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Medizinische Klinik (Munich, Germany :... Aug 2001Since both migraine and vertigo are common complaints in clinical practice they may coincide in an individual patient just by chance. There are, however, numerous... (Review)
Review
EPIDEMIOLOGY
Since both migraine and vertigo are common complaints in clinical practice they may coincide in an individual patient just by chance. There are, however, numerous patients with vestibular symptoms caused by migraine, accounting for 6-8% of diagnoses in specialized dizziness clinics. CLINICAL MANIFESTATION: Migraine-associated vertigo is a vestibular disorder which manifests itself with spontaneous or positional rotational vertigo or dizziness induced by head motion. The vertigo may occur without accompanying headache and may last from seconds to several weeks.
DIAGNOSIS
Migraine-associated vertigo can be diagnosed according to the following criteria: 1. recurrent vestibular symptoms, 2. migraine according to the criteria of the International Headache Society, 3. migrainous symptoms during the vertigo such as headache, photophobia, phonophobia, scintillating scotoma or other auras, 4. exclusion of other causes.
PATHOPHYSIOLOGY
The mechanism of migraine-associated vertigo is still obscure. Several hypotheses relating to the pathophysiology of migraine have been proposed: cortical spreading depression, regional changes in brain perfusion, release of neurotransmitters and paroxysmal dysfunction of ion channels. Clinical findings suggest both central and peripheral vestibular involvement.
THERAPY
Treatment is based on the repertoire of acute and prophylactic medications that are used for migrainous headaches. Controlled studies on the treatment of migraine-associated vertigo are still lacking.
Topics: Age Factors; Diagnosis, Differential; Humans; Migraine Disorders; Sex Factors; Vertigo
PubMed: 11560048
DOI: 10.1007/pl00002230 -
Neurology Jun 1993Migraine is a neurovascular reaction to sudden changes in the internal or external environment. Each individual has a hereditary "migrainous threshold," with the degree... (Review)
Review
Migraine is a neurovascular reaction to sudden changes in the internal or external environment. Each individual has a hereditary "migrainous threshold," with the degree of susceptibility depending on the balance between excitation and inhibition at various levels of the nervous system. The mechanism of migraine has been presented as an unstable trigeminovascular reflex with a segmental defect in the pain control pathway. This defect permits excessive discharge of part of the spinal nucleus of the trigeminal nerve and its thalamic connections in response to excessive afferent input or corticobulbar drive. The end result is the interaction of brain stem and cranial blood vessels, with the afferent impulses from the latter creating the throbbing (pulsating) character of the headache. Diffuse projections from the locus ceruleus to the cerebral cortex could initiate cortical oligemia and possibly spreading depression. Activity in this system could account for the migrainous aura that may occur quite independently of the headache. The headache phase may be interrupted by therapy aimed at either the central or peripheral end of the trigeminovascular afferent pathway. Strong evidence suggests that serotonin (5-hydroxytryptamine, 5-HT) plays an important part in the genesis of migraine. Whether 5-HT is effective in central pain control pathways, the serotonergic projection to the cerebral cortex, its direct action on the cranial blood vessels, or its action at all three sites remains uncertain. It seems probable that the 5-HT agonists act to terminate migraine through the cerebral and extracranial circulations, whereas medications used for prophylaxis may act centrally.
Topics: Cerebrovascular Circulation; Humans; Migraine Disorders; Serotonin
PubMed: 8502382
DOI: No ID Found -
JAMA Apr 2006Menstrual migraine affects approximately 50% to 60% of female migraineurs, but knowledge regarding the role of hormones, especially estrogen, appears incomplete. (Review)
Review
CONTEXT
Menstrual migraine affects approximately 50% to 60% of female migraineurs, but knowledge regarding the role of hormones, especially estrogen, appears incomplete.
OBJECTIVE
To conduct a systematic review to determine the role of hormones on menstrual migraine.
EVIDENCE ACQUISITION
MEDLINE (January 1966 through September 1, 2005) and EMBASE Drugs and Pharmacology (January 1991 through September 1, 2005) were searched for articles published in the English language using the keywords migraine, estrogen, menstrual migraine, pure menstrual migraine, true menstrual migraine, menstrually-associated migraine, menstrually-related migraine, pregnancy, breast-feeding, perimenopause, menopause, nitric oxide, and estrogen receptors. A total of 643 unique articles were reviewed for relevance, scientific rigor, and generalizability. For each relevant citation, the bibliography was reviewed to identify additional sources of pertinent data.
EVIDENCE SYNTHESIS
The influence of estrogen on migraine is evident by a 3-fold greater prevalence among women compared with men, and by significant changes in migraine incidence with changes in female reproductive status. Menstrual migraines are usually more resistant to treatment, generally not associated with aura, of longer duration, and associated with more functional disability compared with attacks at other times of the month. Biochemical and genetic evidence suggest central and peripheral roles for estrogen in the pathophysiology of menstrual migraine, with potential interactions with excitatory circuits, including serotonergic components. Although evidence for estrogen as a preventive treatment for menstrual migraine is inconsistent, serotonin receptor agonists (triptans) provide acute relief and also may have a role in prevention.
CONCLUSIONS
Epidemiological, pathophysiological, and clinical evidence link estrogen to migraine headaches. Triptans appear to provide acute relief and also may be useful for headache prevention. Clear, focused, and evidence-based treatment algorithms are needed to support primary care physicians, neurologists, and gynecologists in the treatment of this common condition.
Topics: Estrogens; Female; Humans; Menopause; Menstruation; Migraine Disorders; Pregnancy
PubMed: 16622144
DOI: 10.1001/jama.295.15.1824 -
Southern Medical Journal Aug 1996Although ubiquitous, migraine remains incompletely understood and thus often ineffectively managed. Fortunately, new advances in our understanding of migraine's origins... (Review)
Review
Although ubiquitous, migraine remains incompletely understood and thus often ineffectively managed. Fortunately, new advances in our understanding of migraine's origins have led to identification and application of therapeutic intervention that is unparalleled in its specificity and clinical efficacy. We present a unified model of migraine genesis and explain how application of the model to clinical practice may improve therapeutic management of this common disorder.
Topics: Cerebrovascular Circulation; Female; Health Care Costs; Humans; Male; Migraine Disorders; Models, Neurological; Prevalence
PubMed: 8701373
DOI: 10.1097/00007611-199608000-00002 -
Cephalalgia : An International Journal... Feb 2004Vertigo and dizziness can be related to migraine in various ways: causally, statistically or, quite frequently, just by chance. Migrainous vertigo (MV) is a vestibular... (Review)
Review
Vertigo and dizziness can be related to migraine in various ways: causally, statistically or, quite frequently, just by chance. Migrainous vertigo (MV) is a vestibular syndrome caused by migraine and presents with attacks of spontaneous or positional vertigo lasting seconds to days and migrainous symptoms during the attack. MV is the most common cause of spontaneous recurrent vertigo and is presently not included in the International Headache Society classification of migraine. Benign paroxysmal positional vertigo (BPPV) and Ménière's disease (MD) are statistically related to migraine, but the possible pathogenetic links have not been established. Moreover, migraineurs suffer from motion sickness more often than controls. Persistent cerebellar symptoms may develop in the course of familial hemiplegic migraine. Dizziness may also be due to orthostatic hypotension, anxiety disorders or major depression which all have an increased prevalence in patients with migraine.
Topics: Diagnosis, Differential; Dizziness; Female; Humans; Male; Meniere Disease; Migraine Disorders; Vertigo
PubMed: 14728703
DOI: 10.1111/j.1468-2982.2004.00662.x -
Functional Neurology 2000Clinical evidence and recent genetic findings seem to indicate an involvement of dopamine in the pathophysiology of the migraine attack. Prodromal symptomatology (mood... (Review)
Review
Clinical evidence and recent genetic findings seem to indicate an involvement of dopamine in the pathophysiology of the migraine attack. Prodromal symptomatology (mood changes, yawning, drowsiness, food craving), accompanying symptoms (nausea, vomiting, hypotension) and postdromal symptoms (mood changes, drowsiness, tiredness) may be related to dopaminergic activation. The dopaminergic system could also play a role in the headache phase, either by taking part in nociception mechanisms, or by regulating cerebral blood flow. A body of pharmacological findings seems to support this involvement. Migraine patients, between attacks, show a higher responsiveness to acute administration of dopaminergic agents. Apomorphine administration induces in migraineurs more yawns as well other dopaminergic symptoms e.g. nausea, vomiting, dizziness. Migraine has been associated with hypotension and, occasionally, with syncope. Bromocriptine causes severe orthostatic syndrome in migraine patients. Both piribedil and apomorphine markedly increase cerebral blood flow of migraine patients, thus indicating enhanced responsiveness of dopamine receptors which are involved in cerebral blood flow regulation. Interictal dopaminergic hypersensitivity has also been demonstrated by means of neuroendocrine tests. Altered dopaminergic control of prolactin secretion exists in migrainous women. L-deprenyl, a MAO-B inhibitor, is significantly more effective in reducing prolactin levels in migraineurs than in controls. Taken together, these findings support the view that hypersensitivity of peripheral and central dopaminergic receptors is a specific migraine trait. Finally, a high density of lymphocytic D5 receptors has been found in migraine sufferers, thus suggesting their upregulation. Therefore, the hypothesis that dopaminergic activation is a primary pathophysiological component in certain subtypes of migraine, namely those characterised by marked dopaminergic symptomatology, has been advanced. From this perspective, a blockade of dopaminergic hyperresponsive receptors can be considered as a rationale for the therapy of migraine.
Topics: Dopamine; Dopamine Agents; Humans; Migraine Disorders; Receptors, Dopamine
PubMed: 11200788
DOI: No ID Found -
Neurology 1999Migraines may occur at any time during the menstrual cycle but are commonly associated with the menses. Migraine-specific medications, such as the triptans, may be... (Review)
Review
Migraines may occur at any time during the menstrual cycle but are commonly associated with the menses. Migraine-specific medications, such as the triptans, may be effective for acute management of menstrual migraine. However, it is important to recognize the relationship between migraines and the menstrual cycle because these headaches may not respond to the usual antimigraine medications. In that case, management may involve perimenstrual migraine prophylaxis, with migraine-specific medications used in addition for severe breakthrough migraines. Prostaglandin inhibitors started just before the time of headache vulnerability may prevent menstrual migraine attacks or reduce the severity of the headaches. Estrogen withdrawal has been shown to precipitate migraine headaches, and a sustained elevated level of estrogen will postpone the migraine. Transdermal estrogen started just before menstruation can provide a sustained low level of estrogen, decreasing the degree of estrogen decline, and thus may prevent induction of migraines. Ergotamine tartrate is usually taken only for acute migraine, but may also be effective for prevention of menstrual migraine when used regularly once or twice per day during the time of risk. By understanding the underlying pathophysiology of the relationship between migraines and the menstrual cycle, the physician can successfully treat migraines associated with menses.
Topics: Female; Humans; Menstruation Disturbances; Migraine Disorders
PubMed: 10487508
DOI: No ID Found -
Headache Sep 2015The aim of this systematic review is to identify the efficacy of different categories of treatments for menstrual migraines as found in randomized controlled trials or... (Review)
Review
OBJECTIVE
The aim of this systematic review is to identify the efficacy of different categories of treatments for menstrual migraines as found in randomized controlled trials or open label studies with similar efficacy endpoints.
BACKGROUND
Menstrual migraine is very common and approximately 50% of women have increased risk of developing migraines related to the menstrual cycle. Attacks of menstrual migraine are usually more debilitating, of longer duration, more prone to recurrence, and less responsive to acute treatment than nonmenstrual migraine attacks.
METHODS
Search for evidence was done in 4 databases that included PubMed, EMBASE, Science Direct, and Web of Science. Eighty-four articles were selected for full text review by 2 separate readers. Thirty-six of the 84 articles were selected for final inclusion. Articles included randomized controlled and open label trials that focused on efficacy of acute and preventative therapies for menstrual migraine. Secondary analyses where excluded because the initial study population was not women with menstrual migraine.
RESULTS
After final screening, 11 articles were selected for acute and 25 for preventive treatment of menstrual migraine. These were further subdivided into treatment categories. For acute treatment: triptans, combination therapy, prostaglandin synthesis inhibitor, and ergot alkaloids. For preventive treatment: triptans, combined therapy, oral contraceptives, estrogen, nonsteroidal anti-inflammatory drug, phytoestrogen, gonadotropin-releasing hormone agonist, dopamine agonist, vitamin, mineral, and nonpharmacological therapy were selected. Overall, triptans had strong evidence for treatment in both acute and short term prevention of menstrual migraine.
CONCLUSIONS
Based on this literature search, of all categories of treatment for menstrual migraine, triptans have the most extensive research with strong evidence for both acute and preventive treatment of menstrual migraine. Further randomized controlled trials should be performed for other therapies to strengthen their use in the care of menstrual migraine patients.
Topics: Adult; Female; Humans; Menstrual Cycle; Migraine Disorders
PubMed: 26264117
DOI: 10.1111/head.12640 -
Cephalalgia : An International Journal... Nov 2006Retinal migraine is usually characterized by attacks of fully reversible monocular visual loss associated with migraine headache. Herein we summarize the clinical...
Retinal migraine is usually characterized by attacks of fully reversible monocular visual loss associated with migraine headache. Herein we summarize the clinical features and prognosis of 46 patients (six new cases and 40 from the literature) with retinal migraine based upon the International Classification of Headache Disorders-2 (ICHD-2) criteria. In our review, retinal migraine is most common in women in the second to third decade of life. Contrary to ICHD-2 criteria, most have a history of migraine with aura. In the typical attack monocular visual features consist of partial or complete visual loss lasting <1 h, ipsilateral to the headache. Nearly half of reported cases with recurrent transient monocular visual loss subsequently experienced permanent monocular visual loss. Although the ICHD-2 diagnostic criteria for retinal migraine require reversible visual loss, our findings suggest that irreversible visual loss is part of the retinal migraine spectrum, perhaps representing an ocular form of migrainous infarction. Based on this observation, the authors recommend migraine prophylactic treatment in an attempt to prevent permanent visual loss, even if attacks are infrequent. We also propose a revision to the ICHD-2 diagnostic criteria for retinal migraine.
Topics: Adolescent; Adult; Aged; Amaurosis Fugax; Blindness; Female; Humans; Male; Migraine Disorders; Retinal Diseases
PubMed: 17059434
DOI: 10.1111/j.1468-2982.2006.01206.x -
Revista de Neurologia Feb 1998Migraine and epilepsy are two clearly different syndromes. All they have in common is that both cause paroxystic neurological phenomena. However, the frequency of... (Review)
Review
Migraine and epilepsy are two clearly different syndromes. All they have in common is that both cause paroxystic neurological phenomena. However, the frequency of epilepsy in patients with migraine, and migraine in those with epilepsy seems to be higher than one would expect. This suggests there may be comorbidity in both conditions. Analysis of this comorbidity is very important since it may give clues as to the physio-pathology and aetiology of certain disorders. This paper analyses the existence of migraine-epilepsy comorbidity and the levels at which it occurs. This coexistence may be due to the episode of one, for example the aura of a migrainous attack, triggering off the other condition, that is an epileptic crisis. So, it may be that the 'migrainous illness' causes the 'epileptic illness' or the other way around. Their coexistence may be due to a risk factor which is common to both, since it has caused a cerebral lesion which is the cause of both disorders. Finally, a risk factor may have a direct effect, without requiring the intervention of an intermediate cerebral lesion to cause both migraine and epilepsy. This last possibility is particularly attractive to explain the comorbidity of migraine with an aura and genetically determined epilepsy.
Topics: Brain Diseases; Cerebrovascular Circulation; Comorbidity; Epilepsy; Humans; Migraine Disorders; Risk Factors
PubMed: 9563095
DOI: No ID Found