Chronic Migraine Sufferers Research Articles

Digital clinics for diagnosing and treating migraine.

Several innovative digital technologies have begun to be applied to diagnosing and treating migraine. We reviewed the potential benefits and opportunities from delivering migraine care through comprehensive digital clinics. There are increasing applications of digitization to migraine diagnosis and management, including e-diaries, and patient self-management, especially after the COVID-19 pandemic. Digital care delivery appears to better engage chronic migraine sufferers who may struggle to present to physical clinics. Digital clinics appear to be a promising treatment modality for patients with chronic migraine. They potentially minimize travel time, shorten waiting periods, improve usability, and increase access to neurologists. Additionally, they have the potential to provide care at a much lower cost than traditional physical clinics. However, the current state of evidence mostly draws on case-reports, suggesting a need for future randomized trials comparing digital interventions with standard care pathways.

Relationship of Plasma Pituitary Adenylate Cyclase-Activating Polypeptide-38 (PACAP-38) Levels with Cerebrovascular Vasomotor Reactivity in Chronic Migraine Sufferers

Introduction: Migraine is a complex health problem and causes disability, especially in women. The current pathophysiology of migraine is a combination of vascular, neurogenic, and neuroinflammatory theories. PACAP-38 is a vasoactive neuropeptide that increases during migraine attacks. Endothelial dysfunction results in impaired vasomotor reactivity. Analysis of vasomotor reactivity is determined by measuring the breath-holding index (BHI) and migraine vascular index (MVI), where there is a decrease in vasomotor reactivity values ??in migraine sufferers. This study aims to determine PACAP-38 levels in chronic migraine sufferers and their relationship to cerebrovascular vasomotor reactivity.
 Methods: This research is a comparative study (cross-sectional) that is carried out in hospitals and health centers spread across the city of Padang from May 2022 to June 2023. The research sample consisted of 30 chronic migraine sufferers and 30 healthy controls. Vasomotor reactivity was assessed by determining BHI and MVI values ??using transcranial Doppler. Plasma PACAP-38 levels were measured using the ELISA method. Data analysis was carried out using SPSS.
 Results: The mean value of vasomotor reactivity in chronic migraine sufferers is 0.355. There is a negative correlation between the frequency and duration of migraine attacks and vasomotor reactivity (frequency p=0.032; duration p=0.022). The mean value of PACAP-38 levels in chronic migraine sufferers was 6.15 pg/ml, and in healthy controls, 4.85 pg/ml; there was a significant difference between plasma PACAP-38 levels in chronic migraine sufferers compared to healthy controls. However, there was no significant difference between plasma PACAP-38 levels and vasomotor reactivity in chronic migraine sufferers.
 Conclusion: There is an increase in plasma PACAP-38 levels in chronic migraine sufferers, but there is no significant relationship between plasma PACAP-38 levels and vasomotor reactivity values.

Exploring Facial Thermography Patterns in Women with Chronic Migraine

(1) Background: Chronic migraine is a debilitating neurological condition affecting millions worldwide. This study delves into the facial point-of-care (POC) thermographic patterns of women with chronic migraine, aiming to shed light on the condition’s pathophysiology and diagnostic potential. (2) Methods: Using infrared POC thermography, the facial temperature distribution of 24 female participants with chronic migraine were analyzed. (3) Results: The findings revealed significant temperature asymmetry in women with right-sided unilateral headaches, particularly in the right frontal and temporal regions. Notably, individuals with bilateral pain did not exhibit thermal pattern differences, suggesting potential diagnostic complexities. While these results offer valuable insights, further research with larger samples is warranted (4) Conclusions: Facial thermography holds promise as an adjunctive tool for migraine diagnosis and understanding its neurophysiological basis; however, cautious interpretation is advised, given the need for validation and expanded investigations. Improved diagnostic criteria and treatment strategies may emerge from this ongoing exploration, ultimately enhancing the quality of life of chronic migraine sufferers.

Excellent Response to OnabotulinumtoxinA: Different Definitions, Different Predictors.

The identification of patients who can benefit the most from the available preventive treatments is important in chronic migraine. We explored the rate of excellent responders to onabotulinumtoxinA in a multicenter European study and explored the predictors of such response, according to different definitions. A pooled analysis on chronic migraineurs treated with onabotulinumtoxinA and followed-up for, at least, 9 months was performed. Excellent responders were defined either as patients with a ≥75% decrease in monthly headache days (percent-based excellent responders) or as patients with <4 monthly headache days (frequency-based excellent responders). The characteristics of excellent responders at the baseline were compared with the ones of patients with a <30% decrease in monthly headache days. Percent-based excellent responders represented about 10% of the sample, whilst frequency-based excellent responders were about 5% of the sample. Compared with non-responders, percent-based excellent responders had a higher prevalence of medication overuse and a higher excellent response rate even after the 1st and the 2nd injection. Females were less like to be frequency-based excellent responders. Chronic migraine sufferers without medication overuse and of female sex may find fewer benefits with onabotulinumtoxinA. Additionally, the excellent response status is identifiable after the first cycle.

Adjunctive treatment of chronic migraine using an oral dental device: overview and results of a randomized placebo-controlled crossover study

ObjectiveTo assess the nocioceptive input of habitual nocturnal jaw clenching that acts as a contributing factor in migraine pathogenesis.BackgroundHabitual nocturnal jaw clenching has been implicated as a trigger, particularly in those whose headaches are present upon waking or shortly thereafter. Nocturnal EMG studies of patients diagnosed with migraine show nearly twice the temporalis clenching EMG levels and double the bite force as matched asymptomatic controls, leading to the speculation that parafunctional clenching activity may have some role in headache pathogenesis. The NTI (Nociceptive Trigeminal Inhibition) oral device is a dental splint designed to reduce nocturnal jaw clenching intensity and is FDA approved for the prevention of medically diagnosed migraine pain based on open label studies. There are no prior placebo-controlled trials to assess the migraine prevention efficacy of the NTI splint. This is the first placebo-controlled cross-over study to assess the efficacy of the NTI splint in patients with Chronic Migraine.MethodA placebo controlled, single-blinded cross-over study was done with IRB oversight assessing the efficacy of the NTI splint compared to placebo using the change in the HIT-6 score as the outcome measure.Results68% of refractory chronic migraine sufferers using the NTI as measured by sequential HIT 6 scores had at least a one-category improvement (severe to substantial, or substantial to some, or some to none) compared to 12% when using a placebo device. 36% of subjects using the NTI device reported a two-category improvement in their HIT-6 score, compared to 0% when using placebo.ConclusionThe improvement in HIT-6 scores produced by the NTI device, suggests that patients with Chronic Migraine may have intense nocturnal jaw clenching as a contributing factor to their headache related disability. An NTI device is one method of assessing whether jaw-clenching is a contributing factor to ongoing migraine.Trial registrationCurrent Controlled Trials NCT04871581. 04/05/2021. Retrospectively registered.

A unique medium chain triglyceride-containing micronutrient complex: Effects on migraine symptoms compared to quality of lif

Purpose: Migraine headaches and associated symptoms are prevalent medical issues. Medium-chain triglyceride (MCT)/nootropic-based compounds have demonstrated benefits in multiple domains. This study assessed the potential relief provided from a unique, high-concentration MCT/nootropic component blend on migraine frequency, duration, secondary symptoms, and quality of life (QOL) during a 60-day clinical investigation. Methods: Forty (n=40) chronic migraine sufferers [migraineurs] were prospectively randomized to participate in the double-blinded study. Both intervention (n=30) and control (n=10) participants were required to maintain lifestyle patterns for the trial duration. Migraine surveys used electronic response forms to allow subjects increased ease and safety during the COVID-19 pandemic. Results. The intervention subjects experienced reduction in migraine episodes by 53%, from 11.6 to 5.4 per month, after 60 days of supplement use. The average episode duration decreased from 260 minutes to 158 minutes, a 39% improvement. Time lost due to severe migraine effect was reduced from an average of more than five days per month to just over two per month, a decrease of 55%. A combined measure of secondary symptoms, which aggregate to illustrate migraine intensity, also decreased according to subject rating by an average of 37%. Self-assessed QOL scales improved by 43% in the intervention cohort. The control subjects showed no significant changes in any measures. Conclusion: Consumption of a unique, nootropic brain complex significantly improved migraine symptoms, including episode frequency, duration, severity, and lost days due to dysfunction. The formulation also beneficially impacted secondary effects and self-reported QOL.

The effects of a unique medium chain triglyceride complex on migraine symptoms: A beta pilot study

Purpose: Migraine headaches are among the most common worldwide medical issues, and various drug therapies only offer limited relief. Medium chain triglyceride (MCT) oil has demonstrated clinical benefits in multiple domains, from enhanced overall energy to increased brain function. This pilot study investigated the potential relief provided from a unique proprietary formulation, including a high concentration MCT-containing blend on migraine frequency, duration, and severity over 30 days. Methods: Fourteen (n=14) chronic migraine sufferers (migraineurs) were prospectively selected to participate in the open-label trial of this patented complex. Participants were instructed to maintain a consistent lifestyle, health factors, and medications while consuming the study compound. Because of the current Corona virus pandemic, the original paper version of the migraine survey was converted to an electronic response form to allow subjects increased safety in rating episodes and symptoms. Results: Overall, the subjects reduced the number of migraine episodes by 39% from the baseline period compared to after 30 days of using the supplement. The average episode duration decreased from 388 minutes to 152 minutes, a 61% reduction. Days/events missed due to migraine severity or complications were reduced from five per month to two per month, a decrease of 60%. A combined measure of specific symptoms also decreased according to subject rating, by an average of 32%. Conclusion: In this beta pilot study, consumption of a high concentration MCT complex produced significant improvements in migraine symptoms in the three significant episode realms of frequency, duration, and lost days due to dysfunction. In addition, migraine symptom surveys can be converted to electronic record keeping, a benefit for both the patient and the clinician. These outcomes have provided further impetus to pursue a rigorous study of specific MCT products to reduce migraine symptoms. A formal confirmatory placebo-controlled trial has been initiated.

Cognitive Decline in Chronic Migraine with Nonsteroid Anti-inflammation Drug Overuse: A Cross-Sectional Study.

Background Chronic migraine with medication overuse headache (CM-MOH) is the most common type of chronic migraine, and it increases risk of stroke and white matter lesions. These pathologic changes could induce cognitive decline. However, the alteration of cognitive function in CM-MOH patients is not established. Therefore, we took this study to reveal the cognitive performances in CM-MOH. Methods This cross-sectional study was conducted between December 2015 and January 2017. Patients were divided into CM-MOH, CMwoMOH (chronic migraine without medication overuse), and MO (migraine without aura) groups. Cognitive function was assessed in all cases during interictal periods using Addenbrooke's Cognitive Examination Test (ACE-R), Trail Making Test A/B (TMT A/B), and Digit Symbol Test (DST). Detailed headache characteristics and evaluation of anxiety, depression, and living and sleep quality were collected. Results 116 patients were included in this study. There were 21 CM-MOHs, 20 CMwoMOHs, 35 MOs, and 40 controls. Age and education were the independent risk factors of cognitive decline (P < 0.05). After adjusting, the risk of cognitive decline was higher in CM compared with control in ACE-R score and language fluency (P < 0.05). In addition, CM-MOH sufferers were in higher risk of memory and executive dysfunction (P < 0.05). The cognitive function had no difference between CM-MOH and CMwoMOH (P > 0.05). Meanwhile, CM-MOH got significantly higher scores than MO in anxiety and depression, with poorer performances in sleep and life quality (P < 0.05). Conclusion The risk of cognitive decline increased in chronic migraine patients. Nonsteroid anti-inflammatory drugs overuse had no influence on cognitive performances among chronic migraine sufferers.

Placebo is not a “sugar pill” but the result of stimulation of neural networks involved in central analgesia and in mood regulation

&lt;div&gt;Placebo was intended as a pill devoid of any active principle &lt;span style="font-size: 10px;"&gt;capable to influence or relieve so called psychosomatic diseases. &lt;/span&gt;&lt;span style="font-size: 10px;"&gt;More recently, it has been shown that placebo can be useful in &lt;/span&gt;&lt;span style="font-size: 10px;"&gt;surgical practice. In fact, sham operation can induce significant&lt;/span&gt;&lt;/div&gt;&lt;div&gt;benefit. Emotions have been shown to play a pivotal role in placebo. &lt;span style="font-size: 10px;"&gt;Present observation concerns an attempt to investigate and &lt;/span&gt;&lt;span style="font-size: 10px;"&gt;therapeutically use scientific evidences in a placebo devoted to &lt;/span&gt;&lt;span style="font-size: 10px;"&gt;sufferers from chronic migraine pain. The present approach has its&lt;/span&gt;&lt;/div&gt;&lt;div&gt;background in the fact that placebo analgesia has been shown to &lt;span style="font-size: 10px;"&gt;largely consist either in the activation both of analgesia pathways &lt;/span&gt;&lt;span style="font-size: 10px;"&gt;and of emotional systems as well as genetic and epigenetic &lt;/span&gt;&lt;span style="font-size: 10px;"&gt;expressions leading to specific behavior. In this perspective &lt;/span&gt;&lt;span style="font-size: 10px;"&gt;placebo has been used to empower a conventional therapy that&lt;/span&gt;&lt;/div&gt;&lt;div&gt;was scored as unsatisfactory by the enrolled chronic migraine &lt;span style="font-size: 10px;"&gt;sufferers. Here proposed placebo seems to transform an ineffective &lt;/span&gt;&lt;span style="font-size: 10px;"&gt;drug therapy into an effective pain relieving approach.&lt;/span&gt;&lt;/div&gt;

Altered Permeability Of The Blood‐CSF Barrier In Chronic Migraine

BackgroundMolecular communication from blood circulation to brain is tightly regulated at multiple biological barriers, but is disrupted in a variety of diseases, disorders, and infections. Recent human and animal data in migraine research has shown conflicting results regarding barrier disruption. These contradictions require resolution because a leaky barrier will expose the brain to potentially harmful components with diverse deleterious effects on brain function.MethodsSince blood‐to‐CSF transfer studies have not yet been performed in migraineurs, we studied surrogate biomarkers of barrier disruption in blood and CSF from non‐headache suffering controls and chronic migraine sufferers.ResultsWhen compared to controls, study participants with chronic migraine had clear evidence of barrier leak based on their higher CSF—blood albumin ratio, CSF fibrinogen levels, and CSF levels of the pericyte biomarker, soluble platelet‐derived growth factor receptor β. To test if other blood components were leaking through this barrier, we examined how CSF and blood lipids relate to the CSF—blood albumin ratio. The CSF—blood ratios of trans palmitoleic acid, linoleic acid, and ceramide were higher in chronic migraine and these lipid ratios correlated significantly with the CSF—blood albumin index, consistent with their derivation, at least partly, from a leaking barrier.ConclusionWe conclude that individuals with chronic migraine have distinct disruption of central nervous system (CNS) barriers that allows leakage into the CNS of multiple blood components, including proteins and lipids, and which likely results from, and contributes to the pathophysiology of migraine. The blood‐brain barrier and molecules that leak into the CNS are potential treatment targets.Support or Funding InformationThe National Institutes of Health, R01 NS043295, Higgins Family TrustsThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Electromyography data in chronic migraine patients by using neurostimulation with the Cefaly® device

The objective of this observational study is to report clinical and instrumental results obtained in 23 chronic migraine sufferers treated with transcutaneous neurostimulation with the Cefaly(®) device. The electrom yography (EMG) parameters of the patients monitored before and during neurostimulation with the Cefaly(®) device showed a significant increase in the EMG amplitude and frequency values in the frontalis, anterior temporalis, auricularis posterior and middle trapezius muscles. The Cefaly(®) device could act on the inhibitory circuit in the spinal cord thus causing a neuromuscular facilitation and may help reduce contraction of frontalis muscles.

Comorbidity profiles of chronic migraine sufferers in a national database in Taiwan

Chronic migraine (CM; ≥15 headache days per month, ≥3 months) is associated with a higher prevalence of comorbidities than episodic migraine (<15 headache days per month). However, it is unclear whether a similar pattern exists in Asian patients. To examine this, a retrospective matched cohort study was conducted using the Taiwan National Health Insurance Research Database. CM cases were defined as patients with at least one neurological outpatient visit with a primary or secondary ICD-9-CM (International Classification of Diseases, Ninth Revision, Clinical Modification) code of 346.11, diagnosed by neurologists at medical centers during 2007–2008. The study group was compared with patients suffering from other migraine subtypes and non-migraineurs in the general population. Both comparison groups were matched with CM sufferers at a 4:1 ratio by age, gender, urbanization level of the residence, income, and hospital setting. Relative risk (RR) was calculated using conditional logistic regression. Compared with patients with other migraines (n = 2,226), CM sufferers (n = 681) had a higher risk of hyperlipidemia (RR = 1.32; P = 0.041), asthma (RR = 1.77; P = 0.007), depression (RR = 1.88; P < 0.0001), bipolar disorder (RR = 1.81; P = 0.022) and anxiety disorders (RR = 1.48; P = <0.0001). Compared with the non-migraineurs (n = 3,790), CM sufferers (n = 948) had significantly increased risks of cardiovascular disease, sinusitis, asthma, gastrointestinal ulcers, vertigo and psychiatric disorders by 1.6–3.9-fold. In conclusion, CM is associated with significant comorbidities in Asian patients. Differences in the comorbidity profiles of CM compared with other migraines have highlighted that patients with CM differ not just in terms of headache frequency but also in other important aspects.

Disability, HRQoL and resource use among chronic and episodic migraineurs: Results from the International Burden of Migraine Study (IBMS)

Migraine imposes significant burden on patients, their families and health care systems. In this study, we compared episodic to chronic migraine sufferers to determine if migraine status predicted headache-related disability, health-related quality of life (HRQoL) and health care resource utilization. A Web-based survey was administered to panelists from nine countries. Participants were classified as having chronic migraine (CM), episodic migraine (EM) or neither using a validated questionnaire. Data collected and then analyzed included sociodemographics, clinical characteristics, Migraine Disability Assessment, Migraine-Specific Quality of Life v2.1, Patient Health Questionnaire and health care resource utilization. Of the respondents, 5.7% had CM and 94.3% had EM, with CM patients reporting significantly more severe disability, lower HRQoL, higher levels of anxiety and depression and greater health care resource utilization compared to those with EM. These results provide evidence that will enhance our understanding of the factors driving health care costs and will contribute to development of cost-effective health care strategies.

Botulinum toxin type A versus amitriptyline for the treatment of chronic daily migraine

Objective To compare the effects of botulinum toxin type A with those of amitriptyline on the treatment of chronic daily migraines. Methods Chronic migraine sufferers were randomized into two groups and treated with 25 or 50 mg/day of amitriptyline or 250 U of botulinum toxin type A. A reduction of at least 50% in the number of pain episodes, in the intensity of pain, and in the number of drug doses for pain and reports of improvement by the patient or by the examiner were the main endpoints. Results Seventy-two subjects were enrolled in the study. A reduction of at least 50% in the number of days of pain was recorded in 67.8% of the patients in the BTX-A group and 72% ( n = 23) of the patients in the AM group ( p = 0.78; RR = 0.94; CI = 0.11–8). The reduction in the intensity of pain, as assessed using the visual analogical scale, was 50% in the BXT-A group and 55.6% in the AM group ( p = 0.79; RR = 1.11; CI = 0.32–3.8). The reduction in the number of pain drug doses was 77% for the toxin group and 71% for the amitriptyline group ( p = 0.76; RR = 0.92; CI = 0.45–1.88). Conclusions Botulinum toxin type A was as effective as amitriptyline for the prophylactic treatment of chronic daily migraines.

Relationship Between Biofeedback and Oxidative Stress in Patients With Chronic Migraine

Chronic migraine (1.5.1) is burdened with headache-related disability. During noxious stimulation, changes of cerebral blood flow enhance the release of oxygen free radicals that react with nitric oxide (NO). We investigated the role of biofeedback in limiting migraine disability by influencing oxidative stress. Peroxides, NO and superoxide dismutase (SOD) were analysed in 20 female subjects with chronic migraine and in 20 female healthy controls before and after biofeedback sessions. NO(x) levels (23.7 +/- 4.2 vs. 34.9 +/- 4.6 microm; P < 0.05) and SOD activity (6.5 +/- 1.0 vs. 8.0 +/- 0.7 U/ml; P < 0.05) were lower in migraine sufferers before treatment than in healthy controls, whereas peroxide levels (145.8 +/- 40.3 vs. 78.0 +/- 20.0 microm; P < 0.05) were higher in migraine sufferers before treatment than in healthy controls. In migraine sufferers NO(x) levels (23.7 +/- 4.2 vs. 31.3 +/- 7.1 microm; P < 0.05) and SOD activity (6.5 +/- 1.0 vs. 7.9 +/- 0.9 U/ml; P < 0.05) were lower before than after treatment, whereas peroxide levels (145.8 +/- 40.3 vs. 82.4 +/- 21.1 microm; P < 0.05) were higher before than after treatment. SOD serum activity correlated positively with NO(x) serum levels and negatively with peroxide serum levels in healthy controls and in chronic migraine sufferers before and after biofeedback. The mean Migraine Disability Assessment Score before biofeedback sessions was higher than after treatment (36.9 +/- 13.9 vs. 18.8 +/- 10.4; P < 0.001). The effectiveness of biofeedback in limiting chronic migraine may be related to muscular relaxation associated with decreased oxidative stress accompanied by psychological well-being.