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Annals of Emergency Medicine Dec 2023Migraine is a leading cause of disability worldwide, and acute migraine attacks are a common reason for patients to seek care in the emergency department (ED). There... (Review)
Review
Migraine is a leading cause of disability worldwide, and acute migraine attacks are a common reason for patients to seek care in the emergency department (ED). There have been recent advancements in the care of patients with migraine, specifically emerging evidence for nerve blocks and new pharmacological classes of medications like gepants and ditans. This article serves as a comprehensive review of migraine in the ED, including diagnosis and management of acute complications of migraine (eg, status migrainosus, migrainous infarct, persistent aura without infarction, and aura-triggered seizure) and use of evidence-based migraine-specific treatments in the ED. It highlights the role of migraine preventive medications and provides a framework for emergency physicians to prescribe them to eligible patients. Finally, it evaluates the evidence for nerve blocks in the treatment of migraine and introduces the possible role of gepants and ditans in the care of patients with migraine in the ED.
Topics: Humans; Migraine Disorders; Emergency Service, Hospital; Seizures; Epilepsy
PubMed: 37436346
DOI: 10.1016/j.annemergmed.2023.05.024 -
Journal of Neurology Apr 2014We have reviewed some of the important studies published within the last 18 months that have advanced our understanding of the epilepsies, their aetiology and treatment.... (Review)
Review
We have reviewed some of the important studies published within the last 18 months that have advanced our understanding of the epilepsies, their aetiology and treatment. Clinical studies have revealed new insights into old themes including seizure prediction, mortality in epilepsy, febrile seizures and the pathophysiology of focal cortical dysplasias. The rapid advances in genetics and particularly whole exome sequencing have had an impact on our understanding of epileptic encephalopathies, and the aetiology of hippocampal sclerosis. Experimental research techniques such as viral vector gene delivery, optogenetics and cell based transplantation techniques have set the framework for novel approaches to the treatment of pharmacoresistant epilepsy. These few examples are indicative of the great strides that have recently been made in epilepsy research.
Topics: Comorbidity; Epilepsy; Humans
PubMed: 24590406
DOI: 10.1007/s00415-014-7294-y -
Neurocase Aug 2020The diagnosis of atypical paroxysmal events represents a significant challenge for clinicians when differentiating epileptic from nonepileptic events. The ictal...
The diagnosis of atypical paroxysmal events represents a significant challenge for clinicians when differentiating epileptic from nonepileptic events. The ictal manifestations of pharyngeal dysesthesias are often misdiagnosed and difficult to distinguish clinically, given their subtle features such as pharyngeal discomfort with and without autonomic symptomology. We report a rare case of isolated ictal pharyngeal dysesthesias localizing to the non-dominant frontal operculum lobe misdiagnosed as psychogenic and later confirmed by continuous video-EEG monitoring.
Topics: Adult; Diagnostic Errors; Electroencephalography; Epilepsy; Female; Humans; Paresthesia; Pharyngeal Diseases; Seizures; Young Adult
PubMed: 32615856
DOI: 10.1080/13554794.2020.1789177 -
Epilepsia Mar 2013In literary accounts of epilepsy the aura has a prominent place as the subjective aspect of the seizure experience. Descriptions by authors with their own aura...
In literary accounts of epilepsy the aura has a prominent place as the subjective aspect of the seizure experience. Descriptions by authors with their own aura experiences stand out by their precision and authenticity. Many different aura types are mentioned, but the ecstatic aura described by Dostoyevsky has received particular attention and is echoed in many later works. Some authors are interested primarily in the possibilities provided by auras to react, for example, by hiding, seeking help, counteracting the oncoming seizure, or taking measures to prevent damage. Others by their unique aura experiences are inspired to create specific literary flavors like oxymora, spectacular metaphors, or the depiction of complex perceptions and states of mind. Some authors, adding a philosophical dimension, proceed to analyze the consequences of patients' subjective seizure experiences for their identity and their self-perception as creative or religious persons. To sum up, the works discussed herein strongly support that literary texts provide valuable insights beyond those of medical texts.
Topics: Epilepsy; Esthetics; Famous Persons; History, 19th Century; History, 20th Century; Humans; Literature, Modern; Medicine in Literature; Self Concept
PubMed: 23294431
DOI: 10.1111/epi.12051 -
Epilepsia Jun 2013
Topics: Consciousness; Epilepsies, Partial; Epilepsy; Humans
PubMed: 23731398
DOI: 10.1111/epi.12171 -
Neurology Nov 2012Migraine aura is commonly considered to be a distinct phase of a migraine attack that precedes headache. The objective of the study was to examine a large number of...
OBJECTIVES
Migraine aura is commonly considered to be a distinct phase of a migraine attack that precedes headache. The objective of the study was to examine a large number of prospectively recorded attacks of migraine with aura and determine the timing of headache and other migraine symptoms relative to aura.
METHODS
As part of a clinical trial we collected prospective data on the time course of headache and other symptoms relative to the aura. Patients (n = 267) were enrolled from 16 centers, and asked to keep a headache diary for 1 month (phase I). They were asked to record headache symptoms as soon as possible after aura began and always within 1 hour of aura onset. A total of 456 attacks were reported during phase I by 201 patients. These patients were then randomized and included in phase II, during which a total of 405 attacks were reported in 164 patients. In total, we present data from 861 attacks of migraine with aura from 201 patients.
RESULTS
During the aura phase, the majority of attacks (73%) were associated with headache. Other migraine symptoms were also frequently reported during the aura: nausea (51%), photophobia (88%), and photophobia (73%). During the first 15 minutes within the onset of aura, 54% of patients reported headache fulfilling the criteria for migraine.
CONCLUSION
Our results indicate that headaches as well as associated migraine symptoms are present early, during the aura phase of the migraine attack in the majority of patients.
Topics: Adolescent; Adult; Aged; Epilepsy; Female; Humans; Incidence; Male; Middle Aged; Migraine Disorders; Prevalence; Prospective Studies; Young Adult
PubMed: 23115208
DOI: 10.1212/WNL.0b013e3182749eed -
Cephalalgia : An International Journal... Jun 2023This narrative review aims to discuss several common neurological and psychiatric disorders that show comorbidity with migraine. Not only can we gain pathophysiological... (Review)
Review
BACKGROUND
This narrative review aims to discuss several common neurological and psychiatric disorders that show comorbidity with migraine. Not only can we gain pathophysiological insights by studying these disorders, comorbidities also have important implications for treating migraine patients in clinical practice.
METHODS
A literature search on PubMed and Embase was conducted with the keywords "comorbidity", "migraine disorders", "migraine with aura", "migraine without aura", "depression", "depressive disorders", "epilepsy", "stroke", "patent foramen ovale", "sleep wake disorders", "restless legs syndrome", "genetics", "therapeutics".
RESULTS
Several common neurological and psychiatric disorders show comorbidity with migraine. Major depression and migraine show bidirectional causality and have shared genetic factors. Dysregulation of both hypothalamic and thalamic pathways have been implicated as a possibly cause. The increased risk of ischaemic stroke in migraine likely involves spreading depolarizations. Epilepsy is not only bidirectionally related to migraine, but is also co-occurring in monogenic migraine syndromes. Neuronal hyperexcitability is an important overlapping mechanism between these conditions. Hypothalamic dysfunction is suggested as the underlying mechanism for comorbidity between sleep disorders and migraine and might explain altered circadian timing in migraine.
CONCLUSION
These comorbid conditions in migraine with distinct pathophysiological mechanisms have important implications for best treatment choices and may provide clues for future approaches.
Topics: Humans; Stroke; Brain Ischemia; Comorbidity; Migraine Disorders; Epilepsy; Sleep Wake Disorders
PubMed: 37293935
DOI: 10.1177/03331024231180564 -
Annals of Neurology Jan 2006Migraine is associated with epilepsy, but the time order and nature of the relationship are unclear. We conducted a population based case control study to clarify the...
OBJECTIVE
Migraine is associated with epilepsy, but the time order and nature of the relationship are unclear. We conducted a population based case control study to clarify the time order to determine whether migraine is a risk factor for epilepsy.
METHODS
Migraine symptoms were evaluated in a population-based case-control study of all incident epilepsy in Icelandic children and in matched controls (next two same sex births in the country).
RESULTS
Migraine was associated with a fourfold increased risk for developing epilepsy, an association explained by migraine with aura (odds ratio, 8.1; 95% confidence interval, 2.7-24.3). Migraine without aura did not increase risk for epilepsy.
INTERPRETATION
Children with migraine with aura have a substantial increased risk to develop subsequent epilepsy. This finding is consistent with the hypothesis that migraine with aura and migraine without aura may be different disorders.
Topics: Adolescent; Case-Control Studies; Child; Child, Preschool; Epilepsy; Female; Humans; Iceland; Male; Migraine with Aura; Odds Ratio; Risk Factors
PubMed: 16374824
DOI: 10.1002/ana.20745 -
Headache May 2009
Topics: Cluster Headache; Comorbidity; Diagnosis, Differential; Epidemiologic Studies; Epilepsy; Humans; Migraine with Aura; Prevalence; Scotoma
PubMed: 19456891
DOI: 10.1111/j.1526-4610.2009.01417.x -
Epileptic Disorders : International... Dec 2015This review discusses the phenomenology, neurophysiology, and localization of epileptic auras with particular emphasis on how auras can manifest as part of an epileptic... (Review)
Review
This review discusses the phenomenology, neurophysiology, and localization of epileptic auras with particular emphasis on how auras can manifest as part of an epileptic network. Epileptic auras, as the first clinical symptom of a seizure, may lead us to infer the site of seizure onset. At the same time, auras can also be a result of activation or alteration in an epileptic network. They can be highly specific or ill-defined in symptomatology. They occur as a result of limited seizure activation, allowing access of the neural signal to the conscious brain. An understanding of epileptic auras offers a window into understanding fundamental brain functions, and helps the clinician at the bedside to make appropriate diagnostic and therapeutic choices.
Topics: Brain; Electroencephalography; Epilepsy; Humans; Neurophysiology; Seizures
PubMed: 26643374
DOI: 10.1684/epd.2015.0786