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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 -
Neurology India 2021Chronic migraine is an under-recognized and under-treated disorder. A greater understanding of the pathophysiology of migraine and transformation to chronic migraine has... (Review)
Review
BACKGROUND
Chronic migraine is an under-recognized and under-treated disorder. A greater understanding of the pathophysiology of migraine and transformation to chronic migraine has led to the first targeted treatments for chronic migraine. In this review, we review current approaches to the diagnosis and management of chronic migraine and discuss recent and emerging novel therapies.
OBJECTIVE
The aim of this study was to provide an update on the diagnosis and management of chronic migraine.
METHODS AND MATERIAL
The PubMed database was searched for relevant articles published on or before October 2020.
RESULTS AND CONCLUSIONS
Chronic migraine is an under-recognized and under-treated disorder. Prompt diagnosis and appropriate management can lead to a significant improvement in the quality of life with subsequent socioeconomic benefits.
Topics: Humans; Migraine Disorders; Quality of Life
PubMed: 34003150
DOI: 10.4103/0028-3886.315972 -
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 -
International Journal of Molecular... May 2023The role of neuroinflammation in the pathophysiology of migraines is increasingly being recognized, and cytokines, which are important endogenous substances involved in... (Review)
Review
The role of neuroinflammation in the pathophysiology of migraines is increasingly being recognized, and cytokines, which are important endogenous substances involved in immune and inflammatory responses, have also received attention. This review examines the current literature on neuroinflammation in the pathogenesis of migraine. Elevated TNF-α, IL-1β, and IL-6 levels have been identified in non-invasive mouse models with cortical spreading depolarization (CSD). Various mouse models to induce migraine attack-like symptoms also demonstrated elevated inflammatory cytokines and findings suggesting differences between episodic and chronic migraines and between males and females. While studies on human blood during migraine attacks have reported no change in TNF-α levels and often inconsistent results for IL-1β and IL-6 levels, serial analysis of cytokines in jugular venous blood during migraine attacks revealed consistently increased IL-1β, IL-6, and TNF-α. In a study on the interictal period, researchers reported higher levels of TNF-α and IL-6 compared to controls and no change regarding IL-1β levels. Saliva-based tests suggest that IL-1β might be useful in discriminating against migraine. Patients with migraine may benefit from a cytokine perspective on the pathogenesis of migraine, as there have been several encouraging reports suggesting new therapeutic avenues.
Topics: Male; Mice; Female; Animals; Humans; Cytokines; Tumor Necrosis Factor-alpha; Interleukin-6; Neuroinflammatory Diseases; Migraine Disorders
PubMed: 37176049
DOI: 10.3390/ijms24098343 -
Current Neurology and Neuroscience... Mar 2017Migraine and stroke are common, disabling neurologic disorders, with a high socioeconomic burden. A link between them has been proposed years ago, and various theories... (Review)
Review
Migraine and stroke are common, disabling neurologic disorders, with a high socioeconomic burden. A link between them has been proposed years ago, and various theories have been proposed to explain this bidirectional relation. However, the precise causes remain unclear. We briefly summarize existing hypotheses of this correlation seeking for recommendations for stroke prevention in migraineurs, if any exist. Among the strongest suggested theories of migraine-stroke association are cortical spreading depression, endovascular dysfunction, vasoconstriction, neurogenic inflammation, hypercoagulability, increased prevalence of vascular risk factors, shared genetic defects, cervical artery dissection, and patent foramen ovale. There is no evidence that any preventive therapy in migraineurs should be used to decrease stroke risk, even in most predisposed subset of patients. However, a woman with migraine with aura should be encouraged to cease smoking and avoid taking oral contraceptives with high estrogen doses. We need further investigation to better understand the complexity of migraine-stroke association and to make firm recommendations for the future.
Topics: Cortical Spreading Depression; Endothelium, Vascular; Humans; Migraine Disorders; Prevalence; Smoking; Stroke
PubMed: 28283957
DOI: 10.1007/s11910-017-0729-y -
Journal of Neuroimmunology Aug 2023Migraines are a considerable social problem and economic burden worldwide. Current acute treatments are based on inhibiting meningeal neurogenic inflammation which has...
Migraines are a considerable social problem and economic burden worldwide. Current acute treatments are based on inhibiting meningeal neurogenic inflammation which has poor results in some patients, whereas the site of action of prophylactic medicines are unknown; therefore, exploring new treatment mechanisms and methods is increasingly needed. Recent evidence suggests that microglia and microglia-mediated neuroinflammation are important in migraine pathogenesis. In the cortical spreading depression (CSD) migraine model, microglia were activated after multiple CSD stimulations, suggesting that microglial activation may be associated with recurrent attacks of migraine with aura. In the nitroglycerin-induced chronic migraine model, the microglial response to extracellular stimuli leads to the activation of surface purine receptors P2X4、P2X7、P2Y12, which mediate signal transduction through intracellular signalling cascades, such as the BDNF/TrkB, NLRP3/IL-1β and RhoA/ROCK signalling pathways, and release inflammatory mediators and cytokines that enhance pain by increasing the excitability of nearby neurons. Inhibition of the expression or function of these microglial receptors and pathways inhibits the abnormal excitability of TNC (trigeminal nucleus caudalis) neurons and intracranial as well as extracranial hyperalgesia in migraine animal models. These findings suggest that microglia may be central in migraine recurrent attacks and a potential target for the treatment of chronic headaches.
Topics: Animals; Microglia; Migraine Disorders; Nitroglycerin; Hyperalgesia; Signal Transduction
PubMed: 37295033
DOI: 10.1016/j.jneuroim.2023.578118 -
Frontiers in Public Health 2023Adults who suffer from migraines are highly susceptible to mental illnesses that may have significant association with their HRQoL. Therefore, this study aimed to...
BACKGROUND
Adults who suffer from migraines are highly susceptible to mental illnesses that may have significant association with their HRQoL. Therefore, this study aimed to investigate how anxiety and depression related to HRQoL in adults with Migraine.
METHODS
Data from the Medical Expenditure Panel Survey for 2017 to 2020 were used to identify adult patients 18 years of age and older with a migraine diagnosis. The Physical and Mental Component Summary (PCS & MCS) scores from the SF-12 were used to calculate HRQoL. To adjust for a wide range of variables, multivariate linear regressions were used to evaluate the association between depression and anxiety and HRQoL among adults with migraine.
RESULTS
Among the 1,713 identified adults with migraines, 11.2% experienced depression, 14.6% experienced anxiety, and 13.7% had both conditions. Compared to migraineurs who had only migraine, adults with comorbid depression and anxiety had the lowest mean scores on the PCS and MCS. Additionally, migraineurs who had depression had significantly lower HRQoL MCS scores (depression: β = -7.552, < 0.001), and those with anxiety had significantly lower HRQoL MCS scores (anxiety: β = -4.844, p < 0.001) compared to those without these comorbidities. Notably, individuals with migraines who exercise had higher scores on both PCS and MCS than those who did not exercise.
CONCLUSION
This nationally representative sample provides insights into the associations between depression and anxiety with poor HRQoL among individuals with migraines. Additionally, it revealed the negative impact of concurrent chronic diseases, and poor socioeconomic status on HRQoL, while emphasizing the beneficial effects of regular exercise. This study highlights the clinical, policy, and public health implications for improving healthcare planning, resource allocation, and promoting lifestyle changes to reduce depression and anxiety in migraine sufferers.
Topics: Adult; Humans; Adolescent; Quality of Life; Depression; Anxiety; Comorbidity; Migraine Disorders
PubMed: 37860801
DOI: 10.3389/fpubh.2023.1241800 -
Current Pain and Headache Reports Nov 2023Historical evidence suggests a shared underlying etiology for migraine and gastrointestinal (GI) disorders that involves the gut-brain axis. Here we provide narrative... (Review)
Review
PURPOSE OF REVIEW
Historical evidence suggests a shared underlying etiology for migraine and gastrointestinal (GI) disorders that involves the gut-brain axis. Here we provide narrative review of recent literature on the gut-brain connection and migraine to emphasize the importance of tailoring treatment plans for patients with episodic migraine who experience GI comorbidities and symptoms.
RECENT FINDINGS
Recent population-based studies report the prevalence of migraine and GI disorders as comorbidities as well as overlapping symptomology. American Headache Society (AHS) guidelines have integrated GI symptoms as part of migraine diagnostic criteria and recommend nonoral therapies for patients with GI symptoms or conditions. Nasal delivery is a recommended nonoral alternative; however, it is important to understand potential adverse events that may cause or worsen GI symptoms in some patients due to the site of drug deposition within the nasal cavity with some nasal therapies. Lastly, clinical perspectives emphasize the importance of identifying GI symptoms and comorbidities in patients with episodic migraine to best individualize migraine management. Support for an association between the gut-brain axis and migraine continues to prevail in recent literature; however, the relationship remains complex and not well elucidated. The presence of GI comorbidities and symptoms must be carefully considered when making treatment decisions for patients with episodic migraine.
Topics: Humans; Migraine Disorders; Brain; Headache; Comorbidity
PubMed: 37792173
DOI: 10.1007/s11916-023-01175-6 -
International Journal of Molecular... Jun 2023Migraine-a primary headache-has circadian and circannual rhythms in the onset of attacks. The circadian and circannual rhythms involve the hypothalamus, which is... (Review)
Review
Migraine-a primary headache-has circadian and circannual rhythms in the onset of attacks. The circadian and circannual rhythms involve the hypothalamus, which is strongly associated with pain processing in migraines. Moreover, the role of melatonin in circadian rhythms has been implied in the pathophysiology of migraines. However, the prophylactic effect of melatonin in migraines is controversial. Calcitonin gene-related peptide (CGRP) has recently attracted attention in the pathophysiology and treatment of migraines. Pituitary adenylate cyclase-activating peptide (PACAP)-a neuropeptide identical to CGRP-is a potential therapeutic target after CGRP. PACAP is involved in the regulation of circadian entrainment to light. This review provides an overview of circadian and circannual rhythms in the hypothalamus and describes the relationship between migraines and the molecular and cellular neurobiology of circadian and circannual rhythms. Furthermore, the potential clinical applications of PACAP are presented.
Topics: Humans; Pituitary Adenylate Cyclase-Activating Polypeptide; Calcitonin Gene-Related Peptide; Melatonin; Neurobiology; Migraine Disorders; Circadian Rhythm
PubMed: 37373239
DOI: 10.3390/ijms241210092 -
Australian Family Physician Jun 2015Childhood migraines create a significant health burden and are probably under-diagnosed and treated. (Review)
Review
BACKGROUND
Childhood migraines create a significant health burden and are probably under-diagnosed and treated.
OBJECTIVES
The aim of this article is to offer a systematic approach to the management of migraine.
DISCUSSION
A systematic approach to the presentation of migraines in children can help to alleviate parental and physician anxiety and allow for an accurate diagnosis. Treatment is multifactorial but pharmacological intervention should certainly play a role along with adjustment of environmental factors and addressing possible underlying psychosocial factors. Referral to a general practitioner (GP) with specialist interests, paediatrician, adolescent physician or neurologist may be appropriate. In extreme circumstances, referral to the emergency department is a reasonable option to allow aggressive abortive treatments, but ongoing management should be coordinated through the GP.
Topics: Adolescent; Analgesics; Child; Headache; Humans; Migraine Disorders; Recurrence; Tryptamines
PubMed: 26209983
DOI: No ID Found