International Headache Society Criteria Research Articles

Moyamoya Disease Masquerading as Hemiplegic Migraine in a Child: A Case Report From India

Moyamoya disease (MMD) is a chronic progressive steno-occlusive disease of the intracranial arterial vessels and their branches characterized by puff smoke appearance on angiography. Multifocal neurological insults and deficits are commonly observed in children with MMD. A 7-year-old boy presented with multiple episodes of transient hemiparesis preceded by headache, vomiting, and visual auras was initially labeled as sporadic hemiplegic migraine according to the International Headache Society criteria. However, the rare association of hemiplegic migraine with MMD compelled us to perform magnetic resonance imaging and digital subtraction angiography, which revealed MMD as the underlying cause for the alternating hemiplegia and headaches in the child.

6301109 Diagnostic cohort study comparing the accuracy of PDPH Trial criteria vs International Headache Society criteria for post-epidural PDPH

6301109 Diagnostic cohort study comparing the accuracy of PDPH Trial criteria vs International Headache Society criteria for post-epidural PDPH

EVALUATION OF MIGRAINE AWARENESS AND ITS IMPACT ON STUDENTS OF NISHTAR MEDICAL UNIVERSITY

The cross-sectional study was conducted in Nishtar Medical Hospital from January 2022 to January 2023 to assess the prevalence, impact, and triggers of migraine in medical students. The study included both male and female students from all the years. The data was collected using a questionnaire containing questions regarding demographics, knowledge about migraine, character of pain, triggers, and accompanying factors. The questionnaire was standardised according to Migraine Disability Assessment Score (MIDAS) and International Headache Society (IHS) criteria. A total of 500 students were invited, of whom 470 (94%) completed the survey. The prevalence of migraine was 25.9% (122/470), and 50% (61/122) had more than five episodes in the last three months. Over one-third, 36% (44/122) of participants experienced severe pain. Moreover, 41% (50/122) sought medical advice, and 19.6% (24/122) were hospitalised. The most common symptoms experienced during an episode were unilateral headache (81.9%), pulsating headache (65.5%), photophobia (60%), and phonophobia (55.7%). The most common triggers were sleep deprivation (73.7%), stress (57.3%), loud sounds (55.7%), hunger (53.2%), and fatigue (51.6%). Of 122, 77 (63.1%) participants reported moderate to severe disability due to migraine attacks. It is concluded that migraine is prevalent among medical students and hurt the well-being and productivity of the students.

Long-term headache after spontaneous intracerebral haemorrhage.

Though headache is commonly observed after stroke and may affect survivors' quality of life, it has rarely been studied after spontaneous intracerebral haemorrhage (ICH). In a cohort of ICH survivors, we assessed the long-term prevalence and determinants of headache. We screened consecutive ICH survivors enrolled in the prospective, single-centre Prognosis of Intracerebral Haemorrhage study for headache 1, 3, and 6 years after ICH, according to the International Headache Society's criteria. Depressive and anxiety symptoms severity was measured at 1-year follow-up. Variables associated with the presence of headache 1 year after ICH were analyzed using univariate and multivariable models. Among the 146 patients included in this study, 31 (21%), 25 (19%), and 14 (20%) patients reported headache at 1-, 3-, and 6-year follow-up, respectively. In an age-adjusted model, patients with headache at ICH onset (adjusted odds ratio [aOR] 2.75; 95% CI 1.02-7.42) and previous history of headache (aOR 4.60; 95% CI 1.74-12.1) were associated with headache at 1-year follow-up. Patients with headache were more likely to report depressive and anxiety symptoms at 1-year follow-up (both p < 0.02). One in five ICH survivors suffered from headache and patients who reported headache at ICH onset were especially at risk.

Ophthalmic Manifestations of Migraine in a Nigerian Tertiary Health Facility.

Migraine is a group of headache syndromes, with a prevalence of 5%-25%. Migraine is a complex recurrent headache disorder, often unilateral, throbbing or pulsating in nature aggravated by physical activity, bright light, and loud noises. Symptoms associated with migraine without aura are nausea, anorexia, and varying degrees of ophthalmic problems ranging from visual aura, ocular symptoms, and ophthalmoplegia. The study determined the pattern and ophthalmic manifestations of migraine in Aminu Kano Teaching Hospital, Kano, Nigeria. This was an observational cross-sectional study. Ethical clearance was obtained from the research ethical committee of Aminu Kano Teaching Hospital (AKTH). A total of 254 patients diagnosed with migraine using international headache society criteria attending neurology clinic in AKTH were interviewed and examined using a structured questionnaire which captured the biodata, pattern of migraine and ocular symptoms associated with migraine. The data obtained were collated and analysed using Statistical Package for the Social Sciences, version 23. Of the 254 patients examined, there were 95 (37.4%) males and 159 (62.6%) females, (M:F = 1:2) with mean age of 28.9 ± 9.7 years. Migraine without aura was the commonest type seen in 55.8% of patients. Most patients had unilateral headaches. About 52.8% and 57.5% had headaches that were throbbing in nature. The headache lasted for 72 h in 48.2% and 48 h in 30.3%. It was triggered by physical stress in 49.6% and lack of sleep in 46.5%. The commonest associated symptom was nausea in 44.9%, tinnitus in 39.0%, and vomiting in 29.1%. While the commonest ocular/visual symptom was photophobia in 76% of patients. Most of the patients had family history of migraine (62.8%). Migraine without aura (MWOA) was found to be significantly associated with female gender (P = 0.001; OR = 2.48; 95% CI: 1.45-4.25). Scotoma, fortifying spectra were significantly associated with migraine with aura (MWA; P = 0.0004; OR = 28.46; 95% CI: 11.53-70.35). Migraine is one of the most common types of primary headache. There is a female preponderance. Migraine has significant association with visual disturbances and ocular symptoms.

Vasomotor reactivity measurement using Breath Holding Index to objectively diagnose migraine in Indonesia

Objective. Migraine is currently diagnosed using the subjective fulfilment of the International Headache Society (IHS) criteria. Considering the pathophysiology of endothelial dysfunction in migraine, this study aimed to utilize the breath holding index (BHI) to diagnose migraine objectively by assessing the vasodilatation response of intracranial arteries in migraine without aura. Material and method. 128 subjects with primary headache in the interictal phase were cross-sectional recruited and classified into migraine and non-migraine groups. BHI was performed using transcranial Doppler examination. Confirmed migraine was diagnosed using the validated IHS-equivalent Indonesian Migraine Screen Questionnaire (MS-Q) score of ≥4, BHI of &lt;0.69, and one-month clinical response to topiramate and/or indomethacin administration based on the nature of their headache. Result. This study enrolled 104 and 24 subjects with migraine and non-migraine headache, respectively. The sociodemographic profile was similar between groups. Reduced ipsilateral BHI was more observed in the migraine than the non-migraine group (0.70 vs 1.53, p&lt;0.001), with sensitivity of 49 (39-59) % and specificity of 92 (81-100) % using the established cut off value of 0.69. Conclusion. The breath holding index is a highly specific, moderately sensitive and objective tool to diagnose migraine. Measurement of vasoconstrictive response may be considered to further increase the sensitivity of this objective diagnostic tool.

Acil Serviste Sekonder Tip Baş Ağrı Tanılı Hastalarda Ağrı Karakteri ile Radyolojik Görüntüleme Bulgularının Karşılaştırılmalı Olarak Değerlendirilmesi; Prospektif Analiz

Objective: Secondary type headache is observed at a rate of 4-5% in the emergency department. In this prospecitve study, it was aimed to evaluate the results of patients with secondary headache, such as consultation, hospitalization, and discharge decision in correlation with radiological imaging findings.&#x0D; &#x0D; Material and Methods: This is a single-center, prospective and methodological study. According to International Headache Society criteria, sociodemographic characteristics, emergency department examination findings of a total of 200 patients with secondary headache were recorded.&#x0D; &#x0D; Results: Fifty percent of the patients had throbbing pain, 29.5% had constrictive pain, and the rate of pathological findings on CT was significantly higher in patients with squeezing pain (p=0.019). The hospitalization rate was significantly higher in the patients for whom consultation was requested, and 69.0% of the patients who were admitted to the hospital had constrictive pain (p

Epidemiology of Migraines in Iraqi Females: Emphasis on Dietary Influence.

Introduction Migraine is a neurological condition that frequently results in a severe headache. The headache comes in episodes and is occasionally accompanied by nausea, vomiting, and sensitivity to light. Migraines can be caused by a variety of conditions and can last anywhere from three to four hours to several days, with females experiencing them three times more frequently than men. Studies have found some evidence that lifestyle variables, such as nutrition, may play an important role in the emergence of migraines. The purpose of this research is to determine the epidemiology of migraine among females with an emphasis on the relationship between headaches and the dietary habits of females who are enduring migraine attacks in Iraq. Methods This study is descriptive research employing a quantitative method, specifically a survey. The data collection process involved a three-section online survey disseminated to females through internet platforms, including WhatsApp, Viber, Facebook, and Instagram. In this research, 360 females from Sulaymaniyah, Iraq, aged 18 to 35, participated. The survey's primary questions centered on the characteristics of the female respondents, drawing from the International Headache Society (IHS) criteria for migraine diagnosis. Participants meeting the migraine diagnostic criteria were also asked a few questions about aura symptoms. The Migraine Disability Assessment (MIDAS) questionnaire was incorporated, accompanied by inquiries about headache treatment, headache-related signs and symptoms, headache triggers, factors that relieve headaches, sleep routines, dietary consumption, and the impact of each factor on migraines. Results Of the 360 females who participated in the study, 159 (44.2%) experienced migraines, while 201 (55.8%) did not. The dietary habits of females who experienced migraines showed a statistically significant relationship to the duration of their headaches, specifically those lasting from 4 to 72 hours. This relationship was particularly evident in relation to nuts (p-value= 0.000), hot/spicy foods (p-value= 0.000), tomatoes (p-value= 0.005), bananas (p-value=0.01), aspartame (p-value=0.012), beverages containing caffeine (p-value=0.000), and citrusy fruits (p-value=0.008). These findings are based on p-values less than the commonly accepted alpha of 0.05. To maintain good health, it's essential to adhere to healthy eating habits and proper nutritional guidelines. Further research is necessary to identify additional dietary triggers for migraines. Enhancing data collection methods, such as using face-to-face interviews, could improve the quality of future research. Conclusion This study determined the prevalence of migraines among a sample of females in Sulaymaniyah, Iraq, and identified various foods consumed in excess by females without considering their potential impact on migraines.

Trigger Factors of Migraine in Patients Attending Headache and Neurology Outpatient Clinics at Ain Shams University Hospitals

Abstract Background Migraine is the second most common cause of headache, affecting approximately 15% of women and 6% of men. Also, it is one of the most ten disabling diseases in the world. Objectives To determine the triggers of migraine headache in migraine patients attending Headache clinic at Ain Shams university hospitals. Methods A descriptive study was carried out among 292 migraine subjects from different parts of Cairo governorate from December 2019 to March 2020. Case definition of migraine was based on the International Headache Society (IHS) criteria. Results Females constituted 85.6% of the study sample. The majority of the sample (71.3%) aged 18-39 years. Psychological problems as: stress and family problems were the commonest triggers (89%), followed by fatigue (86.3%), too little sleep (staying up late) (82.2%), loud noises (77.7%), hunger, fasting and missing meals (75.3%), bright lights or and sun exposure (75%), and in relation to females menstruation (61.9%), hot weather (61.3%), too much sleep (46.9%), odors (46.2%). The least triggers were physical exercise, caffeinated drinks, smoking, chocolate and dairy products, and ice-cream were 28.8%, 26%, 24.7%, 23.3%, 16.1% respectively. Forty percent of the study population had positive family history of migraine, 30.1% of them reported major stresses (moving of residence, marriage, or death of a close relative) in the last year. Conclusion Stress, anxiety, family problems, fatigue, too little sleep, and loud noises were the commonest triggers of migraine headache. Family history was present in 41.1% of migraine patients.

Can Serum Magnesium Level and Visual Evoked Potentials (P100) be a Predictive in Migraineurs?: Evidence Based Study.

Few dating back, the role of visual evoked potentials changes and reduced level of intracellular magnesium have appeared in migraine patients both throughout the attacks and in the interictal periods. Moreover, there is a lack of evidence regarding the correlation between magnesium levels and visual evoked potentials. To assess the changes in the levels of magnesium in migraineurs compared to a healthy control group is our prime intention. Also, to correlate serum magnesium levels with visual evoked potentials changes within the migraineurs is a secondary part of the study. After applying inclusion and exclusion criteria as per the study protocol, in total, 80 subjects were enrolled in the study. Of which 40 were migraineurs diagnosed as per the International Headache Society criteria for severe migraine headache. Rest of 40 was nonmigraineurs served as a control group of the study. All included patient was submitted to demographic profile, previous history of the disease and drug intake, thorough clinical investigation and baseline laboratory parameters. Apart from this, the measurement of visual evoked potentials changes (4th block) and magnesium levels were done as per our standard operating procedures. In migraineurs, serum total Mg level was considerably lower compared to the control group (1.79 ± 0.14 mg/dl versus 2.10 ± 0.17 mg/dl, P < 0.0001) and amplitude of P100 (P < 0.0001) was negatively correlated to reduced serum Mg level (P < 0.0001). As expected, both elevated visual evoked potential amplitude and reduced level of brain magnesium can be a demonstration of neuronal hyperexcitability of the optic pathways associated with a dropped threshold for migraine attacks.

BOTULINUM TOXIN FOR TREATMENT OF MIGRAINE HEADACHES – A STUDY FROM TERTIARY EYE CARE CENTRE

Background - Migraine is one of the common causes of recurrent headaches. Botulinum toxin type A (Botox®) is a neurotoxin produced by Clostridium botulinum that paralyzes nerves. The purpose of this study was to evaluate the efficacy of pericranial Botox® administration in migraine headache in patients attending a tertiary eye care centre. Method - A prospective,non-randomized study consisting of 54 patients was performed.Subjects were candidates who either sought Botox® treatment for hyperfunctional facial lines with concomitant headache or candidates for Botox® treatment specifically for headaches. Headaches were classified based on International Headache Society criteria. Botox® was injected into the glabellar,temporal,frontal,and/or suboccipital regions of the head and neck.Patients were treated every three months,with a maximum of three sessions.Botox dosage ranged from 75 - 155 Units per patient.Main outcome measures were relief from migraine headache symptoms, reduction of headache severity and duration of symptom free period. Results - Age ranged from 18 to 65 (mean 34.6±6.5) years. Among 54 subjects treated prophylactically,complete response (symptom elimination) was noted in 31 (57.40%) with a mean {Standard deviation – (SD)} response duration of 4.3 (2.4) months; 16 (29.62%) reported partial response (≥50% reduction in headache frequency or severity) with a mean (SD) response duration of 2.5 (1.7) months. 7 (12.96%) reported no response. No systemic adverse effects were reported.Conclusion - Botox® is found to be a safe and effective therapy for prophylactic treatment of migraine.

Migraine awareness, prevalence, triggers, and impact on university students: a cross-sectional study

BackgroundMigraine is a public health concern, and university students have been found to be particularly susceptible to stress and other factors that trigger migraines. The objective of this study was to determine the prevalence, awareness, and impact of migraine on University of Sharjah students.A cross-sectional study was conducted using a self-administered questionnaire. The diagnosis of migraine was made according to the International Headache Society (IHS) criteria and the impact on life was calculated through the Migraine Disability Assessment (MIDAS) score.ResultsThe overall migraine prevalence was 26.35% with 25.3% of migraineurs were unaware of having migraine. The most common reported symptoms during a migraine headache attack were one side headache (82.7%) and pulsating headache (66%). Sleep deprivation (74.7%), stress (58%), and hunger or skipping meals (57.3%), were the most common triggering factors. Almost 60% of the migraineurs had a disability ranging from moderate to severe and hospital admission was needed by 30%.ConclusionsThe prevalence of migraine was high among university students, wherein some students might be unaware of having migraines. Migraine has a deleterious impact on students’ productivity and wellbeing. Well-designed interventions such as screening programs might be needed to help in proper diagnosis and management of migraine attacks as well as special educational programs to raise awareness about migraine.

Clinical Diagnosis and Magnetic Resonance Imaging in Patients With Transient and Minor Neurological Symptoms: A Prospective Cohort Study.

Background:The utility of magnetic resonance imaging (MRI) brain in patients with transient or minor neurological symptoms is uncertain. We sought to determine the proportion of participants with transient or minor neurological symptoms who had MRI evidence of acute ischemia at different clinical probabilities of transient ischemic attack (TIA) or minor stroke.Methods:Cohort of participants with transient or minor neurological symptoms from emergency and outpatient settings. Clinicians at different levels of training gave each participant a diagnostic probability (probable when TIA/stroke was the most likely differential diagnosis; possible when TIA/stroke was not the most likely differential diagnosis; or uncertain when diagnostic probability could not be given) before 1.5 or 3T brain MRI ≤5 days from onset. Post hoc, each clinical syndrome was defined blind to MRI findings as National Institute of Neurological Disorders and Stroke criteria TIA/stroke; International Headache Society criteria migraine aura; non-TIA focal symptoms; or nonfocal symptoms. MRI evidence of acute ischemia was defined by 2 reads of MRI. Stroke was ascertained for at least 90 days and up to 18 months after recruitment.Results:Two hundred seventy-two participated (47% female, mean age 60, SD 14), 58% with MRI ≤2 days of onset. Most (92%) reported focal symptoms. MR evidence of acute ischemia was found, for stroke/TIA clinical probabilities of probable 23 out of 75 (31% [95% CI, 21%–42%]); possible 26 out of 151 (17% [12%–24%]); and uncertain 9 out of 43, (20% [10%–36%]). MRI evidence of acute ischemia was found in National Institute of Neurological Disorders and Stroke criteria TIA/stroke 40 out of 95 (42% [32%–53%]); migraine aura 4 out of 38 (11% [3%–25%]); non-TIA focal symptoms 16 out of 99 (16% [10%–25%]); and no focal features 1 out of 29 (3% [0%–18%]). After MRI, a further 14 (5% [95% CI, 3–8]) would be treated with an antiplatelet drug compared with treatment plan before MRI. By 18 months, a new ischemic stroke occurred in 9 out of 61 (18%) patients with MRI evidence of acute ischemia and 2 out of 211 (1%) without (age-adjusted hazard ratio, 13 [95% CI, 3–62]; P<0.0001).Conclusions:MRI evidence of acute brain ischemia was found in about 1 in 6 transient or minor neurological symptoms patients with a nonstroke/TIA initial diagnosis or uncertain diagnosis. Methods to determine the clinical and cost-effectiveness of MRI are needed in this population.

Reproduction and resolution of familiar head pain with upper cervical spine sustained joint mobilization may help identify cervicogenic headaches: a case–control study

ABSTRACT Background The relative value of clinical tests toward identifying cervicogenic headache (CGH) remains under investigated. Whilst certain physical examination findings have been associated with CGH, consensus on which findings provide the strongest association remains elusive. Objectives To determine which cervical musculoskeletal assessment procedures used in CGH are positively associated with CGH. Design Single blind observational study Methods Four selected musculoskeletal assessment procedures of the cervical spine, craniocervical flexion test, cervical flexion-rotation test, cervical retraction range of motion and reproduction and resolution of familiar head pain with upper cervical spine sustained joint mobilization, were applied to 20 headache and 20 controls. Inclusion criteria for the headache group met the International Headache Society criteria for CGH except positive diagnostic blocks. Results Upper cervical spine sustained joint mobilization testing associated with reproduction and resolution of familiar head pain was strongly associated with CGH (Odds Ratio = 36, p < 0.01). This was 78% sensitive and 90% specific in identifying CGH. Other physical tests were not statistically associated with CGH. Conclusions Reproduction and resolution of familiar head pain with upper cervical spine sustained joint mobilization is effective in differentiating those with CGH from control participants. Other cervical measures did not clearly identify CGH in this study.

Lasmiditan for single migraine attack in Japanese patients with cardiovascular risk factors: subgroup analysis of a phase 2 randomized placebo-controlled trial

ABSTRACT Background Some migraine treatments are contraindicated for patients with cardiovascular disease (CVD) or risk factors (CVRFs). We report safety and efficacy of lasmiditan, a new oral acute migraine treatment with no cardiovascular contraindication, in Japanese patients with CVRFs. Research design and methods MONONOFU was a multicenter, randomized, double-blind, placebo-controlled, phase 2 study of Japanese patients with migraine (met International Headache Society criteria, Migraine Disability Assessment score ≥11, disabling migraine for ≥1 year). Eligible patients were randomized (7:3:7:6) to placebo or lasmiditan 50, 100, 200 mg. This prespecified analysis described CVDs, CVRFs, and cardiovascular treatment-emergent adverse events (TEAEs). Efficacy (proportion pain-free, experienced pain relief, most bothersome symptom-free, or disability-free 2 hours post-dose) was evaluated within CVRF subgroups (≤1, ≥2). Results Of 846 randomized patients, 691 were analyzed (CVRF≤1: 375; CVRF≥2: 316). The proportion of lasmiditan-treated patients with ≥1 TEAE was not related to CVRF numbers. Eighteen (3.8%) lasmiditan-treated and three (1.4%) placebo-treated patients reported likely cardiovascular TEAEs. Lasmiditan was more effective than placebo at relieving pain, symptoms, and disability in both CVRF subgroups. There was no consistent relationship between CVRF subgroups and efficacy. Conclusions Lasmiditan was well tolerated and effective in Japanese patients with migraine and CVRFs. Trial registration ClinicalTrials.gov: NCT03962738.

The preventive effect of the combination of atorvastatin and nortriptyline in migraine-type headache: a randomized, triple-blind, placebo-controlled trial

ABSTRACT Background and purpose Migraine ranked as the eighth cause of disability worldwide. Statins with anti-inflammatory and vasodilatory endothelial effects have been introduced as an option for the prevention of migraine-type headaches. The current study aimed to assess the efficacy and tolerability of atorvastatin for the prevention of migraine in adults. Method This prospective, triple-blind, randomized controlled clinical trial was performed in adult migraineurs from mid-July 2019 to late-April 2020. Patients were randomly assigned to receive atorvastatin or placebo in combination with nortriptyline for 24-weeks. The frequency of headache was the primary outcome, and intensity of the headache and quality of life (QOL) were the secondary outcomes for this study. Results With 34 patients in each arm, 68 patients with migraines based on the International Headache Society (IHS) criteria were enrolled in the study. At week 24, patients in the atorvastatin group experienced significantly fewer migraine attacks than the placebo group (P-value = 0.004). Moreover, there were significant differences between the two groups in QOL at follow-up intervals of 14 (P-value = 0.001) and 24 (P-value < 0.001) weeks. However, no significant difference was observed in the intensity of headache was observed in both groups (P-value > 0.05). The most common adverse effects in intervention and control groups were constipation and insomnia, respectively. Conclusion In patients with migraine, prophylaxis with atorvastatin significantly improved the frequency of headache and QOL over 24 weeks compared with placebo with no effect on the intensity of headache. Statins seem to be a potential promising drug for prophylaxis of migraine headaches.

A Comparative Study on the Efficacy of Coenzyme Q10 and Amitriptyline in the Prophylactic Treatment of Migraine Headaches in Children: A Randomized Controlled Trial.

Background:Migraine, one of the most common headaches in children, has a significant impact on children and their family's quality of life (QoL). There are two approaches for controlling migraine headaches preventative and controlling acute attacks. Several drugs have been used for this purpose, and tricyclic antidepressants were at the top. Amitriptyline has shown not only a desirable effect on controlling the headaches but also some adverse side effects. Recently, finding effective drugs with fewer side effects, become more critical. Among them, nutraceuticals were one of the promising ones.Materials and Methods:In this randomized clinical trial on 72 patients aged 5–15 years old with diagnosis of migraine based on the International Headache Society criteria, we compare the effectiveness of coenzyme Qten on frequency, duration, and severity of childhood migraine. For comparing the QoL, we used the International PedMIDAS questionnaire.Results:Coenzyme Qten showed good therapeutic effects in children, especially in long-term use; however, amitriptyline showed more rapid response. After 3 months of treatment, clinical outcomes in the two groups did not significantly differ from each other. Similarly, Children's QoL increased in the same way. There are more reported side effects in children using amitriptyline compared to coenzyme Qten.Conclusions:According to results, Co-enzyme Q10, with fewer side effects and comparable therapeutic effects, especially in the long term, could be a good drug for prophylactic treatment of migraine headaches.

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BACKGROUNDBipolar disorder is an episodic psychiatric illness characterized by episodes of mania and hypomania. Presentation of bipolar disorder differs in women as compared to men, due to frequent occurrence of comorbidities like migraine, thyroid disorders, polycystic ovarian syndrome, etc. Migraine is one of the most disabling primary headaches and is more commonly seen in women with bipolar disorder. Women with migraine also tend to have more frequent mood episodes and greater psychosocial impairment. There are limited studies conducted on migraine and bipolar disorder in women in India.AIMS AND OBJECTIVESTo determine the co-occurrence of Migraine in women with Bipolar Affective DisorderMETHODOLOGYWomen with Bipolar Affective Disorder, who visited the Psychiatry Out Patient Department of a Tertiary Care Hospital in South India, were evaluated for the presence of migraine headache using the International Headache Society criteria for diagnosis.RESULTSOut of 80 subjects, 40% (N = 32) women with Bipolar Affective Disorder (BPAD) were also suffering from Migraine. 38.2% (N = 13) women with Type 1 BPAD had migraine; while 61.7% (N = 21) women with Type 2 BPAD had migraine.CONCLUSIONMigraine is a frequent complaint in women with bipolar disorder. It was more commonly seen in women with BPAD type 2. As the presence of migraine affects course and treatment response in women with bipolar disorder, it emphasizes on the importance of detailed evaluation and further research in the area.

Body Mass Index and Migraine: A Hospital-Based Study in Lahore

Background: Obesity and migraine are the most common disorders among general population that are linked with disability and impaired life quality. Though, several studies have investigated the relationship between obesity and migraine but yet there is no complete knowledge regarding association between BMI and migraine, particularly chronic migraine. Objective: The objective of the study was to find the association between body mass index and migraine. Material and Methods: It was a prospective study carried out at Neurology Outpatient Department of Lahore General Hospital, Lahore. Total of 545 patients with major complaint of headache were included after fulfilling “episodic migraine” (n=370) and “chronic migraine” (n=175) criteria according to International Headache Society (IHS) criteria. Results: Among 370 patients with episodic migraine (EM), 78.4% were females while among 175 patients with chronic migraine (CM), 81.1% were females. In EM group, the mean age of the patients was 41.72+21.35 years and in CM group, it was 45.80+15.79 years. In EM group, mean pain intensity was 4.6+2.41 and in CM group, mean pain intensity was 4.3+2.51. Among EM group patients, mean duration of headache was 4.85+5.17 days and among CM group patients, mean duration was 20.88+8.86 days. Mean BMI (Body Mass Index) of patients in EM groups was 22.91+3.89 while in CM groups was 24.43+3.43 (P=0.002). In EM group, 9.7% patients and in CM group, 6.3% patients were underweight (P=0.189). In EM group, 11.4% patients and in CM group, 30.3% patients were overweight (P=0.002). However, in EM group, only 1.3% patients and in CM group, 3.4% patients were obese (P=0.087). Multiple logistic regression analysis of chronic migraine group showed significant results (P &lt;0.05) regarding headache days/month, BMI, overweight and obese. Conclusion: Study concluded that overweight and obesity were associated factors for migraine. Chronic migraine patients were more likely to have elevated BMI than the episodic migraine patients. Keywords: Body mass index, migraine, obesity, chronic, headache

Plasma Lipolysis and Changes in Plasma and Cerebrospinal Fluid Signaling Lipids Reveal Abnormal Lipid Metabolism in Chronic Migraine.

BackgroundLipids are a primary storage form of energy and the source of inflammatory and pain signaling molecules, yet knowledge of their importance in chronic migraine (CM) pathology is incomplete. We aim to determine if plasma and cerebrospinal fluid (CSF) lipid metabolism are associated with CM pathology.MethodsWe obtained plasma and CSF from healthy controls (CT, n = 10) or CM subjects (n = 15) diagnosed using the International Headache Society criteria. We measured unesterified fatty acid (UFA) and esterified fatty acids (EFAs) using gas chromatography-mass spectrometry. Glycerophospholipids (GP) and sphingolipid (SP) levels were determined using LC-MS/MS, and phospholipase A2 (PLA2) activity was determined using fluorescent substrates.ResultsUnesterified fatty acid levels were significantly higher in CM plasma but not in CSF. Unesterified levels of five saturated fatty acids (SAFAs), eight monounsaturated fatty acids (MUFAs), five ω-3 polyunsaturated fatty acids (PUFAs), and five ω-6 PUFAs are higher in CM plasma. Esterified levels of three SAFAs, eight MUFAs, five ω-3 PUFAs, and three ω-6 PUFAs, are higher in CM plasma. The ratios C20:4n-6/homo-γ-C20:3n-6 representative of delta-5-desaturases (D5D) and the elongase ratio are lower in esterified and unesterified CM plasma, respectively. In the CSF, the esterified D5D index is lower in CM. While PLA2 activity was similar, the plasma UFA to EFA ratio is higher in CM. Of all plasma GP/SPs detected, only ceramide levels are lower (p = 0.0003) in CM (0.26 ± 0.07%) compared to CT (0.48 ± 0.06%). The GP/SP proportion of platelet-activating factor (PAF) is significantly lower in CM CSF.ConclusionsPlasma and CSF lipid changes are consistent with abnormal lipid metabolism in CM. Since plasma UFAs correspond to diet or adipose tissue levels, higher plasma fatty acids and UFA/EFA ratios suggest enhanced adipose lipolysis in CM. Differences in plasma and CSF desaturases and elongases suggest altered lipid metabolism in CM. A lower plasma ceramide level suggests reduced de novo synthesis or reduced sphingomyelin hydrolysis. Changes in CSF PAF suggest differences in brain lipid signaling pathways in CM. Together, this pilot study shows lipid metabolic abnormality in CM corresponding to altered energy homeostasis. We propose that controlling plasma lipolysis, desaturases, elongases, and lipid signaling pathways may relieve CM symptoms.