Clinical Features Of Migraine Research Articles

Migraine: Genetic Variants and Clinical Phenotypes.

Migraine is a common, chronic neurovascular disorder caused by a complex interaction between genetic and environmental risk factors. In the last two decades, molecular genetics of migraine have been intensively investigated. In a few cases, migraine is transmitted as a monogenic disorder, and the disease phenotype cosegregates with mutations in different genes like CACNA1A, ATP1A2, SCN1A, KCNK18, and NOTCH3. In the common forms of migraine, candidate genes as well as genome-wide association studies have shown that a large number of genetic variants may increase the risk of developing migraine. At present, few studies investigated the genotype-phenotype correlation in patients with migraine. The purpose of this review was to discuss recent studies investigating the relationship between different genetic variants and the clinical characteristics of migraine. Analysis of genotype-phenotype correlations in migraineurs is complicated by several confounding factors and, to date, only polymorphisms of the MTHFR gene have been shown to have an effect on migraine phenotype. Additional genomic studies and network analyses are needed to clarify the complex pathways underlying migraine and its clinical phenotypes.

Subgrouping Factors Influencing Migraine Intensity in Women: A Semi-automatic Methodology Based on Machine Learning and Information Geometry.

Migraine is a heterogeneous condition with multiple clinical manifestations. Machine learning algorithms permit the identification of population groups, providing analytical advantages over other modeling techniques. The aim of this study was to analyze critical features that permit the differentiation of subgroups of patients with migraine according to the intensity and frequency of attacks by using machine learning algorithms. Sixty-seven women with migraine participated. Clinical features of migraine, related disability (Migraine Disability Assessment Scale), anxiety/depressive levels (Hospital Anxiety and Depression Scale), anxiety state/trait levels (State-Trait Anxiety Inventory), and pressure pain thresholds (PPTs) over the temporalis, neck, second metacarpal, and tibialis anterior were collected. Physical examination included the flexion-rotation test, cervical range of cervical motion, forward head position while sitting and standing, passive accessory intervertebral movements (PAIVMs) with headache reproduction, and joint positioning sense error. Subgrouping was based on machine learning algorithms by using the nearest neighbors algorithm, multisource variability assessment, and random forest model. For migraine intensity, group 2 (women with a regular migraine headache intensity score of 7 on an 11-point Numeric Pain Rating Scale [where 0 = no pain and 10 = maximum pain]) were younger and had lower joint positioning sense error in cervical rotation, greater cervical mobility in rotation and flexion, lower flexion-rotation test scores, positive PAIVMs reproducing migraine, normal PPTs over the tibialis anterior, shorter migraine history, and lower cranio-vertebral angles while standing than the remaining migraine intensity subgroups. The most discriminative variable was the flexion-rotation test score of the symptomatic side. For migraine frequency, no model was able to identify differences between groups (ie, patients with episodic or chronic migraine). A subgroup of women with migraine who had common migraine intensity was identified with machine learning algorithms.

Impact of right-to-left shunt and transcatheter closure on the clinical features of migraine

Objectives: In this study, we aimed to explore the influence of right-to-left shunt (RLS) presence on the clinical features of migraine and to follow-up on the post-operative curative effect of transcatheter patent foramen ovale (PFO) closure on migraine features.Methods: A total of 103 migraine patients were divided into a mild volume RLS group, moderate volume RLS group, large volume RLS group and non-RLS group in accordance with contrast enhancement transcranial Doppler (c-TCD) findings. The Visual Analogue Scale (VAS) score, migraine frequency, migraine duration, migraine disability assessment (MIDAS) and headache impact test-6 (HIT-6) scores were compared amongst the different groups. A total of 39 patients with moderate or large RLS received transcatheter PFO closure and those patients were followed up by the same criteria.Results: The attack frequency, HIT-6 and MIDAS scores amongst the migraine patients with moderate or large RLS were significantly higher than those in patients from the mild RLS group and non-RLS group (p < .05). The transcatheter closure was successful in all patients (n = 39), and no post-operative complications were observed during the hospitalisation and follow-up period. The differences in VAS, HIT-6 and MIDAS scores as well as the headache duration were statistically significant amongst patients before and after PFO closure (p < .05).Conclusions: Moderate to large RLS significantly influenced the clinical features of migraine, and transcatheter PFO closure could significantly relieve headache symptoms in migraine patients with PFO.

Terapêutica da Enxaqueca: Avanços Recentes

Neste artigo são sintetizados os conceitos atuais sobre a fisiopatogenia e as manifestações clínicas da enxaqueca, assim como as terapêuticas disponíveis com destaque para as novas terapêuticas preventivas e suas implicações clínicas e sociais.

Episodic and chronic migraine in children.

Migraine is the most common acute and recurrent headache syndrome in children. This condition has unique clinical characteristics in the pediatric population, that can evolve with age, and significantly impact a child's quality of life, affecting their education, socialization, and family life. The purpose of this review is to describe the varied clinical features of migraine seen in children, and discuss potential treatment options for pediatric migraine, including chronic migraine. In many patients a multifaceted approach involving lifestyle changes, treatment of comorbid conditions, and pharmacological treatments are needed for optimal headache control. WHAT THIS PAPER ADDS: Migraine presents as various phenotypes in children, sometimes evolving as the child ages. An expanded range of treatment options exists for the challenging chronic migraine patient.

Right-to-Left Shunt and the Clinical Features of Migraine with Aura: Earlier but Not More

Background: The causal relationship between patent foramen ovale (PFO) and migraine with aura (MA) is controversial. We aimed at exploring whether attack clinical features relate to the presence of right-to-left shunt (RLS) in MA patients. Methods: We retrospectively examined a cohort of consecutive patients diagnosed with MA in our headache center and undergoing transcranial doppler (TCD) for RLS detection. We collected from our clinical electronic dossiers, clinical features of MA attacks (type, frequency, duration of aura phenomenon, trigger factors, onset age), family history for MA, thrombophilia genotypes, and the response to preventive treatments. RLS was stratified for severity according to the results of the TCD examination. Results: We found 111 patients. Binary logistic regression analysis showed that among features of MA attacks, only onset age was associated with the presence of RLS (p < 0.0001). Patients with RLS presented the first MA attack at a younger age (p < 0.0001). The greater RLS severity, the younger was onset age (p < 0.00001) and the presence of atrial septal aneurysms (ASA) was associated with a further decrease in onset age (ρ = –539, p < 0.00001). Family history for MA was associated with the presence of RLS (chi-square p = 0.022). Response to preventive treatments was not influenced by the type of treatment (antiplatelet compared with no antiplatelet drugs), comorbidity with migraine without aura, RLS presence, or by their double interactions (Logistic regression, consistently p > 0.05). Conclusion: Our findings support the hypothesis that although PFO does not influence MA attack frequency, it is not merely a bystander in MA physiopathology, as RLS, its severity, and the presence of ASA possibly make a difference in the disease history.

The synergistic effects of nano-curcumin and coenzyme Q10 supplementation in migraine prophylaxis: a randomized, placebo-controlled, double-blind trial

ABSTRACT Introduction: Migraine is a disabling neurovascular disorder characterized by increasing levels of pro-inflammatory cytokines and oxidative stress biomarkers. Curcumin and coenzyme Q10 (CoQ10) can exert neuroprotective effects through modulation of inflammation and oxidative stress. The aim of the present study was to evaluate the combined effects of nano-curcumin and CoQ10 supplementation on migraine symptoms and quality of life in migraine patients. Methods: One-hundred men and women (mean age 32 years) with episodic migraine based on the International Headache Society (IHS) criteria participated in this study. The subjects were randomly divided into four groups as (1) combination of nano-curcumin (80 mg) plus CoQ10 (300 mg), (2) nano-curcumin (80 mg), (3) CoQ10 (300 mg) and (4) the control (nano-curcumin and CoQ10 placebo included oral paraffin oil) beside usual prophylactic drugs for 8 weeks. Frequency, severity, duration of headache attacks, the headache diary results (HDR) and headache disability based on migraine-specific questionnaires were assessed at the baseline and end of the study. Results: Ninety-one of 100 patients completed the study. The results showed a significant effect of nano-curcumin and CoQ10 supplementation on frequency, severity, duration of migraine attacks and HDR compared to other groups (All P < 0.001). Nano-curcumin and CoQ10 group also had better scores in migraine-specific questionnaires at the end of the study compared to other groups (All P < 0.001). There were no side effects reported by the participants. Conclusions: These findings suggest a possible synergistic effect of nano-curcumin and CoQ10 on clinical features of migraine. Trial registration number: IRCT2017080135444N1.

Insomnia in patients with migraine

Objective: to evaluate the significance of insomnia and chronobiological patterns in the development of headache (HA) attacks for the formation of clinical features of migraine and for the elaboration of strategies for its prevention.Patients and methods. A prospective comparative study was conducted in 60 patients aged 18–65 years who were diagnosed as having migraine (with or without aura) with comorbid sleep disorder. Group 1 consisted of 30 patients with migraine and insomnia; Group 2 comprised 30 patients with migraine without insomnia. The study participation included four visits to a physician for 12 months.Results and discussion. Persistent sleep disorders in patients with migraine were shown to worsen the course of the underlying disease: HA attacks had a greater intensity, mainly left-sided localization and a longer duration. Group 1 patients were observed to have a chronic course of the disease with a frequency of ≥8 attacks per month in 33% of cases. Analysis of biological rhythms revealed that individuals with evening and mildly evening chronotypes were characterized by the greatest changes in the sleep-wake cycle, by sleep deprivation and its reduced efficiency. Analysis of the data of HA and sleep diaries kept by the patients for 12 months showed that Group 1 had four peaks of the daily distribution of HA attacks; 13.4% of attacks occurred during sleep and early morning.Conclusion. The coexistence of sleep disorders and HA is not only manifested as the overlapping of clinical manifestation, but also largely determines their natural course and prognosis, i.e. their progression into a chronic form. Therefore, it is imperative to identify sleep disorders in migraines, since their correction is effective and, in most cases, allows chronic HA to progress to an episodic form.

Traditional and Novel Migraine Therapy in the Aging Population.

Migraine is a common disabling disorder that affects 36 million Americans. The clinical features of migraine are less typical in the people above age 60, making the diagnosis and treatment difficult in this group. In this review, we will discuss migraine-specific drugs and their use in populations about age 60 who suffer from migraine. This discussion will include an overview of traditional treatments for the acute and preventive treatment of migraine, and considerations for their use in patient populations above age 60. In addition, we will discuss newer agents that show a more promising safety profile.

Clinical characteristics of migraine: A prospective cross-sectional study over nine years

Background: Migraine is the most common primary headache. This study aimed to describe clinical observations about migraine in outpatients in Iraq, including migraine types and subtypes, duration and frequency of acute attacks, severity, disability, effects on the quality of life, and complications. Methods: This is an outpatient-based prospective cross-sectional study, conducted in the Misan province, Iraq over nine years, and included 1412 patients aged 12 to 50 years. The data was collected from clinical records of patients who attended outpatient clinics. Results: The study included 1100 women (77.9%) and 312 men (22.1%); the women/men ratio being 3.5:1. The median age and standard deviation (SD) was 21 ± 5.42 years. The mean age at first attack of migraine was 17 ± 4.91 years. Migraine without aura was the most common type, accounting for 68% of the cases. The mean frequency of the attacks was (2 ± 4.63) days/month. In general, acute attacks were moderate to severe. Conclusions: In our study, we observed that migraine causes a headache resulting in episodes of temporary functional disability and women suffered more than men (ratio of 3.5:1). The mean age at first attack was a young age, and a family history of migraine highly altered distribution. Migraine without aura was the most common type, and symptoms including nausea and vomiting and photophobia were experienced by patients, which were used to diagnose migraines. Experienced aura was the most common migraine with aura, but also aura without a headache and aura with migraine were prevalent; therefore, it is important to differentiate between migraine subtypes. Visual aura was the most common aura, while motor symptoms were very rare. Chronic persistent headaches were a common complication recorded. These features provide evidence for the creation of screening tools in migraine prevention migraine.

Kinesiophobia Is Associated with Migraine.

The aim of this study was to assess kinesiophobia in patients with migraine and to determine its association and correlation with cutaneous allodynia and clinical manifestations of migraine. A cross-sectional study. A headache clinic of a university-based hospital. Eighty-nine patients diagnosed with migraine by a neurologist specialized in headache. Patients completed the Tampa Scale for Kinesiophobia (TSK) and the 12-item Allodynia Symptom Checklist (ASC-12) and described the frequency, duration, and intensity of migraine attacks, as well as number of years with migraine. The prevalence of kinesiophobia was 53%, and it was associated with the classification of severe cutaneous allodynia (X2= 9.96, P = 0.02) but not with its presence (X2= 3.11, P = 0.07). Kinesiophobia and clinical migraine features were not significantly associated (P > 0.05), nor were TSK score, ASC-12 score, or clinical migraine features (r < 0.21, P > 0.05). Subjects with migraine, with or without kinesiophobia, believed that physical activity could not help to control or relieve their pain, and those with kinesiophobia, furthermore, believed that exercise may be harmful. Kinesiophobia is present in about half of migraineurs. It was associated with worsened cutaneous allodynia severity, but not with its presence, in patients with migraine. Education strategies should be implemented as negative beliefs related to exercise are present despite its evidence of benefit in migraine treatment.

Thyrotropin levels and severity of symptoms in migraine patients of tertiary headache center.

The role of thyroid regulation in migraine is poorly understood, and data is contradictory. To study the possible association of clinical features of migraine with patients' thyroid function. One hundred and thirty migraine patients of a tertiary headache center took part in an open-label, cross-sectional comparative study. The Migraine Disability Assessment questionnaire, Spielberger State-Trait Anxiety Inventory, Beck Depression Inventory, Vanderbilt's Questionnaire of Pain Management, Gothenburg Quality of Life Questionnaire and Migraine-Specific Quality of Life questionnaire were used. The effectiveness of the attacks' therapy was assessed according to the Migraine Assessment of Current Therapy questionnaire. Levels of thyrotropine (thyroid stimulating hormone), thyroxine, and triiodothyronine were studied by standard immune chemiluminescent method using the Immulite-2000 set. An inverse correlation between levels of thyroid stimulating hormone in serum and duration of headache attacks was revealed. The effectiveness of abortive therapy for attacks showed a statistically significant positive correlation with thyroid stimulating hormone level. Quality of life measured by a general quality of life questionnaire, as well as the functional and social indices of a migraine-specific questionnaire, showed direct correlation with serum thyroid stimulating hormone. These results show an association of a more severe clinical course of migraine with lower thyroid stimulating hormone levels.

Linking migraine frequency with family history of migraine

BackgroundMigraine is a complex genetic disorder that is brought about by multiple genetic and environmental factors. We aimed to assess whether migraine frequency is associated with genetic susceptibility.MethodsWe investigated in 2829 migraine patients (14% males) whether ‘migraine frequency’ (measured as the number of migraine days per month) was related to ‘genetic load’ (measured as the number of parents affected with migraine) using a validated web-based questionnaire. In addition, we investigated associations with age-at-onset, migraine subtype, use of acute headache medication, and comorbid depression.ResultsWe found an association between the number of migraine days per month and family history of migraine for males (p = 0.03), but not for females (p = 0.97). This association was confirmed in a linear regression analysis. Also, a lower age-at-onset (p < 0.001), having migraine with aura (p = 0.03), and a high number of medication days (p = 0.006) were associated with a stronger family history of migraine, whereas lifetime depression (p = 0.13) was not.DiscussionMigraine frequency, as measured by the number of migraine days per month, seems associated with a genetic predisposition only in males. A stronger family history of migraine was also associated with a lower age-at-onset, a higher number of medication days, and migraine with aura. Our findings suggest that specific clinical features of migraine seem more determined by genetic factors.

The New *G29A and G1222A of HCRTR1, 5-HTTLPR of SLC6A4 Polymorphisms and Hypocretin-1, Serotonin Concentrations in Migraine Patients.

Migraine is one of the most common primary headache disorders that affects 11% of the adult population. The disease is divided into two main clinical subtypes: migraine with aura (MA) and migraine without aura (MO). Both serotonergic and hypocretinergic systems are involved in the migraine pathomechanism. Polymorphisms in the serotonin transporter gene (SLC6A4) and the hypocretin receptor 1 gene (HCRTR1) may be risk factors for migraine development due to their ability to affect serotonin and hypocretin-1 (HCRT-1) concentrations. The aim of the study was to analyze, for the first time in the Polish population, the 5-HT transporter linked polymorphic region (5-HTTLPR) in SLC6A4, G1222A (rs2271933) and the never before studied *G29A (rs41263963) polymorphisms in the HCRTR1 gene, as well as the 5-HT and hypocretin-1 plasma concentrations in migraine patients (MA, MO) and control subjects. The study included 123 patients that were diagnosed with migraine and 123 control subjects. Methods such as PCR, HRMA and sequencing were used for genotyping, while 5-HT was determined by HPLC/EC and hypocretin-1 by ELISA. No significant differences were observed in 5-HTTLPR frequencies. The A allele of HCRTR1 G1222A occurred more often in MO, while the GA genotype of HCRTR1 *G29A was more frequent among MA when compared to control group (p < 0.05). The mean age of migraine onset in individuals with HCRTR1 *G29A was 18 years old for patients with MA and 26 years old for MO patients. The localization and type of HCRTR1 polymorphisms (G1222A—missense variant in exon 7, *G29A−3′UTR variant) may predispose patients to the clinical subtype of migraine: MO or MA, respectively. In control subjects, the short allele of 5-HTTLPR tended to decrease the 5-HT concentration, while the A allele of HCRTR1 G1222A decreased both 5-HT and hypocretin-1 levels. Serotonin concentrations differed in terms of clinical features of migraine. The relation between genotypes of 5-HTTLPR, HCRTR1 G1222A, and 5-HT concentrations may bedisturbed in migraine. It seems that HCRTR1 *G29A is more strongly associated with regulating the 5-HT in patients with MA than MO, and therefore may contribute to the early age of onset for migraine.

Perceived Pain Extent is Not Associated With Widespread Pressure Pain Sensitivity, Clinical Features, Related Disability, Anxiety, or Depression in Women With Episodic Migraine.

People with migraine present with varying pain extent and an expanded distribution of perceived pain may reflect central sensitization. The relationship between pain extent and clinical features, psychological outcomes, related disability, and pressure pain sensitivity in migraine has been poorly investigated. Our aim was to investigate whether the perceived pain extent, assessed from pain drawings, relates to measures of pressure pain sensitivity, clinical, psychological outcomes, and related disability in women with episodic migraine. A total of 72 women with episodic migraine completed pain drawings, which were subsequently digitized allowing pain extent to be calculated utilising novel software. Pressure pain thresholds were assessed bilaterally over the temporalis muscle (trigeminal area), the cervical spine (extratrigeminal area), and tibialis anterior muscle (distant pain-free area). Clinical features of migraine, migraine-related disability (migraine disability assessment questionnaire [MIDAS]), and anxiety and depression (Hospital Anxiety-Depression Scale [HADS]) were also assessed. Spearman ρ correlation coefficients were computed to reveal correlations between pain extent and the remaining outcomes. No significant associations were observed between pain extent and pressure pain thresholds in trigeminal, extratrigeminal or distant pain-free areas, migraine pain features, or psychological variables including anxiety or depression, and migraine-related disability. Pain extent within the trigeminocervical area was not associated with any of the measured clinical outcomes and not related to the degree of pressure pain sensitization in women with episodic migraine. Further research is needed to determine if the presence of expanded pain areas outside of the trigeminal area can play a relevant role in the sensitization processes in migraine.

Association between Body Mass Index and Migraine: A Survey of Adult Population in China

Both migraine and obesity are prevalent disorders in the general population, which are characterized by disability and impaired quality of life. Although so many researches had studied the association between migraine and obesity, there are still no full knowledge of the relationship between body mass index (BMI) and migraine, especially chronic migraine (CM). In this study, we analyzed a previous epidemiological survey data of primary headache patients in Chongqing, which surveyed consecutive neurological outpatients through face-to-face interview with physicians using a headache questionnaire. 166 episodic migraine (EM) patients and 134 chronic migraine (CM) patients were included in the study out of 1327 primary headache patients. And 200 healthy adults from the physical examination center were included as a control group. Finally, we found that the patients with migraine (EM and CM) were more likely to be overweight, obese, or morbidly obese compared to those in the healthy group. Significant difference was found between BMI and frequency of migraine attacks but not severity or duration of headache onset. And no significant difference was found in severity and duration of headache onset between episodic and chronic migraine among different BMI classifications. Such may update our knowledge about the clinical features of migraine and BMI, revealing that the frequency of attacks may be associated with being overweight, obese, or morbidly obese in patients with migraine and that the extent of being overweight, obese, or morbidly obese in CM patients was lower than that in EM patients.

Migraine and Obesity in Parakou in 2017: Case-Control Study

Objective: We aim to study the relationship between migraine and obesity at Titirou in Parakou in 2017. Method: It was a case-control study which included 66 migrainers according to International Headache Society (IHS) criteria 2013 (case) matched to 132 controls by age, sex and residence. Size and weight have been measured in each subject. Body mass index has been calculated. Migraine history and sociodemographic information have been collected from 1st May to 31st August 2017 and analyzed by using Epi Info 7 software. The association between migraine and obesity was estimated by odds ratio and their confidence interval. Results: There has been no difference among those suffering from migraine and controls according to sociodemographic characteritics. Obesity has significantly been associated with migraine with OR 4.24 (1.93 - 9.25). The weight more than 70 Kg has been associated with the migraine with OR: 2.02 (1.06 - 3.90). The overweight and obesity have been associated with migraine OR with respectively 1.9 (1.1 - 3.9) and 4.4 (2.0 - 9.5). No difference has been found between migraine and the clinical characteristics of migraine (type, severity, intensity). Conclusion: Obesity has been associated with migraine and has to be taken into account in migraine management.

Effect of abdominal obesity on migraine features in Indian population

Background: Migraine is a common headache disorder affecting large population globally. Some studies found an association between abdominal obesity (AO) and characteristics of migraine headache, whereas others found no such association. Aims and Objectives: Therefore, this study aims to find out the effect of AO on various clinical characteristics of migraine in Indian population. Materials and Methods: Male and female migraineurs, between 20 and 50 years, were recruited for the study after obtaining informed consent. Details of migraine history (age of onset of headache in years, frequency of headache per month, and duration of pain in hours) and severity according to migraine disability assessment score were noted. Waist circumference (WC) and waist–hip ratio (WHR) were measured for each patient. AO was determined from WC cutoff for the Asian population. Comparison of clinical features of migraine in groups with and without AO was done using independent sample t-test. P < 0.05 was considered statistically significant. Results: A total of 50 patients, 21 males and 29 females (age mean [standard deviation] 28.7 [6.8] and mean 30.4 [6.4], respectively) were selected. Differences in WC and WHR were statistically significant between males and females. There was statistically significant difference in severity of migraine in male patients and, severity and frequency of migraine among female patients with and without AO. Conclusion: Individuals with abdominal obesity have increased frequency and severity of Migraine, compared to those without abdominal obesity. Weight loss may have a potential role in controlling migraine frequency and severity.

Clinical Characteristics of Migraine in Twelve Sudanese families

Clinical Characteristics of Migraine in Twelve Sudanese families

Neuronal Dysexcitability May Be a Biomarker of Migraine: A Visual Evoked Potential Study.

We report neuronal sensitization and impaired habituation in migraine using pattern reversal visual evoked potential (PRVEP) and correlate these with clinical characteristics of migraine. Sixty-five migraineurs and 30 healthy controls were included. A detailed clinical examination was done and migraine characteristics, including migraine trigger, photophobia, phonophobia, and allodynia were noted. Consecutive 5 blocks of PRVEP were recorded averaging 100 epochs at 3 Hz stimuli. The amplitude of N75 and P100 were measured. Amplitude of first block was considered for sensitization, and impaired habituation was considered if any subsequent block was not suppressed. Migraineurs had sensitization of P100 (14.01 ± 6.02 vs 11.60 ± 5.17 µV; P = .049), but not of N75 (42.22 ± 4.79 vs 11.08 ± 4.56 µV; P = .27) compared with the controls. Impaired habituation of N75 was more marked and persisted up to fourth block of VEP recoding. Impaired habituation of P100 was significant only in the third block. Baseline N75 and P100 amplitudes were higher in females, and N75 was also higher in those with longer duration of illness. These phenomena did not correlate with visual triggers. Sensitization and impaired habituation were marked during headache. Based on the PRVEP findings, it may be concluded that migraineurs have sensitization of P100 and impaired habituation of N75 especially during headache. These phenomena may be useful for therapeutic monitoring.