflammation, the cardiovascular system and connective tissue. Our results provide novel insight into the likely genes and biological mechanisms that underlie both MA and MO, and when combined with previous data, highlight the neuropeptide FF-amide peptide encoding gene (NPFF) as a novel candidate risk gene for

  20. Evaluation of olfaction in patients with migraine using an odour stick identification test.

    PubMed

    Saisu, Akihiro; Tatsumoto, Muneto; Hoshiyama, Eisei; Aiba, Saiko; Hirata, Koichi

    2011-07-01

    Peculiar characteristics of migraine headaches include the arousal of olfaction during the attacks and osmophobia. We performed an olfactory test to evaluate the association between olfaction and migraines. We evaluated olfactory dysfunction in 80 migraine patients (31 experienced migraines with aura (MWA), 49 migraine without aura (MWOA)) and 30 healthy controls. Participants were assessed for concurrent osmophobia. Olfaction was evaluated using an odour stick identification test (OSIT), in which participants were asked to identify various odours during a migraine-free period. The degree of offensiveness of each odour was also evaluated. Sixty-three percent of migraine patients were found to have concurrent osmophobia (MWA 71%; MWOA 57%). The percentages of migraine patients and controls who correctly identified test odours were 91% (92%, MWA; 89%, MWOA) and 92%, respectively. Perfume, rose and Japanese cypress odours were more offensive to migraine patients than to controls. All test odours were found to be more offensive to MWA than to MWOA patients. The OSIT showed certain odours to be highly offensive to migraine patients even when they were not experiencing migraine headaches. More attention should be paid to odours that are perceived to be offensive by migraine patients, particularly those with MWA.

  1. 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.

  2. Reliability and validity of the migraine disability assessment scale among migraine and tension type headache in Iranian patients.

    PubMed

    Zandifar, Alireza; Asgari, Fatemeh; Haghdoost, Faraidoon; Masjedi, Samaneh Sadat; Manouchehri, Navid; Banihashemi, Mahboobeh; Ghorbani, Abbas; Najafi, Mohammad Reza; Saadatnia, Mohammad; Lipton, Richard B

    2014-01-01

    MIDAS is a valid and reliable short questionnaire for assessment of headache related disability. Linguistic validation of Persian MIDAS and assessment of psychometric properties between tension type headache (TTH) and migraine were the aims of this study. Patients with migraine or TTH were included. At the first visit, we administered a headache symptom questionnaire, MIDAS, and SF-36. Patients filled out MIDAS in second and third visit within three and eight weeks after base line visit. Internal consistency (Cronbach α ) and test-retest reproducibility (Spearman correlation coefficient) were used to assess reliability. Convergent validity and MIDAS capability to differentiate between chronic and episodic headaches (migraine and TTH) were also assessed. The 267 participants had episodic migraine (EM-64%), chronic migraine (CM-13.5%), episodic TTH (ETTH-13.5%), and chronic TTH (CTTH-9). Internal consistency reliability was 0.8 for the entire sample, 0.72 for TTH, and 0.82 for migraine. Test-retest reliability for all questions between visit 1 and visit 2 varied from 0.54 to 0.71. Convergent validity was assessed using SF-36 as an external referent. Patients with episodic headaches (EM and ETTH) had significantly lower MIDAS scores than chronic headaches (CM and CTTH). Persian MIDAS is a valid and reliable questionnaire for migraine and TTH that can differentiate between episodic headache and chronic headache.

  3. 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

  4. Increased interictal visual network connectivity in patients with migraine with aura.

    PubMed

    Tedeschi, Gioacchino; Russo, Antonio; Conte, Francesca; Corbo, Daniele; Caiazzo, Giuseppina; Giordano, Alfonso; Conforti, Renata; Esposito, Fabrizio; Tessitore, Alessandro

    2016-02-01

    To evaluate the resting-state visual network functional connectivity in patients with migraine with aura and migraine without aura during the interictal period. Using resting-state functional magnetic resonance imaging, the resting-state visual network integrity was investigated in 20 patients with migraine with aura, 20 age- and sex-matched patients with migraine without aura and 20 healthy controls. Voxel-based morphometry and diffusion tensor imaging were used to assess whether between-groups differences in functional connectivity were dependent on structural or microstructural changes. Resting-state functional magnetic resonance imaging data showed that patients with migraine with aura, compared to both patients with migraine without aura and healthy controls, had a significant increased functional connectivity in the right lingual gyrus within the resting-state visual network (p < 0.05, cluster-level corrected). This abnormal resting-state visual network functional connectivity was observed in the absence of structural or microstructural abnormalities and was not related to migraine severity. Our imaging data revealed that patients with migraine with aura exhibit an altered resting-state visual network connectivity. These results support the hypothesis of an extrastriate cortex involvement, centred in the lingual gyrus, a brain region related to mechanisms underlying the initiation and propagation of the migraine aura. This resting-state functional magnetic resonance imaging finding may represent a functional biomarker that could differentiate patients experiencing the aura phenomenon from patients with migraine without aura, even between migraine attacks. © International Headache Society 2015.

  5. Stress at work in migraine patients: differences in attack frequency.

    PubMed

    González-Quintanilla, V; Toriello-Suárez, M; Gutiérrez-González, S; Rojo-López, A; González-Suárez, A; Viadero-Cervera, R; Palacio-Portilla, E J; Oterino-Durán, A

    2015-03-01

    Migraine is a common and prevalent disease that contributes to health expenditure and interferes with quality of life. Our goal was to analyse the level of stress at work in a sample of migraine and its possible association with the chronicity of the process We applied the Maslach Burnout Inventory, consisting of 22 items grouped into blocks that assess emotional exhaustion (EE), personal accomplishment (PA), depersonalisation at work (DP)] and positive influence (PI), to 94 consecutive subjects recruited in the outpatient clinic. Differences were compared between clinical groups (chronic migraine [CM]: > 15 days/month with headache over a 3-month period vs episodic migraine [EM]: < 15 days/month with headache) using the general linear model adjusted for age and MIDAS score The mean age was higher in the CM group. Mean MIDAS scores were 51 ± 4.1 in CM, and 17.7 ± 15 in EM (P=.001). Adjusted means for EE were 24.6 ± 2.6 in CM patients, 16.2 ± 2.6 in EM patients, and 13.4 ± 2.3 (P=.03) in the healthy group. MIDAS scale scores were inversely correlated to PA (P<.05) DISCUSSION: Our results suggest that the level of EE at work is higher in EM than in CM patients, while PA levels decrease as impact on the MIDAS scale increases. The Maslach scale is a potentially useful tool for studying migraine impact. Surprisingly, EE is higher in patients with fewer episodes; this tendency could be related to stress adaptation mechanisms present in patients with chronic illness. Copyright © 2013 Sociedad Española de Neurología. Published by Elsevier Espana. All rights reserved.

  6. Prevalence of migraine, probable migraine and tension-type headache in the Croatian population.

    PubMed

    Vuković, Vlasta; Plavec, Davor; Pavelin, Sanda; Janculjak, Davor; Ivanković, Mira; Demarin, Vida

    2010-01-01

    Population-based epidemiological studies about headaches, especially migraine, have been carried out in many countries. The aim of this study was to assess the 1-year prevalence of migraine, probable migraine and tension-type headache (TTH) in the Croatian population. The design of the study was a cross-sectional survey of an adult population sample using a self-completed questionnaire. The 1-year crude prevalence of migraine without and with aura in this study was 7.5%, of probable migraine 11.3%, and of TTH 21.2%. The 1-year age- and sex-adjusted prevalence of migraine was 6.2%, of probable migraine 8.8%, and of TTH 20.7%; the prevalence of migraine combined with probable migraine was 15.0%. Total crude prevalence of headache (combination of migraine, probable migraine and TTH) was 39.9%. Prevalence of migraine was higher in continental than in Mediterranean areas of Croatia. Multivariate regression analysis showed that the highest risk of suffering from any kind of headache is observed for the following people: living in Dubrovnik, being female, having elementary or high school education, being married, employed and living in an urban or suburban area. The prevalence of migraine and probable migraine is similar as in other Western countries. Certain demographic characteristics differ among patients with and without headache. Copyright 2010 S. Karger AG, Basel.

  7. 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.

  8. 3D-neuronavigation in vivo through a patient's brain during a spontaneous migraine headache.

    PubMed

    DaSilva, Alexandre F; Nascimento, Thiago D; Love, Tiffany; DosSantos, Marcos F; Martikainen, Ilkka K; Cummiford, Chelsea M; DeBoer, Misty; Lucas, Sarah R; Bender, MaryCatherine A; Koeppe, Robert A; Hall, Theodore; Petty, Sean; Maslowski, Eric; Smith, Yolanda R; Zubieta, Jon-Kar

    2014-06-02

    A growing body of research, generated primarily from MRI-based studies, shows that migraine appears to occur, and possibly endure, due to the alteration of specific neural processes in the central nervous system. However, information is lacking on the molecular impact of these changes, especially on the endogenous opioid system during migraine headaches, and neuronavigation through these changes has never been done. This study aimed to investigate, using a novel 3D immersive and interactive neuronavigation (3D-IIN) approach, the endogenous µ-opioid transmission in the brain during a migraine headache attack in vivo. This is arguably one of the most central neuromechanisms associated with pain regulation, affecting multiple elements of the pain experience and analgesia. A 36 year-old female, who has been suffering with migraine for 10 years, was scanned in the typical headache (ictal) and nonheadache (interictal) migraine phases using Positron Emission Tomography (PET) with the selective radiotracer [(11)C]carfentanil, which allowed us to measure µ-opioid receptor availability in the brain (non-displaceable binding potential - µOR BPND). The short-life radiotracer was produced by a cyclotron and chemical synthesis apparatus on campus located in close proximity to the imaging facility. Both PET scans, interictal and ictal, were scheduled during separate mid-late follicular phases of the patient's menstrual cycle. During the ictal PET session her spontaneous headache attack reached severe intensity levels; progressing to nausea and vomiting at the end of the scan session. There were reductions in µOR BPND in the pain-modulatory regions of the endogenous µ-opioid system during the ictal phase, including the cingulate cortex, nucleus accumbens (NAcc), thalamus (Thal), and periaqueductal gray matter (PAG); indicating that µORs were already occupied by endogenous opioids released in response to the ongoing pain. To our knowledge, this is the first time that changes

  9. 3D-Neuronavigation In Vivo Through a Patient's Brain During a Spontaneous Migraine Headache

    PubMed Central

    DosSantos, Marcos F.; Martikainen, Ilkka K.; Cummiford, Chelsea M.; DeBoer, Misty; Lucas, Sarah R.; Bender, MaryCatherine A.; Koeppe, Robert A.; Hall, Theodore; Petty, Sean; Maslowski, Eric; Smith, Yolanda R.; Zubieta, Jon-Kar

    2014-01-01

    A growing body of research, generated primarily from MRI-based studies, shows that migraine appears to occur, and possibly endure, due to the alteration of specific neural processes in the central nervous system. However, information is lacking on the molecular impact of these changes, especially on the endogenous opioid system during migraine headaches, and neuronavigation through these changes has never been done. This study aimed to investigate, using a novel 3D immersive and interactive neuronavigation (3D-IIN) approach, the endogenous µ-opioid transmission in the brain during a migraine headache attack in vivo. This is arguably one of the most central neuromechanisms associated with pain regulation, affecting multiple elements of the pain experience and analgesia. A 36 year-old female, who has been suffering with migraine for 10 years, was scanned in the typical headache (ictal) and nonheadache (interictal) migraine phases using Positron Emission Tomography (PET) with the selective radiotracer [11C]carfentanil, which allowed us to measure µ-opioid receptor availability in the brain (non-displaceable binding potential - µOR BPND). The short-life radiotracer was produced by a cyclotron and chemical synthesis apparatus on campus located in close proximity to the imaging facility. Both PET scans, interictal and ictal, were scheduled during separate mid-late follicular phases of the patient's menstrual cycle. During the ictal PET session her spontaneous headache attack reached severe intensity levels; progressing to nausea and vomiting at the end of the scan session. There were reductions in µOR BPND in the pain-modulatory regions of the endogenous µ-opioid system during the ictal phase, including the cingulate cortex, nucleus accumbens (NAcc), thalamus (Thal), and periaqueductal gray matter (PAG); indicating that µORs were already occupied by endogenous opioids released in response to the ongoing pain. To our knowledge, this is the first time that changes in

  10. 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.

  11. 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).

  12. Detecting Migraine in Patients with Mild Traumatic Brain Injury Using Three Different Headache Measures

    PubMed Central

    Anderson, Kirsten; Tinawi, Simon; de Guise, Elaine

    2015-01-01

    Posttraumatic migraine may represent an important subtype of headache among the traumatic brain injury (TBI) population and is associated with increased recovery times. However, it is underdiagnosed in patients with mild traumatic brain injury (mTBI). This study examined the effectiveness of the self-administered Nine-Item Screener (Nine-Item Screener-SA), the Headache Impact Test- 6 (HIT-6), the 3-Item Migraine Screener, and the Rivermead Post-Concussion Questionnaire (RPQ) at discriminating between mTBI patients with (n = 23) and without (n = 20) migraines. The Nine-Item Screener demonstrated significant differences between migraine patients with and without migraine on nearly every question, especially on Question 9 (disability), sensitivity: 0.95 and specificity: 0.65 (95% CI, 0.64–0.90). The HIT-6 demonstrated significant differences between migraine and no-migraine patients on disability and pain severity, with disability having a sensitivity of 0.70 and specificity of 0.75 (95% CI, 0.54–0.83). Only Question 3 of the 3-Item ID Migraine Screener (photosensitivity) showed significant differences between migraine and no-migraine patients, sensitivity: 0.84 and specificity: 0.55 (CI, 0.52–0.82). The RPQ did not reveal greater symptoms in migraine patients compared with those without. Among headache measures, the Nine-Item Screener-SA best differentiated between mTBI patients with and without migraine. Disability may best identify migraine sufferers among the TBI population. PMID:26106255

  13. 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.

  14. 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.

  15. Study of sleep microstructure in patients of migraine without aura.

    PubMed

    Nayak, C; Sinha, S; Nagappa, M; Nagaraj, K; Kulkarni, G B; Thennarasu, K; Taly, A B

    2016-03-01

    Although the relationship between sleep and migraine has been widely reported, studies on sleep microstructure are few. The aim was to study and compare microstructural polysomnographic characteristics in patients of "migraine without aura" (MOA) with controls. Twenty-five patients of MOA and 25 age- and gender-matched healthy controls were subjected to overnight polysomnography. Microstructural sleep analysis, including arousal and cyclic alternating pattern (CAP) analysis was performed. Arousals and CAP parameters were compared between the two groups using the Mann-Whitney U test (p ≤ 0.05). The overall arousal index (p = 0.528) and that during non-rapid eye movement (NREM) sleep (p = 0.503) were comparable between the two groups. However, the arousal index was lower in migraineurs during rapid eye movement (REM) sleep (p = 0.001). The overall CAP rate (p = 0.020) as well as the number of CAP cycles and sequences (p = 0.032) was lower among migraineurs. The total phase A duration (p < 0.0001) was increased, and conversely, phase B duration (p = 0.001) was decreased in migraineurs. The phase A1 duration (p = 0.036) was higher in migraineurs. Finally, phase A1 (p = 0.357) index was comparable, and conversely, A2 (p < 0.0001) and A3 (p = 0.020) indices were decreased in migraineurs. This study showed a decreased REM arousability as well as a decreased overall CAP rate and CAP cycling in patients with migraine as compared to controls. This indicates that there is probably an alteration of the arousal mechanisms in patients with migraine that may facilitate the occurrence of headache paroxysms during sleep.

  16. 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.

  17. Altered kynurenine pathway metabolites in serum of chronic migraine patients.

    PubMed

    Curto, Martina; Lionetto, Luana; Negro, Andrea; Capi, Matilde; Fazio, Francesco; Giamberardino, Maria Adele; Simmaco, Maurizio; Nicoletti, Ferdinando; Martelletti, Paolo

    2015-01-01

    Activation of glutamate (Glu) receptors plays a key role in the pathophysiology of migraine. Both NMDA and metabotropic Glu receptors are activated or inhibited by metabolites of the kynurenine pathway, such as kynureninic acid (KYNA), quinolinic acid (QUINA), and xanthurenic acid (XA). In spite of the extensive research carried out on KYNA and other kynurenine metabolites in experimental models of migraine, no studies have ever been carried out in humans. Here, we measured all metabolites of the kynurenine pathway in the serum of patients affected by chronic migraine (CM) and age- and gender-matched healthy controls. We assessed serum levels of tryptophan (Trp), L-kynurenine (KYN), KYNA, anthranilic acid (ANA), 3-hydroxyanthranilic acid (3-HANA), 3-hydroxykynirenine (3-HK), XA, QUINA, and 5-hydroxyindolacetic acid (5-HIAA) in 119 patients affected by CM (ICHD-3beta criteria) and 84 age-matched healthy subjects. Patients with psychiatric co-morbidities, systemic inflammatory, endocrine or neurological disorders, and mental retardation were excluded. Serum levels of all metabolites were assayed using liquid chromatography/tandem mass spectrometry (LC-MS/MS). LC-MS/MS analysis of kynurenine metabolites showed significant reductions in the levels of KYN (-32 %), KYNA (-25 %), 3-HK (-49 %), 3-HANA (-63 %), 5-HIAA (-36 %) and QUINA (-80 %) in the serum of the CM patients, as compared to healthy controls. Conversely, levels of Trp, ANA and XA were significantly increased in CM patients (+5 %, +339 % and +28 %, respectively). These findings suggest that in migraine KYN is unidirectionally metabolized into ANA at expenses of KYNA and 3-HK. The reduction in the levels of KYNA, which behaves as a competitive antagonist of the glycine site of NMDA receptors, is consistent with the hypothesis that NMDA receptors are overactive in migraine. The increase in XA, a putative activator of Glu2 receptors, may represent a compensatory event aimed at reinforcing endogenous

  18. How to investigate and treat: migraine in patients with temporomandibular disorders.

    PubMed

    Gonçalves, Daniela A G; Camparis, Cinara M; Franco, Ana Lucia; Fernandes, Giovana; Speciali, José G; Bigal, Marcelo E

    2012-08-01

    Migraine and temporomandibular disorders (TMD) are highly prevalent conditions that frequently coexist in the same patient. The relationship between migraine and TMD is complex. Migraineurs often have pain in the TMD area; TMD sufferers, in turn, often experience headaches in addition to the pain in the jaw. Finally, migraine and TMD are comorbid, and the final phenotype of patients with the comorbidity may represent the aggregated contribution of both. Herein we briefly discuss the clinical commonalities of migraine and TMD, and the differential diagnosis of these conditions with other causes of facial pain. We close by presenting our experience in the treatment of patients with the comorbidity.

  19. Visual evoked potentials in subgroups of migraine with aura patients.

    PubMed

    Coppola, Gianluca; Bracaglia, Martina; Di Lenola, Davide; Di Lorenzo, Cherubino; Serrao, Mariano; Parisi, Vincenzo; Di Renzo, Antonio; Martelli, Francesco; Fadda, Antonello; Schoenen, Jean; Pierelli, Francesco

    2015-01-01

    Patients suffering from migraine with aura can have either pure visual auras or complex auras with sensory disturbances and dysphasia, or both. Few studies have searched for possible pathophysiological differences between these two subgroups of patients. Methods - Forty-seven migraine with aura patients were subdivided in a subgroup with exclusively visual auras (MA, N = 27) and another with complex neurological auras (MA+, N = 20). We recorded pattern-reversal visual evoked potentials (VEP: 15 min of arc cheques, 3.1 reversal per second, 600 sweeps) and measured amplitude and habituation (slope of the linear regression line of amplitude changes from the 1st to 6th block of 100 sweeps) for the N1-P1 and P1-N2 components in patients and, for comparison, in 30 healthy volunteers (HV) of similar age and gender distribution. VEP N1-P1 habituation, i.e. amplitude decrement between 1st and 6th block, which was obvious in most HV (mean slope -0.50), was deficient in both MA (slope +0.01, p = 0.0001) and MA+ (-0.0049, p = 0.001) patients. However, VEP N1-P1 amplitudes across blocks were normal in MA patients, while they were significantly greater in MA+ patients than in HVs. Our findings suggest that in migraine with aura patients different aura phenotypes may be underpinned by different pathophysiological mechanisms. Pre-activation cortical excitability could be higher in patients with complex neurological auras than in those having pure visual auras or in healthy volunteers.

  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. Autonomous control of cardiovascular reactivity in patients with episodic and chronic forms of migraine.

    PubMed

    Mamontov, Oleg V; Babayan, Laura; Amelin, Alexander V; Giniatullin, Rashid; Kamshilin, Alexei A

    2016-01-01

    The autonomous cardiovascular control can contribute to progression of migraine. However, current data on cardiovascular reactivity in migraine, especially severe forms, are essentially contradictory. The main aim of this study was to compare the autonomous regulation of circulation in patients with episodic and chronic migraine and healthy subjects. Seventy three migraine patients (mean age 35 ± 10) including episodic migraine (51 patients, 4-14 headache days/months) and chronic migraine (22 patients, ≥15 headache days/month) along with age-match control (71 healthy voluntaries) were examined. The autonomic regulation of circulation was examined with the tilt-table test, a deep breathing and Valsalva Maneuver, handgrip test, cold-stress vasoconstriction, arterial baroreflex and blood pressure variability. The changes in heart rate induced by deep breathing, Valsalva Maneuver, and blood pressure in tilt-table test in patients with migraine did not differ from the control group. In contrast, the values of cold-stress-vasoconstriction forearm blood-flow reactivity (p <0.001), the increase in diastolic blood pressure in handgrip test (p <0.001), mean blood pressure in the late stage of the second phase of Valsalva Maneuver (p <0.001) and blood pressure variability (p <0.005) were all higher in patients with migraine than in the control group. Thus, both episodic and chronic migraine are associated with significant disturbances in autonomous control resulting in enhanced vascular reactivity whereas the cardiac regulation remains largely unchanged.

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

    PubMed

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

    2015-03-01

    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. 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. 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. 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.

  3. [Gluten migraine].

    PubMed

    Kopishinskaya, S V; Gustov, A V

    2015-01-01

    to study the prevalence of migraine among patients with celiac disease (CD) and clinical features of «gluten migraine» syndrome and to assess the efficacy of gluten diet in its treatment. Authors examined 200 CD patients (main group) and 100 patients with reflux esophagitis and without CD (control group). All patients fulfilled the headache diary during three months before the diagnosis of migraine was made and six months during gluten diet. CD group had migraine syndrome four times more often than the control group (48.5%; p<0.001). In CD group migraine attacks were 2.5 times more frequent than in the control group (р=0.004), but the duration of the attacks was less long, 8 hours in average. The migraine attacks measured by the Visual Analog Scale were less intensive, 55% in average, and had a later onset. The attacks were more frequent in CD patients who were older than 50 years old (р<0.05). The attacks disappeared in 25% of patients with migraine syndrome who were on the gluten diet and the reduction in the intensity and/or frequency of attacks was observed in 38% of patients. We revealed the clear association between migraine syndrome and CD and the high efficacy of gluten diet in the treatment of migraine symptoms.

  4. 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

  5. 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.

  6. Prevalence of personality disorders in patients with chronic migraine.

    PubMed

    Kayhan, Fatih; Ilik, Faik

    2016-07-01

    The present study aimed to investigate the prevalence of personality disorders (PDs) in patients with chronic migraine (CM). This study included 105 CM patients who were diagnosed according to the criteria of the International Headache Society (IHS) and 100 healthy volunteers. PDs were diagnosed with the Structured Clinical Interview for DSM, Revised Third Edition Personality Disorders, and pain severity and level of disability were assessed with the Migraine Disability Assessment (MIDAS) test. Of the 105 CM patients, 85 (81%) had at least one PD. PDs were more prevalent in the patient group than in the healthy control group, and the most common PDs were obsessive-compulsive (n=53, 50.5%), dependent (n=20, 19%), avoidant (n=20, 19%), and passive-aggressive (n=14, 13.3%) PDs. The MIDAS scores of the CM patients with PDs were higher than those of the CM patients without PDs. PDs, particularly obsessive-compulsive, dependent, avoidant, and passive-aggressive PDs, were frequently observed in CM patients in the present study. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. 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.

  8. From wakefulness to sleep: migraine and hypnic headache association in a series of 23 patients.

    PubMed

    Ruiz, Marina; Mulero, Patricia; Pedraza, María Isabel; de la Cruz, Carolina; Rodríguez, Cristina; Muñoz, Irene; Barón, Johanna; Guerrero, Angel Luis

    2015-01-01

    We analyzed characteristics of hypnic headache (HH), migraine and the relationship between both headaches in 23 patients. HH is an uncommon primary headache characterized by exclusively sleep-related attacks. Concurrence of other headaches, mainly migraine, has been reported, but relationship between both syndromes has rarely been considered. We prospectively collected data in a headache outpatient office from January 2008 to September 2013. Demographic data and migraine and hypnic headache mean features were assessed. Twenty-three out of 2500 (0.92%) were diagnosed with HH or probable HH, and 16 of them (69.5%) had a history of migraine. Mean age at onset of HH and migraine was 56.2 ± 9.3 and 24.6 ± 12.2 years, respectively. In 12 cases, migraine attacks disappeared at 56.7 ± 9.8 years old. Regarding the relationship between both syndromes, in 10 patients, migraine disappeared and HH began immediately after. In 1 case there was a pain-free period, and in 5 an overlap between both headaches was registered. A history of migraine is common in HH patients in our series. Most frequent transition pattern was an immediate change between both syndromes. Hypnic headache and migraine might share a common pathophysiological predisposition. © 2014 American Headache Society.

  9. Enhanced depth imaging optical coherence tomography of the choroid in migraine patients: implications for the association of migraine and glaucoma.

    PubMed

    Dadaci, Zeynep; Doganay, Fatma; Oncel Acir, Nursen; Aydin, Hacer Doganay; Borazan, Mehmet

    2014-07-01

    To compare the choroidal thickness measurements obtained during the attack period and during the pain-free interval in migraine patients using enhanced depth imaging optical coherence tomography (OCT). 58 eyes of 29 subjects with a diagnosis of migraine with or without aura were enrolled in this observational, cross-sectional study. Two OCT scans were performed for each patient, one during the peak period of the migraine attack and the other during the headache-free interval, using the enhanced depth imaging mode. Choroidal thicknesses were measured at the fovea, at three locations nasal and at three locations temporal to the fovea at 500 μm intervals. In patients with unilateral headaches, the choroidal thickness measurements obtained during the attack period were significantly increased only in the eyes on the headache side (p<0.001) compared to basal levels. At the fovea, the choroidal thickness measured in the pain-free interval was 373.45 ± 76.47 μm (mean ± SD), which increased to 408.80 ± 77.70 μm during the attack period (p<0.001). When the choroidal thickness measurements of patients with bilateral headaches were compared to basal levels, a statistically significant increase was observed at five out of the seven measured points in the right eyes (p<0.05) and at all seven measured points in the left eyes (p<0.05). Choroidal thickness was found to be significantly increased in migraine patients during the attack period when compared to basal levels. The possible implications of this finding on the association between migraine and glaucoma are discussed. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  10. 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

  11. 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.

  12. [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.

  13. Investigation of MTHFR C677T gene polymorphism, biochemical and clinical parameters in Turkish migraine patients: association with allodynia and fatigue.

    PubMed

    Bahadir, Anzel; Eroz, Recep; Dikici, Suber

    2013-11-01

    We investigated whether there is any relationship between biochemical and clinical parameters of migraine and methylenetetrahydrofolate reductase (MTHFR) gene C677T polymorphism, associated with the migraine subtypes, symptoms, and gender. A total of 150 migraine patients with and without aura (MA and MO) and 107 non-sufferers were included in the study. Biochemical and clinical parameters were measured and genetic analysis was performed. The MTFHR C677T genotype was significantly higher in the migraine group (p = 0.000). The CT genotype frequency of individuals with a family history of migraine was significantly higher (p = 0.025). This genotype frequency was higher in patients who suffer from compression, allodynia, fatigue, and sleeplessness (p = 0.027, 0.023, 0.006, and 0.05, respectively). Homocysteine and total cholesterol levels were significantly higher in the migraine group than the control group (p = 0.007 and 0.010, respectively). However, the other biochemical and clinical parameters did not differ from each other (p > 0.05), with only attack frequency being significantly higher in the MO group (p = 0.005). While the folate and HDL levels were significantly higher in females (p = 0.001 and 0.000, respectively), the homocysteine and triglyceride levels were significantly higher in males (p = 0.000 for each one). BMIs were significantly lower in the control than the migraine group (p = 0.021); however, an association between the C677T variant and BMI was not found (p = 0.787) in the migraine group. An association between the MTHFR C667T polymorphism and migraine susceptibility was found. Additional studies including genetic, clinic, and biochemical parameters should be conducted to better understand the disease.

  14. 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.

  15. Abnormal sensorimotor plasticity in migraine without aura patients.

    PubMed

    Pierelli, Francesco; Iacovelli, Elisa; Bracaglia, Martina; Serrao, Mariano; Coppola, Gianluca

    2013-09-01

    The period between migraine attacks is characterized by paradoxical responses to repetitive sensory and transcranial magnetic stimulation (TMS). Abnormal long-term cortical functional plasticity may play a role and can be assessed experimentally by paired associative stimulation (PAS), in which somatosensory peripheral nerve stimuli are followed by TMS of the motor cortex. Changes in motor-evoked potential (MEP) amplitudes were recorded in 16 migraine without aura patients (MO) and 15 healthy volunteers (HV) before and after PAS, which consisted of 90 peripheral electrical right ulnar nerve stimulations and subsequent TMS pulses over the first dorsal interosseous (FDI) muscle activation site with a delay of 10 ms (excitability depressing) or 25 ms (excitability enhancing). As a control experiment of the 31 subjects studied, 8 (4 MO and 4 HV) also underwent PAS10 earlier, the recording of somatosensory high-frequency oscillations (HFOs) reflecting thalamocortical activation (early HFOs). Although PAS10 reduced MEP amplitudes in HV (-17.7%), it significantly increased amplitudes in MO (+35.9%). Although in HV MEP amplitudes were significantly potentiated (+55.1) after PAS25, only a slight, nonsignificant increase was observed in MO (+18.8%). In the control experiment, performed on 8 subjects pooled together, Pearson's correlation showed an inverse relationship between the percentage of MEP amplitude changes after PAS10 and early HFO amplitudes (r=-0.81; P=.01). Because we observed that the more deficient the long-term PAS-induced change, the more the thalamocortical activation decreased, we hypothesize that the abnormalities in long-term cortical plasticity observed in the interictal period between migraine episodes could be due to altered thalamic control. Copyright © 2013 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  16. [Coping with stress and pain in migraine patients.].

    PubMed

    Bornmann, M; Schneeberg-Kirchner, S; Weber, H

    1989-12-01

    During a semi-structured interview 82 migraine patients were asked biographical and illnessrelated questions. They completed psychological instruments on coping behavior (Stressverarbeitungsfragebogen), self-concept (Frankfurter Selbstkonzeptskalen), attributional style (IE-SV-F), illness behavior, and illness-related attributions (Tübinger Attributions-fragebogen). The theoretical background of this research is a cognitive model of coping with stress and illness. The results support the interrelations between coping with stress and coping with illness assumed in the model. They justify considering coping with illness to be scopespecific coping behavior. Furthermore, the results emphasize the importance of cognitive processes for stress-coping in general, as well as for illness-related coping behavior. With regard to personality variables, migraineurs, as compared with healthy persons, show to a larger extent coping strategies that are apt to maintain rather than to reduce stress, such as resignation, withdrawal, and avoidance behavior. They also have a more unfavorable selfconcept of achievement, emotional stability and selfassertiveness, lower self-esteem and a more external pattern of causal attributions. Some of the pain behavior strategies could be identified as being focused on illness (guarding behavior, avoidance and social withdrawal, resignation and complaint); only the attempt to relax is regarded as being focused on health. Migraine patients show a preference neither for medical nor psychological causal attributions of their illness but score significantly higher on medical than psychological control attributions. The results have implications for psychological therapy.

  17. 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

  18. [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.

  19. Facilitating communication with patients for improved migraine outcomes.

    PubMed

    Buse, Dawn C; Lipton, Richard B

    2008-06-01

    Effective communication is integral to good medical care. Medical professional groups, regulatory agencies, educators, researchers, and patients recognize its importance. Quality of medical communication is directly related to patient satisfaction, improvement in medication adherence, treatment compliance, other outcomes, decreased risk of malpractice, and increase in health care providers' levels of satisfaction. However, skill level and training remain problematic in this area. Fortunately, research has shown that medical communication skills can be successfully taught and acquired, and that improvement in communication skills improves outcomes. The American Migraine Communication Studies I and II evaluated the current state of health care provider-patient communication in headache care and tested a simple educational intervention. They found problematic issues but demonstrated that these areas could be improved. We review theoretical models of effective communication and discuss strategies for improving communication, including active listening, interviewing strategies, and methods for gathering information about headache-related impairment, mood, and quality of life.

  20. 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.

  1. 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.

  2. Abnormal resting-state brain activity in headache-free migraine patients: A magnetoencephalography study.

    PubMed

    Li, Feng; Xiang, Jing; Wu, Ting; Zhu, Donglin; Shi, Jingping

    2016-08-01

    The aim of this study is to quantitatively assess the resting-state brain activity in migraine patients during the headache-free phase with magnetoencephalography (MEG). A total of 25 migraine patients during the headache-free phase and 25 gender- and age-matched control patients were studied with a whole-head MEG system at eyes-closed resting-state. MEG data were analyzed in multifrequency range of 4-200Hz. In a regional cortex analysis, the spectral power of gamma oscillations in left frontal and left temporal regions was significantly increased in migraine patients as compared to controls (all p<0.001), but no significant difference was found between the two groups for the global channels. Analyses of source location showed that there were significant differences in the distribution of gamma oscillation between migraine subjects and controls (p<0.025). Migraine patients in resting-state had altered brain activities in spectral power value and source distribution that can be detected and analyzed by MEG. Abnormal brain activities in the left frontal and temporal regions may be involved in pain modulation and processing of migraine. These findings provide new insights into the possible mechanisms of migraine attacks. Copyright © 2016 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  3. Evidences of Reduced Antioxidant Activity in Patients With Chronic Migraine and Medication-Overuse Headache.

    PubMed

    Lucchesi, Cinzia; Baldacci, Filippo; Cafalli, Martina; Chico, Lucia; Lo Gerfo, Annalisa; Bonuccelli, Ubaldo; Siciliano, Gabriele; Gori, Sara

    2015-01-01

    Migraine is a complex multifactorial, neurobiological disorder, whose pathogenesis is not fully understood, nor are the mechanisms associated with migraine transformation from episodic to chronic pattern. A possible role of impaired oxidative mitochondrial metabolism in migraine pathogenesis has been hypothesized, and increased levels of peripheral markers of oxidative stress have been reported in migraine patients, although the literature data are limited and heterogeneous. The aim of this cross-sectional study was to determine plasmatic levels of advanced oxidation protein products, ferric-reducing antioxidant power and total plasmatic thiol groups, all plasmatic markers related to oxidative stress, in a sample of chronic migraine patients and medication-overuse headache, compared to a control group of healthy subjects. Thirty-three patients with a diagnosis of both chronic migraine and medication-overuse headache (International Classification of Headache Disorders,3rd edition, beta version) and 33 healthy, headache-free subjects were enrolled. Patients with comorbid/coexisting conditions were excluded, as well as patients in treatment with migraine preventive drugs. Plasmatic levels of advanced oxidation protein products, ferric-reducing antioxidant power, and total thiol groups were determined in migraine patients and controls; moreover, oxidative stress biomarkers were compared in migraine patients with triptan compared to non-steroidal anti-inflammatory drug overuse. The statistical analysis showed significantly lower levels of ferric-reducing antioxidant power and total plasmatic thiol groups, both expression of antioxidant power, in patients with chronic migraine and medication-overuse headache compared to controls (respectively, ferric antioxidant power median [interquartile range] 0.53 [0.22] vs 0.82 [0.11] mmol/L, P < .001; total thiol groups 0.25 [0.08] vs 0.51 [0.11] μmol/L, P < .001). Moreover, no statistically significant differences in

  4. Cerebral reactivity in migraine patients measured with functional near-infrared spectroscopy.

    PubMed

    Pourshoghi, Ahmadreza; Danesh, Arash; Tabby, David Stuart; Grothusen, John; Pourrezaei, Kambiz

    2015-12-08

    There are two major theories describing the pathophysiology of migraines. Vascular theory explains that migraines resulted from vasodilation of meningeal vessels irritating the trigeminal nerves and causing pain. More recently, a neural theory of migraine has been proposed, which suggests that cortical hyperexcitability leads to cortical spreading depression (CSD) causing migraine-like symptoms. Chronic migraine requires prophylactic therapy. When oral agents fail, there are several intravenous agents that can be used. Understanding underlying causes of migraine pain would help to improve efficacy of migraine medications by changing their mechanism of action. Yet to date no study has been made to investigate the link between vascular changes in response to medications for migraine versus pain improvements. Functional near-infrared spectroscopy (NIRS) has been used as an inexpensive, rapid, non-invasive and safe technique to monitor cerebrovascular dynamics. In this study, a multi-distance near-infrared spectroscopy device has been used to investigate the cortical vascular reactivity of migraine patients in response to drug infusions and its possible correlation with changes in pain experienced. We used the NIRS on 41 chronic migraine patients receiving three medications: magnesium sulfate, valproate sodium, and dihydroergotamine (DHE). Patients rated their pain on a 1-10 numerical scale before and after the infusion. No significant differences were observed between the medication effects on vascular activity from near channels measuring skin vascularity. However, far channels--indicating cortical vascular activity--showed significant differences in both oxyhemoglobin and total hemoglobin between medications. DHE is a vasoconstrictor and decreased cortical blood volume in our experiment. Magnesium sulfate has a short-lived vasodilatory effect and increased cortical blood volume in our experiment. Valproate sodium had no significant effect on blood volume

  5. 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

  6. 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

  7. Autonomic dysfunction in pediatric patients with headache: migraine versus tension-type headache.

    PubMed

    Rabner, Jonathan; Caruso, Alessandra; Zurakowski, David; Lazdowsky, Lori; LeBel, Alyssa

    2016-12-01

    To examine symptoms indicating central nervous system (CNS) autonomic dysfunction in pediatric patients with migraine and tension-type headache. A retrospective chart review assessed six symptoms (i.e. constipation, insomnia, dizziness, blurry vision, abnormal blood pressure, and cold and clammy palms and soles) indicating central nervous system (CNS) autonomic dysfunction in 231 patients, ages 5-18 years, diagnosed with migraine, tension-type headache (TTH), or Idiopathic Scoliosis (IS). Higher frequencies of "insomnia," "dizziness," and "cold and clammy palms and soles" were found for both migraine and TTH patients compared to the IS control group (P < 0.001). Frequencies of all six symptoms were greater in TTH than migraine patients with "cold and clammy palms and soles" reaching significance (P < 0.001). The need for prospective research investigating autonomic dysfunction in pediatric headache patients is discussed.

  8. The anti-migraine effects of M2000 (β-D-mannuronic acid) on a patient with rheumatoid arthritis; as a case report.

    PubMed

    Vojdanian, Mahdi; Ahmadi, Hossein; Jamshidi, Ahmad Reza; Mahmoudi, Mahdi; Gharibdoost, Farhad; Barati, Anis; Mirshafiey, Abbas

    2017-06-04

    Rheumatoid arthritis (RA) and migraine are both common disorders which are caused by a faulty immune system and autonomic nervous system dysfunction, respectively. Although current treatment outlook has been shown a great improvement in these two diseases, however many side effects have been reported. We report a case of 43-years-female that has been suffered from rheumatoid arthritis for 3 years with a 6 years history of migraine. She had used different types of medication for both rheumatoid arthritis and migraine but during these 6 years no improvement was observed and even migraine progression in this patient became worse. She was admitted to the hospital for 12 weeks follow up to evaluate the effect of β-D-mannuronic acid (M2000) on her RA disease. During 12 weeks of M2000 therapy RA indices including Disease Activity Score (DAS28), simple disease activity index(SDAI) and C-reactive protein (CRP),erythrocyte sedimentation rate (ESR), rheumatoid factor (RF)), anti-cyclic citrullinated peptide antibodies(anti-CCP) and blood determinants were measured. A significant improvement was seen after 12 weeks of M2000 therapy in both rheumatoid arthritis and migraine which are considered as inflammatory diseases. Therefore, it might be concluded that M2000 as a novel non-steroidal anti-inflammatory drugs (NSAIDs) with immunosuppressive property is able to treat migraine in addition to its potent efficacy on treatment of rheumatoid arthritis. Copyright© Bentham Science Publishers; For any queries, please email at epub@benthamscience.org.

  9. 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.

  10. Factors associated with frovatriptan response in patients with migraine: A prospective, observational study.

    PubMed

    Seo, Jong-Geun; Park, Sung-Pa

    2016-04-01

    Almost one-third of patients with migraine do not adequately respond to triptans. We examined factors contributing to frovatriptan response in patients with migraine. We enrolled new patients with migraine who consecutively visited our headache clinic. Eligible patients were instructed to take 2.5 mg of frovatriptan as soon as possible after migraine attack. The responsiveness was determined by whether headache was relieved or absent within 4 hours after the intake of frovatriptan. We assessed frovatriptan to be efficacious when headache responded to its administration in at least one of two successive migraine attacks and inefficacious when headache was not relieved in either attack. We included demographic, clinical and psychiatric variables in the analysis of factors associated with frovatriptan response. Of 128 eligible patients, 28 (21.9%) experienced frovatriptan inefficacy. In 24 patients with current major depressive disorder, 12 (50.0%) had frovatriptan inefficacy. Only current major depressive disorder was identified as a risk factor for inefficacy (odds ratio = 5.500, 95% confidence interval 2.103-14.382, ITALIC! p = 0.001). Depression may be a risk factor of frovatriptan inefficacy in patients with migraine, even though half of patients with major depressive disorder respond to frovatriptan. © International Headache Society 2015.

  11. 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.

  12. Persistence and switching patterns of oral migraine prophylactic medications among patients with chronic migraine: A retrospective claims analysis

    PubMed Central

    Hepp, Zsolt; Dodick, David W; Varon, Sepideh F; Chia, Jenny; Matthew, Nitya; Hansen, Ryan N; Devine, Emily Beth

    2016-01-01

    Background Migraine prevention guidelines recommend oral prophylactic medications for patients with frequent headache. This study examined oral migraine preventive medication (OMPM) treatment patterns by evaluating medication persistence, switching, and re-initiation in patients with chronic migraine (CM). Methods A retrospective US claims analysis (Truven Health MarketScan® Databases) evaluated patients ≥18 years old diagnosed with CM who had initiated an OMPM between 1 January, 2008 and 30 September, 2012. Treatment persistence was measured at six and 12 months’ follow-up. Time-to-discontinuation was assessed for each OMPM and compared using Cox regression models. Among those who discontinued, the proportion that switched OMPMs within 60 days or re-initiated treatment between 61 to 365 days, and their associated persistence rates, were also assessed. Results A total of 8707 patients met the inclusion/exclusion criteria. Persistence to the initial OMPM was 25% at six months and 14% at 12 months. Based on Kaplan-Meier curves, a sharp decline of patients discontinuing was observed by 30 days, and approximately half discontinued by 60 days. Similar trends in time-to-discontinuation were seen following the second or third OMPM. Amitriptyline, gabapentin, and nortriptyline had significantly higher likelihood of non-persistence compared with topiramate. Among patients who discontinued, 23% switched to another prophylactic and 41% re-initiated therapy within one year. Among patients who switched, persistence was between 10 to 13% and among re-initiated patients, persistence was between 4 to 8% at 12 months. Conclusions Persistence to OMPMs is poor at six months and declines further by 12 months. Switching between OMPMs is common, but results indicate that persistence worsens as patients cycle through various OMPMs. PMID:27837173

  13. Persistence and switching patterns of oral migraine prophylactic medications among patients with chronic migraine: A retrospective claims analysis.

    PubMed

    Hepp, Zsolt; Dodick, David W; Varon, Sepideh F; Chia, Jenny; Matthew, Nitya; Gillard, Patrick; Hansen, Ryan N; Devine, Emily Beth

    2017-04-01

    Background Migraine prevention guidelines recommend oral prophylactic medications for patients with frequent headache. This study examined oral migraine preventive medication (OMPM) treatment patterns by evaluating medication persistence, switching, and re-initiation in patients with chronic migraine (CM). Methods A retrospective US claims analysis (Truven Health MarketScan® Databases) evaluated patients ≥18 years old diagnosed with CM who had initiated an OMPM between 1 January, 2008 and 30 September, 2012. Treatment persistence was measured at six and 12 months' follow-up. Time-to-discontinuation was assessed for each OMPM and compared using Cox regression models. Among those who discontinued, the proportion that switched OMPMs within 60 days or re-initiated treatment between 61 to 365 days, and their associated persistence rates, were also assessed. Results A total of 8707 patients met the inclusion/exclusion criteria. Persistence to the initial OMPM was 25% at six months and 14% at 12 months. Based on Kaplan-Meier curves, a sharp decline of patients discontinuing was observed by 30 days, and approximately half discontinued by 60 days. Similar trends in time-to-discontinuation were seen following the second or third OMPM. Amitriptyline, gabapentin, and nortriptyline had significantly higher likelihood of non-persistence compared with topiramate. Among patients who discontinued, 23% switched to another prophylactic and 41% re-initiated therapy within one year. Among patients who switched, persistence was between 10 to 13% and among re-initiated patients, persistence was between 4 to 8% at 12 months. Conclusions Persistence to OMPMs is poor at six months and declines further by 12 months. Switching between OMPMs is common, but results indicate that persistence worsens as patients cycle through various OMPMs.

  14. 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

  15. 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.

  16. [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.

  17. 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

  18. The Prevalence of Dry Eye and Sjögren Syndrome in Patients with Migraine.

    PubMed

    Sarac, Ozge; Kosekahya, Pinar; Yildiz Tasci, Yelda; Keklikoglu, Hava D; Deniz, Orhan; Erten, Şükran; Çağıl, Nurullah

    2017-06-01

    To evaluate the presence of dry eye and primary Sjögren syndrome (SS) in patients with migraine. In total, 46 eyes of 46 patients with migraine (group 1) and 50 eyes of 50 healthy subjects (group 2) were included in this study. Detailed ophthalmologic, neurologic and rheumatologic examination were performed on all participants. Ocular surface disease index questionnaire, tear function tests, visual analog scale for pain, serologic analysis were also performed. Dry eye symptoms and findings were significantly higher and more severe in group 1 when compared with group 2. Primary SS was not found in any of the participants. The migraine lifetime duration was negatively correlated with the tear function tests while it was positively correlated with the ocular surface disease index scores. Dry eye symptoms and findings are higher in migraine patients when compared with the healthy subjects without the presence of Sjögren syndrome.

  19. Electron microscopic and proteomic comparison of terminal branches of the trigeminal nerve in patients with and without migraine headaches.

    PubMed

    Guyuron, Bahman; Yohannes, Elizabeth; Miller, Robert; Chim, Harvey; Reed, Deborah; Chance, Mark R

    2014-11-01

    The purpose of this study was to compare the ultrastructural appearance and protein expression of the zygomaticotemporal branch of the trigeminal nerve in patients with and without migraine headaches. After confirmation of migraine headache diagnosis on 15 patients, a 5-mm segment of the zygomaticotemporal branch of the trigeminal nerve that is routinely removed during migraine surgery was compared to similarly sized nerve segments obtained from 15 control patients without a history of migraine headaches, who underwent an endoscopic forehead lift where this nerve is routinely transected. The segments were snap-frozen at -80°C for the downstream proteomics analysis. In addition, the cytoarchitectural differences of the nerve segments obtained from the 15 migraine and 15 control subjects were examined in detail under the electron microscope. Analysis of liquid chromatography/tandem mass spectrometry data sets identified differentially expressed proteins and networks composed of highly connected molecular modules (p=10 and p=10) in patients with migraine headaches. The nerves from patients with migraine headaches had a linear organization, disrupted myelin sheaths and target axons, and discontinuous neurofilaments that were poorly registered with the discontinuous myelin sheaths, suggesting axonal abnormality. This study offers electron microscopic and proteomic evidence of axonal abnormality and deregulation of the myelination process in patients with migraine headaches compared with controls, offering the first objective evidence to support the role of peripheral mechanisms in the migraine headache cascade and an explanation as to why the surgical treatment of migraine headaches is efficacious.

  20. 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.

  1. 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.

  2. Characterising the premonitory stage of migraine in children: a clinic-based study of 100 patients in a specialist headache service.

    PubMed

    Karsan, N; Prabhakar, P; Goadsby, P J

    2016-12-01

    The premonitory stage of migraine attacks, when symptomatology outside of pain can manifest hours to days before the onset of the headache, is well recognised. Such symptoms have been reported in adults in a number of studies, and have value in predicting an impending headache. These symptoms have not been extensively studied in children. We aimed to characterise which, if any, of these symptoms are reported in children seen within a Specialist Headache Service. We reviewed clinic letters from the initial consultation of children and adolescents seen within the Specialist Headache Service at Great Ormond Street Hospital between 1999 and 2015 with migraine in whom we had prospectively assessed clinical phenotype data. We randomly selected 100 cases with at least one premonitory symptom recorded in the letter. For these patients, the age at headache onset, presence of family history of headache, headache diagnosis, presence of episodic syndromes which may be associated with headache, developmental milestones, gestation at birth, mode of delivery and presence of premonitory symptoms occurring before or during headache were recorded. Of the 100 patients selected, 65 % were female. The age range of the patients was 18 months to 15 years at the time of headache onset. The most common diagnosis was chronic migraine in 58 %, followed by episodic migraine (29 %), New Daily Persistent Headache with migrainous features (8 %) and hemiplegic migraine (5 %). A history of infantile colic was noted in 31 % and was the most common childhood episodic syndrome associated with migraine. The most common premonitory symptoms recorded were fatigue, mood change and neck stiffness. The commonest number of reported premonitory symptoms was two. Premonitory symptoms associated with migraine are reported in children as young as 18 months, with an overall clinical phenotype comparable to adults. Better documentation of this stage will aid parents and clinicians to better understand

  3. Cognitive impairment and quality of life in patients with migraine-associated vertigo.

    PubMed

    Wang, N; Huang, H-L; Zhou, H; Yu, C-Y

    2016-12-01

    To study the impact of migraine-associated vertigo (MV) on the cognitive state of patients and their quality of life. A total of 120 patients were enrolled in the study, including 40 diagnosed with MV, forty with a simple migraine and 40 healthy volunteers. Cognitive assessments were done using the mini-mental state examination (MMSE), and a battery of tests for cognitive functions in performance, memory, language, space and attention during interictal periods. Also, MRI was used to detect brain white matter lesions and SF-36 for quality of life. The scores of cognitive tests (MMSE, tracing, memory and VFT scores) in MV cases were significantly lower than those in the simple migraine group. TMT-A and TMT-B scores in the MV group were the highest followed by those in the simple migraine group. The incidence of deep brain, peripheral lateral ventricle and total white matter lesions in the MV group was higher than that in the simple migraine group. Finally, the deep lesion and peripheral lateral ventricle scores in the MV group were significantly higher than those in the simple migraine group. The physical, social, mental and total health scores in the MV group were significantly lower than those in the simple migraine group. All the differences found between groups had statistical significance, and all the variables examined fared best in the healthy control group. MV patients show a more pronounced cognitive impairment than patients with a simple migraine or healthy volunteers, the incidence of brain white matter lesions is increased in them, and their quality of life is severely compromised.

  4. Examination of fluctuations in atmospheric pressure related to migraine.

    PubMed

    Okuma, Hirohisa; Okuma, Yumiko; Kitagawa, Yasuhisa

    2015-01-01

    Japan has four seasons and many chances of low atmospheric pressure or approaches of typhoon, therefore it has been empirically known that the fluctuation of weather induces migraine in people. Generally, its mechanism has been interpreted as follows: physical loading, attributed by atmospheric pressure to human bodies, compresses or dilates human blood vessels, which leads to abnormality in blood flow and induces migraine. We report our examination of the stage in which migraine tends to be induced focusing on the variation of atmospheric pressure. Subjects were 34 patients with migraine, who were treated in our hospital. The patients included 31 females and three males, whose mean age was 32 ± 6.7. 22 patients had migraine with aura and 12 patients had migraine without aura. All of patients with migraine maintained a headache diary to record atmospheric pressures when they developed a migraine. The standard atmospheric pressure was defined as 1013 hPa, and with this value as the criterion, we investigated slight fluctuations in the atmospheric pressure when they developed a migraine. It was found that the atmospheric pressure when the patients developed a migraine was within 1003-1007 hPa in the approach of low atmospheric pressure and that the patients developed a migraine when the atmospheric pressure decreased by 6-10 hPa, slightly less than the standard atmospheric pressure. Small decreases of 6-10 hPa relative to the standard atmospheric pressure of 1013 hPa induced migraine attacks most frequently in patients with migraine.

  5. 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.

  6. 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

  7. Low serum diamine oxidase (DAO) activity levels in patients with migraine.

    PubMed

    Izquierdo-Casas, Joan; Comas-Basté, Oriol; Latorre-Moratalla, M Luz; Lorente-Gascón, Marian; Duelo, Adriana; Vidal-Carou, M Carmen; Soler-Singla, Luis

    2017-06-17

    Histamine intolerance is a disorder in the homeostasis of histamine due to a reduced intestinal degradation of this amine, mainly caused by a deficiency in the enzyme diamine oxidase (DAO). Among the several multi-faced symptoms associated with histamine intolerance, headache is one of the most recognized and disabling consequences. The aim of this study was to determine the prevalence of DAO deficiency in patients with a confirmed migraine diagnosis according to the current International Headache Society (IHS) and in non-migraine subjects. DAO activity was assessed in a total of 198 volunteers recruited at the Headache Unit of the Hospital General de Catalunya, 137 in the migraine group and 61 as a control group. DAO enzyme activity in blood samples was determined by ELISA test. Values below 80 HDU/ml (Histamine Degrading Unit/ml) were considered as DAO deficient. Mean value of DAO activity from migraine population (64.5 ± 33.5 HDU/ml) was significantly lower (p < 0.0001) than that obtained from healthy volunteers (91.9 ± 44.3 HDU/ml). DAO deficiency was more prevalent in migraine patients than in the control group. A high incidence rate of DAO deficiency (87%) was observed in the group of patients with migraine. On the other hand, 44% of non-migranous subjects had levels of DAO activity lower than 80 HDU/ml. Despite the multifactorial aetiology of migraine, these results seem to indicate that this enzymatic deficit could be related to the onset of migraine.

  8. Nonendoscopic deactivation of nerve triggers in migraine headache patients: surgical technique and outcomes.

    PubMed

    Gfrerer, Lisa; Maman, Daniel Y; Tessler, Oren; Austen, William G

    2014-10-01

    Low efficacy, significant side effects, and refractory patients often limit the medical treatment of migraine headache. However, new surgical options have emerged. Dr. Bahman Guyuron and others report response rates between 68 and 95 percent after surgical deactivation of migraine trigger sites in select patients. In an effort to replicate and expand migraine trigger-site deactivation surgery as a treatment option, the authors' group and others have developed nonendoscopic algorithms. The exclusion of endoscopic techniques may be useful for surgeons with little experience or limited access to the endoscope and in patients with challenging anatomy. Forty-three consecutive trigger deactivation procedures in 35 patients were performed. Preoperative and 12-month postoperative migraine questionnaires and patient charts were reviewed. Response to surgery in terms of migraine symptom relief and adverse events were evaluated. The overall positive response rate was 90.7 percent. Total elimination of migraine headaches was reported in 51.3 percent of those with a positive response, greater than 80 percent resolution of symptoms was reported in 20.5 percent, and 28.2 percent had resolution between 50 and 80 percent. No significant effect was reported following 9.3 percent of procedures. There were no major adverse events. Nonendoscopic trigger deactivation is a safe and effective treatment in select migraine headache patients. Although surgical techniques and understanding of the mechanisms of relief are evolving, results continue to be promising. This series confirms that excellent results can be attained without the endoscope. The authors continue to study these patients prospectively to improve patient selection and refine the protocol. Therapeutic, IV.

  9. 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.

  10. Structural Changes in the Cerebrum, Cerebellum and Corpus Callosum in Migraine Patients.

    PubMed

    Demir, Berin T; Bayram, Nezihe A; Ayturk, Zübeyde; Erdamar, Hüsamettin; Seven, Pelin; Calp, Ayşegül; Sazak, Merve; Ceylan, Hatice G

    2016-12-01

    The purpose of this study was to demonstrate the relationship among the cerebrum, cerebellum and corpus callosum in migraine patients. This work was conducted with cooperation of the Turgut Özal Medical Faculty, Department of Anatomy and Neurology. Migraine patients were divided into four groups: new patients; 1-5 years; 5-10 years; and, more than 10 years. All patients (n=75) and control subjects (n=20) underwent Magnetic Resonance Imaging (MRI) and brain images were processed by ONIS and Image J. Data were analyzed using the planimetric method. Cerebrum, cerebellum and corpus callosum volume were calculated for all subjects. The footprints of the callosum were as follows: healthy control subjects, new patients and 1-year patients: 12.8%, 5 years: 11.7% and more than 10 years: 10.7%. The cerebrum volume was as follows: healthy control subjects: 1152 cm3, 5-10 years: 1102 cm3 and more than 10 years: 1002 cm3. The results of our study showed atrophy in the cerebrum, cerebellum and corpus callosum of chronic migraine patients. This atrophy was greater in the patients with aura migraines. Our study confirmed that a migraine is an episodic disease that seriously affects the CNS.

  11. Increased risk of trigeminal neuralgia in patients with migraine: A nationwide population-based study.

    PubMed

    Lin, Kuan-Hsiang; Chen, Yung-Tai; Fuh, Jong-Ling; Wang, Shuu-Jiun

    2015-12-20

    The objectives of this article are to evaluate the association between migraine and trigeminal neuralgia and to investigate the effects of age, sex, migraine subtype, and comorbid risk factors on trigeminal neuralgia development. This population-based cohort study was conducted using data from Taiwan's National Health Insurance Research Database. Individuals aged ≥ 20 years with neurologist-diagnosed migraine between 2005 and 2009 were included. A non-headache age-, sex-, and propensity score-matched control cohort was selected for comparison. All participants were followed until the end of 2010, death, or the occurrence of trigeminal neuralgia. Cox proportional hazards regression was used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for comparison of the risk of trigeminal neuralgia between groups. Both cohorts (n = 137,529 each) were followed for a mean of 3.1 years. During the follow-up period, 575 patients (421,581 person-years) in the migraine cohort and 88 matched controls (438,712 person-years) were newly diagnosed with trigeminal neuralgia (incidence rates, 136.39 and 20.06/100,000 person-years, respectively). The HR for trigeminal neuralgia was 6.72 (95% CI, 5.37-8.41; p < 0.001). The association between migraine and trigeminal neuralgia remained significant in sensitivity analyses. Among migraine subtypes, patients with migraine with aura were at greater risk of trigeminal neuralgia development. No other significant interaction was identified in subgroup analyses. Migraine is a previously unidentified risk factor for trigeminal neuralgia. The association between these conditions suggests a linked underlying mechanism, which is worthy of further exploration. © International Headache Society 2015.

  12. 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.

  13. 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.

  14. Migraine in Assiut Governorate, Egypt: epidemiology, risk factors, comorbid conditions and predictors of change from episodic to chronic migraine.

    PubMed

    Kandil, Mahmoud Rafaat; Hamed, Sherifa Ahmed; Fadel, Kawthar Abdel-Motagally; Khalifa, Hossam Eldin; Ghanem, Mostafa Kamel; Mohamed, Khaled Osama

    2016-03-01

    Headache is one of the most common complaints in medicine. Epidemiological and population-based studies reported that migraine has a variable prevalence worldwide. This study was done to estimate the prevalence of migraine across various age groups in Assiut district, Egypt. This is a door-to-door study. It included 4700 randomly selected individuals. Headache was reported in 1668 subjects (35.49%), of them, 87.65% (n = 1462) had primary headaches. Migraine prevalence was 10.51% with female-to-male ratio of 2.4:1 particularly in ages of 20-40 years. The mean age of patients was 31.46 ± 13.39 years and age at onset was 24.16 ± 12.10 years. Nearly, 63.5% had frequent attacks, 65.2% of the attacks were severe enough to stop daily activities and lasted for >1 day in 32.5% of females compared to 40.7% and 14.5% for males. Chronic or daily migraine was more in females (35.3% versus 20.7% for males). Approximately, 5.6% had chronic migraine and 1.2% had daily migraine from the start, while 24.2% had transformation from episodic to chronic migraine within 6.1 ± 4.4 years. Migraine was prevalent among those with middle educational levels and labor workers. The duration of migraine attacks was found to reduce with age but the chronic/daily migraine increased with age. Hypertension, anxiety, irritable bowel syndrome, and depression were common comorbidities with migraine. We believe that the work done in this study is informative as it determined the actual prevalence of migraine across various age groups and the important predictors of change in the severity, duration, and frequency of migraine in our locality.

  15. Personality traits in patients with cluster headache: a comparison with migraine patients.

    PubMed

    Muñoz, I; Hernández, M S; Santos, S; Jurado, C; Ruiz, L; Toribio, E; Sotelo, E M; Guerrero, A L; Molina, V; Uribe, F; Cuadrado, M L

    2016-01-01

    Cluster headache (CH) has been associated with certain personality traits and lifestyle features, but there are few studies assessing personality profiles in CH. We aimed to analyze personality traits in patients with CH, and to compare them with those found in migraine. We included all consecutive patients with CH attending 5 outpatient offices between January and December 2013. Personality traits were evaluated using the Salamanca screening test, a validated inventory assessing 11 personality traits grouped in 3 clusters. We analyzed the test results in this population, and compared them with those of a migraine population previously assessed with the same test. Eighty patients with CH (75 men, 5 women; mean age, 43.2 ± 9.9 years) were recruited. The reference population consisted of 164 migraine patients (30 men, 134 women; mean age 36.4 ± 12.7 years). In CH patients, the most frequent personality traits were anancastic (52.5 %), anxious (47.5 %), histrionic (45 %), schizoid (42.5 %), impulsive (32.5 %) and paranoid (30 %). When compared to migraine patients, paranoid (p < 0.001; χ2 test), and schizoid traits (p = 0.007; χ2 test) were significantly more prevalent in CH patients. In logistic regression analysis the paranoid trait was significantly associated with CH (p = 0.001; OR: 3.27, 95 % CI [1.66-6.43]). According to the Salamanca screening test, personality traits included in cluster A (odd or eccentric disorders) are more prevalent in CH patients than in a population of migraineurs. Larger studies are needed to determine whether certain personality traits are related to CH.

  16. Visual Field Losses in Patients with Migraine without Aura and Tension-Type Headache.

    PubMed

    Yener, Arif Ü; Korucu, Osman

    2017-04-01

    The aim of the study was to compare the visual fields during pain attacks in the patients with migraine without aura and tension-type headache using automated perimetry. In this study 25 patients with migraine and 25 patients with tension-type headache were evaluated.The optic disc, macula and retina were assessed and patients with normal values were enrolled into the study. Intraocular pressure of all patients were measured. Furthermore, visual field test was applied to both groups using Humphrey field analyzer (Carl-Zeiss Meditec, model-745 i, Dublin, CA, USA). Both mean deviation and pattern standart deviation values of these two goups were not statistically significant.

  17. An open-label trial of a sumatriptan auto-injector for migraine in patients currently treated with subcutaneous sumatriptan.

    PubMed

    Landy, Stephen H; Tepper, Stewart J; Wein, Theodore; Schweizer, Edward; Ramos, Elodie

    2013-01-01

    To assess the ability of patients, during an acute migraine attack, to successfully self-inject a single dose of sumatriptan using a novel sumatriptan auto-injector (Alsuma(®)), and to evaluate the safety, tolerability, and effectiveness of this sumatriptan auto-injector during an acute migraine attack. This sumatriptan auto-injector is a single-use system for the rapid subcutaneous delivery of 6 mg of sumatriptan succinate in the acute management of migraine pain. This auto-injector was developed to address the clinical need for an easy-to-use and rapid-to-administer system that did not require any assembly during the time of an ongoing attack. This was an open-label, phase 3 trial conducted at 10 sites in the USA. Male or female adults, ages 18-60 years old, were eligible for study entry if they met International Headache Society criteria for migraine with or without aura, with at least 2 attacks per month, and if they reported use of subcutaneous injectable sumatriptan on at least 2 occasions within the previous 2 months. During the onset of a migraine attack of moderate-to-severe intensity, patients were asked to administer a 6-mg subcutaneous dose of sumatriptan using the auto-injector. Patients returned to the study site within 72 hours of the migraine for the post-treatment assessment visit. A total of 63 patients met entry criteria and received a dose of study medication (the intent-to-treat sample). Sixty-one patients (96.8%) reported injection in the thigh, and 2 patients (3.2%) reported injection in the arm. On the patient questionnaire, 100% of patients (95% confidence interval [CI] 94.3-100%) "agreed" or "agreed strongly" that the written instructions for the auto-injector were clear and easy to follow (30.2% "agreed"; 69.8% "agreed strongly"); 95.2% of patients (95% CI 86.7-99.0%) found that the auto-injector was easy to use (36.5% "agreed"; 58.7% "agreed strongly"), and 65.1% of patients (95% CI 52.0-76.7%) stated that they preferred the new auto

  18. Impact of migraine on fibromyalgia symptoms.

    PubMed

    Giamberardino, Maria Adele; Affaitati, Giannapia; Martelletti, Paolo; Tana, Claudio; Negro, Andrea; Lapenna, Domenico; Curto, Martina; Schiavone, Cosima; Stellin, Luisa; Cipollone, Francesco; Costantini, Raffaele

    2015-01-01

    Fibromyalgia (FMS) and high frequency episodic/chronic migraine (M) very frequently co-occur, suggesting common pathophysiological mechanisms; both conditions display generalized somatic hyperalgesia. In FMS-M comorbidity we assessed if: a different level of hyperalgesia is present compared to one condition only; hyperalgesia is a function of migraine frequency; migraine attacks trigger FMS symptoms. Female patients with fibromyalgia (FMS)(n.40), high frequency episodic migraine (M1)(n.41), chronic migraine (M2)(n.40), FMS + M1 (n.42) and FMS + M2 (n.40) underwent recording of: -electrical pain thresholds in skin, subcutis and muscle and pressure pain thresholds in control sites, -pressure pain thresholds in tender points (TePs), -number of monthly migraine attacks and fibromyalgia flares (3-month diary). Migraine and FMS parameters were evaluated before and after migraine prophylaxis, or no prophylaxis, for 3 months with calcium-channel blockers, in two further FMS + H1 groups (n.49, n.39). 1-way ANOVA was applied to test trends among groups, Student's t-test for paired samples was used to compare pre and post-treatment values. The lowest electrical and pressure thresholds at all sites and tissues were found in FMS + M2, followed by FMS + H1, FMS, M2 and M1 (trend: p < 0.0001). FMS monthly flares were progressively higher in FMS, FMS + M1 and FMS + M2 (p < 0.0001); most flares (86-87 %) occurred within 12 h from a migraine attack in co-morbid patients (p < 0.0001). Effective migraine prophylaxis vs no prophylaxis also produced a significant improvement of FMS symptoms (decreased monthly flares, increased pain thresholds)(0.0001 < p < 0.003). Co-morbidity between fibromyalgia and migraine involves heightened somatic hyperalgesia compared to one condition only. Increased migraine frequency - with shift towards chronicity - enhances both hyperalgesia and spontaneous FMS pain, which is reversed by effective migraine

  19. Subclinical vestibular dysfunction in migraine patients: a preliminary study of ocular and rectified cervical vestibular evoked myogenic potentials.

    PubMed

    Kim, Chul-Ho; Jang, Min-Uk; Choi, Hui-Chul; Sohn, Jong-Hee

    2015-01-01

    Many studies have identified various vestibular symptoms and laboratory abnormalities in migraineurs. Although the vestibular tests may be abnormal, the changes may exist without vestibular symptoms. To date, vestibular-evoked myogenic potential (VEMP) has been the easiest and simplest test for measuring vestibular function in clinical practice. Cervical VEMP (cVEMP) represents a vestibulo-collic reflex, whereas ocular VEMP (oVEMP) reflects a vestibulo-ocular pathway. Therefore, we determined whether ocular and rectified cervical VEMPs differed in patients with migraine or tension type headache (TTH) and compared the results to controls with no accompanying vestibular symptoms. The present study included 38 females with migraine without aura, 30 with episodic TTH, and 50 healthy controls without vestibular symptoms. oVEMP and cVEMP using a blood pressure manometer were recorded during a headache-free period. From the VEMP graphs, latency and amplitude parameters were analyzed, especially following EMG rectification in cVEMP. With respect to oVEMP, the migraine group exhibited significantly longer mean latencies of bilateral n1 and left p1 than the other groups (p < 0.05). Amplitudes of n1-p1 were lower than in other groups, but the difference did not reach statistical significance. In regards to cVEMP, p13 and n23 latencies and amplitudes after rectification did not differ significantly among groups. An abnormal interictal oVEMP profile was associated with subclinical vestibular dysfunction in migraineurs, suggesting pathology within the vestibulo-ocular reflex. oVEMP is a more reliable measure than cVEMP to evaluate vestibular function in migraineurs, although results from the two tests in patients with migraine are complementary.

  20. Effectiveness of ropivacaine trigger points inactivation in the prophylactic management of patients with severe migraine.

    PubMed

    García-Leiva, Juan M; Hidalgo, Javier; Rico-Villademoros, Fernando; Moreno, Vicente; Calandre, Elena P

    2007-01-01

    Tenderness and referred pain have been described in migraine and involved in its pathogenesis. The present study was performed to evaluate the prophylactic effectiveness of ropivacaine injections during a 12-week period. A total of 52 patients agreed to participate in the study. Trigger points were explored by manual palpation and injected weekly with 10 mg ropivacaine. The frequencies of migraine attacks were recorded from 4 weeks before the beginning of injections until 4 weeks after the last one, and a Clinical Global Impression improvement scale was completed in the final visit. All of the subjects had one or more trigger points, located in temporal and/or suboccipital areas in most of the cases. In nine (17.3%) patients the frequency of attacks was reduced >or=50%, and in 19 (36.5%) cases the reduction was comprised between 11% and 49%. A total of 31 (59.6%) patients reported to be much or very much improved after finishing the injection period. In 11 cases rescue medication intake was reduced >or=50% in comparison with baseline period, and the attacks of severe intensity decreased significantly. Eight (26.6%) out of 30 patients suffering chronic migraine reverted to episodic migraine. Local pain in injection sites was reported by 14 patients, and 13 subjects (25.5%) experienced postinjection soreness. Trigger points inactivation can be an effective palliative measure in the prophylactic management of severe refractory migraine.

  1. Frequency of Migraine as a Chief Complaint in Otolaryngology Outpatient Practice

    PubMed Central

    Muhammad Ali, Maria; Al Zayer, Maha

    2015-01-01

    Objective. To identify the frequency of typical (headache and dizziness) and common atypical (ear fullness, pressure, pain, tinnitus, facial fullness, and nasal congestion) migraine symptoms as chief complaints among patients presenting to otolaryngology clinic. Methods. This is a descriptive study of prospectively collected data from a general otolaryngology practice. Typical migraine presentations were diagnosed by applying international headache society (IHS) criteria for migraine headache and Neuhauser's criteria for migrainous vertigo. Atypical otologic and rhinologic migraine symptoms were diagnosed using individualized criteria. Charts were reviewed at 6-month interval from the first presentation. Results. Out of 1002 consecutive patients, 10.8% presented with “migrainous chief complaint.” All migrainous chief complaint patients had a history of headache but not all of them presented with headache. Corrected female to male ratio in the migraine group was 3 to 1; age distributions were significantly different between the migraine and nonmigraine groups by applying t-test. Out of the atypical complaints, 86% of the patients had a history of concomitant typical presentation. Conclusion. Actual diagnostic criteria for migraine do not satisfy the diversity of its presentation. Investigating the history of migraine is enough to diagnose most atypical presentations. Sound knowledge about migraine seems essential for any ENT practitioner. PMID:25695049

  2. The impacts of migraine and anxiety disorders on painful physical symptoms among patients with major depressive disorder

    PubMed Central

    2014-01-01

    Background No study has simultaneously investigated the impacts of migraine and anxiety disorders on painful physical symptoms (PPS) among patients with major depressive disorder (MDD). The study aimed to investigate this issue. Methods This open-label study enrolled 155 outpatients with MDD, who were then treated with venlafaxine 75 mg per day for four weeks. Eighty-five participants with good compliance completed the treatment. Migraine was diagnosed according to the International Classification of Headache Disorders. MDD and anxiety disorders were diagnosed using the Structured Clinical Interview for DSM-IV-TR. The visual analog scale (VAS) was used to evaluate the severity of eight PPS. Multiple linear and logistic regressions were used to investigate the impacts of migraine and anxiety disorders on PPS. Results Compared with patients without migraine, patients with migraine had a greater severity of PPS at baseline and post-treatment. After controlling for demographic variables and depressive severity, migraine independently predicted the intensities of eight PPS at baseline and four PPS post-treatment. Moreover, migraine independently predicted poorer treatment responses of chest pain and full remission of pains in the head, chest, neck and/or shoulder. Anxiety disorders predicted less full remission of pains in the abdomen and limbs. Conclusion Migraine and anxiety disorders have negative impacts on PPS among patients with MDD. Integrating the treatment of migraine and anxiety disorders into the management of depression might help to improve PPS and the prognosis of MDD. PMID:25382691

  3. The impacts of migraine and anxiety disorders on painful physical symptoms among patients with major depressive disorder.

    PubMed

    Hung, Ching-I; Liu, Chia-Yih; Chen, Ching-Yen; Yang, Ching-Hui; Wang, Shuu-Jiun

    2014-11-10

    No study has simultaneously investigated the impacts of migraine and anxiety disorders on painful physical symptoms (PPS) among patients with major depressive disorder (MDD). The study aimed to investigate this issue. This open-label study enrolled 155 outpatients with MDD, who were then treated with venlafaxine 75 mg per day for four weeks. Eighty-five participants with good compliance completed the treatment. Migraine was diagnosed according to the International Classification of Headache Disorders. MDD and anxiety disorders were diagnosed using the Structured Clinical Interview for DSM-IV-TR. The visual analog scale (VAS) was used to evaluate the severity of eight PPS. Multiple linear and logistic regressions were used to investigate the impacts of migraine and anxiety disorders on PPS. Compared with patients without migraine, patients with migraine had a greater severity of PPS at baseline and post-treatment. After controlling for demographic variables and depressive severity, migraine independently predicted the intensities of eight PPS at baseline and four PPS post-treatment. Moreover, migraine independently predicted poorer treatment responses of chest pain and full remission of pains in the head, chest, neck and/or shoulder. Anxiety disorders predicted less full remission of pains in the abdomen and limbs. Migraine and anxiety disorders have negative impacts on PPS among patients with MDD. Integrating the treatment of migraine and anxiety disorders into the management of depression might help to improve PPS and the prognosis of MDD.

  4. Contact lenses, migraine, and allodynia.

    PubMed

    Timucin, Ozgur Bulent; Karadag, Mehmet Fatih; Mehmet, Baykara

    2016-01-01

    Clinical trials and electrophysiologic studies demonstrated increased perceptual sensitivity in patients suffering from migraines. At least, one triggering factor is described in 85% of migraine patients. The aim of this report was to investigate the relationship between contact lens (CL) usage and migraine attacks in two cases. Two patients who were diagnosed with migraine reported that the frequency of migraine attacks increased after they switched to using CL with different base curves (BCs). These two patients, who began using CL with different BCs experienced discomfort and dryness of the eye. The ocular complaints were followed by migraine attacks. CL intolerance was also developed during migraine attack in one of the cases. The frequency of migraine attacks decreased and allodynia relieved significantly when flatter BCs were selected. CL related stimulus could have triggered the migraine attack. CLs should be well fitted in migraine patients with allodynia.

  5. Contact lenses, migraine, and allodynia

    PubMed Central

    Timucin, Ozgur Bulent; Karadag, Mehmet Fatih; Mehmet, Baykara

    2016-01-01

    Clinical trials and electrophysiologic studies demonstrated increased perceptual sensitivity in patients suffering from migraines. At least, one triggering factor is described in 85% of migraine patients. The aim of this report was to investigate the relationship between contact lens (CL) usage and migraine attacks in two cases. Two patients who were diagnosed with migraine reported that the frequency of migraine attacks increased after they switched to using CL with different base curves (BCs). These two patients, who began using CL with different BCs experienced discomfort and dryness of the eye. The ocular complaints were followed by migraine attacks. CL intolerance was also developed during migraine attack in one of the cases. The frequency of migraine attacks decreased and allodynia relieved significantly when flatter BCs were selected. CL related stimulus could have triggered the migraine attack. CLs should be well fitted in migraine patients with allodynia. PMID:27433037

  6. 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.

  7. Migraine and Meditation: Characteristics of Cortical Activity and Stress Coping in Migraine Patients, Meditators and Healthy Controls-An Exploratory Cross-Sectional Study.

    PubMed

    Keller, Armin; Meyer, Bianca; Wöhlbier, Hans-Georg; Overath, Claudia Helene; Kropp, Peter

    2016-09-01

    The aim of this exploratory cross-sectional study was to investigate the characteristics of cortical activity and stress coping in migraine patients, meditation experienced subjects, and healthy controls. 45 meditation experienced subjects, 46 migraine patients, and 46 healthy controls took part in the study. Cortical activity was measured with the contingent negative variation (CNV), a slow cortical event-related potential. Stress coping was examined with the standardized Stress Coping Questionnaire SVF-78. A one-way analysis of variance was used to investigate possible differences between the groups. CNV-amplitude was significantly higher in migraineurs than in controls. The meditators showed significantly lowest amplitudes. Migraine patients used negative stress-coping strategies significantly more often than meditators and healthy controls. Especially the application of the strategy "rumination" was most frequent in migraine patients and least frequent in meditators. Moreover, frequent rumination was significantly correlated with high CNV-amplitudes. Cortical and stress processing in people with meditation experience was improved compared to migraine patients and healthy controls.

  8. One-day behavioral intervention in depressed migraine patients: effects on headache.

    PubMed

    Dindo, Lilian; Recober, Ana; Marchman, James; O'Hara, Michael W; Turvey, Carolyn

    2014-03-01

    To determine whether a 1-day behavioral intervention, aimed at enhancing psychological flexibility, improves headache outcomes of migraine patients with comorbid depression. Migraine is often comorbid with depression, with each disorder increasing the risk for onset and exacerbation of the other. Managing psychological triggers, such as stress and depression, may result in greater success of headache management. Sixty patients with comorbid migraine and depression were assigned to a 1-day Acceptance and Commitment Training plus Migraine Education workshop (ACT-ED; N = 38) or to treatment as usual (TAU; N = 22). Patients completed a daily headache diary prior to, and for 3 months following, the intervention. Clinical variables examined included headache frequency/severity, medication use, disability, and visit to a health care professional. Comparisons were made between baseline findings and findings at the 3-month follow up. Participants assigned to the ACT-ED condition exhibited significant improvements in headache frequency, headache severity, medication use, and headache-related disability. In contrast, the TAU group did not exhibit improvements. The difference in headache outcomes between ACT-ED and TAU was not statistically significant over time (ie, the treatment by time interaction was nonsignificant). These results complement those of a previous report showing effects of ACT-ED vs TAU on depression and disability. A 1-day ACT-ED workshop targeting psychological flexibility may convey benefit for patients with comorbid migraine and depression.These pilot study findings merit further investigation using a more rigorously designed large-scale trial.

  9. Occipital sulci patterns in patients with schizophrenia and migraine headache using magnetic resonance imaging (MRI).

    PubMed

    Sulejmanpašić, Gorana; Suljić, Enra; Šabanagić-Hajrić, Selma

    2016-08-01

    Aim To examine the presence of morphologic variations of occipital sulci patternsin patients with schizophrenia and migraine headacheregarding gender and laterality using magnetic resonance imaging (MRI). Methods This study included 80 patients and brain scans were performed to analyze interhemispheric symmetry and the sulcal patterns of the occipital region of both hemispheres. Average total volumes of both hemispheres of the healthy population were used for comparison. Results There was statistically significant difference between subjects considering gender (p=0.012)with no difference regarding age(p=0.1821). Parameters of parieto-occipital fissure (p=0.0314), body of the calcarine sulcus (p=0.0213), inferior sagittal sulcus (p=0.0443), and lateral occipital sulcus (p=0.0411) showed statistically significant difference only of left hemisphere in male patients with schizophrenia with shallowerdepth of the sulcus. Conclusion Representation of neuroanatomical structures suggests the existence of structural neuroanatomic disorders with focal brain changes. Comparative analysis of occipital lobe and their morphologic structures (cortical dysmorphology) in patients with schizophreniausing MRI, according to genderindicates a significant cortical reduction in the left hemisphere only in the group of male patients compared to female patients and the control group. Copyright© by the Medical Assotiation of Zenica-Doboj Canton.

  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. Long-term outcomes of occipital nerve stimulation for chronic migraine: a cohort of 53 patients.

    PubMed

    Miller, Sarah; Watkins, Laurence; Matharu, Manjit

    2016-12-01

    Chronic migraine affects up to 2 % of the general population and has a substantial impact on sufferers. Occipital nerve stimulation has been investigated as a potentially effective treatment for refractory chronic migraine. Results from randomised controlled trials and open label studies have been inconclusive with little long-term data available. The long-term efficacy, functional outcome and safety of occipital nerve stimulation was evaluated in an uncontrolled, open-label, prospective study of 53 intractable chronic migraine patients. Fifty-three patients were implanted in a single centre between 2007 and 2013. Patients had a mean age of 47.75 years (range 26-70), had suffered chronic migraine for around 12 years and had failed a mean of 9 (range 4-19) preventative treatments prior to implant. Eighteen patients had other chronic headache phenotypes in addition to chronic migraine. After a median follow-up of 42.00 months (range 6-97) monthly moderate-to-severe headache days (i.e. days on which pain was more than 4 on the verbal rating score and lasted at least 4 h) reduced by 8.51 days (p < 0.001) in the whole cohort, 5.80 days (p < 0.01) in those with chronic migraine alone and 12.16 days (p < 0.001) in those with multiple phenotypes including chronic migraine. Response rate of the whole group (defined as a >30 % reduction in monthly moderate-to-severe headache days) was observed in 45.3 % of the whole cohort, 34.3 % of those with chronic migraine alone and 66.7 % in those with multiple headache types. Mean subjective patient estimate of improvement was 31.7 %. Significant reductions were also seen in outcome measures such as pain intensity (1.34 points, p < 0.001), all monthly headache days (5.66 days, p < 0.001) and pain duration (4.54 h, p < 0.001). Responders showed substantial reductions in headache-related disability, affect scores and quality of life measures. Adverse event rates were favourable with no episodes of

  12. Acupuncture modulates the abnormal brainstem activity in migraine without aura patients.

    PubMed

    Li, Zhengjie; Zeng, Fang; Yin, Tao; Lan, Lei; Makris, Nikos; Jorgenson, Kristen; Guo, Taipin; Wu, Feng; Gao, Yujie; Dong, Mingkai; Liu, Mailan; Yang, Jie; Li, Ying; Gong, Qiyong; Liang, Fanrong; Kong, Jian

    2017-01-01

    Migraine is a common neurological disease with a high prevalence and unsatisfactory treatment options. The specific pathophysiological mechanisms of migraine remain unclear, which restricts the development of effective treatments for this prevalent disorder. The aims of this study were to 1) compare the spontaneous brain activity differences between Migraine without Aura (MwoA) patients and healthy controls (HCs), using amplitude of low-frequency fluctuations (ALFF) calculation method, and 2) explore how an effective treatment (verum acupuncture) could modulate the ALFF of MwoA patients. One hundred MwoA patients and forty-six matched HCs were recruited. Patients were randomized to four weeks' verum acupuncture, sham acupuncture, and waiting list groups. Patients had resting state BOLD-fMRI scan before and after treatment, while HCs only had resting state BOLD-fMRI scan at baseline. Headache intensity, headache frequency, self-rating anxiety and self-rating depression were used for clinical efficacy evaluation. Compared with HCs, MwoA patients showed increased ALFF in posterior insula and putamen/caudate, and reduced ALFF in rostral ventromedial medulla (RVM)/trigeminocervical complex (TCC). After longitudinal verum acupuncture treatment, the decreased ALFF of the RVM/TCC was normalized in migraine patients. Verum acupuncture and sham acupuncture have different modulation effects on ALFF of RVM/TCC in migraine patients. Our results suggest that impairment of the homeostasis of the trigeminovascular nociceptive pathway is involved in the neural pathophysiology of migraines. Effective treatments, such as verum acupuncture, could help to restore this imbalance.

  13. 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.

  14. Association between serum levels of homocysteine with characteristics of migraine attacks in migraine with aura.

    PubMed

    Sadeghi, Omid; Maghsoudi, Zahra; Askari, Gholamreza; Khorvash, Fariborz; Feizi, Awat

    2014-11-01

    Evidences have shown that migraine with aura (MA) is associated with elevated homocysteine levels but, few studies have evaluated the relationship between homocysteine levels and characteristics of migraine attacks such as severity, frequency, duration and headache diary result (HDR). Thus, in this study, we investigated the association between homocysteine levels and characteristics of migraine attacks in patients with MA. This cross-sectional study was carried out in Isfahan city, Iran, in February 2013. Fasting serum levels of homocysteine were measured in 130 MA patients (31 males and 99 females) aged 15-60 years. Severity, frequency and duration of migraine attacks, as well as HDR, were determined in each patient according to international headache society criteria by a neurologist. Linear and ordinal logistic regression tests were used to evaluate the relationship between serum homocysteine levels and characteristics of migraine attacks. There is no significant association between serum levels of homocysteine with severity, frequency, duration and HDR. This association was not significant after adjustment of confounding variables such as age, body mass index (BMI) and family history of migraine. However, serum homocysteine levels were significantly associated with HDR among males after adjustment for age, BMI and family history of migraine (P = 0.01). Significant relationship between homocysteine levels and characteristics of migraine attacks such as severity, frequency, duration and HDR were not found. However, after adjustment of confounding variables, we found a significant positive relationship between homocysteine levels and HDR among men.

  15. Research note. Clinical reports and analysis of patients with clinical manifestations of migraine-like headache and unruptured aneurysm.

    PubMed

    Zhao, M

    2015-02-13

    A retrospective analysis of three cases of clinical manifestations of migraine-like headache, including clinical features, imaging findings, and follow-up results was done to explore the potential correlation between migraine and unruptured aneurysm. Clinical data and digital subtraction angiography (DSA) results were retrospectively analyzed. All three patients met the diagnostic criteria for migraine without aura stated in the second edition of the International Classification of Headache Disorders, established by the International Headache Society in 2004. The DSA results suggested that the aneurysms occurred in the anterior communicating artery (two cases) and in the internal carotid artery (one case); the migraine attacks disappeared after aneurysm embolization, with a follow-up time of 6, 10, and 16 months in the three cases, respectively. The pathogenesis of migraine is not fully understood; however, the potential correlation between migraine attack and unruptured saccular aneurysm needs attention, and the specific pathogenesis should be further investigated.

  16. 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.

  17. When cervical pain is actually migraine: An observational study in 207 patients.

    PubMed

    Viana, Michele; Sances, Grazia; Terrazzino, Salvatore; Sprenger, Till; Nappi, Giuseppe; Tassorelli, Cristina

    2016-12-07

    A large proportion of migraine patients remain undiagnosed or misdiagnosed in Italy. In our experience, many migraineurs self-diagnose their condition as "cervical pain attack" or "cervical pain syndrome" (CP), assuming cervical spine pathology as the cause. We aimed to phenotype and classify the headache of patients with self-diagnosed CP, and to describe this sample of patients. Consecutive patients aged 18 to 75 years, referred to the Headache Center of the Mondino Institute (Pavia, Italy) for a first visit for headache, completed a questionnaire about CP and were subsequently examined by an experienced clinician. Out of 207 patients, 132 (64%) believed they suffered from CP. According to ICHD-IIIβ criteria, these patients suffered from migraine or probable migraine in 91% of cases. The great majority of patients who believed that they suffered from CP underwent unnecessary medical exams (including radiation exposure in 40% of cases) and used treatments that were inadequate for their real diagnosis. The majority of patients with CP suffer from typical migraine. The misdiagnosis produces an economic burden (for patients and the health care system) and leads to impaired quality of life of patients. © International Headache Society 2016.

  18. Real-world economic impact of onabotulinumtoxinA in patients with chronic migraine.

    PubMed

    Rothrock, John F; Bloudek, Lisa M; Houle, Timothy T; Andress-Rothrock, Diane; Varon, Sepideh F

    2014-01-01

    To determine whether the utilization of healthcare resources is reduced after chronic migraine patients are treated for 6 months with onabotulinumtoxinA. OnabotulinumtoxinA is indicated for headache prophylaxis in patients with chronic migraine, but its effect on healthcare resource use is unknown. We analyzed data from an open-label study of 230 chronic migraine patients refractory to ≥2 oral prophylactics who presented to a headache specialty clinic and who were treated with two cycles of onabotulinumtoxinA. Frequency and cost of migraine-related healthcare resource use, including visits to emergency departments, urgent care, or hospitalization, were compared for the 6 months before and after initial treatment. Costs were based on publicly available sources. Compared with the 6 months predating initial treatment, patients had 55% fewer emergency department visits (174 vs 385), 59% fewer urgent care visits (61 vs 150), and 57% fewer hospitalizations (19 vs 45) during the 6-month treatment period (P < .01 for all). Analysis of treatment-related costs yielded an average reduction of $1219.33/patient, off-setting 49.7% of the total estimated cost for 6 months of treatment with onabotulinumtoxinA. Although we are unable to distinguish onabotulinumtoxinA's treatment effect from other potential confounding variables, our analysis showed that severely afflicted, treatment-refractory patients with chronic migraine experienced a significant cost-offset through reduced migraine-related emergency department visits, urgent care visits, and hospitalizations in the 6 months following treatment initiation of onabotulinumtoxinA. Future analyses will assess the longer-term effect of onabotulinumtoxinA treatment and the potential contribution of regression to the mean. © 2014 The Authors. Headache published by Wiley Periodicals, Inc. on behalf of American Headache Society.

  19. Randomised, controlled blink reflex in patients with migraine and tension type headache.

    PubMed

    Yildirim, Gökhan; Sayin, Refah; Cögen, Etem Emre; Odabas, Faruk Omer; Tombul, Temel

    2011-10-01

    To investigate the latencies, amplitudes of R1, R2i and R2k responses and R2 habituation; to compare the groups with each other and with the placebo group and to demonstrate new evidences on migraine and tension-type headache TTH mechanisms. This analytical study was carried out among 40 migraine patients who were admitted to Yuzuncu Yil University, Medical Faculty, Neurology Clinics between May 2009 and December 2009, with or without aura according to the diagnostic criteria of International Headache Society 2004 classification. Forty TTH patients, who were diagnosed with TTH were included, and 40 control group subjects were formed according to the same demographic data. SPSSv13 was used for Chi-square test, one-way ANOVA and Pearson correlation coefficients was used for the determination of the relation between the groups and categorical. Mean age was 33.04 +/- 9.07 years. An average of RR2k latency was significantly high in migraine group comparing with TTH and the control groups, and in TTH group comparing with the control group. Similarly, the average of LR2k latency was found to be significantly higher in migraine group than TTH and the control groups, and significantly higher in TTH group than the control group. Our findings demonstrated that brainstem and trigeminovascular connections play an important role in migraine pathogenesis and that central mechanisms play a role in TTH and concerning these two diseases.

  20. 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

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

    PubMed

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

    2016-01-01

    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. To determine if DFN-11 autoinjector can be used correctly and safely by migraine patients. 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. 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. 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.

  2. 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

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

    PubMed

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

    2016-01-01

    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. 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. 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. Our study shows that add on hydrotherapy enhanced the vagal tone in addition to reducing the frequency and intensity of headaches in migraine patients.

  4. Efficacy and pharmacokinetic activity of frovatriptan compared to rizatriptan in patients with moderate-to-severe migraine.

    PubMed

    Savi, Lidia; Mogavero, Selene; Egan, Colin Gerard

    2014-01-01

    Migraine is a painful neurological disorder that affects over 10% of the general population. Frovatriptan and rizatriptan are antimigraine agents belonging to the triptan class. Although previous studies have independently compared the efficacy of these agents, contemporaneous data examining both pharmacokinetic (PK) properties and efficacy in parallel have not previously been available. In this single-center double-blind study, 18 subjects (ten female) were treated for a single migraine attack with frovatriptan 2.5 mg or rizatriptan 10 mg. Plasma concentrations were measured predose and at 2, 4, 6, 12, 24, 48, and 72 hours after drug administration. The primary end point of this study was to evaluate the association between PK parameters and efficacy measures and recurrence rate. Secondary end points were pain-free and pain-relief episodes at 2 and 4 hours, recurrent episodes within 48 hours, and cumulative hazard of recurrence within 72 hours. At baseline, approximately 17% of patients had mild migraine, while 83% had moderate-severe migraine. Although the time to maximum concentration was similar for both drugs (2.7 versus 2.3 hours), the terminal half-life for frovatriptan was longer than rizatriptan (29.3 versus 3.2 hours, P<0.0001). The proportion of patients who were pain-free at 4 hours without rescue medication was higher in the frovatriptan-treated group, (38.9 versus 5.6%, P=0.045). The cumulative hazard of recurrence over 72 h was reduced by frovatriptan compared to rizatriptan-treated patients (log-rank test, P=0.04). Pain-free and pain-relief episodes for the study period were positively correlated with the concentration:maximum concentration (Cmax) ratio for frovatriptan (r=0.52, P=0.028), but not rizatriptan. Recurrence rate was negatively correlated with the concentration:Cmax ratio for both frovatriptan (r=-0.96, P=0.0024) and rizatriptan (r=-0.98, P=0.0004). Fewer adverse events were observed for frovatriptan compared to rizatriptan (one versus

  5. Efficacy and pharmacokinetic activity of frovatriptan compared to rizatriptan in patients with moderate-to-severe migraine

    PubMed Central

    Savi, Lidia; Mogavero, Selene; Egan, Colin Gerard

    2014-01-01

    Background Migraine is a painful neurological disorder that affects over 10% of the general population. Frovatriptan and rizatriptan are antimigraine agents belonging to the triptan class. Although previous studies have independently compared the efficacy of these agents, contemporaneous data examining both pharmacokinetic (PK) properties and efficacy in parallel have not previously been available. Materials and methods In this single-center double-blind study, 18 subjects (ten female) were treated for a single migraine attack with frovatriptan 2.5 mg or rizatriptan 10 mg. Plasma concentrations were measured predose and at 2, 4, 6, 12, 24, 48, and 72 hours after drug administration. The primary end point of this study was to evaluate the association between PK parameters and efficacy measures and recurrence rate. Secondary end points were pain-free and pain-relief episodes at 2 and 4 hours, recurrent episodes within 48 hours, and cumulative hazard of recurrence within 72 hours. Results At baseline, approximately 17% of patients had mild migraine, while 83% had moderate–severe migraine. Although the time to maximum concentration was similar for both drugs (2.7 versus 2.3 hours), the terminal half-life for frovatriptan was longer than rizatriptan (29.3 versus 3.2 hours, P<0.0001). The proportion of patients who were pain-free at 4 hours without rescue medication was higher in the frovatriptan-treated group, (38.9 versus 5.6%, P=0.045). The cumulative hazard of recurrence over 72 h was reduced by frovatriptan compared to rizatriptan-treated patients (log-rank test, P=0.04). Pain-free and pain-relief episodes for the study period were positively correlated with the concentration:maximum concentration (Cmax) ratio for frovatriptan (r=0.52, P=0.028), but not rizatriptan. Recurrence rate was negatively correlated with the concentration:Cmax ratio for both frovatriptan (r=−0.96, P=0.0024) and rizatriptan (r=−0.98, P=0.0004). Fewer adverse events were observed for

  6. 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.

  7. 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:…

  8. 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:…

  9. Interictal photosensitivity associates with altered brain structure in patients with episodic migraine.

    PubMed

    Chong, Catherine D; Starling, Amaal J; Schwedt, Todd J

    2016-05-01

    Migraine attacks manifest with hypersensitivities to light, sound, touch and odor. Some people with migraine have photosensitivity between migraine attacks, suggesting persistent alterations in the integrity of brain regions that process light. Although functional neuroimaging studies have shown visual stimulus induced "hyperactivation" of visual cortex regions in migraineurs between attacks, whether photosensitivity is associated with alterations in brain structure is unknown. Levels of photosensitivity were evaluated using the Photosensitivity Assessment Questionnaire in 48 interictal migraineurs and 48 healthy controls. Vertex-by-vertex measurements of cortical thickness were assessed in 28 people with episodic migraine who had interictal photosensitivity (mean age = 35.0 years, SD = 12.1) and 20 episodic migraine patients without symptoms of interictal photosensitivity (mean age = 36.0 years, SD = 11.4) using a general linear model design. Migraineurs have greater levels of interictal photosensitivity relative to healthy controls. Relative to migraineurs without interictal photosensitivity, migraineurs with interictal photosensitivity have thicker cortex in several brain areas including the right lingual, isthmus cingulate and pericalcarine regions, and the left precentral, postcentral and supramarginal regions. Episodic migraineurs with interictal photosensitivity have greater cortical thickness in the right parietal-occipital and left fronto-parietal regions, suggesting that persistent light sensitivity is associated with underlying structural alterations. © International Headache Society 2015.

  10. 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.

  11. Genetic Contribution of Catechol-O-methyltransferase Polymorphism in Patients with Migraine without Aura

    PubMed Central

    Park, Jeong Wook; Kim, Joong Seok; Kim, Yeong In; Shin, Hae Eun

    2007-01-01

    Background Recent genetic association studies have investigated the possible genetic role of the dopaminergic system in migraine. Catechol-O-methyltransferase (COMT) is an enzyme that plays a crucial role in the metabolism of dopamine and its genetic polymorphism is associated with three- to fourfold variation of enzymatic activity. Objectives The objective of this study was to elucidate the role of the COMT polymorphism in the genetic susceptibility to migraine and its phenotypic expression in patients with migraine without aura (MWOA). Methods Ninety-seven patients with MWOA and 94 healthy volunteers were included in the study. After amplifying COMT genes by the polymerase chain reaction, we assessed their genotype frequencies and allele distributions by based on restriction fragment length polymorphisms. We classified all MWOA patients into two groups according to their COMT genotype: with the L allele (N = 43), and without this allele (N = 54). Results The genotype frequency and allele distribution of the COMT polymorphism did not differ between MWOA patients and the control group. During migraine attacks, MWOA patients with the L allele showed a higher pain intensity of headache (P = 0.001) and a higher incidence of the accompanying nausea/vomiting (94% vs 75%; P = 0.026) compared with MWOA patients without the L allele. Conclusions Although the COMT polymorphism does not appear to be involved in predisposition to the development of MWOA, this genetic factor could be involved in the phenotypic expression of MWOA. PMID:19513339

  12. Delivery Outcomes of Patients with Acute Migraine in Pregnancy: A Retrospective Study.

    PubMed

    Grossman, Tracy B; Robbins, Matthew S; Govindappagari, Shravya; Dayal, Ashlesha K

    2017-04-01

    To describe labor and delivery outcomes in pregnant patients presenting to the hospital setting with an acute severe migraine headache attack earlier in the same gestation. We retrospectively reviewed pregnancy and delivery records from a database of consecutive inpatient neurology consultations for acute headache in pregnant women over a 5 year period. We identified 86 pregnant women with acute migraine. The mean age was 29.3 (±6.4) years. Nearly half had migraine with aura (35/86 [40.7%]), 12.8% (12/86) had chronic migraine, and 31.4% (27/86) presented in status migrainosus. Complication rates included 54.7%([41/75], 95% CI 29.87, 52.13) for at least one adverse outcome, 28.0% ([21/75], 95% CI 11.78, 30.22) for preterm delivery, 21.3% ([16/75], 95% CI 7.7, 24.3) for preeclampsia, 30.6% ([23/75] 95% CI 13.48, 32.52) for cesarean delivery, and 18.7% ([14/75] 95% CI 6.15, 21.85) for low birthweight. Pregnant women seeking treatment for acute migraine headache experienced a higher rate of preterm delivery, preeclampsia, and low birthweight but a lower rate of cesarean delivery than the local and general populations. More than half (54.7% [41/75] 95% CI 29.87, 52.13) of the study patients experienced some type of adverse birth outcome, suggesting that pregnancies in migraine patients presenting to an acute care setting may benefit from more intense surveillance. © 2017 American Headache Society.

  13. Electron Microscopic and Proteomic Comparison of Terminal Branches of the Trigeminal Nerve in Patients with and without Migraine Headaches

    PubMed Central

    Guyuron, Bahman; Yohannes, Elizabeth; Miller, Robert; Chim, Harvey; Reed, Deborah; Chance, Mark R.

    2015-01-01

    Background The purpose of this study was to compare the ultrastructural appearance and protein expression of the zygomaticotemporal branch of the trigeminal nerve in patients with and without migraine headaches. Methods After confirmation of migraine headache diagnosis on 15 patients, a 5-mm segment of the zygomaticotemporal branch of the trigeminal nerve that is routinely removed during migraine surgery was compared to similarly sized nerve segments obtained from 15 control patients without a history of migraine headaches, who underwent an endoscopic forehead lift where this nerve is routinely transected. The segments were snap-frozen at −80°C for the downstream proteomics analysis. In addition, the cytoarchitectural differences of the nerve segments obtained from the 15 migraine and 15 control subjects were examined in detail under the electron microscope. Results Analysis of liquid chromatography/tandem mass spectrometry data sets identified differentially expressed proteins and networks composed of highly connected molecular modules (p = 10−44 and p = 10−34) in patients with migraine headaches. The nerves from patients with migraine headaches had a linear organization, disrupted myelin sheaths and target axons, and discontinuous neurofilaments that were poorly registered with the discontinuous myelin sheaths, suggesting axonal abnormality. Conclusions This study offers electron microscopic and proteomic evidence of axonal abnormality and deregulation of the myelination process in patients with migraine headaches compared with controls, offering the first objective evidence to support the role of peripheral mechanisms in the migraine headache cascade and an explanation as to why the surgical treatment of migraine headaches is efficacious. PMID:25347655

  14. Refractory migraine in a headache clinic population.

    PubMed

    Irimia, Pablo; Palma, Jose-Alberto; Fernandez-Torron, Roberto; Martinez-Vila, Eduardo

    2011-08-01

    Many migraineurs who seek care in headache clinics are refractory to treatment, despite advances in headache therapies. Epidemiology is poorly characterized, because diagnostic criteria for refractory migraine were not available until recently. We aimed to determine the frequency of refractory migraine in patients attended in the Headache Unit in a tertiary care center, according to recently proposed criteria. The study population consisted of a consecutive sample of 370 patients (60.8% females) with a mean age of 43 years (range 14-86) evaluated for the first time in our headache unit over a one-year period (between October 2008 and October 2009). We recorded information on clinical features, previous treatments, Migraine Disability Assessment Score (MIDAS), and final diagnosis. Overall migraine and tension-type headache were found in 46.4% and 20.5% of patients, respectively. Refractory migraine was found in 5.1% of patients. In refractory migraineurs, the mean MIDAS score was 96, and 36.8% were medication-overusers. Refractory migraine is a relatively common and very disabling condition between the patients attended in a headache unit. The proposed operational criteria may be useful in identifying those patients who require care in headache units, the selection of candidates for combinations of prophylactic drugs or invasive treatments such as neurostimulation, but also to facilitate clinical studies in this patient group.

  15. 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.

  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. 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

  18. Endothelial function in patients with migraine during the interictal period.

    PubMed

    Silva, Federico A; Rueda-Clausen, Christian F; Silva, Sandra Y; Zarruk, Juan G; Guzmán, Juan C; Morillo, Carlos A; Vesga, Boris; Pradilla, Gustavo; Flórez, Mildred; López-Jaramillo, Patricio

    2007-01-01

    The aim of this study is to evaluate endothelial function in migraineurs subjects during the asymptomatic period. Migraine has been proposed as a risk factor for cerebrovascular events. The underlying mechanisms that relate these 2 pathologies are unknown. Nitric oxide (NO) has been proposed as the final causative molecule of migraine. Increased NO metabolites concentrations have been reported in migraineurs subjects during acute migraine attacks, but there is no evidence indicating alterations in endothelial NO release during the symptom free period in theses subjects. Fifty migraineurs subjects and 25 healthy subjects matched by gender and age were included. Every subject underwent a complete examination that included medical history, physical examination, resting electrocardiogram, forearm flow-mediated vasodilation (FMD), blood determinations of fasting nitrates and nitrites (NO(2) (-)+ NO(3) (-)), glucose, lipid profile, creatinine, C-reactive protein, and blood cell count. No differences in FMD or NO(2) (-)+ NO(3) (-) were detected among groups. The only difference between migraineurs and control subjects was a higher mean blood pressure 92.1 (8.8) mmHg versus 86.7 (8.2) mmHg P= .01. The endothelial function is not altered during the interictal period in migraineurs subjects.

  19. Relationship between white matter hyperintensities and retinal nerve fiber layer, choroid, and ganglion cell layer thickness in migraine patients.

    PubMed

    Iyigundogdu, Ilkin; Derle, Eda; Asena, Leyla; Kural, Feride; Kibaroglu, Seda; Ocal, Ruhsen; Akkoyun, Imren; Can, Ufuk

    2017-01-01

    Aim To compare the relationship between white matter hyperintensities (WMH) on brain magnetic resonance imaging and retinal nerve fiber layer (RNFL), choroid, and ganglion cell layer (GCL) thicknesses in migraine patients and healthy subjects. We also assessed the role of cerebral hypoperfusion in the formation of these WMH lesions. Methods We enrolled 35 migraine patients without WMH, 37 migraine patients with WMH, and 37 healthy control subjects examined in the Neurology outpatient clinic of our tertiary center from May to December 2015. RFNL, choroid, and GCL thicknesses were measured by optic coherence tomography. Results There were no differences in the RFNL, choroid, or GCL thicknesses between migraine patients with and without WMH ( p > 0.05). Choroid layer thicknesses were significantly lower in migraine patients compared to control subjects ( p < 0.05), while there were no differences in RFNL and GCL thicknesses ( p > 0.05). Conclusions The 'only cerebral hypoperfusion' theory was insufficient to explain the pathophysiology of WMH lesions in migraine patients. In addition, the thinning of the choroid thicknesses in migraine patients suggests a potential causative role for cerebral hypoperfusion and decreased perfusion pressure of the choroid layer.

  20. [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.

  1. Meeting patient expectations in migraine treatment: what are the key endpoints?

    PubMed

    Antonaci, Fabio; Sances, Grazia; Guaschino, Elena; De Cillis, Ilaria; Bono, Giorgio; Nappi, Giuseppe

    2008-08-01

    Clinical outcomes of migraine treatment are generally based on two major endpoints: acute pain resolution and effects on quality of life (QOL). Resolution of acute pain can be evaluated in a number of ways, each increasingly challenging to achieve; pain relief, pain freedom at 2 h, sustained pain-freedom, and SPF plus no adverse events (SNAE, the most challenging). QOL questionnaires help assess the burden of migraine and identify optimal treatments. Pain resolution and improved QOL form the basis of the ultimate target-meeting patient expectations, to achieve patient satisfaction. To achieve this, it is crucial to choose appropriate endpoints that reflect realistic treatment goals for individual patients. Moreover, SNAE can help discriminate between triptans, with almotriptan having the highest SNAE score. Kaplan-Meier plots are also relevant when evaluating migraine treatments. The use of symptomatic medication may lead to the paradoxical development of medication-overuse headache. In general practice, patients should use simple tools for pain measurement (e.g. headache diary) and a QOL questionnaire. A composite endpoint of pain resolution and QOL restoration would constitute a step forward in migraine management.

  2. Differences in Topographical Pressure Pain Sensitivity Maps of the Scalp Between Patients With Migraine and Healthy Controls.

    PubMed

    Barón, Johanna; Ruiz, Marina; Palacios-Ceña, María; Madeleine, Pascal; Guerrero, Ángel L; Arendt-Nielsen, Lars; Fernández-de-Las-Peñas, César

    2017-02-01

    To investigate differences in topographical pressure pain sensitivity maps of the scalp between patients with migraine and healthy controls considering the chronicity (episodic/chronic) and side (strictly unilateral/bilateral) of the symptoms. It seems that the trigeminal area is sensitized in migraine. No study has investigated topographical pressure sensitivity maps of the scalp in patients with migraine. Pressure pain thresholds (PPTs) were assessed from 21 points distributed over the scalp in 86 patients with episodic migraine, 76 with chronic migraine, and 42 healthy age and matched healthy controls in a blinded design. Topographical pressure pain sensitivity maps based on interpolation of the PPTs were constructed. Clinical features of migraine, anxiety, and depression (Hospital Anxiety and Depression Scale, HADS) were collected. The multivariate ANCOVA revealed significant differences in PPT between points (F = 55.674; P < .001) and groups (F = 5.316; P = .006), but not sides (F = 0.880; P = .417). No significant effect of gender (F = 0.897; P = .656), depression (F = 1.109; P = .220), or anxiety (F = 0.981; F = 0.569) was found. Post hoc comparisons revealed: (1) lower PPTs in both migraine groups than in healthy controls in all points (P < .001); (2) no significant differences between chronic or episodic migraine (P > .335) except for Fp1 (P = .045) and Fp2 (P = .017) points where subjects with chronic migraine had lower PPTs than those with episodic migraine; (3) no differences between bilateral/unilateral migraine (P > .417). An anterior to posterior gradient was found, with the lowest PPTs located in frontal regions and the highest PPTs in occipital areas (all groups, P < .001). We found that patients with migraine exhibited generalized pressure pain hypersensitivity in the head as compared to healthy controls and that hypersensitivity was similar between episodic/chronic and

  3. Generalized mechanical pain sensitivity over nerve tissues in patients with strictly unilateral migraine.

    PubMed

    Fernández-de-las-Peñas, César; Arendt-Nielsen, Lars; Cuadrado, María Luz; Pareja, Juan A

    2009-06-01

    No study has previously analyzed pressure pain sensitivity of nerve trunks in migraine. This study aimed to examine the differences in mechanical pain sensitivity over specific nerves between patients with unilateral migraine and healthy controls. Blinded investigators assessed pressure pain thresholds (PPT) over the supra-orbital nerves (V1) and peripheral nerve trunks of both upper extremities (median, radial, and ulnar nerves) in 20 patients with strictly unilateral migraine and 20 healthy matched controls. Pain intensity after palpation over both supra-orbital nerves was also assessed. A pressure algometer was used to quantify PPT, whereas a 10-point numerical pain rate scale was used to evaluate pain to palpation over the supra-orbital nerve. The analysis of covariance revealed that pain to palpation over the supra-orbital nerve was significantly higher (P<0.001) on the symptomatic side (mean: 3.4, SD: 1.5) as compared with the nonsymptomatic side (mean: 0.5, SD: 1.2) in patients with migraine and both the dominant (mean: 0.2, SD: 0.4) and nondominant (mean: 0.3, SD: 0.5) sides in healthy controls. PPT assessed over the supra-orbital nerve on the symptomatic side (mean: 1.05, SD: 0.2 kg/cm) was significantly lower (P<0.05) than PPT measurements on the nonsymptomatic side (mean: 1.35, SD: 0.3 kg/cm) and either the dominant (mean: 1.9, SD: 0.2 kg/cm) or nondominant (mean: 1.9, SD: 0.3 kg/cm) sides in controls (P<0.001). Finally, PPT assessed over the median, ulnar, and radial nerves were significantly lower in patients with migraine as compared with controls (P<0.001), without side-to-side differences (P>0.6). In patients with unilateral migraine, we found increased mechano-sensitivity of the supra-orbital nerve on the symptomatic side of the head. Outside the head, the same patients showed increased mechano-sensitivity of the main peripheral nerves of both upper limbs, without asymmetries. Such diffuse hypersensitivity of the peripheral nerves lends further

  4. Transient Splenial Lesion of the Corpus Callosum Related to Migraine with Aura in a Pediatric Patient.

    PubMed

    Ünver, Olcay; Kutlubay, Büşra; Besci, Tolga; Ekinci, Gazanfer; Baltacıoğlu, Feyyaz; Türkdoğan, Dilşad

    Transient splenial lesions of the corpus callosum are rare radiological findings first described in association with epilepsy, antiepileptic drugs and viral encephalitis. However, subsequently more cases were described associated with diverse clinical conditions. We describe a 13-year-old girl suffering from migraine with aura presenting with headache, right-sided hemiparesis and encephalopathy. Brain magnetic resonance imaging revealed an ovoid lesion in the splenium of the corpus callosum. The patient's neurological symptoms resolved within 3 days without therapy and the lesion disappeared in follow up magnetic resonance images obtained 3 weeks after the onset of the symptoms. Migraine with aura was considered to be the cause of the lesion. To our knowledge the present case is the first report of a pediatric patient with a diagnosis of migraine with aura presenting with hemiparesis and encephalopathy. A diagnosis of transient lesion of the corpus callosum should be suspected in patients with migraine with aura presenting with hemiparesis and encephalopathy. A mild course and a good prognosis might be expected in the presence of a splenial lesion of the corpus callosum.

  5. 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.

  6. 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.

  7. 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.

  8. Treatment response and tolerability of frovatriptan in patients reporting short- or long-duration migraines at baseline.

    PubMed

    Kelman, Leslie; Harper, Samira Q; Hu, Xiaojun; Campbell, John C

    2010-09-01

    Compare migraine duration with frovatriptan (versus baseline) in migraineurs reporting long- (24-72 h) or short-duration (<24 h) migraines at baseline. Post hoc analysis of two postmarketing surveillance studies of migraineurs in German primary care clinics using frovatriptan (2.5 mg) to treat a single migraine attack. Using case-report forms, physicians recorded migraine characteristics at baseline (aura, duration, frequency, severity) and with frovatriptan (duration, severity, and recurrence). Patients and physicians rated frovatriptan effectiveness and tolerability versus previous therapy; physicians recorded adverse reactions. The primary analysis was change in migraine duration with frovatriptan versus baseline. At baseline, 44.2% (7178/16 253) and 55.8% (9075/16 253) of patients reported short- and long-duration migraines, respectively; long-duration migraines were more often frequent (> or =3/months; 55.5% [4893/8811] vs. 30.6% [2132/6973]; p < 0.001; 95% CI, 23.5-26.5%), severe (61.7% [5584/9047] vs. 33.9% [2427/7156]; p < 0.001; 95% CI, 26.3-29.3%), and accompanied by aura (46.8% [4199/8977] vs. 31.3% [2215/7088]; p < 0.001; 95% CI, 14.0-17.0%). Mean (SD) onset of frovatriptan effect was <1 h; 72.3% (11 592/16 040) of patients required only one frovatriptan tablet. With frovatriptan, patients were 26.8-fold more likely to experience decreased versus increased headache duration (p < 0.001; 95% CI, 23.5-30.2) and 76.5% of patients reporting long-duration migraines at baseline experienced short-duration migraines. Most patients (87-90%) and physicians (70-75%) rated frovatriptan more effective and tolerable than previous therapies. Patients with more severe migraine characteristics at baseline were more likely to have attacks lasting > or =24 h. When using frovatriptan, patients were 26.8-fold more likely to experience decreased versus increased headache duration. Frovatriptan might be a good option for patients with long-duration or recurrent migraine

  9. Childhood trauma and dissociation in tertiary care patients with migraine and tension type headache: a controlled study.

    PubMed

    Kucukgoncu, Suat; Yildirim Ornek, Feride; Cabalar, Murat; Bestepe, Emrem; Yayla, Vildan

    2014-07-01

    The aims of this study were: i) to compare the severity of somatoform and psychoform dissociation and childhood trauma among migraine patients, tension-type headache patients (TTH), and healthy controls; and, ii) to identify any relationships between headache characteristics and dissociative symptoms and traumatic childhood experiences among tertiary care patients with headache. The study sample consisted of 79 patients with migraine, 49 patients with TTH and 40 healthy controls. They completed the socio-demographic form, Childhood Trauma Questionnaire (CTQ), Dissociative Experiences Scale (DES), and the Somatoform Dissociation Questionnaire (SDQ). The average score for childhood emotional abuse was significantly higher in the TTH and migraine patients than in healthy controls; mean scores for emotional neglect and physical abuse were higher in TTH patients than healthy controls; and the total CTQ score was higher in TTH patients than in either migraine patients or healthy controls. Average DES scores were significantly higher in TTH patients versus migraine patients and controls; and SDQ scores were higher in both headache groups than in controls. Headache duration and severity were found to be significantly related to childhood abuse scores among migraine but not TTH patients. Our findings support the evidence of a relationship between childhood trauma and migraines, and suggest that childhood traumatic events are common and deleteriously effect migraine characteristics. Also our study suggests that childhood trauma may have a role in TTH. Significant differences in the DES and SDQ scores between groups may be explained by the differences in childhood trauma experiences. Copyright © 2014 Elsevier Inc. All rights reserved.

  10. Increased prevalence of migraine in Marfan syndrome.

    PubMed

    Vis, Jeroen C; Timmermans, Janneke; Post, Martijn C; Budts, Werner; Schepens, Marc A A M; Thijs, Vincent; Schonewille, Wouter J; de Bie, Rob M A; Plokker, Herbert W M; Tijssen, Jan G P; Mulder, Barbara J M

    2009-08-21

    A high prevalence of migraine has been described in various forms of congenital heart disease, with and without shunt. In this study we investigated the prevalence of migraine in patients with Marfan syndrome (MFS). All 457 adult patients with MFS from the participating centres and 194 controls received a validated questionnaire about headache. Migraine was diagnosed according to the International Headache Society criteria, by three independent neurologists, blinded to patient files. Response rate was 68% and 56% in Marfan patients and controls, respectively. Forty percent of the 309 responding MFS patients (mean age 40+/-14 years; 51% females) and 28% of the 102 controls (mean age 43+/-15 years; 58% females), suffered from migraine (p=0.03). The prevalence of migraine with aura (MA) was 22% in MFS patients and 14% in controls (p=0.06). We found MFS to be an independent risk factor for having overall migraine (OR 1.7; 95%CI 1.1-2.8), also after adjustment for age and gender (OR 1.9; 95%CI 1.1-3.1; p=0.02) and for MA after adjustment for gender (OR 2.0; 95%CI 1.1-3.7; p=0.04). In patient with MFS, previous aortic root surgery appeared to be an independent risk factor for having MA (OR 2.2; 95%CI; 1.2.-4.0, p=0.01) adjusted for gender. MFS is an independent risk factor for having overall migraine and MA. Moreover, we found that a history of aortic root surgery seems to be associated with an increased risk of MA.

  11. 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

  12. [Migraine as predictive factor of the presence of atrial septum aneurysm in patients with stroke and patent foramen ovale].

    PubMed

    Martín Balbuena, S; Fuentes, B; Lara, M; Ortega-Casarrubios, M A; Martínez, P; Díez-Tejedor, E

    2009-04-01

    Ischemic stroke in young patients is associated in up to 30% of cases to a patent foramen ovale (PFO) with or without atrial septum aneurism (ASA). Besides, a frequent association between migraine and PFO has been described, but few studies have addressed the possible association between ASA and migraine in stroke patients. Observational study with inclusion of consecutive ischemic stroke patients in a Stroke Unit Data Bank of the Department of Neurology of a university hospital admitted between January 1994 and December 2005. Those patients who underwent transesophageal echocardiography (TEE) were selected and classified in two groups regarding the history of previous migraine. Logistic regression analysis models were developed to assess the risk of the combination of PFO and ASA in patients with migraine. 631 stroke patients with TEE were included. PFO was present in 61 patients (9.7%), isolated ASA in 34 (5.4%) and both abnormalities in 22 (3.49%). Patients with migraine and PFO had higher frequency of ASA than those with PFO and no migraine (75 vs 30.2%), and the relative risk to carry double interatrial septal abnormalities was 2.5 (95% confidence interval: 1.4-4.4). In the subgroup of patients under 55 years old, migraine history was associated to a nine-folder relative risk of carrying this combination, independently of age or gender. In patients with ischemic stroke and PFO the probability of having ASA could be higher in migrainous. This finding could have diagnostic implications, suggesting the convenience to seek for this association in these patients.

  13. The effects of folic acid and pyridoxine supplementation on characteristics of migraine attacks in migraine patients with aura: A double-blind, randomized placebo-controlled, clinical trial.

    PubMed

    Askari, Gholamreza; Nasiri, Morteza; Mozaffari-Khosravi, Hassan; Rezaie, Masod; Bagheri-Bidakhavidi, Mahdieh; Sadeghi, Omid

    2017-06-01

    The aim of this study was to assess the effects of folic acid alone and in combination with pyridoxine on characteristics of migraine attacks in adult migraine patients with aura. This double-blind, randomized placebo-controlled, clinical trial was conducted on 95 migraine patients with aura (age range 18-65 y) in Isfahan, Islamic Republic of Iran, in 2014. Patients were randomly allocated to receive folic acid (5 mg/d) plus pyridoxine (80 mg/d) or folic acid alone (5 mg/d) or placebo (lactose) for 3 mo. Characteristics of migraine attacks including headache severity, attacks frequency, duration, and headache diary results (HDRs) were obtained for each patient at baseline and at the end of the study. Folic acid plus pyridoxine intake resulted in a significant decrease compared with placebo in headache severity (-2.71 ± 0.08 versus -2.19 ± 0.05; P < 0.001), attack frequency (-3.35 ± 0.09 versus -2.73 ± 0.05; P < 0.001), duration (-7.25 ± 0.17 versus -6.5 ± 0.07; P < 0.001), and HDR (-74.15 ± 0.2 versus -72.73 ± 0.1; P < 0.001). Additionally, the reduction in these characteristics of migraine attacks in the folic acid plus pyridoxine group was significant compared with the group given folic acid alone (P < 0.001). However, these beneficial effects of the combined supplement became nonsignificant for attack duration compared with the folic acid-only and placebo groups after controlling for confounders. Folic acid intake without pyridoxine did not lead to a significant decrease in characteristics of migraine attacks compared with placebo group. Supplementation of folic acid with pyridoxine could decrease the characteristics of migraine attacks including headache severity, attack frequency, and HDR; however, further studies are needed to shed light on the findings of the present study. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. 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. Copyright © 2012 Elsevier B.V. All rights reserved.

  15. The presenting and prescribing patterns of migraine in an Australian emergency department: A descriptive exploratory study.

    PubMed

    Shao, Emily; Hughes, James; Eley, Rob

    2017-01-01

    Migraine is a common neurological condition that frequently presents to the emergency department (ED). Many medications are available to treat migraine. This study aims to characterize the demographics of patients who present to a large metropolitan ED with migraine, and to identify the medications used in treating this condition. This study is a retrospective database interrogation of clinical records, used to collect quantitative data on patient demographics and medication prescriptions in the ED. A total of 2 228 patients were identified as being treated for migraine over a 10-year period. The proportion of the ED population presenting with migraine steadily increased in this time. Females (71%) more commonly presented to the ED with migraine than males. The migraine population was significantly younger (M=37.05, SD=13.23) than the whole ED population (M=46.17 SD=20.50) (P<0.001). A variety of medications were used in the treatment of migraine in the ED. Simple analgesics such as paracetamol and ibuprofen, anti-emetics and intravenous (IV) fluids with phenothiazine additives were commonly used. Over 20% of patients were prescribed oral or parenteral opiates (42 of 194 initial medication prescriptions, and 64 of 292 as required medication prescriptions). Triptans were very rarely used. Migraine is an increasingly common presentation to the ED. People presenting to the ED with migraine are more likely to be younger and female than the general ED population. Peak presentations for migraines occurred in January and February. The medications that are prescribed in the ED for migraine is varied and are not always in line with current evidence for the treatment of migraine. The excessive reliance on opiates and lack of the use of triptans denotes a significant variation from published guidelines.

  16. Reduced fractional anisotropy of corpus callosum modulates inter-hemispheric resting state functional connectivity in migraine patients without aura.

    PubMed

    Yuan, Kai; Qin, Wei; Liu, Peng; Zhao, Ling; Yu, Dahua; Zhao, Limei; Dong, Minghao; Liu, Jixin; Yang, Xuejuan; von Deneen, Karen M; Liang, Fanrong; Tian, Jie

    2012-01-01

    Diffusion tensor imaging (DTI) study revealed reduced fractional anisotropy (FA) values in the corpus callosum (CC) in migraine patients without aura. Abnormalities in white matter integrity, particularly in the CC, may affect inter-hemispheric resting state functional connectivity (RSFC). Unfortunately, relatively little is known about the alterations in functional interactions between the cerebral hemispheres during resting state in migraine patients without aura, and even less about how the inter-hemispheric RSFC are affected by the abnormalities of the CC. Twenty-one migraine patients without aura and 21 healthy controls participated in this study, age-, sex-, and education-matched. Tract-based spatial statistics (TBSS) was employed to investigate the white matter alterations of the CC. Meanwhile, voxel-mirrored homotopic connectivity (VMHC) was used to compare the inter-hemispheric RSFC differences between the patients and controls. TBSS analysis revealed reduced FA values in the genu and the splenium of CC in patient group. VMHC analysis showed decreased inter-hemispheric RSFC of anterior cingulate cortex (ACC) in migraine patients without aura relative to that of the controls. Furthermore, in migraine patients without aura, the reduced FA values of the genu of CC correlated with the decreased inter-hemispheric RSFC of the ACC. Our findings demonstrated that the migraine patients without aura showed reduced FA values of the genu of CC and decreased inter-hemispheric RSFC of the ACC. The correlation between the above structural and functional changes suggested that the reduced fractional anisotropy (FA) of CC modulates inter-hemispheric VMHC in migraine patients without aura. Our results demonstrated that the VMHC alterations of ACC can reflect the FA changes of the genu of CC in migraine patients without aura.

  17. Psychometric Evaluation of a Novel Instrument Assessing the Impact of Migraine on Physical Functioning: The Migraine Physical Function Impact Diary.

    PubMed

    Kawata, Ariane K; Hsieh, Ray; Bender, Randall; Shaffer, Shannon; Revicki, Dennis A; Bayliss, Martha; Buse, Dawn C; Desai, Pooja; Sapra, Sandhya; Ortmeier, Brian; Hareendran, Asha

    2017-10-01

    The objective of this study was to evaluate the measurement properties of the Migraine Physical Function Impact Diary (MPFID), a novel patient-reported outcome (PRO) measure for assessing the impact of migraine on physical functioning. In a prospective, observational study, adults with episodic migraine (EM) or chronic migraine (CM) used an eDiary to complete the MPFID (assessing daily impacts of migraine on physical function) and a headache diary (capturing migraine days, migraine pain intensity, and migraine interference) each day, and other PRO instruments related to migraine. Item-level evaluation, item response theory (IRT), and exploratory factor analysis (EFA) methods were applied to identify domains, select final MPFID items, and develop scoring procedures. Psychometric properties of the final 13-item MPFID were evaluated using confirmatory factor analysis and tests of reliability (Cronbach's α for internal consistency and intra-class correlation [ICC] for test-retest) and validity (convergent and known-groups). The study enrolled 569 adults with chronic or episodic migraine, mean (SD) age 39.9 (12.0) years and 87.2% female. Item-level analyses based on interim data informed selection of a set of 13 items for the MPFID, through evaluation of floor/ceiling effects, item-to-item correlations, factor loadings, and IRT-based fit/misfit statistics. Two domain scores (EA: Impact on Everyday Activities; PI: Physical Impairment) and a global item score for impact on everyday activities were identified. EA and PI domains exhibited high internal consistency (α = 0.97; α = 0.93) and good test-retest reliability among stable subjects (ICCs = 0.74 and 0.77). Convergent validity was demonstrated by moderate correlations (r = ±0.50-0.68; P < .0001) between MPFID domain scores and number of migraine days, headache days, bed days, and other migraine-related PRO instruments. EA and PI scores differentiated between groups who varied by number of

  18. 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.

  19. 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.

  20. Trigeminal somatosensorial evoked potentials suggest increased excitability during interictal period in patients with long disease duration in migraine.

    PubMed

    Abanoz, Yesim; Abanoz, Yasin; Gündüz, Aysegül; Savrun, Feray Karaali

    2016-01-26

    Migraine pathogenesis is suggested to involve many structures in cerebral cortex, brainstem and trigeminovascular system. Electrophysiological studies revealed loss of habituation, decreased cortical preactivation, segmental hypersensitivity and reduction in control of inhibitory descending pathways. Given these information, we aimed to evaluate the excitability changes of the trigeminal pathway in the cortex and brainstem in migraine using trigeminal nerve somatosensory evoked potentials (TSEP). Fifty-one women with migraine without aura and 32 age-matched healthy women were included. TSEPs were recorded in migraine patients during interictal period and in healthy subjects. Sensory thresholds, stimulation intensities, latencies of N1, P1, N2 and P2 waves as well as N1/P1 and N2/P1 amplitudes were measured. Comparisons of ipsilateral latencies with N1-P1 and N2-P1 amplitudes between migraine and control groups showed no difference. Sensory thresholds were also similar. Stimulation thresholds decreased as the attack frequency increased and ipsilateral N1/P1 amplitude increased with prolonged disease duration (p=0.043). Our study did not show significant difference between migraine patients and healthy subjects during interictal period. However, migraine with long duration affects the excitability of the cortical and brainstem trigeminal pathways even during interictal periods. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  1. Patterns of use and health expenses associated with triptans among adults with migraines.

    PubMed

    Wu, Jun; Noxon, Virginia; Lu, Z Kevin

    2015-08-01

    To determine patterns of use, socioeconomic factors, and the impact on total health expenses associated with triptan therapy among patients with migraines. Patients with migraines were identified from the Medical Expenditure Panel Survey household component files (2006 to 2011) and were restricted to those who were 18 years or older and had a migraine diagnosis. The major outcome measures were triptan use during the 2-year period and annualized average total and migraine-related health care expenses and medical utilization. Socioeconomic factors associated with triptan use were analyzed by using logistic regression. The impact of triptan use on total and migraine-related health expenses was assessed by linear regression models with log transformations. Among 1961 patients with a migraine diagnosis (representing 45.6 million individuals in the United States for years 2006 to 2011), 501 received triptans to treat acute migraines (representing 13.1 million individuals in the United States, 28.6%). Patients who were females and had higher income and education levels were more likely to receive triptans to treat migraines. Triptan expense accounted for 49.6% of total migraine-related expenses and 21.9% of total all-cause prescription drug expenses respectively. Compared with nontriptan users, the annualized total health expenses increased by 19.7% in triptan users after adjusting for demographic and health-related variables. The study suggested that socioeconomic factors were associated with triptan use in migraineurs. Higher total and migraine-related health expenses were observed in triptan users.

  2. Detection of changes in the periaqueductal gray matter of patients with episodic migraine using quantitative diffusion kurtosis imaging: preliminary findings.

    PubMed

    Ito, Kenji; Kudo, Masako; Sasaki, Makoto; Saito, Ayumi; Yamashita, Fumio; Harada, Taisuke; Yokosawa, Suguru; Uwano, Ikuko; Kameda, Hiroyuki; Terayama, Yasuo

    2016-02-01

    The periaqueductal gray matter (PAG) is considered to play an important role in generating migraine, but findings from imaging studies remain unclear. Therefore, we investigated whether diffusion kurtosis imaging (DKI) can detect changes in the PAG of migraine patients. We obtained source images for DKI from 20 patients with episodic migraine and 20 healthy controls using a 3 T magnetic resonance imaging scanner. Mean kurtosis (MK), fractional anisotropy (FA), and mean diffusivity (MD) maps were generated, and the values of the PAG and other deep gray and white matter structures were automatically measured using an atlas-based region-of-interest analysis. The metrics of these structures were compared between the patients and controls. The MK and MD values of the PAG were significantly increased in the migraine patients compared with the controls (p < 0.05). The FA values were not significantly different. There were no significant differences in the metrics of the other structures between the patients and controls. The MK values of the PAG were significantly positively correlated with both age and the untreated period in the patient group under univariate analysis (r = 0.53 and 0.56, respectively; p < 0.05) but not multivariate analysis. DKI detected significant increases in the MK and MD values of the PAG in patients with migraine, which suggests that structural changes in the PAG are associated with the pathophysiological mechanisms of migraine.

  3. 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.

  4. Migraine and patent foramen ovale.

    PubMed

    Ailani, Jessica

    2014-02-01

    Migraine is a widespread disorder with a large impact on society. Patent foramen ovale (PFO) is a common occurrence, affecting about 25 % of the population. Observational studies report PFO to be more prevalent in patients with migraine with aura, and patients with migraine with aura have a higher incidence of PFO. The only population-based study does not support this link. It is possible that an association exists between large-sized PFO and migraine. This association may explain how migraine with aura can be triggered. Numerous studies have reported improved migraine with PFO closure, but the only prospective placebo-controlled trial aimed at closure of PFO in patients with migraine with aura did not support this. At this time, evidence does not support the routine detection and closure of PFO in patients with migraine.

  5. 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 ...

  6. The evaluation of sexual dysfunction in male patients with migraine and tension type headache.

    PubMed

    Aksoy, Durdane; Solmaz, Volkan; Cevik, Betul; Gencten, Yusuf; Erdemir, Fikret; Kurt, Semiha Gulsum

    2013-05-29

    Erectile dysfunction (ED), defined as the inability to achieve or maintain an erection sufficient for satisfactory sexual performance, is a common condition. The psychological, hormonal, neurogenic and arterial pathologies, medications, chronic diseases have been reported in the etiology of the ED. This paper aims to study sexual dysfunction in the male patients with migraine and Tension type headache (TTH). 30 migraine cases (Group M), 31 TTH cases (Group T) and 30 control cases (Group C) were included in the study. Patients were evaluated with medical history, physical examination, body mass index (BMI), Beck Depression Inventory, biochemical analysis and hormone profiles. ED was evaluated via International Index of Erectile Function Scale (IIEF). In statistical analysis, variant analysis, post-hoc tukey test, Pearson correlation test, t-test, and fisher's exact chi-square test were used. The patients' mean age was 34.96+/-1.30, 35.54+/-1.52 and 32.26+/-1.38 for group M,T and C, respectively. There was no significant difference between the groups in terms of testosterone levels. Mean IIEF scores was 19.83+/-2.2, 20.39+/-1.35 and 27.83+/-0.34 in groups M,T,C. When M and T groups were compared with group C, there were significant differences, and there was no statistical difference when T and M groups were compared to each other. Beck Depression Scores were not significantly different in groups M, T and C. In this study, it was shown that, migraine and TTH affects the sexual functions negatively in male patients. Chronic diseases may cause sexual disorders in patients because of despair, guilt, and fear of death or pain. Our results suggest that, along with the effect of chronic disease and pain, there must be other complicated factors exist causing the development of SD in patients with migraine and TTH.

  7. Concomitant functional gastrointestinal symptoms influence psychological status in Korean migraine patients.

    PubMed

    Park, Jeong Wook; Cho, Young-Seok; Lee, Soo Yeon; Kim, Eun-Sun; Cho, Hyunjung; Shin, Hae Eun; Suh, Gyoung Im; Choi, Myung-Gyu

    2013-11-01

    Migraine is frequently accompanied by symptoms consistent with functional gastrointestinal disorders (FGIDs). This study evaluated the prevalence of functional gastrointestinal symptoms and assessed the symptoms' relationship with the concomitant functional symptoms of anxiety, depression, and headache-related disability. This prospective study included 109 patients with migraine who were recruited from a headache clinic at a teaching hospital. The participants completed a self-administered survey that collected information on headache characteristics, functional gastrointestinal symptoms (using Rome III criteria to classify FGID), anxiety, depression, and headache-related disability. In total, 71% of patients met the Rome III criteria for at least one FGID. In patients with FGID, irritable bowel syndrome was the most common symptom (40.4%), followed by nausea and vomiting syndrome (24.8%) and functional dyspepsia (23.9%). Depression and anxiety scores were significantly higher in patients meeting the criteria for any FGID. The number of the symptoms consistent with FGID in individual patients correlated positively with depression and anxiety. FGID symptoms defined by the Rome III criteria are highly prevalent in migraine. These symptoms correlate with psychological comorbidities, such as depression and anxiety.

  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. The Stigma of Migraine

    PubMed Central

    Young, William B.; Park, Jung E.; Tian, Iris X.; Kempner, Joanna

    2013-01-01

    Background People who have a disease often experience stigma, a socially and culturally embedded process through which individuals experience stereotyping, devaluation, and discrimination. Stigma has great impact on quality of life, behavior, and life chances. We do not know whether or not migraine is stigmatizing. Methods We studied 123 episodic migraine patients, 123 chronic migraine patients, and 62 epilepsy patients in a clinical setting to investigate the extent to which stigma attaches to migraine, using epilepsy as a comparison. We used the stigma scale for chronic illness, a 24-item questionnaire suitable for studying chronic neurologic diseases, and various disease impact measures. Results Patients with chronic migraine had higher scores (54.0±20.2) on the stigma scale for chronic illness than either episodic migraine (41.7±14.8) or epilepsy patients (44.6±16.3) (p<0.001). Subjects with migraine reported greater inability to work than epilepsy subjects. Stigma correlated most strongly with the mental component score of the short form of the medical outcomes health survey (SF-12), then with ability to work and migraine disability score for chronic and episodic migraine and the Liverpool impact on epilepsy scale for epilepsy. Analysis of covariance showed adjusted scores for the stigma scale for chronic illness were similar for chronic migraine (49.3; 95% confidence interval, 46.2 to 52.4) and epilepsy (46.5; 95% confidence interval, 41.6 to 51.6), and lower for episodic migraine (43.7; 95% confidence interval, 40.9 to 46.6). Ability to work was the strongest predictor of stigma as measured by the stigma scale for chronic illness. Conclusion In our model, adjusted stigma was similar for chronic migraine and epilepsy, which were greater than for episodic migraine. Stigma correlated most strongly with inability to work, and was greater for chronic migraine than epilepsy or episodic migraine because chronic migraine patients had less ability to work. PMID

  11. Cervical Muscle Strength and Muscle Coactivation During Isometric Contractions in Patients With Migraine: A Cross-Sectional Study.

    PubMed

    Florencio, Lidiane Lima; de Oliveira, Anamaria Siriani; Carvalho, Gabriela Ferreira; Tolentino, Gabriella de Almeida; Dach, Fabiola; Bigal, Marcelo Eduardo; Fernández-de-las-Peñas, César; Bevilaqua Grossi, Débora

    2015-01-01

    This cross-sectional study investigated potential differences in cervical musculature in groups of migraine headaches vs. non-headache controls. Differences in cervical muscle strength and antagonist coactivation during maximal isometric voluntary contraction (MIVC) were analyzed between individuals with migraine and non-headache subjects and relationships between force with migraine and neck pain clinical aspects. A customized hand-held dynamometer was used to assess cervical flexion, extension, and bilateral lateral flexion strength in subjects with episodic migraine (n=31), chronic migraine (n = 21) and healthy controls (n = 31). Surface electromyography (EMG) from sternocleidomastoid, anterior scalene, and splenius capitis muscles were recorded during MIVC to evaluate antagonist coactivation. Comparison of main outcomes among groups was conducted with one-way analysis of covariance with the presence of neck pain as covariable. Correlations between peak force and clinical variables were demonstrated by Spearman's coefficient. Chronic migraine subjects exhibited lower cervical extension force (mean diff. from controls: 4.4 N/kg; mean diff from episodic migraine: 3.7 N/kg; P = .006) and spent significantly more time to generate peak force during cervical flexion (mean diff. from controls: 0.5 seconds; P = .025) and left lateral-flexion (mean diff. from controls: 0.4 seconds; mean diff. from episodic migraine: 0.5 seconds; P = .007). Both migraine groups showed significantly higher antagonist muscle coactivity of the splenius capitis muscle (mean diff. from controls: 20%MIVC, P = .03) during cervical flexion relative to healthy controls. Cervical extension peak force was moderately associated with the migraine frequency (rs: -0.30, P = .034), neck pain frequency (rs: -0.26, P = .020), and neck pain intensity (rs: -0.27, P = .012). Patients with chronic migraine exhibit altered muscle performance, took longer to reach peak of

  12. 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.

  13. Intravenous caffeine citrate vs. magnesium sulfate for reducing pain in patients with acute migraine headache; a prospective quasi-experimental study.

    PubMed

    Baratloo, Alireza; Mirbaha, Sahar; Delavar Kasmaei, Hossein; Payandemehr, Pooya; Elmaraezy, Ahmed; Negida, Ahmed

    2017-07-01

    Current evidence suggests that intravenous magnesium sulfate might be effective for reducing migraine pain. In a recent pilot study, we showed that intravenous caffeine citrate could reduce the severity of migraine headache. The objective of this study is to investigate the efficacy of intravenous caffeine citrate vs. magnesium sulfate for management of acute migraine headache. We conducted a prospective quasi-experimental study from January until May 2016 in two educational medical centers of Shahid Beheshti University of Medical Sciences (Shoahadaye Tajrish Hospital and Imam Hossein Hospital), Tehran, Iran. The study included patients who were referred to the emergency department and met the migraine diagnosis criteria of the International Headache Society. Patients were allocated into 2 groups receiving either 60 mg intravenous caffeine or 2 g intravenous magnesium sulfate. The pain scores, based on the visual analog scale, were recorded on admission, as well as one and two hours after receiving the drug. A Chi-Square test and student t-test were used for analysis of baseline characteristics. A Mann-Whitney U test and Wilcoxon singed rank test were used to analyze differences in the visual analogue scale (VAS) score between and within the groups respectively. In total, 70 patients (35 patients in each group) with the mean age of 33.1 ± 11.3 years were included (64.3% female). For the Caffeine citrate group, the median pain score decreased from 9.0 (2.0) to 5.0 (4.0) after one hour and to 3.0 (4.0) after two hours. For the magnesium sulfate group, the pain score decreased from 8.0 (2.0) to 2.0 (2.0) after one hour and to 0.0 (1.0) after two hours. Both intravenous caffeine citrate and intravenous magnesium sulfate reduced pain scores significantly but the magnesium sulfate group showed more improvement than the Caffeine citrate group after one hour (P < 0.001) and after two hours (P < 0.001). It is likely that both intravenous caffeine and intravenous magnesium

  14. 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

  15. Effect of catheter ablation and periprocedural anticoagulation regimen on the clinical course of migraine in atrial fibrillation patients with or without pre-existent migraine: results from a prospective study.

    PubMed

    Mohanty, Sanghamitra; Mohanty, Prasant; Rutledge, J Neal; Di Biase, Luigi; Yan, Rachel Xue; Trivedi, Chintan; Santangeli, Pasquale; Bai, Rong; Cardinal, Deb; Burkhardt, J David; Gallinghouse, Joseph G; Horton, Rodney; Sanchez, Javier E; Bailey, Shane; Hranitzky, Patrick M; Zagrodzky, Jason; Al-Ahmad, Amin; Natale, Andrea

    2015-04-01

    We examined the influence of catheter ablation and periprocedural anticoagulation regimen on trajectory of migraine in atrial fibrillation patients with or without migraine history. Forty patients with (group 1: 64 ± 8 years; men 78%) and 85 (group 2: 61 ± 10 years; men 73%) without migraine history undergoing atrial fibrillation-ablation were enrolled. Migraine status and quality of life were evaluated using standardized questionnaires. Diffusion magnetic resonance imaging of brain was performed for all at pre and 24 hours post procedure. Catheter ablation was performed with (88, 70%) or without (37, 30%) continuous warfarin treatment. Fifty-four patients (11 and 43 from groups 1 and 2, respectively) had subtherapeutic international normalized ratio on procedure day. At 17 ± 5 months follow-up, from group 1, 25 (63%) reported no migraine, 10 (25%) had < 1, and 3 (8%) had 2 to 3 monthly symptoms. Intensity of pain decreased from baseline 7 (Q1-Q3, 4-8) to 2 (0-4) scale points at follow-up (P < 0.001) and duration of headache from median 8 (Q1-Q3, 4-15) to 0.5 (Q1-Q3, 0-2) hours (P < 0.001). Two patients from group 1 reported increased migraine severity and 2 from group 2 had new-onset migraine. Follow-up diffusion magnetic resonance imaging revealed new infarcts in 9.6% (12/125) patients; of which 11 had subtherapeutic preprocedural international normalized ratio on or off continuous warfarin. Quality of life improved significantly in patients with successful ablation, being more pronounced in group 1. In most patients, migraine symptoms improved substantially after catheter ablation. Interestingly, the only cases of new migraine and aggravation of pre-existent headache had subtherapeutic international normalized ratio during the procedure and new cerebral infarcts. © 2015 American Heart Association, Inc.

  16. Three-dimensional localization of abnormal EEG activity in migraine: a low resolution electromagnetic tomography (LORETA) study of migraine patients in the pain-free interval.

    PubMed

    Clemens, Béla; Bánk, József; Piros, Pálma; Bessenyei, Mónika; Veto, Sára; Tóth, Márton; Kondákor, István

    2008-09-01

    Investigating the brain of migraine patients in the pain-free interval may shed light on the basic cerebral abnormality of migraine, in other words, the liability of the brain to generate migraine attacks from time to time. Twenty unmedicated "migraine without aura" patients and a matched group of healthy controls were investigated in this explorative study. 19-channel EEG was recorded against the linked ears reference and was on-line digitized. 60 x 2-s epochs of eyes-closed, waking-relaxed activity were subjected to spectral analysis and a source localization method, low resolution electromagnetic tomography (LORETA). Absolute power was computed for 19 electrodes and four frequency bands (delta: 1.5-3.5 Hz, theta: 4.0-7.5 Hz, alpha: 8.0-12.5 Hz, beta: 13.0-25.0 Hz). LORETA "activity" (=current source density, ampers/meters squared) was computed for 2394 voxels and the above specified frequency bands. Group comparison was carried out for the specified quantitative EEG variables. Activity in the two groups was compared on a voxel-by-voxel basis for each frequency band. Statistically significant (uncorrected P < 0.01) group differences were projected to cortical anatomy. Spectral findings: there was a tendency for more alpha power in the migraine that in the control group in all but two (F4, C3) derivations. However, statistically significant (P < 0.01, Bonferroni-corrected) spectral difference was only found in the right occipital region. The main LORETA-finding was that voxels with P < 0.01 differences were crowded in anatomically contiguous cortical areas. Increased alpha activity was found in a cortical area including part of the precuneus, and the posterior part of the middle temporal gyrus in the right hemisphere. Decreased alpha activity was found bilaterally in medial parts of the frontal cortex including the anterior cingulate and the superior and medial frontal gyri. Neither spectral analysis, nor LORETA revealed statistically significant differences in

  17. 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. Copyright 2002 Elsevier Science Ireland Ltd.

  18. 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. Copyright © 2014 Elsevier Inc. All rights reserved.

  19. 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.

  20. Prevalence of restless legs syndrome in migraine patients with and without aura: a cross-sectional, case-controlled study.

    PubMed

    Lin, Guan-Yu; Lin, Yu-Kai; Lee, Jiunn-Tay; Lee, Meei-Shyuan; Lin, Chun-Chieh; Tsai, Chia-Kuang; Ting, Chi-Hsin; Yang, Fu-Chi

    2016-12-01

    Although the comorbidity of migraine and restless legs syndrome (RLS) has been well-documented, the association between RLS and migraine frequency has yet to be elucidated. The present study aims to evaluate the prevalence of RLS among individuals who experience low-frequency, high-frequency, or chronic migraine presenting with and without aura. We conducted a cross-sectional, case-controlled study involving 505 participants receiving outpatient headache treatment. Standardized questionnaires were administered to collect information on experiences of migraine, RLS, sleep quality, anxiety, depression, and demographics. Participants were categorized into low-frequency (1-8/month), high-frequency (9-14/month), and chronic (≥15/month) headache groups. RLS was diagnosed according to the criteria outlined by the International RLS Study Group (IRLSSG). The Pittsburgh Sleep Quality Index (PSQI) and Hospital Anxiety and Depression Scale (HADS) were used to assess sleep quality and identify symptoms of anxiety and depression. Associations between migraine frequency and RLS prevalence were investigated using multivariate linear and logistic regression. Univariate analysis revealed an effect of migraine frequency on RLS prevalence (p = 0.026), though this effect did not persist following adjustment for baseline characteristics (p = 0.256). The trend was robust in patients whose migraines presented with auras (p univariate = 0.002; p multivariate = 0.043) but not in those without auras (p univariate and p multivariate > 0.05). Higher anxiety [odds ratio (OR) = 1.18, p = 0.019] and sleep disturbance (OR = 1.17, p = 0.023) scores were associated with higher RLS prevalence. Higher migraine frequency correlates with a higher prevalence of RLS, particularly among patients with auras.

  1. 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.

  2. Migraine equivalents as part of migraine syndrome in childhood.

    PubMed

    Tarantino, Samuela; Capuano, Alessandro; Torriero, Roberto; Citti, Monica; Vollono, Catello; Gentile, Simonetta; Vigevano, Federico; Valeriani, Massimiliano

    2014-11-01

    Migraine equivalents are common clinical conditions without a headache component, occurring as repeated episodes with complete remission between episodes. They include abdominal migraine, cyclical vomiting, benign paroxysmal vertigo, and benign paroxysmal torticollis. Other clinical entities, such as motion sickness and limb pain have been associated with migraine. We aimed to investigate the prevalence of migraine equivalents in a large population of children referred to a pediatric headache center and to analyze the possible relationship between migraine equivalents and headache features. A total of 1134 of children/adolescents (73.2% with migraine and 26.8% with tension-type headache) were included. Patients were divided into two groups according to the episode frequency (high and low). Pain intensity was rated on a three-level graduate scale (mild, moderate, and severe pain). Migraine equivalents were reported in 70.3% of patients. Abdominal migraine (48.9%), limb pain (43.9%), and motion sickness (40.5%) were the most common migraine equivalents. Although headache type (migraine or tension-type headache) did not correlate with migraine equivalents presence (χ(2) = 33.2; P = 0.27), high frequency of headache episodes correlated with the occurrence of migraine equivalents. Moreover, migraine equivalents indicated a protective role for some accompanying feature of the headache episode. Our results suggest that migraine equivalents should not be considered merely as headache precursors, but they as part of the migrainous syndrome. Thus, their inclusion among the diagnostic criteria for pediatric migraine/tension-type headache is useful. Copyright © 2014 Elsevier Inc. All rights reserved.

  3. 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

  4. Impulsivity among migraine patients: Study in a series of 155 cases.

    PubMed

    Muñoz, I; Hernández, M S; Pedraza, M I; Domínguez, E; Ruiz, M; Isidro, G; Mayor, E; Sotelo, E M; Molina, V; Guerrero, A L; Uribe, F

    Impulsivity is a psychological phenomenon that has not been extensively studied in headache patients. We aim to assess the presence of impulsivity in patients with chronic migraine (CM) and medication overuse (MO). All patients examined in an outpatient headache clinic between January 2013 and March 2014 were included. Episodic migraine, CM, and MO were diagnosed according to ICHD-III beta criteria. We prospectively gathered demographic and clinical characteristics. Mood disorders were evaluated using the Hospital Anxiety and Depression Scale (HADS) and impulsiveness was assessed with the Plutchik impulsivity scale. A total of 155 patients were included (22 men, 133 women). The mean age (SD) was 38.2 (11.7) years (range, 18-70); 104 patients (67.1%) presented CM and, among them, 74 (71.1%) had MO. Of the patient total, 28.4% met criteria for anxiety, 7.1% for depression and 16.1% for impulsivity. The CM group showed higher scores for HADS-anxiety (8.5 [SD 4.5] vs. 6.4 [SD 3.6], p=0.003) and HADS-depression (4.4 [4.3] vs. 1.9 [2.3], p<0.001). Among CM cases only, scores for HADS-anxiety (9.3 [4.4] vs. 6.8 [4.3], p=0.01) and HADS-Depression (5.1 [4.6] vs. 2.7 [2.9], p=0.002) were higher in patients who also had MO. We found no associations between Plutchik scale scores or presence of impulsivity with either CM or MO. Impulsivity is a common trait in our population of migraine patients, but unlike mood disorders, it is not correlated with either CM or MO. Copyright © 2014 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Trigger factors of migraine and tension-type headache: experience and knowledge of the patients.

    PubMed

    Wöber, Christian; Holzhammer, Julia; Zeitlhofer, Josef; Wessely, Peter; Wöber-Bingöl, Ciçek

    2006-09-01

    The objective was to examine potential trigger factors of migraine and tension-type headache (TTH) in clinic patients and in subjects from the population and to compare the patients' personal experience with their theoretical knowledge. A cross-sectional study was carried out in a headache centre. There were 120 subjects comprising 66 patients with migraine and 22 with TTH from a headache outpatient clinic and 32 persons with headache (migraine or TTH) from the population. A semistructured interview covering biographic data, lifestyle, medical history, headache characteristics and 25 potential trigger factors differentiating between the patients' personal experience and their theoretical knowledge was used. The most common trigger factors experienced by the patients were weather (82.5%), stress (66.7%), menstruation (51.4%) and relaxation after stress (50%). The vast majority of triggers occurred occasionally and not consistently. The patients experienced 8.9+/-4.3 trigger factors (range 0-20) and they knew 13.2+/-6.0 (range 1-27). The number of experienced triggers was smallest in the population group (p=0.002), whereas the number of triggers known did not differ in the three study groups. Comparing theoretical knowledge with personal experience showed the largest differences for oral contraceptives (65.0 vs. 14.7%, p<0.001), chocolate (61.7 vs. 14.3%, p>0.001) and cheese (52.5 vs. 8.4%, p<0.001). In conclusion, almost all trigger factors are experienced occasionally and not consistently by the majority of patients. Subjects from the population experience trigger factors less often than clinic patients. The difference between theoretical knowledge and personal experience is largest for oral contraceptives, chocolate and cheese.

  6. 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.

  7. Effects of betaxolol and flunarizine on visual fields and intraocular pressure in patients with migraine.

    PubMed

    Yarangümeli, Alper; Comoglu, Selçuk; Köz, Ozlem Gürbüz; Elhan, Atilla Halil; Kural, Gülcan

    2003-05-01

    Fifty-one patients with migraine were divided into four groups to investigate the effects of topical betaxolol and systemic calcium channel blocker flunarizine on visual fields (VF) and intraocular pressure (IOP). The first group (Group 0) was followed with no medications, topical betaxolol (bid) was precribed to the second group (Group B), oral flunarizine (10 mg daily) was prescribed to the third group (Group F), and the last group (Group BF) was assigned for combined betaxolol and flunarizine treatment. After a mean follow-up time of 4.2 +/- 1.2 months (3-6 months), IOP measurements and VF tests were repeated. Group B and Group BF were found to be statistically different from the other groups in terms of IOP reduction and VF improvement according to mean deviation and corrected pattern standard deviation indices in the second examinations. On the other hand, Group F and Group BF differed from the other two groups considering the improvement in migrainous complaints. VF findings which are probably influenced by perfusion problems due to vasospastic mechanisms in migraineurs, improved following topical betaxolol treatment. However, systemic use of flunarizine--a calcium channel blocker--did not seem to be effective on visual fields although it had beneficial effects on migraine.

  8. 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.

  9. Migraine-like accompanying features in patients with cluster headache. How important are they?

    PubMed

    Zidverc-Trajkovic, Jasna; Podgorac, Ana; Radojicic, Aleksandra; Sternic, Nadezda

    2013-10-01

    According to the International Classification of Headache Disorders diagnostic criteria, the differences between migraine and cluster headache (CH) are clear. In addition to headache attack duration and pain characteristics, the symptoms accompanying headache represent the key features in a differential diagnosis of these 2 primary headache disorders. Just a few studies of patients with CH exist examining the presence of nausea, vomiting, photophobia, phonophobia, and aura, the features commonly accompanying migraine headache. The aim of this study was to determine the presence of migraine-like features (MF) in patients with CH and establish the significance of these phenomena related to other clinical features and response to treatment. One hundred and fifty-five patients with CH were studied, and 24.5% of them experienced at least one of MF during every CH attack. Nausea and vomiting were the most frequently reported MF. The clinical presentation between CH patients with and without MF was not significantly different with the exception of aggravation of pain by effort (20.6% vs 4.1%) and facial sweating (13.2% vs 0.85%), both more frequent in CH patients with MF. Inferred from the results of our study, the presence of MF in CH patients had no important influence on the diagnosis and treatment of CH patients. The major differences of these 2 primary headache disorders, attack duration, lateralization, and the nature of associated symptoms, as delineated in the International Classification of Headache Disorders, are still useful tools for effective diagnosis. © 2013 American Headache Society.

  10. Non-invasive vagus nerve stimulation (nVNS) as symptomatic treatment of migraine in young patients: a preliminary safety study.

    PubMed

    Grazzi, Licia; Egeo, Gabriella; Liebler, Eric; Padovan, Anna Maria; Barbanti, Piero

    2017-05-01

    Recent clinical experiences and clinical trials have demonstrated the safety, tolerability, and efficacy of non-invasive vagus nerve stimulation (nVNS; gammaCore(®)) for the acute and prophylactic treatment of migraine. nVNS has a favorable adverse event profile, making it an attractive option for sensitive patient populations. We explored the safety, tolerability, and efficacy of nVNS as acute migraine treatment in adolescents. A group of adolescent patients suffering from migraine without aura were trained to use gammaCore to manage their migraine attacks. 46.8% of the treated migraine attacks (22/47) were considered successfully treated and did not require any rescue medication. No device-related adverse events were recorded. This preliminary study suggests that nVNS may represent a safe, well-tolerated, and effective for acute migraine treatment in adolescents.

  11. [Role of migraine history in the development of postoperative nausea and vomiting in patients undergoing general and combined general-epidural anesthesia].

    PubMed

    Khoronenko, V E; Baskakov, D S

    2014-01-01

    To assess the role of migraine history in the development of postoperative nausea and vomiting (PONV) in patients undergoing general and combined general-epidural anaesthesia. 127 women with oncogynecological pathology were randomized into 3 groups according to anaesthesia method. Patients of the group C (comparative group; n = 43; 18 with migraine) received general anaesthesia. Patients of the Group CA (n = 40; 19 with migraine) received combined general-epidural anaesthesia. Patients of the group D (n = 44; 19 with migraine) received general anaesthesia with adding of Droperidolum. All patients received standard prophylactics of PONV- Ondansetronum 8 mg and dexamethasone 8 mg intravenous. In the group C a PONV occurred in 15 of 43 women (34.9%). PONV occurred in 6 of 18 women with migraine (33.3%) and in 9 of 25 women without migraine (36%). In the group CA a PONV occurred in 10 of 40 women (25%). PONV occurred in 8 of 19 women with migraine (42.1%) and in 2 of 21 women without migraine (9.5%; p = 0.036 in comparison with group C). In the group D a PONV occurred in 8 of 44 women (18.2%). PONV occurred in 1 of 19 women with migraine (5.3% p = 0.03 in comparison with group C and p = 0.008 with group CA) and in 7 of 25 women without migraine (28%; there was no significant difference with groups C and CA). Migraine history is a significant risk factor of PONV. Epidural component of anaesthesia does not effect on frequency of PONV in women with migraine, but Droperidolum use allows increasing the frequency of PONV.

  12. 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.

  13. 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

  14. 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.

  15. Affective brain regions are activated during the processing of pain-related words in migraine patients.

    PubMed

    Eck, Judith; Richter, Maria; Straube, Thomas; Miltner, Wolfgang H R; Weiss, Thomas

    2011-05-01

    Several brain areas that constitute the neural matrix of pain can be activated by noxious stimuli and by pain-relevant cues, such as pictures, facial expressions, and pain-related words. Although chronic pain patients are frequently exposed to pain-related words, it remains unclear whether their pain matrix is specifically activated during the processing of such stimuli in comparison to healthy subjects. To answer this question, we compared the neural activations induced by verbal pain descriptors in a sample of migraine patients with activations in healthy controls using functional magnetic resonance imaging. Participants viewed pain-related adjectives and negative, non-pain-related adjectives that were matched for valence and arousal and were instructed to either generate mental images (imagination condition) or to count the number of vowels (distraction condition). In migraine patients, pain-related adjectives as compared with negative adjectives elicited increased activations in the left orbitofrontal cortex and anterior insula during imagination and in the right secondary somatosensory cortex and posterior insula during distraction. More pronounced pain-related activation was observed in affective pain-related regions in the patient as compared with the control group during imagination. During distraction, no differential engagement of single brain structures in response to pain-related words could be observed between groups. Overall, our findings indicate that there is an involvement of brain regions associated with the affective and sensory-discriminative dimension of pain in the processing of pain-related words in migraine patients, and that the recruitment of those regions associated with pain-related affect is enhanced in patients with chronic pain experiences. Copyright © 2011 International Association for the Study of Pain. Published by Elsevier B.V. All rights reserved.

  16. 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

  17. Nicotinamide-N-Methyltransferase gene rs694539 variant and migraine risk.

    PubMed

    Sazci, Ali; Sazci, Gensay; Sazci, Bilgen; Ergul, Emel; Idrisoglu, Halil Atilla

    2016-12-01

    Migraine is a common neurovascular disorder affecting 10 to 20 % of the world population usually subdivided into migraine with auro (MA) and migraine without auro (MO). Homocysteine is involved in the pathophysiology of a number of neurological disorders. Elevated levels of homocysteine in the plasma is produced by the MTHFR gene rs 1801133 and rs 1801131 variants as well as the NNMT gene rs 694539 variant. With the polymerase chain reaction-restriction fragment length polymorphism method developed recently in our laboratory, we were able to show an association between the NNMT gene rs694539 variant and migraine for the first time. Here we report the association of the Nicotinamide-N-methyltransferase gene (NNMT) rs694539 variant with migraine in a case-control study of 433 patients with migraine and 229 healthy controls (χ2 = 6.076, P = 0.048). After stratification, we were able only to show an association between the NNMT gene rs694539 variant and female patients with migraine on the genotype and allelic levels. However there was no association in male patients with migraine (χ2 = 1.054, P = 0.590). Consequently our results clearly indicate that the NNMT gene rs694539 variant is a genetic risk factor for migraine.

  18. Migraine variants--occurrence in pediatric neurology practice.

    PubMed

    Pacheva, Iliyana H; Ivanov, Ivan S

    2013-09-01

    Migraine is common in pediatric neurology practice, while migraine variants are rare and pose diagnostic problems. The aim was to establish the occurrence of migraine variants in pediatric neurology practice and among migraine, and to discuss their presentation. The files of 2509 newly diagnosed patients, aged 0-18 years, treated as in- and out-patients in the Neuropediatric Ward at the Plovdiv Medical University Hospital between 2002 and 2006 were examined retrospectively. Migraine forms were diagnosed according to ICHD-II. Benign paroxysmal torticolis and alternating hemiplegia of childhood were also accepted as migraine variants according to proposed diagnostic criteria in the appendix of ICHD-II. Some specific forms like acute confusional migraine (ACM), Alice in wonderland syndrome (AWS), ophthalmoplegic migraine were also diagnosed although not included as migraine variants in the ICHD-II classification. 111 patients met diagnostic criteria for migraine. Patients with migraine variants comprised 24.3% of migrainous cases. Basilar type migraine was the most common (6.3% of all migrainous patients), followed by benign paroxysmal vertigo (5.4%), hemiplegic migraine (3.6%), ACM (2.7%), benign paroxysmal torticolis (2.7%), typical aura without headache (1.8%), abdominal migraine (1.8%), AWS (0.9%), ophthalmoplegic migraine (0.9%) and cyclical vomiting (0.9%). Alternating hemiplegia of childhood and retinal migraine was not found. Some patients either presented or were classified as different migraine variants. Basilar type migraine was the most common migraine variant. ACM and AWS should be regarded as distinct entities in the ICHD as migraine with complex aura. Benign paroxysmal torticollis also deserves its place as a migraine variant. Cases of ophthalmoplegic migraine with spontaneous remission and no cranial nerve enhancement on MRI should be considered as migraine form. Analyzing migraine variants will contribute to better awareness and adequate diagnosis

  19. 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

  20. 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

  1. 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.

  2. 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

    2017-04-07

    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.

  3. 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

  4. 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

  5. Pattern Visual Evoked Potential, Pattern Electroretinogram, and Retinal Nerve Fiber Layer Thickness in Patients with Migraine during and after Aura.

    PubMed

    El-Shazly, Amany Abd El-Fattah; Farweez, Yousra Ahmed; Hamdi, Momen Mahmoud; El-Sherbiny, Noha Ezzat

    2017-09-01

    To study pattern visual evoked potential (PVEP), pattern electroretinogram (PERG), and retinal nerve fiber layer (RNFL) thickness in patients with migraine during and after aura. We included 60 eyes of 60 patients with migraine (Group 1) and 30 healthy volunteers (30 eyes) as controls (Group 2). Group 1 was studied twice, during a visual aura (1-a) and in between attacks (1-b). All participants underwent full ophthalmological examination, PVEP, PERG, and optical coherence tomographyOCT imaging of the RNFL thickness for each patient. RNFL thickness was found to be thinner in patients during the aura compared to controls. It increased significantly post-aura but remained lower than the controls. Prolonged P100 latency and decreased amplitude were found in patients during aura compared to controls with significant change in between attacks to values comparable to the controls. We found prolonged N95 latency and decreased amplitude in patients during aura compared to controls with significant change post-aura to values comparable to the controls. There was positive correlation between average RNFL thicknesses and VA and spherical equivalent; but it showed negative correlation with duration of migraine, attack duration, and aura duration. Multiple regression analysis showed that the most important determinants of average RNFL thickness in patients of migraine were attack and aura duration (beta = -0.21 and -0.26 and p = 0.03 and 0.04, respectively). Migraine attacks impose both functional and structural retinal changes. The functional changes are fully reversible after the aura but not the structural ones. So, vigorous prevention of migraine attacks would be protective for retina.

  6. 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.

  7. Association of pre- and post-treatment expectations with improvements after acupuncture in patients with migraine.

    PubMed

    Zheng, Hui; Huang, Wenjing; Li, Juan; Zheng, Qianhua; Li, Ying; Chang, Xiaorong; Sun, Guojie; Liang, Fanrong

    2015-04-01

    To study whether a higher expectation of acupuncture measured at baseline and after acupuncture is associated with better outcome improvements in patients with migraine. We performed a secondary analysis of a previous published trial in which 476 patients with migraine were randomly allocated to three real acupuncture groups and one sham acupuncture control group. All the participants received 20 sessions of acupuncture over a 4-week period. The primary outcome was the number of days with a migraine attack (NDMA) assessed at 5-8 weeks after randomisation. The secondary outcomes were visual analogue scale, headache intensity and quality of life assessed at 4, 8 and 16 weeks after randomisation. Expectations of the acupuncture effect were assessed at baseline and at the end of treatment and categorised into five levels, with 0% the lowest and 100% the highest. Outcome improvement was first compared among the participants with different expectation levels using an analysis of variance model. The association between expectations of treatment and outcome improvement was then calculated using a logistic regression model. Patients with 100% baseline expectations did not report significantly fewer NDMA than those with 0% baseline expectations after adjusting for the covariates (at 5-8 weeks, 1.7 vs 3.9 days, p=0.987). High baseline expectations had no significant impact on improvement of the primary outcome (100% vs 0%: OR 8.50, 95% CI 0.89 to 191.65, p=0.682). However, patients with 100% post-treatment expectations reported fewer NDMA than those with 0% expectations (primary outcome: 1.3 vs 5.0 days, p<0.001) and were more likely to have a favourable response (100% vs 0%: OR 68.87, 95% CI 6.26 to 1449.73, p=0.002). Similar results were found when analysing the impact of expectation on the secondary outcomes. A high level of expectation after acupuncture treatment rather than at baseline was associated with better long-term outcome improvements in patients with

  8. [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.

  9. [Migrainous infarct in pregnancy].

    PubMed

    Parajuá, J L; Calles, C

    We present the case of a migrainous patient who had a cerebral infarct during a migrainous crisis. She was 26 weeks pregnant. The infarct, detected on MRI was in the right thalamic region. It presented as left hemiparesia and left hemi-hypo-estesia. Laboratory tests were normal. There was full recovery from the episode. Migraine is considered to be a risk factor per se for stroke, especially in young women. The association of migrainous ictus, which is a diagnosis by exclusion of other aetiologies, and pregnancy is rare, as is apparent on review of the subject. In the Western world, pregnancy is not considered to be a risk factor for ictus. The functional prognosis of migrainous stroke is good, with minimal risk of relapse.

  10. 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. PMID:28360580

  11. A pulmonary right-to-left shunt in patients with hereditary hemorrhagic telangiectasia is associated with an increased prevalence of migraine.

    PubMed

    Post, Martijn C; Letteboer, Tom G W; Mager, Johannes J; Plokker, Thijs H; Kelder, Johannes C; Westermann, Cornelius J J

    2005-10-01

    Hereditary hemorrhagic telangiectasia (HHT) is a rare autosomal-dominant vascular dysplasia with a high prevalence of pulmonary arteriovenous malformation (PAVM). Recent studies report an increased prevalence of migraine in patients with a cardiac right-to-left shunt. The aim of our study was to evaluate whether there is also an increased prevalence of migraine in patients with a pulmonary right-to-left shunt (PAVM). All patients with HHT referred to our hospital till April 2004 with or without PAVM and with or without migraine were included in the study. In total, 538 HHT patients (41.6% men; mean age +/- SD, 39.3 +/- 18.6 years) could be included. PAVM was present in 208 patients (38.7%; mean age, 39.3 +/- 17.6 years). Significantly more women were present in the PAVM subgroup compared to the non-PAVM subgroup, 65.4% vs 53.9% (p = 0.009). Migraine occurred in 88 patients with HHT, a prevalence of 16.4%. The prevalence of migraine in women with HHT was significantly higher compared to men, 19.4% vs 12.1%, respectively (p = 0.03) The prevalence of migraine in patients with PAVM was 21.2%, which was significantly higher then in patients without PAVM, 13.3% (p = 0.02). The occurrence of PAVM in the patients with migraine is significantly higher than in those without migraine, 50.0% vs 36.4%, respectively (p = 0.02). This study showed a higher prevalence of PAVM in patients with migraine and HHT. The right-to-left shunt due to the PAVM might play a causal role in the pathogenesis of migraine in patients with HHT. This needs to be determined in further studies.

  12. 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

  13. [Mechanisms underlying migraine chronification].

    PubMed

    Shibata, Mamoru

    2012-01-01

    Chronification of migraine occurs in approximately 3% of entire cases annually. Some risk factors, like obesity and affective disorder, exacerbate the migraine disease conditions. The incidence of migraine chronification is dependent on the baseline frequency of migraine attacks. Functional MRI data support that dysfunction of the descending anti-nociceptive systems plays an important role in the development of migraine chronification. Moreover, several studies employing voxel-based morphometry have revealed morphological alterations of gray matter density in various brain regions, some of which are irrelevant to the sensory or limbic systems. It remains to be determined whether such organic changes are either causative of or attributable to migraine chronification. A preclinical study showed that cortical spreading depression can activate matrix metalloproteinase-9, potentially leading to disruption of blood-brain barrier and subsequent parenchymal damage. We demonstrated that TRPV1 (transient receptor potential vanilloid subfamily, member 1) stimulation in the trigeminal nociceptors induces morphological changes of microglia and astrocytes in the trigeminal nucleus caudalis. Recently, botulinum neurotoxin type-A (BoNT-A) has been approved for patients with chronic migraine. The primary action of BoNT-A is inhibition of regulated exocytosis at the peripheral nerve terminals, raising the possibility that certain peripheral factors are implicated in the development of migraine chronification.

  14. Frequency of pediatric migraine with aura in a clinic-based sample.

    PubMed

    Genizi, Jacob; Khourieh Matar, Amal; Zelnik, Nathanel; Schertz, Mitchell; Srugo, Isaac

    2016-01-01

    To assess the prevalence and risk factors for pediatric migraine with aura (MWA) among patients presenting to pediatric neurology clinics. Headache is a common complaint among children, and the prevalence of migraine is about 8%. Up to one third of adults with migraine report experiencing aura; however, the exact percentage in children is unknown. Medical records of children presenting with headache to three pediatric neurology clinics in Haifa in the last 5 years were retrospectively reviewed. Inclusion criteria were a diagnosis of migraine headache at 5-18 years of age. Of 260 children (140 female) who had migraine, 26.2% experienced aura. MWA was more common among females compared to males (32.6% vs 18.9%, P < .01) and among older children (OR: 2.50, 95% CI: 1.20-5.20; P < .01). Among those who experienced aura, visual aura was more common in females than males (66.7% vs 33.3%, P < .04). Family history of migraine was strongly related to MWA (P < .02): the odds of MWA were 2.46 times greater in children who had a family history of migraine. (OR: 2.46, 95% CI: 1.08-5.62; P < .03). MWA is as common in children as in adults. Aura is more common in older children. Children who have MWA are more likely to have a family history of migraine. © 2015 American Headache Society.

  15. Migraine patients have a higher prevalence of PTSD symptoms in comparison to chronic tension-type headache and healthy subjects: a case-control study.

    PubMed

    Zarei, Mohammad Reza; Shabani, Mohammad; Chamani, Goli; Abareghi, Fatemeh; Razavinasab, Moazamehosadat; Nazeri, Masoud

    2016-11-01

    Headache is one of the most common disorders and has a heavy socioeconomic burden on both patients and society. Previous studies have demonstrated a high prevalence of psychological issues (e.g. depression and anxiety) in headache and especially migraine patients. The current study was designed to evaluate the prevalence of post-traumatic stress disorder (PTSD) symptomatology in chronic migraine (CM), chronic tension-type headache (CTTH) and healthy subjects. CM and CTTH subjects were selected consecutively from patients referring to the department of neurology clinic at Shafa Hospital, Kerman University of Medical Sciences, Kerman, Iran. PTSD symptomatology was assessed using PTSD checklist civilian version-Persian edition (PCL-C). Control subjects were enrolled from the family members of headache patients who did not have any history of headache. Chi-square test was used to analyse data and p < .05 was considered statistically significant. Of the 60 control subjects, 5 had a PTSD symptomatology (8.3%); this prevalence was 13.3% for CTTH and 40% for CM groups. CM patients had a significantly higher prevalence of PTSD symptomatology in comparison to CTTH and control subjects (p < .05). With reference to gender, most of the subjects with PTSD symptomatology were female. Results of the current study demonstrated that CM patients have a higher prevalence of PTSD symptomatology compared to another chronic headache condition (CTTH) and healthy subjects, which should be considered while treating CM patients. Further studies in larger populations are demanded.

  16. Prospective analysis of the use of OnabotulinumtoxinA (BOTOX) in the treatment of chronic migraine; real-life data in 254 patients from Hull, U.K.

    PubMed

    Khalil, Modar; Zafar, Hassan W; Quarshie, Victoria; Ahmed, Fayyaz

    2014-09-01

    Chronic migraine affects 2% of the population. It results in substantial disability and reduced quality of life. Medications used for prophylaxis in episodic migraine may also work in chronic migraine. The efficacy and safety of OnabotulinumtoxinA (BOTOX) in adults with chronic migraine was confirmed in the PREEMPT programme. However, there are few real-life data of its use. 254 adults with chronic migraine were injected with OnabotulinumtoxinA BOTOX as per PREEMPT Protocol between July 2010 and May 2013, their headache data were collected using the Hull headache diary and analysed to look for headache, migraine days decrements, crystal clear days increment in the month post treatment, we looked at the 50% responder rate as well. Our prospective analysis shows that OnabotulinumtoxinA, significantly, reduced the number of headache and migraine days, and increased the number of headache free days. OnabotulinumtoxinA Botox also improved patients' quality of life. We believe that these results represent the largest post-marketing cohort of patients treated with OnabotulinumtoxinA in the real-life clinical setting. OnabotulinumtoxinA is a valuable addition to current treatment options in patients with chronic migraine. Our results support findings of PREEMPT study in a large cohort of patients, we believe, is representative of the patients seen in an average tertiary headache centre. While it can be used as a first line prophylaxis its cost may restrict its use to more refractory patients who failed three oral preventive treatments.

  17. 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.

  18. 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.

  19. Overuse of paracetamol caffeine aspirin powders affects cerebral glucose metabolism in chronic migraine patients.

    PubMed

    Di, W; Shi, X; Zhu, Y; Tao, Y; Qi, W; Luo, N; Xiao, Z; Yi, C; Miao, J; Zhang, A; Zhang, X; Fang, Y

    2013-04-01

    Overuse of analgesic plays a prominent role in migraine chronification. Paracetamol caffeine aspirin (PCA) powders are commonly used in Chinese migraineurs. This study investigated the effects of the specific combination analgesic on cerebral glucose metabolism in chronic migraine (CM). 18F-FDG-PET was used to measure regional metabolism in all subjects. Brain metabolisms of CM patients with analgesic overuse (AO-CM; n=10), no analgesic overuse (NAO-CM; n=10), and no regimen (NR-CM; n=10) and 17 age- and gender-matched normal controls (NC) were compared using statistical parametric mapping. Then, all patients underwent brain MRI analysis within 7 days after PET scans, as well as MMSE and MoCA scale for cognitive function tests. Glucose metabolic changes in CM patients taking different dosage of analgesic during headache-free periods and clear distinctions in several brain regions were observed. Patients with AO-CM exhibited significant metabolic reductions in thalamus, as well as increased metabolism in middle temporal gyrus and insula relative to NR-CM and NAO-CM. However, in these regions, no difference was observed in AO-CM except for increased metabolism in the right insula relative to NC group. Overusing PCA powders affects regional brain glucose metabolism in CM. Increased metabolism in the right insula may be associated with recurrently overusing of PCA powders. © 2012 The Author(s) European Journal of Neurology © 2012 EFNS.

  20. 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.

  1. Headache, migraine and oral contraceptives.

    PubMed

    1998-01-01

    Many physicians will not provide oral contraceptives (OCs) to women with a history of migraine due to concerns about increasing the risk of a cerebrovascular accident. The World Health Organization's revised medical eligibility criteria indicate that only women with serious migraine that includes focal neurologic symptoms should be cautioned against OC use. This article reviews the research evidence on headache, migraine, and OCs. The recent literature suggests that healthy, nonsmoking women using low-dose OCs (35 mcg of estrogen or less) have no increased risk of stroke. Although the presence of diabetes, hypertension, and/or migraine appears to be associated with an increased risk of cerebral thromboembolism, the use of OCs does not synergistically add to the risk. It is important, however, for physicians to differentiate between tension headaches, migraines with aura (classic migraine), and migraines without aura (common migraine). Women with classic migraine should avoid OCs if an alternative method of contraception can be used. Common migraine is not a contraindication to OC use, although the frequency and severity of headaches during OC use should be monitored. OC discontinuation should be discontinued, at least temporarily, if previously existing migraine suddenly worsens, headaches that are qualitatively different than the type usually experienced by the patient occur, headaches wake a patient from sleep, or double vision or loss of vision occur.

  2. 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.

  3. TRPV1, CGRP and SP in scalp arteries of patients suffering from chronic migraine.

    PubMed

    Del Fiacco, Marina; Quartu, Marina; Boi, Marianna; Serra, M Pina; Melis, Tiziana; Boccaletti, Riccardo; Shevel, Elliot; Cianchetti, Carlo

    2015-04-01

    The transient receptor potential vanilloid type-1 receptor (TRPV1) and the neuropeptides calcitonin gene-related peptide (CGRP) and substance P (SP) appear to be differently involved in migraine pain. A role of neurovascular scalp structures is also suggested by several data. We performed a quantitative study of TRPV1-like immunoreactive (LI), CGRP-LI and SP-LI innervation of scalp arterial samples from patients affected with chronic migraine (CM). Short segments of scalp arteries were collected from 17 participants undergoing vascular surgery for treatment-resistant CM and from 6 controls who underwent neurosurgery for various indications. The immunoreactivity of the arterial innervation to TRPV1, CGRP, SP and to the pan-neuronal marker protein gene product 9.5 (PGP9.5) was examined. Immunoreactive nerve fibres in vessel cross-sections were quantified by computerised image analysis. A significant increase of TRPV1-LI nerve fibres was found in the arterial wall from CM compared with control patients (p<0.05), while no significant difference was found for CGRP and SP. This study yields the first evidence for the existence of a TRPV1-LI innervation in human scalp arteries and provides the first quantitative assessment of the TRPV1-LI, CGRP-LI and SP-LI innervation of those vessels. The increase of TRPV1-LI periarterial nociceptive fibres of scalp arteries may represent, at least in some participants, a structural condition favouring CM (and possibly migraine), for example, by causing a higher sensitivity to algogenic agents. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  4. Prospective analysis of the use of OnabotulinumtoxinA (BOTOX) in the treatment of chronic migraine; real-life data in 254 patients from Hull, UK

    PubMed Central

    2014-01-01

    Background Chronic migraine affects 2% of the population. It results in substantial disability and reduced quality of life. Medications used for prophylaxis in episodic migraine may also work in chronic migraine. The efficacy and safety of OnabotulinumtoxinA (BOTOX) in adults with chronic migraine was confirmed in the PREEMPT programme. However, there are few real-life data of its use. Method 254 adults with chronic migraine were injected with OnabotulinumtoxinA BOTOX as per PREEMPT Protocol between July 2010 and May 2013, their headache data were collected using the Hull headache diary and analysed to look for headache, migraine days decrements, crystal clear days increment in the month post treatment, we looked at the 50% responder rate as well. Results Our prospective analysis shows that OnabotulinumtoxinA, significantly, reduced the number of headache and migraine days, and increased the number of headache free days. OnabotulinumtoxinA Botox also improved patients’ quality of life. We believe that these results represent the largest post-marketing cohort of patients treated with OnabotulinumtoxinA in the real-life clinical setting. Conclusion OnabotulinumtoxinA is a valuable addition to current treatment options in patients with chronic migraine. Our results support findings of PREEMPT study in a large cohort of patients, we believe, is representative of the patients seen in an average tertiary headache centre. While it can be used as a first line prophylaxis its cost may restrict its use to more refractory patients who failed three oral preventive treatments. PMID:25178393

  5. Impact of Amitryptiline on Migraine Disability Assessment Score

    PubMed Central

    Nischal, Hanock

    2014-01-01

    Aim: Migraine headache is a common disorder, several drugs have been tried as a prophylaxis to reduce the attacks of headache. Aim of this study is to see the impact of amitriptyline on quality of life in migraneurs using Migraine Disability Assessment Score. Materials and Methods: In this study 300 patients of either gender who required prophylaxis for migraine without aura were selected. The patients were of the age group 18-60 years. The MIDAS questionnaire was administered to patients before starting treatment and again after 45 days prophylaxis. The improvement was noted. Statistical Analysis: It is a prospective study where the severity of symptoms and ‘quality of life’ in patients is assessed before and after treatment using mean, frequency, standard deviation and paired‘t’ test. Results: A total of 300 patients were subjected to migraine prophylaxis with amiptriptyline. The study showed female preponderance. The mean MIDAS score before and after treatment with amitriptyline was 11.6 and 9.4 respectively. The student‘t’ test showed p-value of <0.005 which was significant. Conclusion: Migraine prophylaxis with amitriptyline for a period of 45 days decreased the severity of symptoms and also reduction in days of migraine attacks. However the long term effects on quality of life could not be assessed. The study needs to be conducted in a large scale to evaluate the consistency and accuracy of the test. PMID:25386467

  6. Acute confusional migraine: is it a distinct form of migraine?

    PubMed

    Pacheva, I; Ivanov, I

    2013-03-01

    The International Classification of Headache Disorders (ICHD-II) - 2004 recognises many migraine variants (different from migraine without aura and migraine with typical aura), but acute confusional migraine (ACM) remains unclassified and most clinicians are not well acquainted with it. The aim of this study was to illustrate ACM in the neuropaediatric practice, to discuss its place in the ICHD-II and to propose diagnostic criteria. A total of 2509 files of newly diagnosed patients, aged 0-18 years, treated as in- and outpatients in the Neuropaediatric Ward at the Plovdiv Medical University Hospital between 2002 and 2006 were screened retrospectively. Their diagnosis was based on detailed medical history, physical and neurological examination, additional functional, imaging and laboratory investigations. Migraine and migraine variants were diagnosed according to ICHD-II, but specific forms (e.g. ACM and Alice in wonderland syndrome) were also included. One hundred and eleven patients met the diagnostic criteria for migraine. Migraine variants comprised 24.3% of all migraine cases. In particular, ACM represented 11.1% of migraine variants or 2.7% of migraine and 0.12% of all paediatric neurological diseases. Here, we report three cases of ACM with analysis of the typical clinical and EEG features, review the literature and propose diagnostic criteria. ACM may present as either the only manifestation of a migraine attack or in the context of other migraine forms. ACM should have its own distinct place in the ICHD-II, may be as a subtype of migraine with complex aura. © 2013 Blackwell Publishing Ltd.

  7. 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

  8. 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. © 2013 The Scandinavian Psychological Associations.

  9. 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

  10. [Basilar-type migraine: pathophysiology, symptoms and signs, and treatment].

    PubMed

    Kozubski, Wojciech

    2005-01-01

    Basilar-type migraine (BTM) is a type of migraine with aura symptoms resulting from brain stem or bi-hemispheric structures but without motor elements. There are no precise data on the frequency of BTM. The main cohort of the patients includes young people and children with female predomination. The onset of the disease usually occurs before the age of 25. The diagnosis of BTM is based on the finding of two migraine attacks accompanied by a specific aura, with dysarthria, vertigo, tinnitus, impaired hearing, double vision, visual aura elements, ataxia of a cerebellar type, loss of consciousness, and bilateral paresthesias. In the differential diagnosis one should consider the pathology of posterior fossa, diseases with recurrent vertigo, complex epileptic seizures, CADASIL and MELAS syndromes, and alternative hemiplegic migraine with cerebellar symptoms and signs. In the prophylaxis sodium valproate and calcium-entry blockers and, especially in the prophylaxis of vertigo, betahistine chloride are used.

  11. Alexithymic characteristics in pediatric patients with primary headache: a comparison between migraine and tension-type headache.

    PubMed

    Gatta, M; Spitaleri, C; Balottin, U; Spoto, A; Balottin, L; Mangano, S; Battistella, P A

    2015-01-01

    Alexithymia is a personality construct characterized by difficulties in verbal emotional expression and a limited ability to use one's imagination. Evidence of alexithymic characteristics was found in adults suffering from headache, while little is known about children. The aim of this study was to establish the prevalence of alexithymia in two different subgroups of children and adolescents suffering from primary headache. We also looked for correlation between alexithymia in children and in their mothers. This study involved 89 participants: 47 (11 males, 36 females, aged 8 to 17 years) suffering from tension-type headache (TTH), and 42 (18 males, 24 females, aged 8 to 17 years) suffering from migraine (M), based on the International Classification of Headache Disorders (ICHD 2013). A control group of 32 headache-free subjects (26 females and 6 males, aged 8 to 17 years) was also considered. Two questionnaires were administered to measure alexithymia: the Alexithymia Questionnaire for Children to young patients and controls, and the Toronto Alexithymia Scale (TAS-20) to the mothers. Higher rates of alexithymia emerged in the TTH group compared to the M group. In particular, TTH sufferers had difficulty identifying their feelings. The mothers of children with headaches didn't score higher in alexithymia compared to other mothers. In the M and in the control group, there was a significant correlation between the rates of alexithymia in young people and in their mothers. To date no other study has investigated alexithymia in subgroups of primary headaches in developmental age. Our results suggest that patients suffering from TTH are more alexithymic than M patients. This pave the way to etiopathogenetic and clinical considerations, calling for a comprehensive and multidisciplinary approach to tackle the problem of headache.

  12. 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

  13. 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

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

    PubMed

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

    2014-08-01

    Chronic rhinosinusitis (CRS) and migraine are common entities with overlapping symptomatology, yet little research exists that 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). Retrospective analysis of a prospective cohort. 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 preoperative and postoperative QOL was compared to patients without migraine (n = 183). Patients migraine and CRS were more likely to be female (P = 0.023); experience allergies (P = 0.024), fibromyalgia (P = 0.009), and 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). 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. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  15. MAOA and TNF-β gene polymorphisms are associated with photophobia but not osmophobia in patients with migraine.

    PubMed

    Ishii, Masakazu; Usami, Shino; Hara, Hajime; Imagawa, Atsuko; Masuda, Yutaka; Shimizu, Shuniichi

    2014-06-01

    Photophobia and osmophobia are typical symptoms associated with migraine, but the contributions of gene polymorphisms to these symptoms are not fully elucidated. We investigated whether the gene polymorphisms are involved in photophobia and osmophobia in patients with migraine. Ninety-one migraine patients and 119 non-headache healthy volunteers were enrolled. The 12 gene polymorphisms were determined by polymerase-chain-reaction (PCR) and PCR restriction-fragment-length polymorphism analysis. Photophobia and osmophobia were observed in 49 (54%) and 31 patients (34%), respectively. Distributions of monoamine oxidase A (MAOA) T941G and tumour necrosis factor-β (TNF-β) G252A polymorphisms were significantly different between patients with photophobia and controls. However, no gene polymorphism differences were observed between patients with osmophobia and controls. The MAOA T941G and TNF-β G252A gene polymorphisms appear to contribute to photophobia but not to osmophobia. We propose that different gene polymorphisms are responsible for photophobia and osmophobia symptoms during migraine.

  16. Low rate of self-awareness and medical recognition of migraine in Germany.

    PubMed

    Radtke, A; Neuhauser, H

    2012-10-01

    The study's objective was to assess self-awareness and medical recognition of migraine and their determinants in Germany. We conducted a nationally representative study of the general population of Germany (N = 7341, aged ≥18 years) by means of computer-assisted telephone interviews. Migraine was diagnosed based on the International Classification of Headache Disorders, second edition (ICDH-II). Twelve-month prevalence of ICHD-II-migraine was 10.6% (women 15.6%, men 5.3%). Seventy percent of ICDH-II-migraineurs recognised their headaches as migraine (moderate agreement between ICDH-II and self-diagnosis, κ = 0.46). Only 42% of migraineurs consulted a physician in the previous 12 months. Of those, 63% reported a medical diagnosis of migraine (moderate agreement, κ = 0.40). Women were more likely to be self-aware (odds ratio [OR] 1.81, 95% confidence interval [CI] 1.27-2.60), but the difference was no longer significant when adjusting for migraine features. Physician recognition was more likely in patients with higher educational level (high vs. low education OR 3.90, 95% CI 1.43-10.61 after adjusting for migrainous features). Best predictors for self-awareness and medical recognition of migraine were typical migraine accompaniments and greater headache intensity. Self-awareness and physician recognition of migraine are low in Germany. Presence of typical migraine features and greater headache intensity facilitate medical recognition and awareness of migraine, especially in females.

  17. 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

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

    PubMed

    Zhao, Ling; Liu, Jixin; Dong, Xilin; Peng, Yulin; Yuan, Kai; Wu, Fumei; Sun, Jinbo; Gong, Qiyong; Qin, Wei; Liang, Fanrong

    2013-10-17

    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. 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. 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. 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.

  19. International Classification of Headache Disorders 3rd edition beta-based field testing of vestibular migraine in China: Demographic, clinical characteristics, audiometric findings and diagnosis statues.

    PubMed

    Zhang, Yixin; Kong, Qingtao; Chen, Jinjin; Li, Lunxi; Wang, Dayan; Zhou, Jiying

    2016-03-01

    This study explored the clinical characteristics of vestibular migraine in Chinese subjects and performed a field test of the criteria of the International Classification of Headache Disorders 3rd edition beta version. Consecutive patients with vestibular migraine were surveyed and registered in a headache clinic during the study period. The diagnosis of vestibular migraine was made according to International Classification of Headache Disorders 3rd edition beta version. Assessments included standardized neuro-otology bedside examination, pure-tone audiogram, bithermal caloric testing, neurological imaging, cervical X-ray or magnetic resonance imaging, Doppler ultrasound of cerebral arteries and laboratory tests. A total of 67 patients (62 female/five male, 47.8 ± 10.3 years old) were enrolled in this study. The mean ages of migraine and vertigo onset were 32.2 ± 11.5 and 37.9 ± 10.1 years, respectively. The most common migraine subtype was migraine without aura (79%), followed by migraine with aura (12%) and chronic migraine (9%). The duration of vertigo attacks varied from seconds to days and 25% of patients had attacks that lasted less than 5 minutes. Among the patients with short-lasting attacks, 75% of these patients had ≥5 attacks per day within 72 hours. Auditory symptoms were reported in 36% of the patients. Migraine prophylactic treatments were effective in 77% of the patients. Our study showed that the clinical features of vestibular migraine in China were similar to those of Western studies. The definition of vertigo episodes and migraine subtypes of vestibular migraine in International Classification of Headache Disorders 3rd edition beta version might be modified further. More than five vertigo attacks per day within 72 hours might be helpful as far as identifying vestibular migraine patients with short-lasting attacks. © International Headache Society 2015.

  20. Alliaceous migraines.

    PubMed

    Roussos, Alexander P; Hirsch, Alan R

    2014-02-01

    To report a migraineur with osmophobia and trigger to garlic and onion aroma. While odors serve as a trigger in 70% of migraineurs, alliaceous aromas have been described only rarely. Furthermore, nor has more than one type of alliaceous odor acted as a trigger in the same individual. Neither has migraine with aura been described as precipitated by such aromas. A patient experiencing migraines with aura, triggered almost exclusively by alliaceous aromas, is described. 32-year-old woman; 5 years previously felt nasal pruritis upon eating a red onion dip. Shortly thereafter, the mere aroma of raw onions caused a sensation of her throat closing along with an associated panic attack. Over the intervening years, upon exposure to onions and garlic aroma she experienced a fortification spectra and visual entopia, followed by a bipareital, crushing level 10/10 headache, burning eyes and nose, lacrimation, perioral paresthesias, generalized pruritis, nausea, fatigue, sore throat, dysarthria, confusion, dyspnea, palpitations, presyncopal sensations, hand spasms, tongue soreness, neck pain, phonophobia, and photophobia. These would persist for 1 hour after leaving the aroma. She was unresponsive to medication and would wear a surgical mask when out. The patient also experienced chemosensory complaints: dysosmias every few months; phantosmias of food or cleaning products every month for a minute of level 5/10 intensity; pallinosmia of onion or garlic odor for 30 minutes after exposure; and metallic pallinugeusia after eating with metal utensils. Neurological exam normal except for bilateral positive Hoffman reflexes. Quick Smell Identification Test 3/3 and Brief Smell Identification Test 12/12 were normal. Magnetic resonance imaging and computed tomography with and without contrast normal. Allergy skin test was positive for garlic and onion. Nose plug and counter stimulation with peppermint prevented the onset of headaches and associated symptoms. This is the first report of

  1. 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.

  2. Experience of Surgical Treatment for Occipital Migraine in Taiwan.

    PubMed

    Lin, Shang-Hsi; Lin, Huwang-Chi; Jeng, Chu-Hsu; Hsieh, Cheng-Han; Lin, Yu-Hsien; Chen, Cha-Chun

    2016-03-01

    Refractory migraine surgery developed since 2003 has excellent results over the past 10 years. According to the pioneer of migraine surgery, Dr. Bahman Guyuron, 5 major surgical classifications of migraines are described in the field of plastic surgery, namely, frontal migraine, temporal migraine, rhinogenic migraine, occipital migraine, and auriculotemporal migraine. In this study, we present the preliminary surgical results of the occipital migraine surgery. A total of 22 patients with simple occipital migraines came to our outpatient clinic for help from June 2014 to February 2015. Thirteen cases were excluded owing to ineligibility for operation or other reasons. The patients who concurrently experienced other types of migraines were precluded even if they received combined migraine surgery. Therefore, 9 simple occipital migraine cases were enrolled in this study. Migraine severity was evaluated by uniform questionnaires to identify the source of migraine. Neurolysis was performed under general anesthesia, with the patient in a prone position. Postoperative conditions were evaluated at the second, fourth, sixth, and eighth weeks by posttreatment questionnaires. Of all the 9 patients, 5 experienced single-sided migraines of greater occipital nerve origin (2 left-sided and 3 right-sided cases). Two patients had bilateral migraines of greater occipital nerve origin, and unilateral right lesser occipital nerve origin was noted in one patient. The last patient had right-sided migraines of greater and lesser occipital nerve origin. As a result in the follow-up, a response rate greater than 90% was documented, and complete resolution was observed in 2 patients. Drug doses were reduced more than 50% in the remaining patients. The overall efficacy of occipital migraine surgery in this study was 88.8% (8/9 cases). Some patients with migraine are good candidates for surgical resolution with appropriate and meticulous selection. Similar to what is observed in Western

  3. A report of three patients in whom the surgical closure of terminal branches of the external carotid arteries for treatment of migraine resulted in significantly reduced frequency of epileptic attacks.

    PubMed

    Shevel, E I

    2016-11-02

    Three patients under treatment for grand mal epilepsy, and who were also suffering from chronic migraine, underwent vascular surgery for their migraine. A serendipitous benefit from the successful vascular surgery for migraine was a significant reduction in the frequency of their grand mal seizures.

  4. [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.

  5. Systematic re-evaluation of genes from candidate gene association studies in migraine using a large genome-wide association data set.

    PubMed

    de Vries, Boukje; Anttila, Verneri; Freilinger, Tobias; Wessman, Maija; Kaunisto, Mari A; Kallela, Mikko; Artto, Ville; Vijfhuizen, Lisanne S; Göbel, Hartmut; Dichgans, Martin; Kubisch, Christian; Ferrari, Michel D; Palotie, Aarno; Terwindt, Gisela M; van den Maagdenberg, Arn Mjm

    2016-06-01

    Before the genome-wide association (GWA) era, many hypothesis-driven candidate gene association studies were performed that tested whether DNA variants in genes that had been selected based on prior knowledge about migraine pathophysiology were associated with migraine. Most studies involved small sample sets without robust replication, thereby making the risk of false-positive findings high. Genome-wide marker data of thousands of migraine patients and controls from the International Headache Genetics Consortium provide a unique opportunity to re-evaluate key findings from candidate gene association studies (and other non-GWA genetic studies) in a much larger data set. We selected 21 genes from published candidate gene association studies and six additional genes from other non-GWA genetic studies in migraine. Single nucleotide polymorphisms (SNPs) in these genes, as well as in the regions 500 kb up- and downstream, were inspected in IHGC GWAS data from 5175 clinic-based migraine patients with and without aura and 13,972 controls. None of the SNPs in or near the 27 genes, including the SNPs that were previously found to be associated with migraine, reached the Bonferroni-corrected significance threshold; neither when analyzing all migraine patients together, nor when analyzing the migraine with and without aura patients or males and females separately. The available migraine GWAS data provide no clear evidence for involvement of the previously reported most promising candidate genes in migraine. © International Headache Society 2015.

  6. Weight regain after discontinuation of topiramate treatment in patients with migraine: a prospective observational study.

    PubMed

    Verrotti, Alberto; Parisi, Pasquale; Agostinelli, Sergio; Loiacono, Giulia; Marra, Francesca; Coppola, Giangennaro; Pisani, Laura Rosa; Gorgone, Gaetano; Striano, Pasquale; Pisani, Francesco; Belcastro, Vincenzo

    2015-02-01

    To monitor weight regain after therapy discontinuation in patients with migraine experiencing weight loss during topiramate (TPM) treatment. Patients with migraine without aura were enrolled in this observational prospective study. Weight, body mass index (BMI), waist circumference, systolic and diastolic blood pressure, plasma levels of total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, leptin, and ghrelin, and homeostatic model assessment of insulin resistance (HOMA-IR) were evaluated before starting TPM (T1), at 3 (T2) and 6 (T3) months of treatment and 6 months after withdrawal of TPM (T4). Weight loss/regain was considered as a change of 5% of pre-TPM body weight. A total of 241 patients were analyzed. Of these, 87 (36%) patients experienced weight loss on TPM medication. During TPM therapy significant reductions in mean values of weight (p<0.001), BMI (p<0.001), waist circumference (p<0.01), HOMA-IR (p<0.01), and leptin (p<0.01) were observed. After TPM discontinuation, all of these parameters showed a clear trend to increase at T4, achieving pre-TPM values in 27 patients. Among potential predictors, only HOMA-IR before starting TPM (parameter estimate=1.36, effect size=0.75; p=0.006) was significantly associated with weight regain after therapy discontinuation. Loss of body weight is a reversible effect, which at 6 months after TPM discontinuation shows a clear trend to return to baseline values. HOMA-IR is the only predictive factor of weight regain.

  7. Enalapril improves endothelial function in patients with migraine: A randomized, double-blind, placebo-controlled trial

    PubMed Central

    Javanmard, Shaghayegh Haghjooy; Sonbolestan, Seyed Ali; Heshmat-Ghahdarijani, Kian; Saadatnia, Mohamad; Sonbolestan, Seyed Ahamad

    2011-01-01

    BACKGROUND: There are increasing evidences of endothelial dysfunction in migraine. The ACE-inhibitors have previously been shown to be effective in migraine prophylaxis. Furthermore, ACE inhibitors have beneficial effects on endothelial dysfunction. We therefore investigated whether Enalapril is effective in endothelial function improvement. METHODS: In this randomized clinical trial, 10 mg Enalapril daily was compared with matched placebo in 40 patients with migraine for two months. Flow Mediated Dilation (FMD), serum total nitrite and C-reactive protein (CRP) were measured in all patients at the baseline and after 2 months. RESULTS: patients’ FMD increased in the case group after treatment with Enalapril (p = 0.002) while there was no significant change in control group. Total nitrite concentration increased in case group (p = 0.000), while there was no significant difference before treatment. There was no significant difference in the CRP concentrations in two groups. CONCLUSIONS: These results indicate that ACE inhibition can improve endothelial function in patients with migraine, as it has been shown by both FMD and serum levels of nitric oxide. The mechanism could be either that Enalapril limits the angiotensin IIinduced production of superoxide radicals which would normally inactivate nitric oxide, or that it may increase bradykinin-mediated nitric oxide release. PMID:21448379

  8. 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 ...

  9. 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.

  10. 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.

  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. Migraine and migraines of specialists: perceptions and management.

    PubMed

    Donnet, Anne; Becker, Henri; Allaf, Bashar; Lantéri-Minet, Michel

    2010-07-01

    To describe the perception of migraine by neurologists in France, to compare perceptions between neurologists who did and did not suffer from migraines and to describe treatments used for their own migraines. Patients with migraine are usually undertreated, as treatment guidelines are frequently not followed and, therefore, resulting treatment satisfaction is low. One reason for this may be inappropriate perceptions of physicians concerning the seriousness of the pathology and the need to treat. However, available information on physician perceptions of migraine is limited. This was an observational, epidemiological survey conducted both in hospital- and community-based neurologists in France. Participating neurologists completed an anonymous questionnaire which collected data on demographics, migraine status, and perceptions of migraine. Neurologists who considered themselves migraineurs also provided data on migraine impact, treatment and on treatment satisfaction. Distributions of responses to questions on migraine perceptions were compared between migraineur and nonmigraineur neurologists. The study included 368 neurologists, of whom 179 (48.6%) were migraineurs themselves. Some 92.3% of participants claimed to be very or quite interested in migraine. Migraine was considered a real illness by 96.5% of neurologists and to be very or quite disabling by 96.6%. Around half perceived migraine as a challenging condition to manage with respect to unrealistic patient expectations (46.2%), time-consuming treatment (48.9%), and complications because of anxious or depressive comorbidity (59.9%) or medical nomadism (consulting multiple physicians for the same condition; 47.0%). No significant differences in any perception items were observed between migraineur and nonmigraineur neurologists. In total, 83.1% of neurologists were satisfied with acute headache treatments and 60.4% with prophylactic headache treatments. The most frequently reported treatments for neurologist

  13. 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.

  14. Influence of greater occipital nerve block on pain severity in migraine patients: A systematic review and meta-analysis.

    PubMed

    Tang, Yongguo; Kang, Junfang; Zhang, Yu; Zhang, Xuejun

    2017-08-14

    Greater occipital nerve (GON) block may be a promising approach to treat migraine. However, the results remained controversial. We conducted a systematic review and meta-analysis to explore the efficacy of GON block in migraine patients. PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases were systematically searched. Randomized controlled trials (RCTs) assessing the efficacy of GON block versus placebo in migraine patients were included. Two investigators independently searched articles, extracted data, and assessed the quality of included studies. Meta-analysis was performed using the random-effect model. Six RCTs were included in the meta-analysis. Overall, compared with control intervention in migraine patients, GON block intervention was found to significantly reduce pain score (Std. mean difference=-0.51; 95% CI=-0.81 to -0.21; P=0.0008), number of headache days (Std. mean difference=-0.68; 95% CI=-1.02 to -0.35; P<0.0001), and medication consumption (Std. mean difference=-0.35; 95% CI=-0.67 to -0.02; P=0.04), but demonstrated no influence on duration of headache per four weeks (Std. mean difference=-0.07; 95% CI=-0.41 to 0.27; P=0.70). Compared to control intervention, GON block intervention can significantly alleviate pain, reduce the number of headache days and medication consumption, but have no significant influence on the duration of headache per four weeks for migraine patients. Copyright © 2017. Published by Elsevier Inc.

  15. 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.

  16. Intravenous magnesium sulphate relieves migraine attacks in patients with low serum ionized magnesium levels: a pilot study.

    PubMed

    Mauskop, A; Altura, B T; Cracco, R Q; Altura, B M

    1995-12-01

    1. We tested the hypothesis that patients with an acute attack of migraine headache and low serum levels (< 0.54 mmol/l) of ionized magnesium are more likely to respond to an intravenous infusion of magnesium sulphate (MgSO4) than patients with higher serum ionized magnesium levels. 2. Serum ionized magnesium levels were drawn immediately before infusion of 1 g of MgSO4 in 40 consecutive patients with an acute migraine headache. 3. Pain reduction of 50% or more as measured on a headache intensity verbal scale of 1 to 10, occurred within 15 min of infusion in 35 patients. In 21 patients, at least this degree of improvement or complete relief persisted for 24h or more. Pain relief lasted at least 24h in 18 of 21 patients (86%) with serum ionized magnesium levels below 0.54 mmol/l, and in 3 of 19 patients (16%) with ionized magnesium levels at or above 0.54 mmol/l (P < 0.001). Mean ionized magnesium levels in patients with relief lasting for at least 24h were significantly lower than in patients with no relief or brief relief (P < 0.01). 4. Measurement of serum ionized magnesium levels may be useful in identifying patients with migraine headaches who may respond to an intravenous infusion of MgSO4.

  17. 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.

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

    PubMed

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

    2014-04-01

    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. 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. 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). It seems that yoga exercises, as a complementary treatment beside pharmacological treatments, can be potentially an effective way of improving vascular functions in migraineurs.

  19. 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

  20. 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.

  1. 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.

  2. Frequency of the C677T variant of the methylenetetrahydrofolate reductase (MTHFR) gene in patients with migraine with or without aura - a preliminary report.

    PubMed

    Szczygioł, Dorota; Motta, Ewa; Gołba, Anna; Stęposz, Arkadiusz; Witecka, Joanna; Dębski, Marek; Błaszkiewicz, Daria; Sieroń, Aleksander

    2012-01-01

    The aim of our study was to evaluate the frequency of the C677T variant in the methylenetetrahydrofolate reductase (MTHFR) gene in patients with migraine with or without aura and to find an association between this variant and vascular lesions in magnetic resonance imaging of the head, presence of patent foramen ovale (PFO) and increased level of homocysteine. Ninety-one patients with migraine, aged 19-57, were investigated in this study. The MTHFR C677T variant was genotyped in this group and levels of homocysteine, folic acid and vitamin B12 were measured. Transcranial Doppler sonography with test for PFO detection by injection of air contrast during the Valsalva manoeuvre was performed in each patient. Frequency of the C677T variant in the MTHFR gene was similar in patients and controls. Hyperhomocysteinaemia was significantly more frequent in migraine patients with the C677T variant. The prevalence of PFO was significantly higher in migraine patients with aura and the homozygous variant of the MTHFR gene. Frequency of the C677T variant in the MTHFR gene was similar in patients and controls. Significantly more frequent prevalence of PFO in migraine patients with aura (with homozygous recessive genotype of MTHFR probably suggests their common genetic basis. Hyperhomocysteinaemia was significantly more frequent in migraine patients with the C677T variant, which could be an additional risk factor of this disease.

  3. 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.

  4. 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.

  5. 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.

  6. 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.

  7. MR Neurography of Greater Occipital Nerve Neuropathy: Initial Experience in Patients with Migraine.

    PubMed

    Hwang, L; Dessouky, R; Xi, Y; Amirlak, B; Chhabra, A

    2017-09-07

    MR imaging of peripheral nerves (MR neurography) allows improved assessment of nerve anatomy and pathology. The objective of this study was to evaluate patients with unilateral occipital neuralgia using MR neurography and to assess the differences in greater occipital nerve signal and size between the symptomatic and asymptomatic sides. In this case-control evaluation using MR neurography, bilateral greater occipital nerve caliber, signal intensity, signal-to-noise ratios, and contrast-to-noise ratios were determined by 2 observers. Among 18 subjects with unilateral occipital migraines, the average greater occipital nerve diameter for the symptomatic side was significantly greater at 1.77 ± 0.4 mm than for the asymptomatic side at 1.29 ± 0.25 mm (P = .001). The difference in nerve signal intensity between the symptomatic and asymptomatic sides was statistically significant at 269.06 ± 170.93 and 222.44 ± 170.46, respectively (P = .043). The signal-to-noise ratios on the symptomatic side were higher at 15.79 ± 4.59 compared with the asymptomatic nerve at 14.02 ± 5.23 (P = .009). Contrast-to-noise ratios were significantly higher on the symptomatic side than on the asymptomatic side at 2.57 ± 4.89 and -1.26 ± 5.02, respectively (P = .004). Intraobserver performance was good to excellent (intraclass coefficient correlation, 0.68-0.93), and interobserver performance was fair to excellent (intraclass coefficient correlation, 0.54-0.81). MR neurography can be reliably used for the diagnosis of greater occipital nerve neuropathy in patients with unilateral occipital migraines with a good correlation of imaging findings to the clinical presentation. © 2017 American Society of Neuroradiology.

  8. 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.

  9. Migraine, Osmophobia, and Anxiety.

    PubMed

    Rocha-Filho, Pedro Augusto Sampaio; Marques, Karine Sobral; Torres, Rinailda Cascia Santos; Leal, Kamila Nazare Ribas

    2016-04-01

    To evaluate the association between osmophobia and the characteristics of patients and their headaches, among migraine patients. This was a cross-sectional study. Patients who consecutively sought medical attendance in a primary care unit were asked about their headaches over the last 12 months. Those who had migraine were included. A semi-structured interview, the Headache Impact Test and the Hospital Anxiety and Depression Scale were used. 147 patients had migraine; 78 had osmophobia; 60 had significant anxiety symptoms; and 78 had significant depression symptoms. The mean age of these patients was 43.2 years (± 13.7); 91.2% were women. The mean length of time with complaints of headache was 13.8 years (± 12). Among the migraine patients, those with anxiety, more years of headache history, and phonophobia presented significantly more osmophobia (multivariate logistic regression). Osmophobia in migraine patients is associated with significant anxiety symptoms, length of headache history, and phonophobia. © 2015 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  10. 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.

  11. De Novo Migraine With Aura After Surgical Repair of Aortic Coarctation.

    PubMed

    Kato, Yuji; Hayashi, Takeshi; Kobayashi, Toshiki; Masuoka, Ayumu; Abe, Tetsuya; Hasebe, Takahiro; Tanahashi, Norio; Takao, Masaki

    2017-05-01

    Coarctation of the aorta (CoA) is reported to be associated with an increased risk for migraine. We describe here the case of a 13-year-old female patient who presented migraine with aura after surgical repair of CoA with a stent. As possible reasons for her condition, we postulate host responses to stent placement and/or disturbed cerebral autoregulation related to intracranial hypertension before the surgical repair and hypotension afterward, leading to hypoperfusion. This case demonstrates that de novo migraine with aura can occur after surgical repair of CoA and should be recognized as a potential complication. © 2016 American Headache Society.

  12. Prospective testing of ICHD-3 beta diagnostic criteria for migraine with aura and migraine with typical aura in patients with transient ischemic attacks.

    PubMed

    Lebedeva, Elena R; Gurary, Natalia M; Gilev, Denis V; Olesen, Jes

    2017-01-01

    Introduction The International Classification of Headache Disorders 3rd edition beta (ICHD-3 beta) gave alternative diagnostic criteria for 1.2 migraine with aura (MA) and 1.2.1 migraine with typical aura (MTA) in the appendix. The latter were presumed to better differentiate transient ischemic attacks (TIA) from MA. The aim of the present study was to field test that. Methods Soon after admission, a neurologist interviewed 120 consecutive patients diagnosed with TIA after MRI or CT. Semi-structured interview forms addressed all details of the TIA episode and all information necessary to apply the ICHD-3beta diagnostic criteria for 1.2, 1.2.1, A1.2 and A1.2.1. Results Requiring at least one identical previous attack, the main body and the appendix criteria performed almost equally well. But requiring only one attack, more than a quarter of TIA patients also fulfilled the main body criteria for 1.2. Specificity was as follows for one attack: 1.2: 0.73, A1.2: 0.91, 1.2.1: 0.88 and A1.2.1: 1.0. Sensitivity when tested against ICHD-2 criteria were 100% for the main body criteria (because they were unchanged), 96% for A1.2 and 94% for A1.2.1. Conclusion The appendix criteria performed much better than the main body criteria for 1.2 MA and 1.2.1 MTA when diagnosing one attack (probable MA). We recommend that the appendix criteria should replace the main body criteria in the ICHD-3.

  13. 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

  14. '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

  15. Effect of hypoxia on BOLD fMRI response and total cerebral blood flow in migraine with aura patients.

    PubMed

    Arngrim, Nanna; Hougaard, Anders; Schytz, Henrik W; Vestergaard, Mark B; Britze, Josefine; Amin, Faisal Mohammad; Olsen, Karsten S; Larsson, Henrik Bw; Olesen, Jes; Ashina, Messoud

    2017-01-01

    Experimentally induced hypoxia triggers migraine and aura attacks in patients suffering from migraine with aura (MA). We investigated the blood oxygenation level-dependent (BOLD) signal response to visual stimulation during hypoxia in MA patients and healthy volunteers. In a randomized double-blind crossover study design, 15 MA patients were allocated to 180 min of normobaric poikilocapnic hypoxia (capillary oxygen saturation 70-75%) or sham (normoxia) on two separate days and 14 healthy volunteers were exposed to hypoxia. The BOLD functional MRI (fMRI) signal response to visual stimulation was measured in the visual cortex ROIs V1-V5. Total cerebral blood flow (CBF) was calculated by measuring the blood velocity in the internal carotid arteries and the basilar artery using phase-contrast mapping (PCM) MRI. Hypoxia induced a greater decrease in BOLD response to visual stimulation in V1-V4 in MA patients compared to controls. There was no group difference in hypoxia-induced total CBF increase. In conclusion, the study demonstrated a greater hypoxia-induced decrease in BOLD response to visual stimulation in MA patients. We suggest this may represent a hypoxia-induced change in neuronal excitability or abnormal vascular response to visual stimulation, which may explain the increased sensibility to hypoxia in these patients leading to migraine attacks.

  16. 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.

  17. 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.

  18. Behavioral therapy for chronic migraine.

    PubMed

    Pistoia, Francesca; Sacco, Simona; Carolei, Antonio

    2013-01-01

    Chronic migraine is a disabling condition which affects a considerable proportion of patients. Several risk factors and lifestyle habits contribute to the transformation of migraine into a chronic form. Behavioral treatments, including relaxation, biofeedback, and cognitive behavioral therapy reduce the risk of episodic into chronic migraine transformation, thus restraining the headache-related disability. The rationale of behavioral therapies is that a medical problem should be recognized and thoroughly examined by the patient to be successfully managed. Being aware of factors which precipitate or aggravate migraine allows patients to progressively modulate the frequency and duration of their attacks. Similarly, the acquisition of healthy habits improves the quality of life and the subjective well-being of patients and contributes to breaking the vicious cycle that leads to migraine chronification. The highest level of care is achieved when behavioral therapies are integrated with other treatments, including physical and pharmacological interventions.

  19. Migraine prodromes separated from the aura: complete migraine.

    PubMed Central

    Blau, J N

    1980-01-01

    Detailed questioning of 50 patients with uncomplicated migraine has shown that 17 had symptoms that preceded the headache phase by several hours. These prodromes consisted of changes in mood, behaviour, wakefulness, appetite, bowel activity, or fluid balance. The term "complete migraine" is proposed for attacks that include prodromal symptoms, whose occurrence implies an initial diffuse cerebral or hypothalamic disturbance. PMID:7437756

  20. [Migraine or headache management: a pharmacy survey].

    PubMed

    Desamericq, Gaëlle; Revol, Anne; Laforest, Laurent; Chamba, Geneviève; Bauguil, Gisèle; Ritleng, Cécile; Van Ganse, Eric

    2009-01-01

    To describe the characteristics and the management of migraine. Data on headaches, drug consumption and life habits of 762 patients were collected using questionnaires and pharmacy records. The migraine attack was characterized by a severe pain for more than 80% of the patients. The frequency was more than 2 attacks a week in 16% of the cases. Eighty four per cent of the patients had triptans and 45% had a long-term migraine treatment. Nonspecific analgesics were prescribed for 55%. The frequency of over-consumption of treatments of migraine attacks was 46%. The management of migraine still remains inadequate. The pharmacist could contribute to its improvement.

  1. Migraine surgery: a plastic surgery solution for refractory migraine headache.

    PubMed

    Kung, Theodore A; Guyuron, Bahman; Cederna, Paul S

    2011-01-01

    Migraine headache can be a debilitating condition that confers a substantial burden to the affected individual and to society. Despite significant advancements in the medical management of this challenging disorder, clinical data have revealed a proportion of patients who do not adequately respond to pharmacologic intervention and remain symptomatic. Recent insights into the pathogenesis of migraine headache argue against a central vasogenic cause and substantiate a peripheral mechanism involving compressed craniofacial nerves that contribute to the generation of migraine headache. Botulinum toxin injection is a relatively new treatment approach with demonstrated efficacy and supports a peripheral mechanism. Patients who fail optimal medical management and experience amelioration of headache pain after injection at specific anatomical locations can be considered for subsequent surgery to decompress the entrapped peripheral nerves. Migraine surgery is an exciting prospect for appropriately selected patients suffering from migraine headache and will continue to be a burgeoning field that is replete with investigative opportunities.

  2. 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.

  3. To Be or Not to Be Patent: The Relationship Between Migraine and Patent Foramen Ovale.

    PubMed

    Kahya Eren, Nihan; Bülbül, Nazlı G; Yakar Tülüce, Selcen; Nazlı, Cem; Beckmann, Yeşim

    2015-01-01

    Migraine is a common neurological disorder with an uncertain pathogenesis. A pathophysiological link has been proposed between the migraine headache and patent foramen ovale (PFO). However, the data about the association of migraine with the presence of PFO are conflicting. The study aims to prospectively investigate the prevalence of PFO in patients with migraine compared with that of control subjects. A total of 203 migraineous patients and 212 control subjects with similar demographic characteristics to that of case subjects regarding age and gender were included in the study. Transthoracic echocardiography with agitated saline injection was used to evaluate the presence of PFO. PFO was judged to be present if any microbubble was seen in the left cardiac chambers within the first 5 cardiac cycles from the maximum right atrial opacification at rest or after provocative maneuvers. Mean age of the patients was 37.2 ± 9.8 years and 93% were female. Migraine with aura was present in 32% (n = 65) of the patients. The prevalence of PFO was similar in patients with migraine and the control subjects (42% vs 44%; odds ratio 0.90, 95% confidence interval 0.61-1.33, P = .61). Likewise, the prevalence of PFO was similar in migraineurs patients with or without aura (41% vs 42%; odds ratio 0.95, 95% confidence interval 0.51-1.76, P = .87). This study suggest that PFO is not more common in patients with migraine compared with healthy subjects. Therefore, our findings suggest that the relationship between migraine headache and the presence of PFO is questionable. © 2015 American Headache Society.

  4. Assessing Barriers to Chronic Migraine Consultation, Diagnosis, and Treatment: Results From the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study.

    PubMed

    Dodick, David W; Loder, Elizabeth W; Manack Adams, Aubrey; Buse, Dawn C; Fanning, Kristina M; Reed, Michael L; Lipton, Richard B

    2016-05-03

    .61; 95% CI 3.05-6.96). Among those consulting a healthcare professional, 126 (24.6%) received an accurate diagnosis and 56 of those with a correct diagnosis (44.4%) received both acute and preventive pharmacologic treatments; odds of a CM diagnosis were higher for women (OR 1.93; 95% CI 1.03-3.61), those with greater migraine severity (OR 1.25; 95% CI 1.14-1.37), and those currently consulting a specialist (OR 2.38; 95% CI 1.54-3.69). No predictors of receiving appropriate treatment were identified among those currently consulting. Among our sample of people with chronic migraine, only 56 (4.5%) individuals successfully traversed the series of 3 barriers to successful chronic migraine care (ie, consulted a healthcare professional for migraine, received an accurate diagnosis, and were prescribed minimal acute and preventive pharmacologic treatments). Our findings suggest that <5% of persons with chronic migraine traversed 3 barriers to receiving care for headache (consultation, diagnosis, and treatment), representing a large unmet need for improving care in this population. Predictors of consulting a healthcare professional included age, having health insurance, greater migraine-related disability, and greater migraine symptom severity. Among those consulting, predictors of an appropriate diagnosis included consulting a specialist, female sex, and greater migraine severity. Public health efforts are needed to improve outcomes for patients with chronic migraine by a range of interventions and educational efforts aimed at improving consultation rates, diagnostic accuracy, and adherence to minimal pharmacologic treatment. © 2016 The Authors Headache published by Wiley Periodicals, Inc. on behalf of American Headache Society.

  5. Multiple sclerosis presenting initially with a worsening of migraine symptoms.

    PubMed

    Lin, Guan-Yu; Wang, Chih-Wei; Chiang, Tsung-Ta; Peng, Giia-Sheun; Yang, Fu-Chi

    2013-08-09

    Multiple sclerosis (MS) is a chronic autoimmune disease that targets myelinated axons in the central nervous system. Headache has been reported as a subtle symptom of the onset of MS, with a variable frequency of 1.6-28.5%; however, it remains unclear whether headache is a true symptom of MS onset. Here, we report the case of a female patient who had a history of migraine without aura and experienced worsening of migraine-headache symptoms as the initial manifestation of MS. Three similar cases were reported previously; however, unlike this case, those cases had no history of migraine without aura. In our case, we excluded factors that could trigger migraine attacks, such as changes in weather, drugs, alcohol, caffeine withdrawal, stress, fatigue, lack of sleep, hormonal therapy, diet, and hunger. The patient had one episode of MS attack with the simultaneous presence of asymptomatic gadolinium-enhancing and non-enhancing lesions, including hyperintense lesions in the bilateral periventricular white matter, body of the corpus callosum, and periaqueductal grey matter, as observed on the T2-weighted images obtained at the first brain magnetic resonance imaging. In addition, after the injection of gadolinium contrast, ring enhancement over these lesions was noted in T1-weighted images, which was suggestive of active demyelination. MS was diagnosed according to the McDonald criteria (2010 revision). We conclude that MS with periaqueductal grey matter involvement may present with worsening migraine. It is important to be cautious if any secondary causes exist, especially when the patient has a history of migraine without aura. MS should be one of the differential diagnoses in young women showing a change in headache pattern or poor clinical drug response to migraine treatment accompanied by episodes of focal neurological deficit. Failure to recognize MS may lead to inappropriate treatment and worse prognosis; early diagnosis in patients with MS is essential to improve

  6. A comparative study of psychiatric comorbidity, quality of life and disability in patients with migraine and tension type headache.

    PubMed

    Bera, Sagar Chandra; Khandelwal, Sudhir K; Sood, Mamta; Goyal, Vinay

    2014-01-01

    To compare psychiatric co-morbidity, quality of life and disability between patients of migraine and tension type headache and healthy controls. Study subjects included 40 consecutive adult patients each with migraine and tension type of headache (TTH) of either gender fulfilling International Headache Society-II criteria and suffering for 2 years They were recruited from a headache clinic in a tertiary care teaching hospital and were assessed on Mini International Neuropsychiatric Interview (MINI), World Health Organization Quality of Life-BREF (WHOQOL-BREF) Hindi version and the Headache Impact Test-6 (HIT-6). Age and sex matched 40 healthy controls were assessed on MINI and WHOQOL-BREF. The three groups were compared for statistical significance on various scales. Depression emerged as the most prevalent psychiatric disorder in both the headache groups. There was significant impairment in quality of life on all domains along with functional disability in subjects with both types of headache. Psychiatric comorbidity, especially depression is common in patients with migraines and tension type headache. Quality of life and functional ability are significantly impaired in these patients. The clinician should remain aware of consequences of prolonged headache, and should provide timely intervention.

  7. Vitamin Supplementation as Possible Prophylactic Treatment against Migraine with Aura and Menstrual Migraine

    PubMed Central

    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. PMID:25815319

  8. 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.

  9. The relationships between migraine, depression, anxiety, stress, and sleep disturbances.

    PubMed

    Yalinay Dikmen, Pinar; Yavuz, Burcu Goksan; Aydinlar, Elif Ilgaz

    2015-06-01

    To assess the relationships between migraine, depression, anxiety, stress, and sleep problems. Psychiatric conditions and sleep disturbances are common in migraineurs. Depression, anxiety, stress, migraine, and sleep problems frequently coexist as comorbidities. Eighty-seven episodic migraineurs (62 females, 25 males; 32.8 ± 6.9) and 41 control subjects (25 females, 16 males; 31.5 ± 5.6) were prospectively enrolled for the study. The participants completed a sociodemographic data form and a migraine disability assessment scale (MIDAS), depression, anxiety, stress scale (DASS), and Pittsburg Sleep Quality Index (PSQI). In migraineurs, a significant positive correlation was found between PSQI total scores and MIDAS scores (migraine related disability for at least three consecutive months) (r = 0. 234, p = 0.04). Only 24.1 % of migraineus (n = 21) had minimal or no disability, 75.9 % of the patients (n = 66) had more than a little disability according to MIDAS scores. PSQI total scores were also correlated with pain intensity over a three month period (MIDAS B) (r = 0.221, p = 0.04). While PSQI scores were found significantly different between migraineurs and control subjects (5.5 ± 2.9 vs 4.5 ± 2.5; p = 0.04), the correlation of all the DASS subscale scores between the groups was not statistically significant. Our findings showed that episodic migraine was a risk factor on its own for sleep disturbances without comorbid depression, anxiety, and stress. Moreover, migraine-related disability and pain intensity in migraine attacks were related to poor sleep quality.

  10. 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.

  11. 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.

  12. 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.

  13. 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

  14. The clinical utility of vestibular autorotation test in patients with vestibular migraine.

    PubMed

    Thungavelu, Yogun; Wang, Wei; Lin, Peng; Chen, Taisheng; Xu, Kaixu

    2017-10-01

    To investigate the characteristics and clinical utility of vestibular autorotation test (VAT) in patients with vestibular migraine. This study included two groups, an experimental group (441 patients) and a control group (65 healthy subjects). Both groups undertook VAT; the parameters evaluated were horizontal gain/phase, vertical gain/phase and asymmetry. The differences in VAT results between the two groups were investigated. There were no statistical differences between the VAT data of the control group when compared to the reference value from the manufacturer (p > .05). There were statistically significant differences in VAT results between the experimental and control group, namely elevated horizontal gain at frequency 2, 3, 4 and 5 Hz, horizontal phase delay at frequency 2, 4, 5 and 6 Hz, elevated vertical gain at frequency 2 6Hz and vertical phase delay at frequency 4 6Hz. The results of this study using VAT in VM patients demonstrate elevated horizontal gain, vertical gain and delay in horizontal phase, vertical phase. We suggest the application of VAT as a diagnostic tool which may provide objective evidence that can contribute to the diagnosis of VM and also in differential diagnosis.

  15. Efficacy of Noninvasive Brain Stimulation on Pain Control in Migraine Patients: A Systematic Review and Meta-Analysis.

    PubMed

    Shirahige, Lívia; Melo, Lorena; Nogueira, Fernanda; Rocha, Sérgio; Monte-Silva, Kátia

    2016-11-01

    To evaluate the efficacy of noninvasive brain stimulation (NIBS) on pain control in migraine patients. Recent studies have used NIBS as an abortive and prophylactic treatment for migraine; however, its efficacy regarding meaningful clinical effects remains to be critically analyzed. Systematic review of controlled clinical trials. Searches were conducted in six databases: MEDLINE (via PubMed), LILACS (via BIREME), CINAHL (via EBSCO), Scopus (via EBSCO), Web of Science, and CENTRAL. Two independent authors searched for randomized controlled clinical trials published through until January 2016 that involved the use of transcranial direct current stimulation (tDCS) and transcranial magnetic stimulation (TMS) in migraineurs. Studies which met the eligibility criteria were assessed and methodological quality was examined using the Cochrane tool for assessing risk of bias. Information about pain intensity (primary outcome), migraine attacks, painkiller intake, and adverse effects were extracted. Eight studies were included in the quantitative analysis with 153 migraine patients that received NIBS and 143 sham NIBS. In overall meta-analysis, we did not find significant results for pain intensity (SMD: -0.61; CI: -1.35 to 0.13; P = .11), for migraine attacks (SMD: -0.44; 95%; CI: -1.15 to 0.26; P = .22), and for painkiller intake (SMD: -0.57; 95% CI: -1.21 to 0.07; P = .08). However, subgroup analysis considering only tDCS effects have demonstrated a decrease for pain intensity (SMD: -0.91; 95% CI: -1.79 to -0.03; P = .04), migraine attacks (SMD: -0.75; 95% CI: -1.25 to -0.24; P = .004), and painkiller intake (SMD: -0.64; 95% CI: -1.21 to -0.07; P = .03). Subgroup analysis for TMS did not reveal significant effects for any outcome. Low or very low quality of evidence suggests that our primary outcome evaluation failed to find support for the superiority of NIBS over sham treatment. Although, subgroup analysis reveals that tDCS have moderate to high

  16. Long-Term Pain Reduction Does Not Imply Improved Functional Outcome in Patients Treated With Combined Supraorbital and Occipital Nerve Stimulation for Chronic Migraine.

    PubMed

    Clark, Shannon W; Wu, Chengyuan; Boorman, David W; Chalouhi, Nohra; Zanaty, Mario; Oshinsky, Michael; Young, William B; Silberstein, Stephen D; Sharan, Ashwini D

    2016-07-01

    Dual supraorbital and occipital nerve stimulation (SONS and ONS) have shown promising efficacy in treating primary headaches. However, its functional outcome is not well studied. To present functional outcome studies of combined SONS and ONS for chronic migraine using verified metrics. Consecutive patients with both SONS and ONS assessed with Migraine Disability Assessment (MIDAS) and Beck Depression Index (BDI) both preoperatively and postoperatively were studied. Selected predictor variables included patients with ≥50% improvement of pain, disability status, number of years from diagnosis to implantation, and narcotic use. Functional outcome variables included net improvement of ranked MIDAS and BDI scores. Multivariate analysis of variance was performed to assess the correlation between the outcome and predictor variables. Sixteen patients (12 female; average age 52 years old) were studied. Follow-up ranged from 5 to 80 months (average 44.5; σ = 21.4 months). At most recent follow-up, eight patients had a positive response (≥50% improvement in headache), which was the only predictor of functional outcome (total MIDAS, MIDAS-B, and BDI) (p = 0.021). Of note, improvement in functional outcome was only significant during the perioperative 3-6 months period and not throughout long-term follow-up. Among the predictor variables, a strong inverse correlation was found between disability status and positive response to stimulation (r = -0.582). There is a paucity of studies in quality of life, productivity, and psychosocial aspects with peripheral nerve stimulation therapy for headache. Patients with a positive response to SONS and ONS also reported overall improvement in their functional status as reflected by MIDAS and BDI in the perioperative period. Unfortunately, this effect waned over the long-term follow-up. © 2016 International Neuromodulation Society.

  17. Childhood maltreatment and migraine (part II). Emotional abuse as a risk factor for headache chronification.

    PubMed

    Tietjen, Gretchen E; Brandes, Jan L; Peterlin, B Lee; Eloff, Arnolda; Dafer, Rima M; Stein, Michael R; Drexler, Ellen; Martin, Vincent T; Hutchinson, Susan; Aurora, Sheena K; Recober, Ana; Herial, Nabeel A; Utley, Christine; White, Leah; Khuder, Sadik A

    2010-01-01

    To assess in a headache clinic population the relationship of childhood abuse and neglect with migraine characteristics, including type, frequency, disability, allodynia, and age of migraine onset. Childhood maltreatment is highly prevalent and has been associated with recurrent headache. Maltreatment is associated with many of the same risk factors for migraine chronification, including depression and anxiety, female sex, substance abuse, and obesity. Electronic surveys were completed by patients seeking treatment in headache clinics at 11 centers across the United States and Canada. Physician-determined data for all participants included the primary headache diagnoses based on the International Classification of Headache Disorders-2 criteria, average monthly headache frequency, whether headaches transformed from episodic to chronic, and if headaches were continuous. Analysis includes all persons with migraine with aura, and migraine without aura. Questionnaire collected information on demographics, social history, age at onset of headaches, migraine-associated allodynic symptoms, headache-related disability (The Headache Impact Test-6), current depression (The Patient Health Questionnaire-9), and current anxiety (The Beck Anxiety Inventory). History and severity of childhood (<18 years) abuse (sexual, emotional, and physical) and neglect (emotional and physical) was gathered using the Childhood Trauma Questionnaire. A total of 1348 migraineurs (88% women) were included (mean age 41 years). Diagnosis of migraine with aura was recorded in 40% and chronic headache (>or=15 days/month) was reported by 34%. Transformation from episodic to chronic was reported by 26%. Prevalence of current depression was 28% and anxiety was 56%. Childhood maltreatment was reported as follows: physical abuse 21%, sexual abuse 25%, emotional abuse 38%, physical neglect 22%, and emotional neglect 38%. In univariate analyses, physical abuse and emotional abuse and neglect were significantly

  18. Migraine triggered by epileptic discharges in a Rasmussen's encephalitis patient after surgery.

    PubMed

    Fusco, Lucia; Specchio, Nicola; Ciofetta, Giancarlo; Longo, Daniela; Trivisano, Marina; Vigevano, Federico

    2011-08-01

    After 2years from disconnective surgery for Rasmussen's encephalitis, a child, 9years old, began to present severe migraine attacks, lateralized to the operated side, lasting 1-2days. Video/EEG recordings during two different migraine attacks, with an interval of 6months from each other, showed, in both recordings, subsequent ictal discharges over the affected and disconnected hemisphere. Migraine and ictal discharges in both occasion disappeared with diazepam i.v. The EEGs performed during migraine-free period, on the contrary, showed very rare and mild subclinical ictal discharges. Although a casual relationship could not be excluded, a pure neuronal pathogenetic mechanism can be suggested, mediated by post- and inter-ictal cortical depression. Copyright © 2010 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.

  19. The serotonin transporter gene polymorphism STin2 VNTR confers an increased risk of inconsistent response to triptans in migraine patients.

    PubMed

    Terrazzino, Salvatore; Viana, Michele; Floriddia, Elisa; Monaco, Francesco; Mittino, Daniela; Sances, Grazia; Tassorelli, Cristina; Nappi, Giuseppe; Rinaldi, Maurizio; Canonico, Pier Luigi; Genazzani, Armando A

    2010-09-01

    The aim of the present observational study was to assess the value of the C825T polymorphism of the beta-3 subunit of G proteins (GNB3) as well as of variants in the SLC6A4 gene (5HTTLPR and STin2 VNTR) and DRD2 gene (TaqI A and NcoI) as predictive markers for consistency in headache response to triptans in migraine patients. Consistent responders to triptans were defined as the migraineurs who experienced a > or =2 point reduction in a 4-point scale intensity of pain from 3 (severe) to 0 (absent) 2h after triptan administration, in at least two attacks out of the three. Genotyping was performed by PCR and PCR-RFLP on genomic DNA extracted from peripheral blood. The impact of clinical and biological variables on consistency status of headache response to triptans was evaluated by using a binary logistic regression model with stepwise selection. Forty-three (33%) of the 130 migraine patients included in the study did not consistently respond to triptan administration. In a binary logistic regression model, STin 2.12/12 genotype (OR=3.363, 95% CI: 1.262-8.966, P=0.005) and non-use of migraine prophylactic medications (OR=2.848, 95% CI: 1.019-7.959, P=0.010) were found as significant factors increasing the odds of achieving inconsistent response to triptans. The analysis of classificatory power of the model showed moderate values of sensitivity (0.56), high specificity (0.87), and an overall prediction correctness (0.77). These results support the role of STin2 VNTR polymorphism of serotonin transporter gene as a relevant genetic factor conferring a higher risk of inconsistent response to triptans in migraine patients. Copyright (c) 2010 Elsevier B.V. All rights reserved.

  20. Shared mechanisms of epilepsy, migraine and affective disorders.

    PubMed

    Zarcone, Davide; Corbetta, Simona

    2017-05-01

    , depression and suicidal ideation. Anxiety and depression can be part of symptoms that accompany migraine or seizures. Female patients with a long history of illness and frequent attacks are the most at risk. The impact of these diseases on the quality of life is the most obvious cause of these disorders, furthermore some antiepileptic drugs can have depressive effects on mood; the anxious-depressive disorders often result from the interaction between iatrogenic and psychosocial factor with common neurobiological pathogenesis. A chronic lowering of 5-HT (serotonin) levels has been demonstrated both in migraineurs and in depressed patients; amitriptyline and venlafaxine are the most indicated drugs in the treatment of migraine with comorbid depression currently. Likewise imbalance in dopamine levels has been also demonstrated: a D2 receptor genotype has been directly related to comorbidity migraine-depression. In women, hormonal fluctuations are also crucial, especially in the post-partum and late luteal phase, when the estrogenic reduction, associated with up-regulation of SNPs and down-regulation of serotonergic and GABAergic systems, increases the risk of migraine and depression. Furthermore, central sensitization phenomena have been highlighted in both diseases, and result in a progressive increase in the frequency of attacks up to chronicity and the consequent development of drug resistance and overuse. Further studies will be necessary to deepen the close relationship between these three diseases.

  1. 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.

  2. Management of mal de debarquement syndrome as vestibular migraines.

    PubMed

    Ghavami, Yaser; Haidar, Yarah M; Ziai, Kasra N; Moshtaghi, Omid; Bhatt, Jay; Lin, Harrison W; Djalilian, Hamid R

    2017-07-01

    Mal de debarquement syndrome (MdDS) is a balance disorder that typically starts after an extended exposure to passive motion, such as a boat or plane ride. Management is typically supportive (e.g. physical therapy), and symptoms that persist beyond 6 months have been described as unlikely to remit. This study was conducted to evaluate the response of patients with MdDS to management with migraine prophylaxis, including lifestyle changes and medical therapy. Prospective review. Ambulatory setting at a tertiary care medical center. Clinical history, detailed questionnaires, and audiograms were used to diagnose patients with MdDS. Those patients with the diagnosis of the MdDS were placed on our institutional vestibular migraine management protocol. Treatment response was assessed with a quality-of-life (QOL) survey and visual analog scale. Fifteen patients were diagnosed with MdDS, with a predominance of females (73%) and a mean age of 50 ± 13 years. Eleven patients (73%) responded well to management with a vestibular migraine protocol, which included lifestyle changes, as well as pharmacotherapy with verapamil, nortriptyline, topiramate, or a combination thereof. In comparison, a retrospective control group of 17 patients demonstrated a lower rate of improvement when treated with vestibular rehabilitation and physical therapy. Management of MdDS as vestibular migraine can improve patients' symptoms and increase the QOL. Nearly all the patients suffering from MdDS had a personal or family history of migraine headaches or had signs or symptoms suggestive of atypical migraine. 4 Laryngoscope, 127:1670-1675, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  3. A Phase I, Open-Label, Single-Dose Safety, Pharmacokinetic, and Tolerability Study of the Sumatriptan Iontophoretic Transdermal System in Adolescent Migraine Patients.

    PubMed

    Gutman, Dikla; Hellriegel, Edward; Aycardi, Ernesto; Bigal, Marcelo E; Kunta, Jeevan; Chitra, Rohini; Kansagra, Sujay; Kidron, Orna Srur; Knebel, Helena; Linder, Steven; Ma, Yuju; Pierce, Mark; Winner, Paul K; Spiegelstein, Ofer

    2016-09-01

    To evaluate the safety, tolerability, and pharmacokinetics of sumatriptan delivered by the iontophoretic transdermal system (TDS) in adolescent patients. Since nausea can be a prominent and early symptom of migraine, nonoral treatment options are often required. Sumatriptan iontophoretic TDS is approved for the acute treatment of migraine in adults. The present study evaluates the pharmacokinetics of sumatriptan administered via the iontophoretic TDS in adolescents, contrasting the findings with historical data from adults. Patients aged 12-17 years (inclusive) with acute migraine were treated with sumatriptan iontophoretic TDS for 4 hours. Blood samples for pharmacokinetic profiling of sumatriptan were obtained prior to dosing and at predetermined time points covering the 12 hours postonset of treatment. Key pharmacokinetic endpoints included Cmax (peak plasma drug concentration), tmax (time to Cmax ), AUC0-∞ (area under the plasma concentration-time curve from time 0 to infinity), and t½ (terminal elimination half-life). Safety was evaluated by monitoring of adverse events in addition to laboratory and clinical assessments. The sample consisted of 37 patients, and 36 were included in the PK evaluable population. Cmax , tmax , AUC0-∞ , and t½ values were all similar between male and female patients and between younger (12-14 years) and older (15-17 years) adolescents. When compared with historical adult data, adolescent patients demonstrated similar systemic exposures to those observed in adults (mean Cmax 20.20 (±6.43) ng/mL in adolescents vs 21.89 (±6.15) ng/mL in adults; mean AUC0-∞ 98.1 (±28.1) ng·h/mL in adolescents vs 109.7 (±26.1) ng·h/mL in adults). All adverse events were mild or moderate, with application-site paresthesia being the most common (32%). No clinically relevant changes in laboratory values, vital signs, or electrocardiogram findings were observed. The iontophoretic TDS produced mean systemic exposures to sumatriptan in younger

  4. Migraine in menopausal women: a systematic review

    PubMed Central

    Ripa, Patrizia; Ornello, Raffaele; Degan, Diana; Tiseo, Cindy; Stewart, Janet; Pistoia, Francesca; Carolei, Antonio; Sacco, Simona

    2015-01-01

    Evidence suggests that migraine activity is influenced by hormonal factors, and particularly by estrogen levels, but relatively few studies have investigated the prevalence and characteristics of migraine according to the menopausal status. Overall, population-based studies have shown an improvement of migraine after menopause, with a possible increase in perimenopause. On the contrary, the studies performed on patients referring to headache centers have shown no improvement or even worsening of migraine. Menopause etiology may play a role in migraine evolution during the menopausal period, with migraine improvement more likely occurring after spontaneous rather than after surgical menopause. Postmenopausal hormone replacement therapy has been found to be associated with migraine worsening in observational population-based studies. The effects of several therapeutic regimens on migraine has also been investigated, leading to nonconclusive results. To date, no specific preventive measures are recommended for menopausal women with migraine. There is a need for further research in order to clarify the relationship between migraine and hormonal changes in women, and to quantify the real burden of migraine after the menopause. Hormonal manipulation for the treatment of refractory postmenopausal migraine is still a matter of debate. PMID:26316824

  5. 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.

  6. Preventive Migraine Treatment

    PubMed Central

    Silberstein, Stephen D.

    2015-01-01

    Purpose of Review: This article reviews the evidence base for the preventive treatment of migraine. Recent Findings: Evidence-based guidelines for the preventive treatment of migraine have recently been published by the American Academy of Neurology (AAN) and the Canadian Headache Society (CHS), providing valuable guidance for clinicians. Strong evidence exists to support the use of metoprolol, timolol, propranolol, divalproex sodium, sodium valproate, and topiramate for migraine prevention, according to the AAN. Based on best available evidence, adverse event profile, and expert consensus, topiramate, propranolol, nadolol, metoprolol, amitriptyline, gabapentin, candesartan, Petasites (butterbur), riboflavin, coenzyme Q10, and magnesium citrate received a strong recommendation for use from the CHS. Summary: Migraine preventive drug treatments are underutilized in clinical practice. Principles of preventive treatment are important to improve compliance, minimize side effects, and improve patient outcomes. Choice of preventive treatment of migraine should be based on the presence of comorbid and coexistent illness, patient preference, reproductive potential and planning, and best available evidence. PMID:26252585

  7. Genotypes of the MTHFR C677T and MTRR A66G genes act independently to reduce migraine disability in response to vitamin supplementation.

    PubMed

    Menon, Saras; Lea, Rod A; Roy, Bishakha; Hanna, Michelle; Wee, Shirley; Haupt, Larisa M; Oliver, Chris; Griffiths, Lyn R

    2012-10-01

    Migraine is a chronic disabling neurovascular condition that may in part be caused by endothelial and cerebrovascular disruption induced by hyperhomocysteinaemia. We have previously provided evidence indicating that reduction of homocysteine by vitamin supplementation can reduce the occurrence of migraine in women. The current study examined the genotypic effects of methylenetetrahydrofolate reductase (MTHFR) and methionine synthase reductase (MTRR) gene variants on the occurrence of migraine in response to vitamin supplementation. This was a 6-month randomized, double-blinded placebo-controlled trial of daily vitamin B supplementation (B(6), B(9) and B(12)) on reduction of homocysteine and of the occurrence of migraine in 206 female patients diagnosed with migraine with aura. Vitamin supplementation significantly reduced homocysteine levels (P<0.001), severity of headache in migraine (P=0.017) and high migraine disability (P=0.022) in migraineurs compared with the placebo effect (P>0.1). When the vitamin-treated group was stratified by genotype, the C allele carriers of the MTHFR C677T variant showed a higher reduction in homocysteine levels (P<0.001), severity of pain in migraine (P=0.01) and percentage of high migraine disability (P=0.009) compared with those with the TT genotypes. Similarly, the A allele carriers of the MTRR A66G variants showed a higher level of reduction in homocysteine levels (P<0.001), severity of pain in migraine (P=0.002) and percentage of high migraine disability (P=0.006) compared with those with the GG genotypes. Genotypic analysis for both genes combined indicated that the treatment effect modification of the MTRR variant was independent of the MTHFR variant. This provided further evidence that vitamin supplementation is effective in reducing migraine and also that both MTHFR and MTRR gene variants are acting independently to influence treatment response in female migraineurs.

  8. Magnetic resonance angiography of intracranial and extracranial arteries in patients with spontaneous migraine without aura: a cross-sectional study.

    PubMed

    Amin, Faisal Mohammad; Asghar, Mohammad Sohail; Hougaard, Anders; Hansen, Adam Espe; Larsen, Vibeke Andrée; de Koning, Patrick J H; Larsson, Henrik B W; Olesen, Jes; Ashina, Messoud

    2013-05-01

    Extracranial arterial dilatation has been hypothesised to be the cause of pain in patients who have migraine without aura. To test that hypothesis, we aimed to measure extracranial and intracranial arteries during attacks of migraine without aura. In this cross-sectional study, we recruited patients aged 18-60 years from the Danish Headache Centre and via announcements on a Danish website. We did magnetic resonance angiography during spontaneous unilateral migraine attacks. Primary endpoints were difference in circumference of extracranial and intracranial arterial segments comparing attack and attack-free days and the pain and the non-pain side. The extracranial arterial segments measured were the external carotid (ECA), the superficial temporal (STA), the middle meningeal (MMA), and the cervical part of the internal carotid (ICAcervical) arteries. The intracranial arterial segments were the cavernous (ICAcavernous) and cerebral (ICAcerebral) parts of the internal carotid, the middle cerebral (MCA), and the basilar (BA) arteries. This study is registered at Clinicaltrials.gov, number NCT01471314. Between Oct 12, 2010, and Feb 8, 2012, we recruited 78 patients, of whom 19 women had a scan during migraine and were included in the final analysis. On migraine compared with non-migraine days, we detected no statistically significant dilatation of the extracranial arteries on the pain side (ECA, mean difference 1·2% [95% CI -5·7 to 8·2] p=0·985, STA 3·6% [-3·7 to 11·0] p=0·532, MMA 1·7% [-1·7 to 5·2] p=0·341, and ICAcervical 2·3% [-0·3 to 4·9] p=0·093); the intracranial arteries were more dilated during attacks (MCA, 13·0% [6·4 to 19·6] p=0·001, ICAcerebral 11·5% [5·6 to 17·3] p=0·0004, and ICAcavernous 11·4% [5·3 to 17·5] p=0·001), except for the BA (1·6% [-2·7 to 5·9] p=0·621). Compared with the non-pain side, during attacks we detected dilatation on the pain side of the intracranial arteries (MCA, mean difference 10·5% [0·7-20·3] p

  9. 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.

  10. Unilateral nasal pain with migraine features.

    PubMed

    Alvarez, Mónica; Montojo, Teresa; de la Casa, Beatriz; Vela, Lydia; Pareja, Juan A

    2013-09-01

    Migraine attacks exclusively felt in the face are very rare, the pain involving the territories supplied by the second and third branches of the trigeminal nerve. Two patients suffering from heminasal pain attacks accompanied with typical migrainous features and responsive to oral or intranasal triptans - but not to intranasal lidocaine or oxymetazoline. In one patient, the attacks could be precipitated upon slight touching on the tip of the nose, in the other attacks were preceded by the nasal sensation typically heralding sneezing. Migraine pain mostly develops within the innervation territory of the first branch of the trigeminal nerve, which includes the nose. Therefore, episodes of unilateral nasal pain with migrainous features could be considered a migraine with unusual topography (nasal migraine). Painful nasal attacks occasionally preceded by stimulation of trigeminal afferents in the nose, could be conceived of as migraine-tic syndrome.

  11. Perfusion-weighted MR imaging in persistent hemiplegic migraine.

    PubMed

    Mourand, Isabelle; Menjot de Champfleur, Nicolas; Carra-Dallière, Clarisse; Le Bars, Emmanuelle; Roubertie, Agathe; Bonafé, Alain; Thouvenot, Eric

    2012-03-01

    Hemiplegic migraine is a rare type of migraine that has an aura characterized by the presence of motor weakness, which may occasionally last up to several days, and then resolve without sequela. Pathogenesis of migraine remains unclear and, recently, perfusion-weighted imaging (PWI) has provided a non-invasive method to study hemodynamic changes during acute attacks. Two female patients were admitted in our hospital suffering from prolonged hemiparesis. In both cases, they underwent MRI examination using a 1.5 T magnet including axial diffusion-weighted and perfusion sequences. From each perfusion MRI acquisition two regions of interest were delineated on each hemisphere and, the index of flow, cerebral blood volume, mean transit time, and time to peak were recorded and asymmetry indices from each perfusion parameter were calculated. Perfusion alterations were detected during the attacks. In one case, we observed, after 3 h of left hemiparesia, hypoperfusion of the right hemisphere. In the other case, who presented a familial hemiplegic migraine attack, on the third day of a persistent aura consisting of right hemiplegia and aphasia, PWI revealed hyperperfusion of the left hemisphere. Asymmetry indices for temporal parameters (mean transit time and time to peak) were the most sensitive. These findings resolved spontaneously after the attacks without any permanent sequel or signs of cerebral ischemia on follow-up MRI. PWI should be indicated for patients with migraine attacks accompanied by auras to assess the sequential changes in cerebral perfusion and to better understand its pathogenesis.

  12. Munitions Migraine

    DTIC Science & Technology

    1982-01-01

    MUNITIONS MIGRAINE BY George M. Farnell Assistant Professor of Security Assistance Management Defense Institute of Security Assistance...00-1982 4. TITLE AND SUBTITLE Munitions Migraine 5a. CONTRACT NUMBER 5b. GRANT NUMBER 5c. PROGRAM ELEMENT NUMBER 6. AUTHOR(S) 5d. PROJECT... headaches of having adequate available personnel to perform their tasks in a secure and safe environment. It also must be pointed out that

  13. 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.

  14. Sexual dysfunction in women with migraine and tension-type headaches.

    PubMed

    Solmaz, V; Ceviz, A; Aksoy, D; Cevik, B; Kurt, S; Gencten, Y; Erdemir, F

    2016-11-01

    Primary headaches (PHAs) prominently affect the performance and life quality of people. Sexual dysfunction (SD) is an important health problem caused by several factors. This study aimed to compare the sexual function of women who have PHAs. Forty-one female patients who were diagnosed with migraine, 39 female patients who were diagnosed with tension-type headache (TTHA) and 41 healthy subjects were included in study. Sexual function of the cases were evaluated by using the 'Female Sexual Function Index (FSFI)'. Beck Depression Scale was applied to subjects and those who were diagnosed with depression were excluded from the study. SD was detected in both the migraine and TTHA groups. FSFI subgroup scores were statistically significantly lower in the migraine and TTHA groups compared with the control group. No significant differences were detected between the migraine and TTHA groups in terms of FSFI and its components. In addition, no significant differences were detected between the blood prolactin levels or SD and headache. It was concluded that primary headaches (which are chronic diseases) itself may cause SD in female patients with migraine and TTHA independently of factors that may cause development of SD such as comorbid condition, depression, drug use and age.

  15. Precipitating and relieving factors of migraine versus tension type headache

    PubMed Central

    2012-01-01

    Background To determine the differences of precipitating and relieving factors between migraine and tension type headache. Methods This is a cross sectional study. We retrospectively reviewed the records of 250 migraine patients and 250 patients diagnosed as tension type headache from the specialized headache clinic in Dept. of Neurology, Dhaka Medical College Hospital. Data were collected through a predesigned questionnaire containing information on age, sex, social status and a predetermined list of precipitating and relieving factors. Results In this study, the female patients predominated (67%). Most of the patients were within 21–30 years age group (58.6%). About 58% of them belonged to middle class families. The common precipitating factors like stress, anxiety, activity, journey, reading, cold and warm were well distributed among both the migraine and tension type headache (TTH) patients. But significant difference was demonstrated for fatigue (p < 0.05), sleep deprivation (p < 0.05), sunlight (p < 0.01) and food (p < 0.05), which were common among migraineurs. In consideration of relieving factors of pain, different maneuvers were commonly tried by migraineurs and significant difference were observed for both analgesic drug and massage (p < 0.05), which relieved migraine headache. But maneuvers like sleep, rest and posture were used by both groups. Conclusion The most frequent precipitating factors for headache appear to be identical for both migraine and TTH patients. Even though some factors like fatigue, sleep deprivation, sunlight and food significantly precipitate migraine and drug, massage are effective maneuver for relieving pain among migrianeurs. PMID:22920541

  16. Precipitating and relieving factors of migraine versus tension type headache.

    PubMed

    Haque, Badrul; Rahman, Kazi Mohibur; Hoque, Azharul; Hasan, A T M Hasibul; Chowdhury, Rajib Nayan; Khan, Sharif Uddin; Alam, Mondal Badrul; Habib, Mansur; Mohammad, Quazi Deen

    2012-08-25

    To determine the differences of precipitating and relieving factors between migraine and tension type headache. This is a cross sectional study. We retrospectively reviewed the records of 250 migraine patients and 250 patients diagnosed as tension type headache from the specialized headache clinic in Dept. of Neurology, Dhaka Medical College Hospital. Data were collected through a predesigned questionnaire containing information on age, sex, social status and a predetermined list of precipitating and relieving factors. In this study, the female patients predominated (67%). Most of the patients were within 21-30 years age group (58.6%). About 58% of them belonged to middle class families. The common precipitating factors like stress, anxiety, activity, journey, reading, cold and warm were well distributed among both the migraine and tension type headache (TTH) patients. But significant difference was demonstrated for fatigue (p < 0.05), sleep deprivation (p < 0.05), sunlight (p < 0.01) and food (p < 0.05), which were common among migraineurs. In consideration of relieving factors of pain, different maneuvers were commonly tried by migraineurs and significant difference were observed for both analgesic drug and massage (p < 0.05), which relieved migraine headache. But maneuvers like sleep, rest and posture were used by both groups. The most frequent precipitating factors for headache appear to be identical for both migraine and TTH patients. Even though some factors like fatigue, sleep deprivation, sunlight and food significantly precipitate migraine and drug, massage are effective maneuver for relieving pain among migrianeurs.

  17. Increased incidence of migraine in women correlates with obstetrics and gynaecological surgical procedures.

    PubMed

    Arumugam, Murugesan; Parthasarathy, Varadarajan

    2015-10-01

    Migraine is a common chronic neurological disorder; yet no possible aetiology has been identified so far. There is a debate that migraine worsens in women who undergo procedures such as hysterectomy, dilation and curettage (D&C) or cesarean section for delivery. Hence, the present study was attempted to explore the link between procedures like D&C, hysterectomy and cesarean section for delivery and the prevalence of migraine in women. A total of 185 migraine patients were screened based on the inclusion and exclusion criteria of the International Headache Classification guidelines and 70 females who satisfied the inclusion criteria were included for the study. Of the 70 female patients, the numbers of married and unmarried women were 47 and 27, respectively. About 36 married women (80%, 95% CI: 0.146-0.104) had undergone the procedures related to obstetrics and gynaecology as per their medical history. Interestingly, 12 patients (33%, 95% CI: 0.148-0.176) had not experienced migraine attack prior to the above mentioned surgeries. Although, the age adjusted incidence of diagnosed migraine per 100,000 populations showed higher risk between 16-20 years of age (95% CI: 0.104-0.121), significant risk (95% CI: 0.086-0.113) was also observed in the women of 31-35 years age group in the present study. Based on the present study, surgeries such as D&C, hysterectomy and cesarean section for delivery increased the prevalence of migraine in women. Therefore, such procedures should be avoided unless otherwise essential, particularly in patients with positive past history of migraine. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  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. Migraine and risk of stroke: a national population-based twin study.

    PubMed

    Lantz, Maria; Sieurin, Johanna; Sjölander, Arvid; Waldenlind, Elisabet; Sjöstrand, Christina; Wirdefeldt, Karin

    2017-10-01

    Numerous studies have indicated an increased risk for stroke in patients with migraine, especially migraine with aura; however, many studies used self-reported migraine and only a few controlled for familial factors. We aimed to investigate migraine as a risk factor for stroke in a Swedish population-based twin cohort, and whether familial factors contribute to an increased risk. The study population included twins without prior cerebrovascular disease who answered a headache questionnaire during 1998 and 2002 for twins born 1935-58 and during 2005-06 for twins born between 1959 and 1985. Migraine with and without aura and probable migraine was defined by an algorithm mapping on to clinical diagnostic criteria according to the International Classification of Headache Disorders. Stroke diagnoses were obtained from the national patient and cause of death registers. Twins were followed longitudinally, by linkage of national registers, from date of interview until date of first stroke, death, or end of study on 31 Dec 2014. In total, 8635 twins had any migraineous headache, whereof 3553 had migraine with aura and 5082 had non-aura migraineous headache (including migraine without aura and probable migraine), and 44 769 twins had no migraine. During a mean follow-up time of 11.9 years we observed 1297 incident cases of stroke. The Cox proportional hazards model with attained age as underlying time scale was used to estimate hazard ratios with 95% confidence intervals for stroke including ischaemic and haemorrhagic subtypes related to migraine with aura, non-aura migraineous headache, and any migraineous headache. Analyses were adjusted for gender and cardiovascular risk factors. Where appropriate; within-pair analyses were performed to control for confounding by familial factors. The age- and gender-adjusted hazard ratio for stroke related to migraine with aura was 1.27 (95% confidence interval 1.00-1.62), P = 0.05, and 1.07 (95% confidence interval 0.91-1.26), P = 0

  20. 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

  1. The relationship between right-to-left shunt and brain white matter lesions in Japanese patients with migraine: a single center study.

    PubMed

    Iwasaki, Akio; Suzuki, Keisuke; Takekawa, Hidehiro; Takashima, Ryotaro; Suzuki, Ayano; Suzuki, Shiho; Hirata, Koichi

    2017-12-01

    There may be a link between right-to-left shunt (RLs) and brain white matter lesions (WMLs) in patients with migraine. In this study, we assessed the relationship between WMLs and RLs in Japanese migraine patients. A total of 107 consecutive patients with migraine with (MA) and without aura (MWOA) were included in this study. Contrast transcranial Doppler ultrasound was used to detect RLs. WMLs were graded using brain magnetic resonance imaging based on well-established criteria. The prevalence of RLs was significantly increased in the WMLs positive group (n = 24) compared with the WMLs negative group (n = 83) (75.0% vs. 47.0%, p = 0.015). In prevalence of WMLs between MA and MWOA patients, there were no statistical differences (p = 0.410). Logistic regression analysis adjusted by age and disease duration of migraine identified an RLs-positive status as the sole determinant for the presence of WMLs (OR = 6.15; 95% CI 1.82-20.8; p = 0.003) CONCLUSION: Our study suggests a possible link between RLs and WMLs in Japanese patients with migraine.

  2. Fugue associated with migraine

    PubMed Central

    Porter, G; Shaw, T; Ryan, C J

    2009-01-01

    Fugue states are characterised by a complete loss of memory for all personal details. Although often witnessed on stage and screen, real-life fugue states are rare. They are often psychogenic and rarely organic in origin. Here a case of fugue in a patient with migraines is reported. It is possible that cerebral vasoconstriction in this case caused the memory impairment; this is supported by cerebral hypo-perfusion demonstrated on SPECT scanning. The patient’s fugue resolved after treatment for migraine. PMID:21686740

  3. Assessing Barriers to Chronic Migraine Consultation, Diagnosis, and Treatment: Results From the Chronic Migraine Epidemiology and Outcomes (CaMEO) Study

    PubMed Central

    Loder, Elizabeth W.; Manack Adams, Aubrey; Buse, Dawn C.; Fanning, Kristina M.; Reed, Michael L.; Lipton, Richard B.

    2016-01-01

    .16; 95% CI 1.11–1.22) and presence of health insurance (OR 4.61; 95% CI 3.05–6.96). Among those consulting a healthcare professional, 126 (24.6%) received an accurate diagnosis and 56 of those with a correct diagnosis (44.4%) received both acute and preventive pharmacologic treatments; odds of a CM diagnosis were higher for women (OR 1.93; 95% CI 1.03–3.61), those with greater migraine severity (OR 1.25; 95% CI 1.14–1.37), and those currently consulting a specialist (OR 2.38; 95% CI 1.54–3.69). No predictors of receiving appropriate treatment were identified among those currently consulting. Among our sample of people with chronic migraine, only 56 (4.5%) individuals successfully traversed the series of 3 barriers to successful chronic migraine care (ie, consulted a healthcare professional for migraine, received an accurate diagnosis, and were prescribed minimal acute and preventive pharmacologic treatments). Conclusion Our findings suggest that <5% of persons with chronic migraine traversed 3 barriers to receiving care for headache (consultation, diagnosis, and treatment), representing a large unmet need for improving care in this population. Predictors of consulting a healthcare professional included age, having health insurance, greater migraine‐related disability, and greater migraine symptom severity. Among those consulting, predictors of an appropriate diagnosis included consulting a specialist, female sex, and greater migraine severity. Public health efforts are needed to improve outcomes for patients with chronic migraine by a range of interventions and educational efforts aimed at improving consultation rates, diagnostic accuracy, and adherence to minimal pharmacologic treatment. PMID:27143127

  4. Statistical testing of association between menstruation and migraine.

    PubMed

    Barra, Mathias; Dahl, Fredrik A; Vetvik, Kjersti G

    2015-02-01

    To repair and refine a previously proposed method for statistical analysis of association between migraine and menstruation. Menstrually related migraine (MRM) affects about 20% of female migraineurs in the general population. The exact pathophysiological link from menstruation to migraine is hypothesized to be through fluctuations in female reproductive hormones, but the exact mechanisms remain unknown. Therefore, the main diagnostic criterion today is concurrency of migraine attacks with menstruation. Methods aiming to exclude spurious associations are wanted, so that further research into these mechanisms can be performed on a population with a true association. The statistical method is based on a simple two-parameter null model of MRM (which allows for simulation modeling), and Fisher's exact test (with mid-p correction) applied to standard 2 × 2 contingency tables derived from the patients' headache diaries. Our method is a corrected version of a previously published flawed framework. To our best knowledge, no other published methods for establishing a menstruation-migraine association by statistical means exist today. The probabilistic methodology shows good performance when subjected to receiver operator characteristic curve analysis. Quick reference cutoff values for the clinical setting were tabulated for assessing association given a patient's headache history. In this paper, we correct a proposed method for establishing association between menstruation and migraine by statistical methods. We conclude that the proposed standard of 3-cycle observations prior to setting an MRM diagnosis should be extended with at least one perimenstrual window to obtain sufficient information for statistical processing. © 2014 American Headache Society.

  5. Medication overuse reinstates conditioned pain modulation in women with migraine.

    PubMed

    Guy, Nathalie; Voisin, Daniel; Mulliez, Aurélien; Clavelou, Pierre; Dallel, Radhouane

    2017-01-01

    the contrary, medication overuse reinstated conditioned pain modulation in female migraine patients. They also identify different phenotypes of pain modulation in migraine patients. Registration number N° 2008-A00471-54.

  6. 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

  7. 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

  8. Feverfew for preventing migraine.

    PubMed

    Pittler, M H; Ernst, E

    2004-01-01

    Feverfew (Tanacetum parthenium L.) extract is a herbal remedy used for preventing attacks of migraine. To systematically review the evidence from double-blind randomised controlled trials (RCTs) assessing the clinical efficacy and safety of feverfew versus placebo for preventing migraine. Publications describing (or which might describe) double-blind RCTs of feverfew extract for migraine were sought through the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, Issue 2, 2003); PREMEDLINE/MEDLINE (1966 to July 2003); EMBASE (1974 to July 2003); the trials register of the Cochrane Pain, Palliative and Supportive care group (July 2003); and AMED (1985 to July 2003). Manufacturers of feverfew were contacted and the bibliographies of identified articles checked for further trials. Randomised, placebo-controlled, double-blind trials assessing the efficacy of feverfew for preventing migraine were included. Trials using clinical outcome measures were included. Trials focusing exclusively on physiological parameters were excluded. There were no restrictions regarding the language of publication. Data on patients, interventions, methods, outcome measures, results and adverse events were extracted systematically. Methodological quality was evaluated using the scoring system developed by Jadad and colleagues. Two reviewers independently selected studies, assessed methodological quality and extracted data. Disagreements concerning evaluation of individual trials were resolved through discussion. Five trials (343 patients) met the inclusion criteria. Results from these trials were mixed and did not convincingly establish that feverfew is efficacious for preventing migraine. Only mild and transient adverse events were reported in the included trials. There is insufficient evidence from randomised, double-blind trials to suggest an effect of feverfew over and above placebo for preventing migraine. It appears from the data reviewed that feverfew

  9. 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.

  10. Acupuncture treatment modulates the resting-state functional connectivity of brain regions in migraine patients without aura.

    PubMed

    Zhang, Yong; Li, Kuang-shi; Liu, Hong-wei; Fu, Cai-hong; Chen, Sheng; Tan, Zhong-jian; Ren, Yi

    2016-04-01

    To investigate the modulatory effect of acupuncture treatment on the resting-state functional connectivity of brain regions in migraine without aura (MWoA) patients. Twelve MWoA patients were treated with standard acupuncture treatment for 4 weeks. All MWoA patients received resting-state functional magnetic resonance imaging (fMRI) scanning before and after acupuncture treatment. Another 12 normal subjects matched in age and gender were recruited to serve as healthy controls. The changes of restingstate functional connectivity in MWoA patients before and after the acupuncture treatment and those with the healthy controls were compared. Before acupuncture treatment, the MWoA patients had significantly decreased functional connectivity in certain brain regions within the frontal and temporal lobe when compared with the healthy controls. After acupuncture treatment, brain regions showing decreased functional connectivity revealed significant reduction in MWoA patients compared with before acupuncture treatment. Acupuncture treatment could increase the functional connectivity of brain regions in the intrinsic decreased brain networks in MWoA patients. The results provided further insights into the interpretation of neural mechanisms of acupuncture treatment for migraine.

  11. Development and Validation of a Four-Item Migraine Screening Algorithm Among a Nonclinical Sample: The Migraine-4.

    PubMed

    Walters, A Brooke; Smitherman, Todd A

    2016-01-01

    The present study sought to develop and validate a screening algorithm from the ICHD-3 beta diagnostic criteria for migraine utilizing a nonclinical sample. The goal was to determine the most sensitive and specific symptoms for differentiating migraine from other headache disorders and to validate the derived symptom algorithm as a screening measure. Despite its prevalence and impact, migraine remains under-recognized and under-treated. The U.S. Headache Consortium recommended development and dissemination of validated screening measures as a means to improve diagnosis. Participants were 1829 young adults (71.5% female; 74.4% white; mean age = 19.09 years [SD = 2.05]) who reported headache via computerized diagnostic interview. From this group, 158 were found to have ICHD episodic or chronic migraine and were randomly split into experimental and holdout validation samples. Within the experimental sample, receiver operating characteristic (ROC) curve data were obtained for each candidate symptom (item); backward stepwise logistic regression analysis was performed among the items with the most predictive likelihood ratios to determine the optimal model for differentiating migraine from non-migrainous headache. The retained four-symptom algorithm was then validated among the holdout sample, in which various cutoff points were compared to gold standard diagnosis via ROC curve estimations to determine the optimal operating point (OOP) of the algorithm as a screening measure. Attack duration of 4-72 hours (100% [95% CI = 95-100%]), severity ≥ 5 (91% [82-97%]), photophobia (90% [80-96%]), and phonophobia (90% [80-96%]) showed the highest sensitivity, while vomiting (98% [96-99%]), duration of 4-72 hours (92% [90-94%]), nausea (89% [86-91%]), and headache-related disability (88% [85-91%]) showed the highest specificity. The optimal retained model (Migraine-4) included: duration of 4-72 hours, nausea, photophobia, and phonophobia. Among the holdout

  12. 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

  13. Coexistence of CACNA1A, ATP1A2, and KCNN3 gene mutation in migraine patients with human platelet polymorphism.

    PubMed

    Bhaskar, Shalini; Abdullah, Jafri M; Ghazali, Mazira M

    2008-10-01

    To look for any possible coexistence of CACNA1A, ATP1A2, and KCNN3 gene mutations in migraine patients who had human platelet HPA-1a/1b polymorphism, which is also known as PlA1/A2 polymorphism. The study was carried out at the Neurology Clinic, Hospital University Sains Malaysia, Kelantan, Malaysia between April 2004 and March 2005. The DNA from 4 patients who had migraine with the HPA1a/1b polymorphism were analyzed by polymerase chain reaction using the allele specific oligonucleotide technique to detect the presence of CACNA1A, ATP1A2, and KCNN3 genotypes. We found that the CACNA1A gene mutation alone was present in only one patient who presented with classical migraine with aura. The gene mutations on ATP1A2 and KCNN3 were seen in none of our 4 cases with migraine. There is no coexistence between the platelet HPA-1a/1b polymorphism and the ATP1A2 and KCNN3 gene mutations, though one classical migraine patient with HPA-1a/1b polymorphism had the CACNA1A gene mutation. Larger studies are warranted to confirm these findings.

  14. 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.

  15. 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

  16. 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

  17. 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.

  18. 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.

  19. Meniere's, migraine, and motion sickness.

    PubMed

    Golding, John F; Patel, Mitesh

    2017-05-01

    Elevated Motion Sickness Susceptibility (MSS) in Meniere?s disease (MD) is likely to be a consequence of the onset of MD and not migraine per se. Pathologies of the vestibular system influence MSS. Bilateral vestibular deficits lower MSS, vestibular neuritis or benign paroxysmal positional vertigo have little overall effect, whereas vestibular migraine elevates MSS. However, less is known about MSS in MD, a condition in which many patients experience vestibular loss and migraine symptoms. The authors conducted an online survey that posed diagnostic and disease questions before addressing frequency of headaches, migraines, visual display dizziness (VDD), syncope, social life, and work impact of dizziness (SWID4) and motion sickness susceptibility (MSSQ). The two groups were: diagnosed MD individuals with hearing loss (n = 751) and non-MD individuals in the control group (n = 400). The MD group showed significantly elevated MSS, more headache and migraine, increased VDD, higher SWID4 scores, and increased syncope. MSS was higher in MD than controls only after the development of MD, but not before, nor in childhood. Although elevated in MD compared with controls, MSS was lower than migraine patients from past data. Multivariate analysis revealed VDD, SWID4, and MSS in adulthood as the strongest predictors of MD, but not headache nor migraine.

  20. 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

  1. 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.

  2. [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.

  3. Alexithymia in chronic and episodic migraine: a comparative study.

    PubMed

    Galli, Federica; Caputi, Marcella; Sances, Grazia; Vegni, Elena; Bottiroli, Sara; Nappi, Giuseppe; Tassorelli, Cristina

    2017-06-01

    Alexithymia is a term used to describe a disorder where patients have difficulty in expressing their own feelings in words. The analysis of alexithymia in patients suffering from chronic migraine (CM) or episodic migraine (EM) compared to healthy controls. Two clinical samples formed by 80 CM patients (21 males and 59 females, mean age: 44.65) and 44 EM patients (8 males and 36 females, mean age: 42.18) were enrolled. A group of 67 healthy subjects served as controls (26 males and 41 females, mean age: 41.21). All subjects were requested to fill in the 20-item version of the Toronto Alexithymia Scale (TAS-20). We found a statistically significant difference between groups in Factor 1 (difficulty in describing feelings), F(2, 191) = 7.96, p < 0.001, and in TAS total, F(2, 191) = 5.37, p = 0.005. Post-hoc analyses revealed that CM patients had higher scores in TAS factor 1 and in TAS total than healthy controls. There were no significant differences between CM and EM patients, even if CM sufferers reported a trend towards higher scores in each TAS factor as well as in TAS total. Alexithymia emerges as a potential characteristic trait of migraine, regardless of disease severity.

  4. 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.

  5. 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.

  6. Serum levels of adiponectin, CCL3/MIP-1α, and CCL5/RANTES discriminate migraine from tension-type headache patients.

    PubMed

    Domingues, Renan B; Duarte, Halina; Senne, Carlos; Bruniera, Gustavo; Brunale, Fernando; Rocha, Natália P; Teixeira, Antonio L

    2016-08-01

    Inflammatory molecules and neurotrophic factors are implicated in pain modulation; however, their role in primary headaches is not yet clear. The aim of this study was to compare the levels of serum biomarkers in migraine and tension-type headache. This was a cross-sectional study. We measured serum levels of adiponectin, chemokines, and neurotrophic factors in patients with migraine and tension-type headache. Depression and anxiety symptoms, headache impact and frequency, and allodynia were recorded. We included sixty-eight patients with migraine and forty-eight with tension-type headache. Cutaneous allodynia (p = 0.035), CCL3/MIP-1α (p = 0.041), CCL5/RANTES (p = 0.013), and ADP (p = 0.017) were significantly higher in migraine than in tension-type headache. The differences occurred independently of anxiety and depressive symptoms, frequency and impact of headache, and the presence of pain. This study showed higher CCL3/MIP-1α, CCL5/RANTES, and ADP levels in migraine in comparison with tension-type headache. Our findings suggest distinctive roles of these molecules in the pathophysiology of these primary headaches.

  7. Migraine--the forgotten epidemic: development of the EHF/WHA Rome Declaration on Migraine.

    PubMed

    Diener, Hans-Christoph; Steiner, Timothy J; Tepper, Stewart J

    2006-12-01

    Despite the availability of effective treatments, many migraine sufferers in Europe still do not receive optimal treatment. A panel of specialists, primary-care physicians and patient-group representatives met in Rome on 10-11 June 2005, under the auspices of the European Headache Federation (EHF), the World Headache Alliance (WHA) and the University of Duisburg-Essen, to review the scientific background, management issues, and physician, patient and government perspectives on migraine. The goal of the meeting was to produce the EHF/WHA Rome Declaration on Migraine, a statement of the actions required to improve migraine care and the quality of life of people with migraine. The key recommendation of the EHF/WHA Rome Declaration on Migraine is education of migraine sufferers, health professionals and health-policy makers.

  8. [Migraine and patent foramen ovale].

    PubMed

    Lucas, C

    2013-05-01

    Observational studies indicate an increased prevalence of patent foramen ovale (PFO) in migraineurs with aura and an increased prevalence of migraine and migraine with aura in patients with PFO but a recent stratified meta-analysis does not support pairwise association between PFO and migraine. There are conflicting data regarding causal relationship between these two conditions. According to recent studies, microembolization might provoke a decrease in cerebral oxygen saturation, thus triggering cortical spreading depression and, thereafter, migraine with aura attack. Release of vasoactive substances by activated platelets or atrial natriuretic factor are other pathophysiological explanations. Retrospective analyses of PFO closure suggest clinically significant improvements in migraine patterns. The MIST study is the only prospective study available with a good design but this study gave a negative response about cure of migraine with aura and revealed a high morbidity for such a benign condition. Although PFO closure sometimes appears to affect migraine patterns favorably, the very low grade of available evidence to support this association precludes definitive conclusions. To date, PFO closure in migraineurs with aura is not recommended in daily practice. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  9. Migraine trait symptoms in migraine with and without aura.

    PubMed

    Jürgens, Tim P; Schulte, Laura H; May, Arne

    2014-04-22

    The aim of the study was to determine whether various transient sensory and neuropsychological symptoms (SNS) were associated with migraine using a custom questionnaire. In this hypothesis-generating case-control study, the frequencies of transient SNS in 219 patients with migraine (149 without aura and 70 with aura) were compared with 161 age- and sex-matched healthy controls using a custom questionnaire. Patients from a tertiary academic headache center in Hamburg were contacted by regular mail. Healthy controls without a history of migraine were recruited by means of a screening questionnaire and consecutively approached by e-mail. The presence of both migraine and aura was associated with significantly higher frequencies of autokinesis, metamorphopsia, dyschromatopsia, cinematographic vision, illusionary visual spread, and synesthesia (for all comparisons: corrected p < 0.05). Double vision, inverted 2- and 3-dimensional vision, and altered perception of body weight and size were found more often in patients with migraine without aura than in those with aura. In contrast, aura was associated with the occurrence of visual splitting and corona phenomenon (for all comparisons: corrected p < 0.05). No relevant association with migraine was found for micropsia and macropsia, teleopsia and pelopsia, inverted vision, out-of-body experience, Doppelgänger phenomenon, complex visual hallucinations, and altered perception of body position in space. The observed SNS seem to belong to a physiologic spectrum of multisensory phenomena. Some of these phenomena were significantly accentuated in patients with migraine and may therefore be termed migraine trait symptoms. However, these results will have to be confirmed in a prospective study with face-to-face interviews.

  10. Faster Improvement in Migraine Pain Intensity and Migraine-Related Disability at Early Time Points with AVP-825 (Sumatriptan Nasal Powder Delivery System) versus Oral Sumatriptan: A Comparative Randomized Clinical Trial Across Multiple Attacks from the COMPASS Study.

    PubMed

    Lipton, Richard B; McGinley, James S; Shulman, Kenneth J; Wirth, R J; Buse, Dawn C

    2017-09-07

    Fast relief of migraine pain, associated symptoms, and migraine-related disability are priorities in the acute treatment of migraine. Efforts to improve the pharmacokinetic profiles of acute migraine treatments with the aim of providing faster relief include the development of non-oral routes of administration. AVP-825 (ONZETRA(®) Xsail(®) ) is a delivery system containing 22 mg sumatriptan powder that uses a patient's own breath to deliver medication intranasally, targeting the upper posterior nasal cavity beyond the narrow nasal valve, an area lined with vascular mucosa conducive to rapid drug absorption into the systemic circulation. While most studies comparing treatments measure differences in proportions of patients achieving a dichotomous endpoint at fixed time intervals, in this study we compare trajectories of migraine pain and disability over time for AVP-825 versus 100 mg oral sumatriptan tablets. We used data from the COMPASS study (NCT01667679, clinicaltrials.gov), a double-blind, double-dummy, active-comparator, cross-over study of people with a diagnosis of migraine. Participants treated up to five qualifying migraine attacks within 1 hour of onset with either AVP-825 plus placebo tablets or 100 mg oral sumatriptan tablets plus placebo delivery system during the first of two 12-week treatment periods, and then switched treatment sequences to treat up to five more attacks in the second treatment period. Patients recorded ordinal migraine pain intensity and migraine-related disability before dosing (predose), and at 10, 15, 30, 45, 60, 90 and 120 minutes. Three-level ordinal multilevel models accounted for unique data structure (repeated measures nested within attacks for each patient) and tested for treatment differences in migraine pain and migraine-related disability through the first 2 hours of attacks post dose. Among 259 study participants (mean age 40.0 years, 84.6% female, 78.4% white), there was significant between and within person

  11. A diffusion tensor magnetic resonance imaging study of corpus callosum from adult patients with migraine complicated with depressive/anxious disorder.

    PubMed

    Li, Xian L; Fang, Yan N; Gao, Qing C; Lin, Er J; Hu, San H; Ren, Li; Ding, Ming H; Luo, Bo N

    2011-02-01

    The aim of this study was to investigate the possible microstructural abnormalities of the corpus callosum (CC) in adult patients with migraine without aura complicated with depressive/anxious disorder. Emotional disorders, especially depression and anxiety, are with relatively higher incidence in migraine population. However, the mechanism of migraine complicated with depressive/anxious disorder remains unclear. Diffusion tensor magnetic resonance imaging was carried out in 12 adult patients with simple migraine (without aura and without depressive/anxious disorder) (S-M group), 12 adult patients with complicated migraine (without aura but complicated with depressive/anxious disorder) (Co-M group), and 12 age- and sex-matched healthy subjects (Control group). Fractional anisotropy (FA) and apparent diffusion coefficient were measured at genu, body, and splenium of the CC, respectively. There were significant differences in FA values at all locations of the CC among the 3 groups. The FA values from both the SM and Co-M groups were significantly lower than the control (P < .05 and P < .01, respectively). The FA values from Co-M group were significantly lower than the SM group (P < .01). The apparent diffusion coefficient values of the above regions had no significant differences among these groups (P > .05). There were negative correlations between FA value of genu of the CC and disease course as well as FA value of genu and body of the CC and headache frequency (P < .05). Negative correlations were also found between FA values at all locations of the CC and Hamilton anxiety and Hamilton depression scores (both P < .05). There might be an integrity change of neurofibrotic microstructures existing as a possible neuroanatomical basis in the CC of migraine patients complicated with depressive/anxious disorder. © 2010 American Headache Society.

  12. Headache Attributed to Fibrous Dysplasia of the Ethmoid Bone Mimicking Menstrual Migraine Without Aura.

    PubMed

    Kim, Kyung Soo

    2016-06-01

    The authors experienced a patient of fibrous dysplasia originating from the ethmoid bone which presented with severe headache with some features suggestive of menstrual migraine without aura. Fibrous dysplasia originating from the ethmoid bone is a rare disease entity, but may cause severe headache that can be misdiagnosed as "menstrual migraine" because of similar symptoms in female patients. Because the primary objective of surgery is symptomatic relief, conservative transnasal endoscopic approach may be considered an alternative to more invasive external surgical techniques in carefully selected patients, especially originating from the nasal cavity and paranasal sinuses.

  13. Factors Influencing Migraine Recurrence After Infusion and Inpatient Migraine Treatment in Children and Adolescents.