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The Journal of Headache and Pain Aug 2019The term refractory migraine has been used to describe persistent headache that is difficult to treat or fails to respond to standard and/or aggressive treatments. This... (Review)
Review
The term refractory migraine has been used to describe persistent headache that is difficult to treat or fails to respond to standard and/or aggressive treatments. This subgroup of migraine patients are generally highly disabled and experience impaired quality of life, despite optimal treatments. Several definitions and criteria for refractory migraine have been published, but as yet, an accepted or established definition is not available. This article reviews the published criteria and proposes a new set of criteria. The epidemiology, pathophysiology and management options are also reviewed.
Topics: Humans; Migraine Disorders; Quality of Life
PubMed: 31443629
DOI: 10.1186/s10194-019-1040-x -
European Journal of Neurology May 2021The transition from episodic migraine to chronic migraine, migraine chronification, is usually a gradual process, which involves multiple risk factors. To date, studies...
BACKGROUND
The transition from episodic migraine to chronic migraine, migraine chronification, is usually a gradual process, which involves multiple risk factors. To date, studies of the genetic risk factors for chronic migraine have focused primarily on candidate-gene approaches using healthy individuals as controls.
AIMS AND METHODS
In this study, we used a large cohort of migraine families and unrelated migraine patients (n > 2200) with supporting genotype and whole-genome sequencing data. We evaluated whether there are any genetic variants, common or rare, with a specific association to chronic migraine compared with episodic migraine.
RESULTS
We found no aggregation of chronic migraine in families with a clustering of migraine. No specific rare variants gave rise to migraine chronification, and migraine chronification was not associated with a higher polygenic risk score. Migraine chronification was not associated with allelic associations with an odds ratio above 2.65. Assessment of effect sizes with genome-wide significance below an odds ratio of 2.65 requires a genome-wide association study of at least 7500 chronic migraine patients.
CONCLUSION
Our results suggest that migraine chronification is caused by environmental factors rather than genetic factors.
Topics: Genetic Predisposition to Disease; Genome-Wide Association Study; Genotype; Humans; Migraine Disorders; Risk Factors
PubMed: 33428804
DOI: 10.1111/ene.14724 -
Journal of Integrative Neuroscience Oct 2022Cranial autonomic symptoms (CAS) have been usually associated with trigeminal autonomic cephalalgias (TAC's), however in the last few years several reports in adult and... (Review)
Review
Cranial autonomic symptoms (CAS) have been usually associated with trigeminal autonomic cephalalgias (TAC's), however in the last few years several reports in adult and pediatric population have reported important presence of the CAS in migraine. Also several evidences experimentally show that the increased parasympathetic outflow can enhance the sensitization of nociceptive receptors involved in migraine. The presence of CAS suggests an activation of the trigeminal-autonomic reflex, probably related to an over-activation of the trigeminal afferent arm. For these reasons identifing and understanding of these symptoms in migraine may be important to help in the diagnosis and effective management. The purpose of this review is, analyzing the literature data, to discuss the prevalence of these CAS in migraine, the pathophysiological meaning in the pathogenesis of migraine and whether their presence influences the prognosis and therapy of migraine in adult and pediatric age.
Topics: Adult; Humans; Child; Migraine Disorders; Cytoskeleton; Reflex
PubMed: 36424748
DOI: 10.31083/j.jin2106166 -
PeerJ 2024Activation of the trigeminal vascular system in migraine releases vasoactive neurotransmitters, causing abnormal vasoconstriction, which may affect the ocular system,...
BACKGROUND
Activation of the trigeminal vascular system in migraine releases vasoactive neurotransmitters, causing abnormal vasoconstriction, which may affect the ocular system, leading to retinal damage. The purpose of our study was to determine whether there are differences in each retinal layer between migraine patients and healthy subjects.
METHODS
A case-control study recruited 38 migraine patients and 38 age- and sex-matched controls. Optical coherence tomography was used to measure the thickness of the peripapillary and macular retinal nerve fiber layer (pRNFL and mRNFL), ganglion cell layer (GCL), inner plexiform layer (IPL), and inner nuclear layer (INL).
RESULTS
The mean ages of the migraine patients and controls were 36.29 ± 9.45 and 36.45 ± 9.27 years, respectively. Thirty-four patients (89.48%) in both groups were female. The mean disability score was 19.63 ± 20.44 (indicating severe disability). The superior-outer INL of migraine patients were thicker than controls. Thickness of the GCL at temporal-outer sector and mRNFL at the superior-outer sector of the headache-side eyes was reduced. However, the INL of the headache-side-eye showed negative correlation with the disability score. This is the first study having found thinning of the GCL and mRNFL of the headache-side eyes. The INL was also thickened in migraines but showed negative correlation with the disability score.
CONCLUSIONS
Increased INL thickness in migraine patients may result from inflammation. The more severe cases with a high disability score might suffered progressive retinal neuronal loss, resulting in thinner INL than less severe cases.
Topics: Humans; Female; Migraine Disorders; Male; Adult; Case-Control Studies; Tomography, Optical Coherence; Retina; Middle Aged; Retinal Ganglion Cells
PubMed: 38818459
DOI: 10.7717/peerj.17454 -
Migraine, Migraine Disability, Trauma, and Discrimination in Sexual and Gender Minority Individuals.Neurology Oct 2022This study sought to describe migrainous headache frequency and severity and to examine the relationship between trauma, discrimination, and migraine-associated...
BACKGROUND AND OBJECTIVES
This study sought to describe migrainous headache frequency and severity and to examine the relationship between trauma, discrimination, and migraine-associated disability in a sample of sexual and/or gender minority (SGM) adults.
METHODS
We performed a cross-sectional study of SGM people in The Population Research in Identity and Disparities for Equality Study from August to October 2018. The primary exposure was any trauma or discrimination, regardless of attribution. The primary outcome was moderate-severe migraine disability, as defined by a Migraine Disability Assessment (MIDAS) Questionnaire score of ≥11. We performed descriptive analysis comparing respondents with any migrainous headache with those without. Multivariable logistic regression examined the association between trauma/discrimination and migraine disability, controlling first for sociodemographic and clinical factors and then for psychiatric comorbidities.
RESULTS
Of the 3,325 total respondents, 1,126 (33.9%) screened positive for migrainous headache by ID-Migraine criteria. Most people with migraine self-reported moderate (n = 768, 68.2%) or severe (n = 253, 22.5%) intensity. The median MIDAS score was 11 (interquartile range 5-25). Most respondents with migraine (n = 1,055, 93.7%) reported a history of trauma or discrimination. In unadjusted analysis, exposure to both trauma and discrimination was associated with higher odds of moderate-severe disability (OR 1.76, 95% CI 1.34-2.32). After adjustment for self-reported psychiatric comorbidities of anxiety, depression, and posttraumatic stress disorder, this association lost statistical significance.
DISCUSSION
Migrainous headache is common among our sample of SGM adults, and prior experiences with trauma and discrimination are associated with increased migraine disability. Our findings suggest that psychiatric comorbidities play a significant role in this relationship, identifying a potentially modifiable risk factor for disability in SGM people with migraine.
Topics: Adult; Humans; Cross-Sectional Studies; Migraine Disorders; Comorbidity; Anxiety; Surveys and Questionnaires; Disability Evaluation; Headache
PubMed: 35817570
DOI: 10.1212/WNL.0000000000200941 -
Journal of Medicine and Life 2021In this study, we aimed to find a correlation between anxiety related to dental procedures and migraines. A cross-sectional study was performed on 171 patients who... (Randomized Controlled Trial)
Randomized Controlled Trial
In this study, we aimed to find a correlation between anxiety related to dental procedures and migraines. A cross-sectional study was performed on 171 patients who attended specific dental clinics. The patients were randomly categorized into a migraine group (83) and a control group. To determine the anxiety level, all the patients filled out a validated questionnaire (the Arabic version of the Modified Dental Anxiety Scale). All responses ranged from "not anxious" (scoring 1) to "extremely anxious" (scoring 5). Based on the patient responses, the total score was recorded and compared statistically between the two groups. The sound of drilling was one of the most vital factors causing anxiety and headaches in migraine patients. Comparing the presence or absence of headache and usage of analgesics between the two groups, migraine patients complained to have headaches during or after dental treatment more frequently than controls and used analgesics more than non-migraine controls. Migraine patients visiting dental clinics feel more anxious about the working environment and need certain modifications before, during, and after dental procedures.
Topics: Anxiety; Anxiety Disorders; Cross-Sectional Studies; Dental Anxiety; Headache; Humans; Migraine Disorders
PubMed: 34621373
DOI: 10.25122/jml-2021-0004 -
Molecular Brain Aug 2022Migraine is a complex neurological disease of unknown etiology involving both genetic and environmental factors. It has previously been reported that persistent pain may... (Review)
Review
Migraine is a complex neurological disease of unknown etiology involving both genetic and environmental factors. It has previously been reported that persistent pain may be mediated by the immune and inflammatory systems. Toll-like receptors (TLRs) play a significant role in immune and inflammatory responses and are expressed by microglia and astrocytes. One of the fundamental mechanisms of the innate immune system in coordinating inflammatory signal transduction is through TLRs, which protect the host organism by initiating inflammatory signaling cascades in response to tissue damage or stress. TLRs reside at the neuroimmune interface, and accumulating evidence has suggested that the inflammatory consequences of TLR activation on glia (mainly microglia and astrocytes), sensory neurons, and other cell types can influence nociceptive processing and lead to pain. Several studies have shown that TLRs may play a key role in neuropathic pain and migraine etiology by activating the microglia. The pathogenesis of migraine may involve a TLR-mediated crosstalk between neurons and immune cells. Innate responses in the central nervous system (CNS) occur during neuroinflammatory phenomena, including migraine. Antigens found in the environment play a crucial role in the inflammatory response, causing a broad range of diseases, including migraines. These can be recognized by several innate immune cells, including macrophages, microglia, and dendritic cells, and can be activated through TLR signaling. Given the prevalence of migraine and the insufficient efficacy and safety of current treatment options, a deeper understanding of TLRs is expected to provide novel therapies for managing chronic migraine. This review aimed to justify the view that TLRs may be involved in migraine.
Topics: Central Nervous System; Humans; Microglia; Migraine Disorders; Neuralgia; Toll-Like Receptors
PubMed: 35987639
DOI: 10.1186/s13041-022-00960-5 -
European Review For Medical and... Sep 2022The idea to treat migraine patients with a surgical procedure is relatively recent. The aim of this paper was to describe the surgical techniques and our 11-year...
OBJECTIVE
The idea to treat migraine patients with a surgical procedure is relatively recent. The aim of this paper was to describe the surgical techniques and our 11-year experience in migraine surgery.
PATIENTS AND METHODS
From June 2011 till December 2021, we have performed MH decompression surgery over 527 patients with either frontal (90 pts), occipital (232 pts) or temporal (205 pts) migraine trigger sites.
RESULTS
The surgical procedure elicited a positive response in: (a) occipital trigger site, 95% of patients (86% complete recovery); (b) frontal trigger site, 87% of patients (32% complete recovery); (c) temporal trigger site, 88% of patients (50% complete recovery).
CONCLUSIONS
The described techniques allowed us to obtain a high rate of positive results with a low percentage of minor complications.
Topics: Decompression, Surgical; Humans; Migraine Disorders; Treatment Outcome
PubMed: 36111912
DOI: 10.26355/eurrev_202209_29628 -
NeuroImage. Clinical 2023Current evidences show an increased risk of white matter hyperintensities (WMHs) in migraineurs compared to age-matched controls. However, WMHs prevalence and the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Current evidences show an increased risk of white matter hyperintensities (WMHs) in migraineurs compared to age-matched controls. However, WMHs prevalence and the associations between WMHs and clinical characteristics in migraineurs have not been systematically evaluated using a meta-analytical approach. This study explored the pooled prevalence of WMHs and the associations of WMHs with the clinical characteristics in patients with migraine.
METHODS
A systematic review and meta-analysis of observational studies reporting the occurrence and clinical characteristics of patients with WMHs attributed to migraine was performed. We searched the PubMed, Web of Science, and Embase databases. Random-effects models were used to calculate the pooled prevalence rate, odds ratio (OR), or mean difference (MD) with corresponding 95% confidence intervals (CIs).
RESULTS
Thirty eligible studies were identified including 3,502 migraineurs aged 37.2 (mean) years. The pooled WMHs prevalence was 44 %, 45 %, and 38 % in migraine, migraine with aura, and migraine without aura groups, respectively. In migraineurs with WMHs, the frontal lobe and subcortical white matter were the most susceptible area. Compared with non-migraine controls, patients with migraine had increased odds for WMHs (OR 4.32, 95 % CI = 2.56-7.28, I = 67 %). According to reported univariable results from included studies, pooled analysis showed that clinical characteristics including age, presence of aura, disease duration, hypertension, diabetes mellitus and right-to-left shunt were associated with the presence of WMHs. Migraine pain and aura characteristics were not related to WMHs.
CONCLUSIONS
These data suggest that WMHs are common in migraine, especially in those who are older or have aura, hypertension, diabetes mellitus, or right-to-left shunt. A better understanding of the WMHs attributed to migraine is needed in future studies.
Topics: Humans; White Matter; Prevalence; Magnetic Resonance Imaging; Migraine Disorders; Epilepsy; Hypertension; Leukoaraiosis
PubMed: 36610309
DOI: 10.1016/j.nicl.2023.103312 -
Revista de La Facultad de Ciencias... Mar 2022Vestibular migraine is one of the most common vestibular disorders, which includes headache, photophobia, phonopobia and visual auras. Others as osmophobia are common...
AIM
Vestibular migraine is one of the most common vestibular disorders, which includes headache, photophobia, phonopobia and visual auras. Others as osmophobia are common but usually subregistered, and potentially would be involved in the vestibular migraine episodes. The aim of this study was to perform a search about the frequency and clinical interaction between vestibular migraine and osmophobia.
DATA SEARCH
A literature review search was conducted on PubMed, EBSCO, Scielo, Google Scholar and Bvsalud of published studies between 2011 and 2021 using the MeSH terms ‘vertigo and olfaction disorders’, ‘dizziness and olfaction disorders’, ‘migraine disorders and olfaction disorders’.
STUDY SELECTION
12 articles were found, where patients with diagnosis of vestibular migraine according to Barany Society, reported clinical symptoms and the prevalence of each symptom related was documented. Only two studies, presented relevant information about osmophobia and vestibular migraine
DATA EXTRACTION AND RESULTS
From 277 individuals diagnosed with vestibular migraine in two observational studies, only 5%-12%, reported osmophobia. To date only one case report describe in extension the relationship between vestibular migraine and osmophobia.
CONCLUSIONS
This symptom would be underdiagnosed and subregistered in individuals with vestibular migraine. Further studies are needed to determine this association.
Topics: Dizziness; Headache; Humans; Migraine Disorders; Vertigo; Vestibular Diseases
PubMed: 35312248
DOI: 10.31053/1853.0605.v79.n1.33699