Migraine Group Research Articles

Syncope in Migraine: A Genome-Wide Association Study Revealing Distinct Genetic Susceptibility Variants Across Subtypes.

Syncope is characterized by the temporary loss of consciousness and is commonly associated with migraine. However, the genetic factors that contribute to this association are not well understood. This study investigated the specific genetic loci that make patients with migraine more susceptible to syncope as well as the genetic factors contributing to syncope and migraine comorbidity in a Han Chinese population in Taiwan. A genome-wide association study was applied to 1,724 patients with migraine who visited a tertiary hospital in Taiwan. The patients were genotyped using the Affymetrix Axiom Genome-Wide TWB 2.0 array and categorized into the following subgroups based on migraine type: episodic migraine, chronic migraine, migraine with aura, and migraine without aura. Multivariate regression analyses were used to assess the relationships between specific single-nucleotide polymorphisms (SNPs) and the clinical characteristics in patients with syncope and migraine comorbidity. In patients with migraine, SNPs were observed to be associated with syncope. In particular, the rs797384 SNP located in the intron region of LOC102724945 was associated with syncope in all patients with migraine. Additionally, four SNPs associated with syncope susceptibility were detected in the nonmigraine control group, and these SNPs differed from those in the migraine group, suggesting distinct underlying mechanisms. Furthermore, the rs797384 variant in the intron region of LOC102724945 was associated with the score on the Beck Depression Inventory. The novel genetic loci identified in this study will improve our understanding of the genetic basis of syncope and migraine comorbidity.

Visibility and annoyance of the phantom array effect varies with age and history of migraine

The phantom array effect (PAE) is a series of repeated images that may be perceived when a person moves their eyes in large saccades across a light source (or a specular reflection of that light source) that is modulating in output over time. Fifty-five people, including a group of 25 who experience migraine, evaluated the visibility and annoyingness of phantom arrays produced by 85 unique temporal light modulation waveforms (including sine, rectangular, complex and DC waveforms) generated using an LED placed against a black background. Those with migraine exhibited higher average visibility compared to those without migraine ( p = 0.019) and were relatively more sensitive at higher frequencies ( p < 0.001). Younger participants also found more stimuli to be visible ( p < 0.001). The threshold sensitivity function was similar to that developed for the phantom array visibility measure (PAVM), and PAVM was effective in predicting visibility ( R2 = 0.87 for the relevant region of PAVM < 3). While those in the migraine group did not report seeing the PAE more often in everyday life at a statistically significant level, they reported being more annoyed by it and having more unwanted physiological responses (headaches, eye fatigue and distraction/disorientation). Members of the migraine group were also more likely to have changed their behaviour in architectural spaces (such as leaving a restaurant with ‘flickering’ lights). In the four hours after completing the experiment, 64% of the migraine group (vs. 19% of the non-migraine group) reported experiencing discomfort or an adverse reaction. In particular, 41% reported experiencing a headache (vs. 8% for those in the non-migraine group).

Association Between Migraine and Open-Angle Glaucoma: A Twelve-Year Nationwide Retrospective Korean Cohort Study.

Previous studies have reported that migraine headaches may be one of the possible risk factors for open-angle glaucoma (OAG); however, a consensus has not been reached regarding the association between OAG and migraine. In this study, we examined the risk of developing OAG in migraine patients using a 12-year nationwide cohort. In this study, data from the Korean National Health Insurance Service-National Sample Cohort database from 2002 to 2015 was used to perform a retrospective cohort study. The study included 1,103,302 subjects, out of which 41,148 were diagnosed with migraine during 2003-2008 and were categorized as the migraine group, while 205,741 patients were selected as controls through propensity score matching at a 1:5 ratio. Subjects with migraine or OAG was ascertained based on KCD code. Multivariate Cox regression analysis was used to evaluate the hazard rate of OAG onset in the migraine group, and subgroup analysis was performed to identify any differences based on sex and age. Multivariate Cox regression analysis showed that the incidence of OAG was significantly greater among patients with migraine than among patients in the comparison group (hazard ratio [HR] 1.238; 95% confidence interval [CI] 1.160-1.132, P < 0.001). Moreover, the risk of developing OAG compared to subjects without migraine did not differ according to the presence of an aura (migraine with aura: HR 1.235; 95% CI 1.137-1.342, P < 0.001; migraine without aura: HR 1.248; 95% CI 1.143-1.363, P < 0.001). In subgroup analyses, the patients with migraine under 40-year-old were found to have a greater hazard rate (HR 1.576, 95% CI: 1.268-1.957) of developing OAG in contrast with patients with migraine and over 40-year-old (HR 1.167, 95%CI: 1.089-1.250) when compared to the corresponding non-migraine patients. This study showed that migraine is a significant risk factor for OAG onset in Korean population, and the presence of aura did not affect the hazard rate of OAG development. Patients with migraine showed significantly increased risk of developing OAG in Korean population, without significant differences according to the presence of aura. Our results suggest presence of migraine as a possible risk factor for OAG.

Pediatric migraine is characterized by traits of ecological and metabolic dysbiosis and inflammation.

Recently, there has been increasing interest in the possible role of the gut microbiota (GM) in the onset of migraine. Our aim was to verify whether bacterial populations associated with intestinal dysbiosis are found in pediatric patients with migraine. We looked for which metabolic pathways, these bacteria were involved and whether they might be associated with gut inflammation and increased intestinal permeability. Patients aged between 6 and 17years were recruited. The GM profiling was performed by the 16S rRNA metataxonomics of faecal samples from 98 patients with migraine and 98 healthy subjects. Alpha and beta diversity analyses and multivariate and univariate analyses were applied to compare the gut microbiota profiles between the two group. To predict functional metabolic pathways, we used phylogenetic analysis of communities. The level of indican in urine was analyzed to investigate the presence of metabolic dysbiosis. To assess gut inflammation, increased intestinal permeability and the mucosal immune activation, we measured the plasmatic levels of lipopolysaccharide, occludin and IgA, respectively. The α-diversity analysis revealed a significant increase of bacterial richness in the migraine group. The β-diversity analysis showed significant differences between the two groups indicating gut dysbiosis in patients with migraine. Thirty-seven metabolic pathways were increased in the migraine group, which includes changes in tryptophan and phenylalanine metabolism. The presence of metabolic dysbiosis was confirmed by the increased level of indican in urine. Increased levels of plasmatic occludin and IgA indicated the presence of intestinal permeability and mucosal immune activation. The plasmatic LPS levels showed a low intestinal inflammation in patients with migraine. Pediatric patients with migraine present GM profiles different from healthy subjects, associated with metabolic pathways important in migraine.

Analysis of the center of pressure variables in women with migraine does not reflect differences in balance: A cross-sectional study

IntroductionMigraine is a neurological disease that affects proportionally more women. It has been documented that migraineurs often experience balance disturbances. ObjectiveTo evaluate the balance between migraineur patients (MG) and healthy volunteers classified as control group (CG). MethodA cross-sectional study. Seventy-four women were evaluated: 37 MG and 37 CG. The evaluation of the center of pressure (COP) variables was carried out using a balance platform in three postures, bipodal eyes closed (BEC), right monopodal with eyes open (RMEO), and left monopodal with eyes open (LMEO). Self-report questionnaires (dizziness handicap inventory (DHI), fall risk efficacy scale (FES I), the functional impact scale (HIT 6) and the timed up and go test (TUG test) were used. The U-Mann Whitney test was used to verify differences in the COP between MG and CG. The Kruskal-Wallis one-way ANOVA was used to analyze the differences between migraine groups (MGs) with postures, self-report questionnaires, and TUG test. A p < 0.05 was considered statistically significant. ResultsNo statistically significant changes were found in the balance variables, except the medial-lateral excursion variable in the BEC (p < 0.02) and LMEO (p = 0.04) postures. No significant differences were found between the MGs with HIT 6 (p = 0.48) or FES I (p = 0.49). Significant differences were found between the MGs with DHI (p = 0.003). The TUG test showed statistically significant changes between groups (p < 0.01). ConclusionThe women with migraine in this sample did not show differences in postural balance, however, dizziness and functional differences are shown compared to healthy women.

Aura and osmophobia are associated with the IL1A -889C > T (rs1800587) variant in migraine.

Migraine belongs to the group of primary headaches, affecting 14.4% of the global population. The pathophysiological mechanisms of migraine involve the interplay between hypothalamic activation, cortical spreading depression, trigeminal stimulation, and inflammatory components with neurogenic inflammation or neuroinflammation. To assess the frequency of the IL1A -899C > T (rs1800587) genetic variant in patients with migraine and healthy controls, as well as its association with the clinical manifestations of migraine. We conducted a case-control study involving 92 migraine patients and 88 healthy controls matched for age, sex, body mass index (BMI), and ethnicity. Demographic, anthropometric, and clinical data were obtained. The IL1A -889C > T (rs1800587) variant was identified using real-time polymerase chain reaction. The study comprised predominantly women and Caucasian individuals, with no significant differences in terms of age, sex, ethnicity, or BMI observed between the migraine and control groups. Within the migraine group, 57.6% had episodic migraines, and 45.7% experienced aura. The patients carrying the CT genotype showed stronger associations with the presence of aura (CT: 57.7%; TT: 27.5%; p = 0.027), and those carrying the CT and TT genotypes showed higher osmophobia rates when compared with the CC genotype (p = 0.003). The IL1A -889C > T genetic variant was not associated with migraine susceptibility, be it chronic or episodic, nor to other symptoms associated with migraine. The IL1A -889C > T genetic variant was associated with aura and osmophobia in migraine patients.

Marginal health care expenditures and health-related quality of life burden in patients with migraine.

Migraine, characterized by recurrent, severe headaches, presents a considerable challenge for patients, health care systems, and employers in the United States. However, there is a lack of recent estimates of the economic and humanistic burden in this population. To assess the incremental burden of migraine on the total all-cause health care costs and health-related quality of life (HRQoL) in the United States, using data from the Medical Expenditure Panel Survey (MEPS). This retrospective cross-sectional study included adults (≥18 years) with and without migraine on the 2019-2021 full-year consolidated MEPS Household Component and Medical Provider Component data files. Descriptive analyses were conducted to compare health care expenditures and HRQoL among patients with and without migraine. To estimate the marginal effect of migraine on total health care spending, a two-part model generalized linear models was employed. HRQoL was evaluated using physical component summary (PCS) and mental component summary (MCS) scores based on the items in the Veterans Rand 12 Health Survey. A multivariate linear regression with log-link was conducted to understanding the factors associated with PCS and MCS scores. All analyses accounted for complex survey design of MEPS. The study included approximately 1.14 million patients with migraine and approximately 184 million patients without migraine. The patients with migraine were majorly female (82.81%), aged 18-45 years (50.24%), and residing in the southern region of the United States (41.45%). A two-part model revealed that marginal total health care expenditures among patients with migraine were $6,078.56 (95% CI = $4,618.45-$8,141.34) higher compared with those without migraine. In terms of HRQoL, average PCS scores in migraine and nonmigraine groups were 39.79 and 42.15, respectively. The average MCS scores were 46.63 and 49.95 for migraine and nonmigraine groups, respectively. After adjusting for sociodemographic characteristics, multivariable linear regression models revealed that the PCS score was 2.14 (95% CI = 1.17-4.55) units lower, and the MCS score was 3.19 (95% CI = 2.51-6.07) units lower among patients with migraine compared with those without. Migraine imposes a substantial economic burden on both health care payers and patients in the United States. Notably, prescription drugs make up nearly half of the overall cost. Additionally, patients with migraine experience lower levels of physical and mental HRQoL compared with those without migraine.

High-frequency episodic migraine: Time for its recognition as a migraine subtype?

High-frequency episodic migraine (HFEM) has gained attention in the field of headache research and clinical practice. In this narrative review, we analyzed the available literature to assess the evidence that could help decide whether HFEM may represent a distinct clinical and/or biological entity within the migraine spectrum. The output of the literature search included 61 papers that were allocated to one of the following topics: (i) socio-demographic features and burden; (ii) clinical and therapeutic aspects; (iii) pathophysiology; and (iv) classification. Multiple features differentiate subjects with HFEM from low-frequency episodic migraine and from chronic migraine: education, employment rates, quality of life, disability and psychiatric comorbidities load. Some evidence also suggests that HFEM bears a specific profile of activation of cortical and spinal pain-related pathways, possibly related to maladaptive plasticity. Subjects with HFEM bear a distinctive clinical and socio-demographic profile within the episodic migraine group, with a higher disease burden and an increased risk of transitioning to chronic migraine. Recognizing HFEM as a distinct entity is an opportunity for the better understanding of migraine and the spectrum of frequency with which it can manifest, as well as for stimulating further research and more adequate public health approaches.

White Matter Lesions, Risk Factors, and Etiological Classification in Young versus Old Cerebral Infarction Patients: A Retrospective Study.

To compare the differences in risk factors and etiological classification between cerebral infarction in young patients and elderly patients, and explore the correlation between cerebral infarction in young patients and white matter lesions (WMLs). Sixty young patients with cerebral infarction and 142 elderly patients with cerebral infarction were included. The distributions of risk factors such as hypertension, diabetes, heart disease, smoking status, alcohol consumption status, migraine status, and WMLs in the two groups were carefully investigated and statistically analyzed. According to the univariate analysis, the proportions of males, obese patients, patients with migraine, and patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) in the young group were significantly greater than those in the elderly group. Hypertension, heart disease, and hyperhomocysteinemia were significantly more common in the elderly group than in the young group. According to the TOAST classification, the incidence of stroke of undetermined etiology in the young group was greater than that in the elderly group, whereas the incidence of large-artery atherosclerosis (LAA) in the elderly group was greater than that in the young group. Binary logistic regression analysis revealed that male sex, migraine status, and obstructive sleep apnea-hypopnea syndrome were independently associated with cerebral infarction in young adults, whereas hypertension, heart disease, and hyperhomocysteinemia were independently related to cerebral infarction in elderly individuals. In addition, the incidence of WMLs in the migraine group of young cerebral infarction patients was significantly greater than that in the nonmigraine group. Compared with those in elderly patients with cerebral infarction, the risk factors for cerebral infarction in young patients are relatively controllable. Furthermore, more methods are needed to determine the etiology of unexplained cerebral infarction in young patients. WMLs are thought to have a relatively high incidence in young patients with cerebral infarction and are significantly associated with migraine.

Exploring the Complex Relationship Between Primary Headache Types and Bruxism: Patterns, Mechanisms, and Implications

Objective: The present study aims to explore the relationship between primary headache types and bruxism and determine how these two conditions may affect each other. Material and Methods: A total of 97 cases who applied to the Neurology Polyclinic of our hospital during 01.07.2023-01.08.2023 were included in the study. A comprehensive questionnaire was applied to the participants. The diagnosis of headache was established based on the International Classification of Headache Disorders criteria; the American Academy of Sleep Medicine criteria were used for the diagnosis of sleep bruxism and the Research Diagnostic Criteria for Temporomandibular Disorders were employed for the diagnosis of awake bruxism. Results: Nineteen (19.6%) of the participants were male and 78 (80.4%) were female. Tension-type headache (TTH) was reported by 22 participants (22.7%), 30 participants had migraine-type headache (30.9%), and 45 participants (46.4%) comprised the healthy control group. Sleep bruxism was observed in 29 patients (29.9%), while 11 patients (11.3%) were diagnosed with awake bruxism. Higher rates of sleep bruxism and awake bruxism were seen in patients in the TTH group compared to those in the migraine group and the healthy control group (p

Assessing the Role of Antioxidants in Migraine Patients in Erbil City

Migraine is a prevalent chronic condition that is often characterized by recurrent incapacitating headache attacks and related symptoms. The purpose of this investigation was to assess the potential effects of antioxidants on migraine disease. The main goal of the study was to measure the concentrations of many important antioxidants, such as catalase (CAT), superoxide dismutase (SOD), thioredoxin (TRX), and glutathione peroxidase 1 (GPX1). Ninety participants were recruited from the outpatient headache clinic of the neurology department at Al Jumhury Teaching Hospital in Erbil City for this study. In this study, there were 60 patients with migraine and 30 controls. Among the migraine group, there were 45 female and 15 male participants, while the control group consisted of 20 female and 10 male participants, with matching in terms of age and sex. According to study results, both male and female migraine patients had significantly lower levels of enzymes SOD and GPX1 compared to the control group. Additionally, female migraine patients had lower levels of CAT significantly compared to the control group. In male migraine patients, CAT also showed lower levels, but the difference was not statistically significant. On the other hand, TRX showed lower levels in both female and male migraine patients, but the difference was not statistically significant compared to the control group. There was a negative correlation observed between the frequency of headache-related days per month and the serum concentrations of SOD. This implies that as the levels of SOD in the serum decrease, the number of headache-related days per month tends to increase.

Exploring Facial Somatosensory Distortion in Chronic Migraine: The Role of Laterality and Emotion Recognition—A Cross-Sectional Study

Background: In addition to being highly distressing, chronic migraine headaches are a major socioeconomic challenge. Like other pain syndromes, migraine headaches are associated with psychological and physiological impairments, including sensorimotor and somatosensory deficits. Aim: This study aims to explore whether patients with high-frequency or chronic migraine differ from a healthy population in the areas of laterality recognition (LAT) and facial emotion recognition (FER) and whether there are correlations between these areas and central sensitization of pain and psychological components like stress, depression, anxiety, and alexithymia. Methods: Using a cross-sectional design, individuals with high-frequency or chronic (ICHD classification) migraine (migraine group MG = 45) and healthy individuals (control group CG = 25) were studied using LAT testing (hand, neck, and face); FER testing; and questionnaires, including the Central Sensitization Inventory (CSI) and the Toronto Alexithymia Scale (TAS-20). Results: Data from 70 participants were collected for analysis. Statistically significant differences were found only in the assessment of central sensitization (p &lt; 0.001). Weak to moderate monotonic correlations were found for the MG, especially between alexithymia detection (TAS-20) and facial emotion recognition (FER test). Discussion: The methodological procedure and its accompanying challenges can be seen as limitations of this study. The lack of significant effects must be mentioned, but the selection of the collected questionnaires, the uniform diagnostics, and the statistical processing of a large amount of data represent methodological strengths. Conclusion: The CSI and the TAS-20 could be used in combination with FER to assess chronic migraine. Implementing the described sensorimotor parameters as a therapeutic intervention requires further investigation.

Psychiatric Comorbidities and Quality of Life in Patients with Vestibular Migraine and Migraine without Vertigo: A Cross-Sectional Study from a Tertiary Clinic.

A total of 104 participants were divided into 3 groups: dVM patients (19 participants), MO patients (22 participants), and HCs (63 participants). The scores of the three questionnaires across the three groups were compared using analysis of variance, and linear regression was used to examine the associations between the questionnaire scores within each group. Compared to MO patients and HCs, dVM patients had significantly higher total scores on the HADS (p < 0.0001) and DHI (p < 0.0001) scales, and lower scores for all nine components of the SF-36, indicating poorer health. In the vestibular migraine group, the DHI score was strongly negatively correlated with the Physical Functioning subscale of the SF-36. Anxiety and depression are more prevalent in patients with definite vestibular migraine compared to patients with migraine without vertigo and healthy controls. The physical functioning of patients with definite vestibular migraine is highly affected by their dizziness, resulting in a lower quality of life. Timely screening for psychiatric comorbidity in vestibular migraine patients is essential to prevent psychiatric consequences.

Eccentricity Dependency of Retinal Electrophysiological Deficits in People With Episodic Migraine.

During the non-attack period, people with migraine may show retinal dysfunction. This study builds on previous work by exploring the possibility of foveal and non-foveal visual field and electroretinographic deficits and determining the overlap in eccentricity of such localized visual deficits in people with migraine. Visual fields and multifocal electroretinography (mf-ERG) were tested in 27 people with migraine (aged 19-45 years) and 18 non-headache controls (aged 20-46 years). Data were averaged according to 5 concentric rings at < 1.5 degrees (foveal) and 5 degrees, 10 degrees, 15.5 degrees, and 22 degrees eccentricities (non-foveal). Linear mixed effects modelling was used to predict mf-ERG amplitude, mf-ERG peak time, and visual field sensitivity with fixed effects of eye, group, and eccentricity. Foveal mf-ERG responses, and visual field sensitivity across all eccentricities (foveal and non-foveal) were similar between the migraine and control groups (P>0.05). In contrast, the non-foveal mf-ERG was reduced in amplitude in people with migraine relative to controls (P<0.001), and this group difference depended on eccentricity (P<0.001) - most prominently, in the parafoveal region (ring 2, P=0.001). Retinal electrophysiological deficits were observed in people with migraine in the parafoveal region (between 1.5 degrees and 5 degrees eccentricity), without corresponding visual field deficits. This suggests a spatially localized area of retinal neuronal dysfunction in people with migraine that is insufficient to manifest as a visual field sensitivity loss using standard perimetric methods. Our study highlights the added confound of migraine when conducting standard clinical retinal electrophysiological tests for conditions such as glaucoma, particularly non-foveally.

The Neuroprotective Role of Indole-3-Propionic Acid in Migraine Pathophysiology.

Background and Objectives: Migraine is a leading cause of disability worldwide, with complex pathophysiological mechanisms involving oxidative and nitrosative stress. Recent research suggests that Indole-3-Propionic Acid (IPA) may have a neuroprotective role in reducing nitrosative stress. This study aims to elucidate the roles of IPA and nitrosative stress biomarkers in migraine patients, focusing on their potential as therapeutic targets. Materials and Methods: This cross-sectional, case-control study included 57 migraine patients and 30 healthy controls. Patients were categorized into episodic migraine (EM) and chronic migraine (CM) groups. Socio-demographic and clinical characteristics were documented through structured interviews. Validated scales such as the Visual Analog Score (VAS), Headache Impact Test 6 (HIT-6), Migraine Disability Assessment Test (MIDAS), Migraine 24 h Quality of Life Scale (24 h QoL), Mini-Mental State Examination (MMSE), and Migraine Attacks-Subjective Cognitive Impairments Scale (Mig-SCog) were administered. Venous blood samples were collected, and serum levels of IPA, Nitric Oxide (NO), Nitric Oxide Synthase (NOS), and Peroxynitrite (ONOO-) were measured using ELISA and spectrophotometric methods. Results: Significant differences in serum IPA and NO levels were observed between migraine patients and controls. Specifically, higher serum IPA levels were found in the EM group, while higher serum NO levels were observed in the CM group. Elevated NO levels correlated with increased migraine attack frequency. Conversely, serum IPA levels showed a negative correlation with attack frequency, suggesting a protective role. Specifically, NO levels were positively correlated with the number of painful days, NSAID usage, VAS scores, HIT-6 scores, and MIDAS scores, while negatively correlated with 24 h QoL scores. Conclusions: The study highlights the significant involvement of IPA and nitrosative stress in migraine pathophysiology. Elevated IPA levels, particularly in EM patients, suggest its potential neuroprotective role. These findings underscore the importance of targeting oxidative and nitrosative stress pathways in developing effective migraine therapies.

From the latin "re-cordis, passing through the heart": autonomic modulation differentiates migraineurs from controls when recounting a significant life event.

The literature on clinical psychophysiology highlights the possibility of using Heart Rate Variability (HRV) as an index of psychophysical balance and resilience to stress. This study investigates the differences in stress reactivity and subsequent recovery between a group of migraineurs and healthy controls. Socio-demographic (i.e., sex, age, profession, marital status, and level of education) and psychophysiological (HR and HRV) measures of a group of thirty subjects with migraine (26 migraineurs without aura (86.7%), 2 migraineurs with aura (6.7%), and 2 migraineurs with and without aura (6.7%)) and from thirty healthy control subjects were collected. In particular, HRV was analyzed through frequency-domain parameters, including Low-Frequency (LF; 0.04-0.15 Hz) and High-Frequency (HF; 0.15-0.4 Hz) bands as well as LF/HF ratio during a Psychophysiological Stress Profile (PSP) structured in seven phases: (1) Baseline, (2) Objective stressor 1 (Stroop Test), (3) Rest 1, (4) Objective stressor 2 (Mental Arithmetic Task), (5) Rest 2, (6) Subjective stressor (recount a significant life event), and (7) Rest 3. The LF, HF, and LF/HF ratio values were transformed into a logarithmic scale (i.e., log-LF, log-HF, and log LF/HF ratio). Additionally, LF and HF were converted into normalized units (0-100) (i.e., LF% and HF%) which, in turn, were used to obtain reactivity and recovery to stress through delta values (Δ) calculation. Subjects with migraine reported greater ΔLF% levels of reactivity and recovery to subjective stressor, demonstrating a prevalence of sympathetic activity while recounting a personal life event. At the same time, a lowering of the same values was found in the subjects of the group control. Our results underline the importance of conducting a psychophysiological assessment in patients with headaches because reduced stress management skills could influence the clinical manifestations of the disease, considering stress as one of the most common triggers for migraine patients.

The patterns of anti-compensatory saccades of the SHIMP paradigm can differentiate vestibular migraine from healthy individuals.

The aim of the present study was to characterize the HIMP and SHIMP test findings in individuals with vestibular migraine. The study comprised two groups- group I consisted of twenty five adults diagnosed with Vestibular migraine, and group II comprised twenty-five age matched healthy individuals. HIMP & SHIMP were administered using the ICS impulse system for both groups. Mann-Whitney U test revealed a significant difference (p< 0.05) in VOR gain and VOR suppression gain between the vestibular migraine and healthy individuals. All the subjects in the vestibular migraine group manifested either of the four patterns of anti-compensatory saccades (ACS): (a) bilaterally absent ACS, (b) bilaterally scattered ACS or (c) typical ACS on one side with scattered ACS on the other side (d) unilaterally absent ACS. On the other hand, all the healthy individuals exhibited the presence of an organised ACS bilaterally. VOR pathway is affected in individuals with vestibular migraine. Also, various patterns of ACS are more effective in identifying the subtle vestibular lesion in vestibular migraine. These patterns are useful in differentiating vestibular migraine from healthy individuals.

Navigating the Complexity of Alternating Hemiplegia in Childhood: A Comprehensive Review.

Alternating hemiplegia of childhood (AHC) is a complex neurodevelopmental disorder characterized by paroxysmal and transient events of unilateral or bilateral paresis, usually occurring before 18 months of age. Mutations in the ATP1A3 gene, mainly p.Asp801Asn, p.Glu815Lys, and p.Gly947Arg at the protein level, are found in around 80% of the individuals with AHC. Interestingly, these mutations reflect the degree of severity of the neurological symptoms (p.Glu815Lys > p.Asp801Asn > p.Gly947Arg). Some channels involved in this disorder are N-type voltage-gated calcium channels, ATP-sensitive potassium channels, and the sodium/calcium exchanger. In this context, the management of AHC should be divided into the treatment of attacks, prophylactic treatment, and management of comorbidities commonly found in this group of individuals, including epilepsy, attention-deficit/hyperactivity disorder, aggressive behavior, cognitive impairment, movement disorders, and migraine. The importance of an integrated approach with a multidisciplinary team, such as neuropsychologists and dietitians, is worth mentioning, as well as the follow-up with a neurologist. In the present study, we propose new diagnostic criteria for AHC, dividing it into clinical, laboratory, supporting, and atypical features. Also, we review the location of the mutations in the ATP1A3 protein of individuals with AHC, rapid-onset dystonia-parkinsonism (RDP) variants, and early infantile epileptic encephalopathy (variants with hemiplegic attack). We also include a section about the animal models for ATP1A3 disorders.

Comparison of patients with chronic and episodic migraine with healthy individuals by brain volume and cognitive functions

Objectives: Migraine is a complex neurological disease. In addition to headache, individuals with migraine may develop structural changes inside the brain and cognitive impairment. There is increased evidence associated with impairments in brain volume and cognitive functions in patients with migraine. The present study aimed to investigate the impairment in memory function in individuals with migraine using brain magnetic resonance imaging, volume measurement, and neuropsychological tests. Methods: The study included 20 patients with episodic migraine, 20 patients with chronic migraine, and 20 healthy controls. Subcortical volumes of all participants were measured by FreeSurfer, an automatic segmentation method. The Wechsler Memory Scale-Revised Form (WMS-R), Stroop test, Raven’s Standard Progressive Matrices, Verbal Fluency Test, and Lines Orientation Test were applied in all the study participants. Results: Putamen volume decreased as migraine duration increased, and subcortical gray matter, left cerebellar cortex, and bilateral thalamus volumes were lower in the chronic and episodic group compared to the control group, bilateral putamen and right cerebellar cortex volumes were lower in patients with chronic migraine compared to patients in episodic migraine and control groups. Upon neuropsychological examination, delayed memory was affected as the duration of migraine increased, and there was impairment in patients with chronic migraine upon fluency tests and mental control tests. Conclusions: Changes in subcortical volume and cognitive effects in patients with migraine raise questions about whether migraine qualifies as a benign disease. Structural changes and cognitive impairment may contribute to migraine-associated disability, and therefore, these causalities should be investigated by future studies. Silent infarcts, white matter damage, and cortical spreading depression, which occur in migraine cases, may be associated with subcortical volume changes and thus, cognitive effects. In the context, studies with larger samples to achieve a better understanding are needed.

Increased risks of retinal vascular occlusion in patients with migraine and the protective effects of migraine treatment: a population-based retrospective cohort study

Associations between migraine and retinal vascular occlusion have been reported, but there is no large-scale and comprehensive study. Therefore, we aimed to determine risks of retinal vascular occlusion in patients with migraine. Using the Taiwan National Health Insurance Research Database from 2009 to 2020, we enrolled 628,760 patients with migraine and 628,760 matched individuals without migraine. Study outcomes were diagnoses of retinal vascular occlusion, including retinal artery occlusion (RAO) and retinal vein occlusion (RVO). Adjusted hazard ratio (aHR) of retinal vascular occlusion related to migraine was estimated. The cumulative incidences of subsequent retinal vascular occlusion, RAO, and RVO were significantly higher in migraine patients compared with controls (0.31% vs. 0.21%; 0.09% vs. 0.05%; 0.22% vs. 0.17%; all p < 0.001). The hazards of retinal vascular occlusion, RAO, and RVO were significantly greater in the migraine group (aHR, 1.69 [95% CI, 1.57, 1.83], 2.13 [95% CI, 1.84, 2.48] and 1.53 [95% CI, 1.40, 1.68], respectively). Risks of retinal vascular occlusion were significantly higher in migraine both with aura (MA) and without aura (MO) (aHR, 1.77 [95% CI, 1.58, 1.98], and 1.92 [95% CI, 1.64, 2.25]). Among patients with migraine, nonsteroidal anti-inflammatory drugs, propranolol, and flunarizine significantly reduce their risks of retinal vascular occlusion (aHR, 0.19 [95% CI, 0.16, 0.22], 0.73 [95% CI, 0.62, 0.86], 0.84 [95% CI, 0.76, 0.93]). Migraine, MA and MO are independently associated with higher risks of retinal vascular occlusion, RAO, and RVO.