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Cephalalgia : An International Journal... Nov 2019The clinical picture, but also neuroimaging findings, suggested the brainstem and midbrain structures as possible driving or generating structures in migraine. (Review)
Review
BACKGROUND
The clinical picture, but also neuroimaging findings, suggested the brainstem and midbrain structures as possible driving or generating structures in migraine.
FINDINGS
This has been intensely discussed in the last decades and the advent of modern imaging studies refined the involvement of rostral parts of the pons in acute migraine attacks, but more importantly suggested a predominant role of the hypothalamus and alterations in hypothalamic functional connectivity shortly before the beginning of migraine headaches. This was shown in the NO-triggered and also in the preictal stage of native human migraine attacks. Another headache type that is clinically even more suggestive of hypothalamic involvement is cluster headache, and indeed a structure in close proximity to the hypothalamus has been identified to play a crucial role in attack generation.
CONCLUSION
It is very likely that spontaneous oscillations of complex networks involving the hypothalamus, brainstem, and dopaminergic networks lead to changes in susceptibility thresholds that ultimately start but also terminate headache attacks. We will review clinical and neuroscience evidence that puts the hypothalamus in the center of scientific attention when attack generation is discussed.
Topics: Autonomic Nervous System; Brain Stem; Craving; Dopamine; Emotions; Endocrine System; Headache; Humans; Hypothalamus; Migraine Disorders; Nitric Oxide; Nociception; Pain Perception; Photophobia; Prodromal Symptoms
PubMed: 31466456
DOI: 10.1177/0333102419867280 -
Cureus Jun 2021Vestibular migraine (VM) is one of the most common types of episodic vertigo. Over the last 11 years, this disorder has been studied by both neurologists and... (Review)
Review
Vestibular migraine (VM) is one of the most common types of episodic vertigo. Over the last 11 years, this disorder has been studied by both neurologists and otolaryngologists. Based on the clinical symptoms and previous migraine history, the Barany Society and the International Classification of Headache Disorders have created the diagnostic criteria for VM. Unilateral and pulsatile headache, phonophobia, photophobia, auras, and a previous history of migraine have been included in these criteria. Although these symptoms are common and widely known, other symptoms not included in the Barany Society criteria are emerging and have been described in some clinical studies. These emerging criteria include audio-vestibular symptoms such as hearing loss, ear fullness, and tinnitus. Ringing ears could be associated with other vestibular disorders such as superior canal dehiscence and Ménière's disease, but not in VM. The frequency, pathophysiological contributors, and clinical characteristics of this symptom in individuals with VM will be explored in this review.
PubMed: 34336489
DOI: 10.7759/cureus.15998 -
Nursing Standard (Royal College of... Jan 2024Migraine is a common neurological disorder characterised by a severe, pulsating headache, sometimes accompanied with photophobia or phonophobia and nausea and/or...
Migraine is a common neurological disorder characterised by a severe, pulsating headache, sometimes accompanied with photophobia or phonophobia and nausea and/or vomiting. The symptoms of migraine can have a significant adverse effect on a person's ability to undertake normal activities. Nurses have an important role in assisting patients in identifying migraine triggers and in supporting them to manage the symptoms of migraines through lifestyle changes and pharmacological treatments. This article describes different types of migraines and some differential diagnoses and 'red flag' symptoms that could indicate a more serious condition. The author also discusses non-pharmacological and pharmacological management strategies and treatments.
Topics: Humans; Migraine Disorders; Nausea; Vomiting; Photophobia; Hyperacusis
PubMed: 37994154
DOI: 10.7748/ns.2023.e12059 -
Cephalalgia : An International Journal... Aug 2023Clinical trials on anti-calcitonin gene-related peptide monoclonal antibodies poorly investigated their impact on migraine accompanying symptoms.
BACKGROUND
Clinical trials on anti-calcitonin gene-related peptide monoclonal antibodies poorly investigated their impact on migraine accompanying symptoms.
OBJECTIVE
To evaluate the impact of basal accompanying symptoms on anti-CGRP monoclonal antibodies treatment response and their evolution after six months of treatment in migraine patients.
METHODS
Patients with migraine diagnosis seen in the Headache Clinic and treated with erenumab, galcanezumab or fremanezumab were prospectively recruited. They completed a daily eDiary which provided data on headache frequency and the following accompanying symptoms of each day: photophobia, phonophobia, nausea, dizziness, and aura. Patients were classified as responders or non-responders based on 50% or greater reduction in headache days per month at month 6 (≥50% response rate). Accompanying symptoms ratios based on headache days per month were assessed per patient at baseline and after three and six months. Comparisons for basal characteristics, basal accompanying symptoms ratios and their evolution after six months between responders and non-responders were performed.
RESULTS
One hundred and fifty-eight patients were included, 44% (69/158) showed ≥50% response rate after six months. A significant reduction in headache days per month in both groups was found at month 6 (-9.4 days/month in ≥50% response rate group; p < 0.001, -2.2 days/month in <50% response rate group; p = 0.004). Additionally, significant decreases in photophobia (-19.5%, p < 0.001), phonophobia (-12.1%, p = 0.010) and aura ratios (-25.1%, p = 0.008) were found in ≥50% response rate group. No statistically significant reductions were found in nausea and dizziness in any group since their reduction was correlated with the decrease in headache days per month. Higher photophobia ratios at baseline were predictive of an increased response between months 3 and 6 (Incidence Risk Ratio = 0.928, p = 0.040).
CONCLUSIONS
The days per month with photophobia, phonophobia and aura decreased at a higher rate than headache days per month after six months in the ≥50% response group. Higher photophobia ratios were associated with higher response rates between three and six months. It could indicate an involvement of peripheral CGRP in photophobia as well as a central modulation of migraine through these treatments which mainly act on the periphery.
Topics: Humans; Antibodies, Monoclonal; Dizziness; Headache; Hyperacusis; Migraine Disorders; Nausea; Photophobia; Treatment Outcome
PubMed: 37555331
DOI: 10.1177/03331024231177636 -
Frontiers in Neurology 2022To investigate the auditory features of patients with vestibular migraine (VM) and to analyze the possible relevant factors of hearing loss.
OBJECTIVES
To investigate the auditory features of patients with vestibular migraine (VM) and to analyze the possible relevant factors of hearing loss.
METHODS
A total of 166 patients with VM were enrolled. Demographic variables, age of onset, disease course, distribution of vestibular attacks, characteristics of hearing loss, and the coexistence of related disorders, such as visual aura, familial history, motion sickness, nausea, headache, photophobia, otalgia, tinnitus, aural fullness, and phonophobia, were analyzed and compared.
RESULTS
Patients with VM can manifest otalgia (8.4%), tinnitus (51.8%), aural fullness (41%), and phonophobia (31.9%). Of 166 patients, the prevalence of VMw was 21.1% ( = 35). Patients with VMw mainly manifested mild and easily reversible low-frequency hearing loss. The proportions of tinnitus and aural fullness were significantly larger in patients with VMw than that in patients with VMo ( < 0.05). The duration of vestibular symptoms was significantly shorter in patients with VMw ( < 0.05). However, the age of onset, disease course, gender, frequency of vestibular attacks, the coexistence of visual aura, familial history, motion sickness, nausea, headache, photophobia, otalgia, and phonophobia had no significant difference between the two groups.
CONCLUSION
Auditory symptoms were common in patients with VM. The hearing loss of VM was characterized by a mild and easily reversible low-frequency hearing loss, accompanied by higher proportions of tinnitus and aural fullness, and a shorter duration of vestibular symptoms compared with patients with VMo.
PubMed: 35911900
DOI: 10.3389/fneur.2022.944001 -
NeuroRehabilitation 2022Photophobia is a common sensory symptom after traumatic brain injury (TBI) that may have a grave impact on a patient's functional independence, neurorehabilitation, and... (Review)
Review
BACKGROUND
Photophobia is a common sensory symptom after traumatic brain injury (TBI) that may have a grave impact on a patient's functional independence, neurorehabilitation, and activities of daily living. Post-TBI photophobia can be difficult to treat and the majority of patients can suffer chronically up to and beyond one year after their injury.
OBJECTIVES
This review evaluates the current theories of the pathophysiology of photophobia and the most-common co-morbid etiologies of light sensitivity in TBI to help guide the differential diagnosis and individualized management of post-TBI photophobia.
METHODS
Primary articles were found via PubMed and Google Scholar search of key terms including "photophobia" "light sensitivity" "photosensitivity" "photo-oculodynia" "intrinsically photosensitive retinal ganglion cells" "ipRGC" and "concussion" "brain injury" "dry eye". Due to paucity of literature papers were reviewed from 1900 to present in English.
RESULTS
Recent advances in understanding the pathophysiology of photophobia in dry eye and migraine and their connection to intrinsically photosensitive retinal ganglion cells (ipRGC) have revealed complex and multifaceted trigeminovascular and trigeminoautonomic pathways underlying photophobia. Patients who suffer a TBI often have co-morbidities like dry eye and migraine that may influence the patient's photophobia.
CONCLUSION
Post-traumatic photophobia is a complex multi-disciplinary complaint that can severely impact a patient's quality of life. Exploration of underlying etiology may allow for improved treatment and symptomatic relief for these patients beyond tinted lenses alone.
Topics: Activities of Daily Living; Brain Concussion; Brain Injuries, Traumatic; Diagnosis, Differential; Dry Eye Syndromes; Humans; Migraine Disorders; Photophobia; Quality of Life
PubMed: 35311726
DOI: 10.3233/NRE-228014 -
Pain Nov 2023Migraine is a disabling disorder characterized by recurrent headaches, accompanied by abnormal sensory sensitivity and anxiety. Despite extensive historical use of...
Migraine is a disabling disorder characterized by recurrent headaches, accompanied by abnormal sensory sensitivity and anxiety. Despite extensive historical use of cannabis in headache disorders, there is limited research on the nonpsychoactive cannabidiol (CBD) for migraine and there is no scientific evidence to prove that CBD is an effective treatment. The effects of CBD are examined here using a calcitonin gene-related peptide (CGRP)-induced migraine model that provides measures of cephalic allodynia, spontaneous pain, altered light sensitivity (photophobia), and anxiety-like behavior in C57BL/6J mice. A single administration of CGRP induced facial hypersensitivity in both female and male mice. Repeated CGRP treatment produced progressively decreased levels in basal thresholds of allodynia in females, but not in males. A single CBD administration protected both females and males from periorbital allodynia induced by a single CGRP injection. Repeated CBD administration prevented increased levels of basal allodynia induced by repeated CGRP treatment in female mice and did not lead to responses consistent with migraine headache as occurs with triptans. Cannabidiol, injected after CGRP, reversed CGRP-evoked allodynia. Cannabidiol also reduced spontaneous pain traits induced by CGRP administration in female mice. Finally, CBD blocked CGRP-induced anxiety in male mice, but failed in providing protection from CGRP-induced photophobia in females. These results demonstrate the efficacy of CBD in preventing episodic and chronic migraine-like states with reduced risk of causing medication overuse headache. Cannabidiol also shows potential as an abortive agent for treating migraine attacks and headache-related conditions such as spontaneous pain and anxiety.
PubMed: 37310430
DOI: 10.1097/j.pain.0000000000002960 -
Progress in Retinal and Eye Research Sep 2022In the vertebrate retina, rods and cones both detect light, but they differ in functional aspects such as light sensitivity and temporal resolution, and in some cell... (Review)
Review
In the vertebrate retina, rods and cones both detect light, but they differ in functional aspects such as light sensitivity and temporal resolution, and in some cell biological aspects. For functional aspects, both types of photoreceptors use a phototransduction cascade, consisting of a series of enzymatic reactions, to convert photon capture to an electrical signal. To understand the mechanisms underlying the functional differences between rods and cones at the molecular level, we compared biochemically, each of the reactions in the phototransduction cascades of rods and cones using the cells isolated and purified from carp retina. Although the cascade proteins are identical or are functionally similar between rods and cones, their activities together with their expression levels are mostly different. In general, reactions that generate a response are somewhat less effective in cones than in rods, but each of the reactions for termination and recovery of a response are much more effective in cones. These findings explain lower light sensitivity and briefer light responses in cones than in rods. In addition, our considerations suggest that a Ca-binding protein, S-modulin or recoverin, has a currently unnoticed role in shaping light responses. Upon comparison of the expression levels of proteins and/or mRNAs using purified cells, several proteins were found to be specifically or predominantly expressed in cones. These proteins will be of interest in future studies aimed at characterizing the differences between rods and cones.
Topics: Animals; Humans; Light Signal Transduction; Photophobia; Retina; Retinal Cone Photoreceptor Cells; Retinal Rod Photoreceptor Cells
PubMed: 34974196
DOI: 10.1016/j.preteyeres.2021.101040 -
Journal of Neurology Jan 2023The degree of involvement of the autonomic nervous system in progressive supranuclear palsy (PSP) has been investigated in several studies, often providing conflicting... (Review)
Review
BACKGROUND
The degree of involvement of the autonomic nervous system in progressive supranuclear palsy (PSP) has been investigated in several studies, often providing conflicting results. There is a need for a better characterization of autonomic dysfunction in PSP, to enhance our understanding of this highly disabling neurodegenerative disease including patients' needs and possibly be of value for clinicians in the differential diagnosis among Parkinsonian syndromes.
METHODS
We applied a systematic methodology to review existing literature on Pubmed regarding autonomic nervous system involvement in PSP.
RESULTS
PSP reported quite frequently symptoms suggestive of autonomic dysfunction in all domains. Cardiovascular autonomic testing showed in some cases a certain degree of impairment (never severe). There was some evidence suggesting bladder dysfunction particularly in the storage phase. Dysphagia and constipation were the most common gastrointestinal symptoms. Instrumental tests seemed to confirm sudomotor and pupillomotor disturbances.
CONCLUSIONS
PSP patients frequently reported visceral symptoms, however objective testing showed that not always these reflected actual autonomic impairment. Further studies are needed to better delineate autonomic profile and its prognostic role in PSP.
Topics: Humans; Supranuclear Palsy, Progressive; Neurodegenerative Diseases; Primary Dysautonomias; Parkinsonian Disorders; Autonomic Nervous System
PubMed: 36042018
DOI: 10.1007/s00415-022-11347-w