Differential Diagnosis Of Migraine Research Articles

Cranial Autonomic Symptoms and Neck Pain in Differential Diagnosis of Migraine

Cranial autonomic symptoms and neck pain have been reported to be highly prevalent in migraine, although they are rarely considered in clinical evaluation. The aim of this review is to focus on the prevalence, pathophysiology, and clinical characteristics of these two symptoms, and their importance in the differential diagnosis between migraines and other headaches. The most common cranial autonomic symptoms are aural fullness, lacrimation, facial/forehead sweating, and conjunctival injection. Migraineurs experiencing cranial autonomic symptoms are more likely to have more severe, frequent, and longer attacks, as well as higher rates of photophobia, phonophobia, osmophobia, and allodynia. Cranial autonomic symptoms occur due to the activation of the trigeminal autonomic reflex, and the differential diagnosis with cluster headaches can be challenging. Neck pain can be part of the migraine prodromal symptoms or act as a trigger for a migraine attack. The prevalence of neck pain correlates with headache frequency and is associated with treatment resistance and greater disability. The convergence between upper cervical and trigeminal nociception via the trigeminal nucleus caudalis is the likely mechanism for neck pain in migraine. The recognition of cranial autonomic symptoms and neck pain as potential migraine features is important because they often contribute to the misdiagnosis of cervicogenic problems, tension-type headache, cluster headache, and rhinosinusitis in migraine patients, delaying appropriate attack and disease management.

Diagnostic value of migraine biomarker — calcitonin-gene-related peptide

Objective — to study the diagnostic significance of the serum level of calcitonin‑gene‑related peptide as a tool for the differential diagnosis of migraine with comorbid neck pain and tension of the pericranial muscles and cervicogenic headache. Methods and subjects. The study included 112 patients (84 women, 28 men) aged from 18 to 58 years. In 77 patients episodic migraine was diagnosed (with a typical aura in 17 and without aura in 60 patients), in 35 patients suffered from cervicalgia with muscle‑tonic syndromes and cervicogenic headache. Among patients with migraine, 42 had concomitant cervicalgia with muscle‑tonic dysfunction. The examined patients were distributed into 3 clinical groups: I — combination of episodic migraine with cervicalgia, II — episodic migraine, III — cervicalgia without migraine. In all patients, pain intensity was assessed using a visual analogue scale, the effect of migraine on daily activity and performance using the MIDAS and HIT‑6 scales, and the Neck Disability Index. The control group for comparing the serum level of CGRP consisted of 30 clinically healthy persons. The serum level of CGRP was determined by enzyme‑linked immunosorbent assay using the sandwich ELISA principle. Results. In the group of patients with a combination of episodic migraine with cervicalgia and cervicogenic headache, compared with the group with isolated migraine, the number of days with headache over the last 3 months was higher (р < 0.001), the influence of headache on daily activity and performance according to the MIDAS scales and HIT‑6 was more significant (both р < 0.001) and the number of combined analgesics used was higher (р < 0.001). Plasma level of CGRP was statistically significantly higher in patients with episodic migraine compared with the group with cervicalgia without migraine (р < 0.05), where it did not differ from the control. The CGRP level was statistically significantly higher in women with migraine compared to men (р < 0.001), but did not differ in patients with migraine with and without aura (р > 0.05). Conclusions. The serum level of calcitonin‑gene‑related peptide is a reliable diagnostic and differential diagnostic laboratory biomarker of episodic migraine. The presence of concomitant cervicalgia in patients with episodic migraine significantly affects the level of CGRP in the blood plasma and the course of the disease (an increase in the number of days with headache, the amount of analgesic use, decreased performance and daily activity).

Neurophysiological methods in the assessment of different forms of migraine

The review considers the efficacy of neurophysiological methods for the study of migraine. According to many authors, such neurophysiological methods as analysis of visual and somatosensory evoked potentials, trigeminal evoked potentials are informative for assessing the functional state of trigeminocervical and sensory systems. Analysis of bioelectric activity of the brain is used for differential diagnosis of migraine and epilepsy, evaluation of various forms and types of migraine. Studies with recording and analysis of laser evoked potentials, as well as the effects of transcranial magnetic stimulation, both diagnostic and non-pharmacological rehabilitation effects on pain syndrome, which increases the efficiency and quality of life in migraine, are considered.

Migraine Aura: Updates in Pathophysiology and Management

To provide an updated review of the pathophysiology, diagnosis, and management of migraine with aura. Thalamic and other subcortical regions may play a role in the pathophysiology of migraine. There is inter-patient and intra-patient attack variability in the characteristics of typical aura especially visual aura symptoms. Migraine with brainstem aura may originate cortically. Migraine with retinal aura may be associated with structural and functional changes in the retina. Although cortical spreading depression (CSD) continues to be the predominant theory surrounding the pathophysiology of migraine with aura, the exact mechanism of action of CSD and its role in relation of all phases of migraine including features of aura are not fully understood. Novel experimental models and newer diagnostic tools including neuroimaging are currently being used to enhance of understanding of migraine with and without aura. Transient ischemia attacks, stroke, and epilepsy should be considered in your differential diagnosis of migraine with aura. There are no specific therapies for migraine with aura.

Hematological parameters in pediatric patients with primary headache

Aim: The present study aimed to evaluate the pain parameters in children with primary headache according to the International Classification of Headache Disorders, 3rd edition, diagnostic criteria and to investigate the role of hematological parameters in diagnosis in case the distinguish is difficult especially in children with migraine and tension headache. Materials and Methods: Medical data belonging age, gender, headache characteristics, hematological parameters of the outpatients with headache consulted in Beþtepe Child Neurology Outpatient Clinic of Dr. Sami Ulus Children's Hospital between July 2017 and August 2019 were examined retrospectively. SPSS statistical software was used to perform statistical data analysis. Results: A total of 243 patients (151 female, 92 male) were included in the study. The mean age was 13.68 ± 2.25 years. One hundred and one (58 female, 43 male) patients were diagnosed with migraine and 142 (93 female, 49 male) with tension type headache. Migraine presented the characteristics of unilateral (61.2%), pulsatile (88.5%) headache of moderate to severe intensity that worsens with physical activity, occurs usually in mornings (%46,5) and is accompanied by nausea or by photophobia and phonophobia (%34,3). Tension-type headache presented the characteristics of circumferential (53,2%), pressing (87.7%) headache of mild severe intensity that is triggered by school stress and accompanied phonophobia (65.2%), and occurs usually in evenings (55.3%). White blood cells, neutrophil, monocyte, monocyte-lymphocyte ratio and neutrophil-lymphocyte ratio were significantly higher in patients with migraine and lymphocyte and platelet counts were significantly higher in patients with tension type headache. Conclusion: In terms of shining a light on the future, consideration of the contribution of hematological parameters to differential diagnosis as a diagnostic support, due to the difficulties associated in particular with the presence of overlapping symptoms in the differential diagnosis of migraine and tension headache in childhood could make a significant difference.

Migraine 'masks': differential diagnosis of acute headache

Differential diagnosis of migraine, can be difficult, especially of migraine with aura. On the one hand, some diseases can produce symptoms similar to migraine (cerebral aneurysm before rupture, reversible cerebral vasoconstriction syndrome). On the other hand, migraine with aura and some other disorders are conditions that have common pathophysiological mechanisms (e.g., CADASIL and MELAS syndrome, antiphospholipid syndrome). Thirdly, clinical presentations of migraine are often difficult to distinguish from features of other headache conditions (migraine with aura - transient ischemic attack, migraine with visual aura - occipital epilepsy). The author discusses the differential diagnosis of acute headache, especially thunderclap headache, and main strategies of effective treatment of migraine attacks.

Recognizing CADASIL: a Secondary Cause of Migraine with Aura.

CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) is an important disease to consider in the differential diagnosis of migraine with aura. This review examines current literature regarding migraine in CADASIL, as well as diagnostic and treatment modalities. Recent studies have shown that smoking is a modifiable risk factor for progression of CADASIL (Chabriat et al. in Stroke 47:4-11, 2015). Specific imaging changes and findings on clinical exam can predict disease progression. However, migraine symptoms often precede MRI changes (Guey et al. in Cephalalgia 36:1038-47, 2015). A recent paper on migraine treatment in CADASIL reevaluates the prevailing belief that vasoconstrictive abortive medications are contraindicated in these patients (Tan and Markus in PLoS ONE 11:e0157613, 2016). CADASIL is an autosomal dominantly inherited vasculopathy causing ischemic pathology in younger individuals due to a mutation in the NOTCH3 gene. The mutation results in impaired arterial contractility due to accumulation of granular osmiophilic extracellular material (GOM) in vascular smooth muscle cells (VSMCs). Clinical manifestations include migraine with and without aura, cognitive decline, ischemic events, and mood disorders. The presenting symptom is often migraine with aura. Characteristic MRI changes are often present. Genetic screening is available to confirm NOTCH3 mutation and pathognomic changes are often seen in skin biopsy. Treatment of migraine is similar to the general population, but with some notable and specific differences. Further studies in CADASIL, other small vessel arteriopathies, and migraine may help us understand more about the pathophysiology of these conditions and help with treatment development.

The usefulness of children’s drawings in the diagnosis of headache (Pediatrics. — 2002. Mar. — 109 (3). — P. 460-472: англ.)

The aim of the work was to determine the information content of the figures in the differential diagnosis of migraine and non-migraine headache in children. The need for such a study is dictated by the fact that young children usually cannot accurately characterize headaches, and this makes it difficult to correctly diagnose.

Migraine chronobiology.

This study was undertaken to determine whether migraine attacks exhibits circadian, menstrual, or seasonal variations in frequency and, thus, to characterize more precisely this relapsing, remittent, pleomorphic disease. An analysis of 3582 well-documented migraine attacks in 1698 adults was undertaken. The demographics of the study population accurately represented the known epidemiology of the disease. Migraine attacks started more frequently between 4 AM and 9 AM and within the first few days after onset of menses; this migraine periodicity is strongest amongst women not using oral contraceptives. Seasonal periodicity, if any, is clearly weaker than circadian or menstrual. These chronobiological features may assist in the differential diagnosis of migraine from premenstrual headache and fibromyalgia.

Diagnosis of Headache in Childhood and Adolescence: A Study in 437 Patients

We investigated whether the criteria for idiopathic headache published by the International Headache Society (IHS) are useful in childhood and adolescence and compared the diagnoses according to this classification with those of Vahlquist. We used a semi-structured questionnaire to examine a total of 437 children and adolescents referred consecutively to a headache outpatient clinic. Twenty-eight of 437 patients were excluded because of symptomatic or unclassifiable headache. Of 409 patients with idiopathic headache, 70.4% had definite migraine or tension-type headache (IHS 1.1, 1.2, 2.1, 2.2), 20.5% had a migrainous disorder (IHS 1.7) and 9.1% had headache of the tension-type not fulfilling the criteria (IHS 2.3). In the differential diagnosis of migraine and tension-type headache the intensity of pain, aggravation of headache by physical activity, nausea and vomiting were the most important features. The quality of pain, photo- and phonophobia were less helpful and location least important. The duration of migraine attacks was less than 2 h in 19.0% of the migraine patients. In general, the diagnostic criteria of migraine were highly specific but less sensitive, and those of tension-type headache highly sensitive but less specific. The agreement between IHS criteria and those of Vahlquist was marked (kappa = 0.57). We conclude that the IHS criteria are useful for classifying headache in children and adolescents referred to a headache outpatient clinic. A forthcoming modification of the IHS criteria should consider a reduction of the minimum duration of migraine attacks from 2 h to 1 h and should try to increase the sensitivity of the criteria for migraine and the specificity of the criteria for tension-type headache.

The influence of acetazolamide on cerebral low-flow regions in migraine--an interictal 99mTc-HMPAO SPECT study.

Acetazolamide, a carbonic anhydrase inhibitor, has proved to be useful in the assessment of "vasodilatory capacity" in cerebrovascular disease. To obtain further information on the nature of interictal low-flow regions in migraine, we reinvestigated 20 asymptomatic patients suffering from migraine with aura (n = 15) or without aura (n = 5) and who had either minor (n = 12) or marked (n = 8) regional hypoperfusion when examined in a previous 99mTc-HMPAO SPECT investigation. These patients received acetazolamide IV prior to tracer application. In 14/20 cases regional hypoperfusion resolved. Three patients with migraine with aura had less pronounced regional hypoperfusion compared to baseline. No change in baseline hypoperfusion was detectable in three older patients. No further decreases in flow were measured. In contrast to patients with cerebrovascular ischemia, in whom acetazolamide usually enhances low-flow regions, vasodilatory capacity appears intact in most migraine patients with interictal regional hypoperfusion. Thus, the "acetazolamide test" might be useful in the differential diagnosis of migraine with aura from transient cerebrovascular ischemia.