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Handbook of Clinical Neurology 2023Migraine affects over a billion people worldwide and brings with it a huge burden of disability. It is a disease which disproportionally affects the working age... (Review)
Review
Migraine affects over a billion people worldwide and brings with it a huge burden of disability. It is a disease which disproportionally affects the working age population which heightens its economic impact, both at the individual family level and the societal level. Women are significantly more affected by migraine at every age and in all social and geographical groups. At the most severe end of the spectrum, chronic migraine is associated with poorer overall physical and mental health as well as increased risk of unemployment and lower household income. Estimates of the incidence and prevalence of migraine vary with sex, race, ethnicity, geography, socioeconomic, and educational status, suggesting there are many factors at play. In many cases, it is not clear whether these factors are causative of migraine, the effects of migraine, or (as is most likely) a combination of both. Future studies should aim to clarify these links, so that modifiable factors can be addressed where possible and those at risk of developing chronic migraine might receive targeted treatment at an early stage.
Topics: Humans; Female; Migraine Disorders; Prevalence
PubMed: 38043969
DOI: 10.1016/B978-0-12-823356-6.00017-2 -
Nutrients Jul 2022Migraine is related to brain energy deficiency. Niacin is a required coenzyme in mitochondrial energy metabolism. However, the relationship between dietary niacin and...
Migraine is related to brain energy deficiency. Niacin is a required coenzyme in mitochondrial energy metabolism. However, the relationship between dietary niacin and migraines remains uncertain. We aimed to evaluate the relationship between dietary niacin and migraine. This study used cross-sectional data from people over 20 years old who took part in the National Health and Nutrition Examination Survey between 1999 and 2004, collecting details on their severe headaches or migraines, dietary niacin intake, and several other essential variables. There were 10,246 participants, with 20.1% (2064/10,246) who experienced migraines. Compared with individuals with lower niacin consumption Q1 (≤12.3 mg/day), the adjusted OR values for dietary niacin intake and migraine in Q2 (12.4−18.3 mg/day), Q3 (18.4−26.2 mg/day), and Q4 (≥26.3 mg/day) were 0.83 (95% CI: 0.72−0.97, p = 0.019), 0.74 (95% CI: 0.63−0.87, p < 0.001), and 0.72 (95% CI: 0.58−0.88, p = 0.001), respectively. The association between dietary niacin intake and migraine exhibited an L-shaped curve (nonlinear, p = 0.011). The OR of developing migraine was 0.975 (95% CI: 0.956−0.994, p = 0.011) in participants with niacin intake < 21.0 mg/day. The link between dietary niacin intake and migraine in US adults is L-shaped, with an inflection point of roughly 21.0 mg/day.
Topics: Adult; Cross-Sectional Studies; Diet; Humans; Migraine Disorders; Niacin; Nutrition Surveys; United States; Young Adult
PubMed: 35893904
DOI: 10.3390/nu14153052 -
Revue Neurologique Sep 2021Migraine is a complex brain disorder explained by the interaction of genetic and environmental factors. In monogenic migraines, including familial hemiplegic migraine... (Review)
Review
Migraine is a complex brain disorder explained by the interaction of genetic and environmental factors. In monogenic migraines, including familial hemiplegic migraine and migraine with aura associated with hereditary small-vessel disorders, the identified genes encode proteins expressed in neurons, astrocytes or vessels, which all increase the susceptibility to cortical spreading depression. Study of monogenic migraines showed that the neurovascular unit plays a prominent role in migraine. Genome-wide association studies have identified multiple susceptibility variants that only cause a small increase of the global migraine risk. The variants belong to several complex networks of "pro-migraine" molecular abnormalities, which are mainly neuronal or vascular. Genetics has also underscored the importance of genetic factors shared between migraine and its major co-morbidities including depression and high blood pressure. Further studies are still needed to map all of the susceptibility loci for migraine and then to understand how these genomic variants lead to migraine cell phenotypes. Thanks to the advent of new technologies such as induced pluripotent stem cells, genetic data will hopefully finally be able to lead to therapeutic progress.
Topics: Cortical Spreading Depression; Epilepsy; Genome-Wide Association Study; Humans; Migraine Disorders; Migraine with Aura
PubMed: 34304862
DOI: 10.1016/j.neurol.2021.06.002 -
Arquivos de Neuro-psiquiatria May 2022Vestibular migraine (VM) remains an underdiagnosed condition, often mistaken with brainstem aura. VM is defined by recurrent vestibular symptoms in at least 50% of...
Vestibular migraine (VM) remains an underdiagnosed condition, often mistaken with brainstem aura. VM is defined by recurrent vestibular symptoms in at least 50% of migraine attacks. Diagnosis is established by clinical criteria based on the International Classification of Headache Disorders (ICHD-3). Estimated prevalence of VM is 1 to 2.7% of the adult population. Vestibular symptoms usually appear after the headache. VM pathophysiology remains poorly understood. Vertigo may occur before, during, after the migraine attack, or even independently, and may last seconds to hours or days. Pathophysiological mechanisms for VM are still poorly understood and are usually extrapolated from migraines. Differential diagnoses include Ménière's disease, benign paroxysmal positional vertigo, brainstem aura, transient ischemic attack, persistent perceptual postural vertigo, and episodic type 2 ataxia. Specific treatment recommendations for vestibular migraine are still scarce.
Topics: Adult; Benign Paroxysmal Positional Vertigo; Diagnosis, Differential; Epilepsy; Humans; Migraine Disorders
PubMed: 35976301
DOI: 10.1590/0004-282X-ANP-2022-S111 -
Handbook of Clinical Neurology 2024Migrainous infarction is defined as a migraine attack occurring as migraine with aura, typical of the patient's previous attacks, except that one or more aura symptoms... (Review)
Review
Migrainous infarction is defined as a migraine attack occurring as migraine with aura, typical of the patient's previous attacks, except that one or more aura symptoms persist for >60min, and neuroimaging demonstrates ischemic infarct in the relevant area. To better understand migrainous infarction, one must disentangle the complex interactions between migraine and stroke. In this chapter, we first discuss the migraine-stroke association in sections including "Increased Risks of Stroke and Subclinical Infarcts in Patients With Migraine," "Migrainous Headache Cooccurring or Triggered by Ischemic Stroke," "Stroke Progression in Patients With Migraine," and "Clinic Conditions Associated With Higher Risks of Both Migraine and Stroke." As an extreme example of migraine-stroke association, the annual incidence of migrainous infarction was reported to be 0.80/100,000/year, with the incidence in females nearly twofold that of male patients. Patients diagnosed with migrainous infarction are typically younger (average age 29-39 in case series), have fewer traditional vascular risk factors, and have more favorable prognosis compared to strokes from traditional risk factors. Thorough evaluation is recommended to rule out other etiologies of stroke. Patients diagnosed with migrainous infarction should receive antiplatelet therapy and migraine preventive therapy to avoid future events. Vasoactive medications, including triptans and ergots, should be avoided.
Topics: Female; Humans; Male; Adult; Migraine Disorders; Stroke; Risk Factors; Infarction; Prognosis; Migraine with Aura
PubMed: 38307663
DOI: 10.1016/B978-0-12-823357-3.00021-5 -
Clinics in Plastic Surgery Apr 2020Migraine headaches affect more than 35 million Americans and are ranked the third-highest cause of disability worldwide, resulting in decreased quality of life and... (Review)
Review
Migraine headaches affect more than 35 million Americans and are ranked the third-highest cause of disability worldwide, resulting in decreased quality of life and serious economic consequences. There are 4 types of migraine headaches: frontal, temporal, occipital, and rhinogenic. Each type has a well-described trigger site. Migraines headaches often are refractory to medical therapy and may respond well to botulinum toxin type A. Migraine surgery is another option to release trigger sites. A systematic review of the migraine surgery literature found an average success rate of 90%, with elimination or greater than 50% improvement of migraine headaches after migraine surgery.
Topics: Botulinum Toxins, Type A; Female; Humans; Migraine Disorders; Neuromuscular Agents; Quality of Life
PubMed: 32115055
DOI: 10.1016/j.cps.2020.01.003 -
Cells Dec 2022To perform a systematic review of real-world outcomes for anti-CGRP-mAbs. (Review)
Review
OBJECTIVE
To perform a systematic review of real-world outcomes for anti-CGRP-mAbs.
METHODS
Following the PRISMA guidelines, we searched PubMed for real-world data of erenumab, galcanezumab, fremanezumab, or eptinezumab in patients with migraines.
RESULTS
We identified 134 publications (89 retrospective), comprising 10 pharmaco-epidemiologic and 83 clinic-based studies, 38 case reports, and 3 other articles. None of the clinic-based studies provided follow-up data over more than one year in more than 200 patients. Findings suggest that there are reductions in health insurance claims and days with sick-leave as well as better treatment adherence with anti-CGRP-mAbs. Effectiveness, reported in 77 clinic-based studies, was comparable to randomized controlled trials. A treatment pause was associated with an increase in migraine frequency, and switching to another antibody resulted in a better response in some of the patients. Adverse events and safety issues were addressed in 86 papers, including 24 single case reports.
CONCLUSION
Real-world data on anti-CGRP-mAbs are limited by retrospective data collection, small patient numbers, and short follow-up periods. The majority of papers seem to support good effectiveness and tolerability of anti-CGRP-mAbs in the real-world setting. There is an unmet need for large prospective real-world studies providing long-term follow-ups of patients treated with anti-CGRP-mAbs.
Topics: Humans; Calcitonin Gene-Related Peptide; Prospective Studies; Retrospective Studies; Antibodies, Monoclonal; Migraine Disorders
PubMed: 36611935
DOI: 10.3390/cells12010143 -
Neurologic Clinics Feb 2023The most common headache disorders in adolescents are tension-type headache, migraine, and posttraumatic headache. These disorders in adolescents may have different... (Review)
Review
The most common headache disorders in adolescents are tension-type headache, migraine, and posttraumatic headache. These disorders in adolescents may have different characteristics than in adults but can be similarly disabling. This review highlights the emerging abortive and preventive treatment options for the adolescent population. Although future high-quality headache studies in this age group are still needed, current evidence for the safety and efficacy of various treatment modalities is also discussed.
Topics: Adult; Adolescent; Humans; Headache; Tension-Type Headache; Migraine Disorders; Headache Disorders; Post-Traumatic Headache
PubMed: 36400554
DOI: 10.1016/j.ncl.2022.08.001 -
Brain and Nerve = Shinkei Kenkyu No... May 2023Migraine is one of the most disabling diseases with a significant socioeconomic impact. Approximately 8.4% of Japanese people experience migraines. In Japan, five types...
Migraine is one of the most disabling diseases with a significant socioeconomic impact. Approximately 8.4% of Japanese people experience migraines. In Japan, five types of triptans have been approved since the year 2000. Furthermore, the development of lomerizine and the approval of valproic acid and propranolol for migraine prophylaxis have greatly improved the treatment of patients with migraines. The 2006 Clinical Practice Guidelines for Chronic Headache were published by the Japanese Headache Society and prompted evidence-based migraine treatment. However, we did not obtain satisfactory results. Since 2021, the number of new treatment options in Japan will increase. Some patients with migraines do not benefit from the poor efficacy, side effects, or vasoconstrictive effects of triptan. Selective 5-hydroxytryptamine (HT) 1F receptor agonist (ditan), which does not stimulate the 5-HT 1B receptor, can compensate for the shortcomings of triptan. Calcitonin gene-related peptide (CGRP) is a neuropeptide that plays a vital role in migraine pathophysiology and is a target for migraine preventive therapies. Monoclonal antibodies targeting CGRP (galcanezumab and fremanezumab) and its receptor (erenumab) have shown consistent efficacy in migraine prophylaxis, with excellent safety profiles. Its effects on refractory cases have also been reported, and a paradigm shift in migraine treatment is emerging.
Topics: Humans; Calcitonin Gene-Related Peptide; Calcitonin Gene-Related Peptide Receptor Antagonists; Migraine Disorders; Headache; Propranolol
PubMed: 37194515
DOI: 10.11477/mf.1416202361 -
Handbook of Clinical Neurology 2023Migraine aura occurs in about a third of patients with migraine and consists of a group of transient focal neurological symptoms that appear from 5 to 60min and then... (Review)
Review
Migraine aura occurs in about a third of patients with migraine and consists of a group of transient focal neurological symptoms that appear from 5 to 60min and then resolve prior to or in the early phase of a migraine headache attack. Migraine auras may consist of visual, language, unilateral sensory, or motor symptoms. There has been considerable debate as to the origins of the migrainous aura. Investigations during physiologically induced visual auras suggest that the phenomenon of cortical spreading depression or its human equivalent underpins the migraine aura. Single gene defects have been linked to relatively rare forms of the motor subtypes of aura known as familial hemiplegic migraine (FHM). These include CACNA1A (FHM1), ATP1A2 (FHM2), and SCN1A (FHM3). In the familial hemiplegic forms of migraine, the more typical forms of aura are almost always also present. Despite ample epidemiological evidence of increased heritability of migraine with aura compared to migraine without aura, identification of the specific variants driving susceptibility to the more common forms of aura has been problematic thus far. In the first genome-wide association study (GWAS) that focused migraine with aura, a single SNP rs835740 reached genome-wide significance. Unfortunately, the SNP did show statistical significance in a later meta-analysis which included GWAS data from subsequent studies. Here, we review the clinical features, pathophysiological theories, and currently available potential evidence for the genetic basis of migraine aura.
Topics: Humans; Migraine with Aura; Genome-Wide Association Study; Migraine Disorders; Epilepsy
PubMed: 38043972
DOI: 10.1016/B978-0-12-823356-6.00016-0