Migraine Pain Research Articles

The Effect of Group Emotional Schema Therapy on Cognitive Emotion Strategies in Women with Migraine Headaches: a Pilot Study

The aim of the current study was to examine the effect of emotional schema therapy (EST) on migraine severity and cognitive emotion regulation strategies. In this study, 16 women with migraine were randomly assigned to EST group (n = 8) and a waitlist control group (WLC; n = 8). Participants in the EST group received 12 sessions of group emotional schema therapy. Ahwaz Migraine Headache Questionnaire (AMQ) and Cognitive Emotion Regulation Questionnaire (CERQ) were measured pre-treatment, post-treatment, and at 1-month of follow-up. Results indicated that EST was more effective than WLC in reducing migraine severity at post-test and follow-up. In addition, participants in the treatment condition showed significant improvement in adaptive cognitive emotion regulation strategies at post-test and follow-up. Furthermore, as the results showed, time, group, and interaction did not reduce maladaptive cognitive emotion regulation strategies significantly. Our results suggest that emotional schema therapy may be useful in alleviating migraine pains.

Unmet needs in the acute treatment of migraine attacks and the emerging role of calcitonin gene-related peptide receptor antagonists: An integrative review.

Migraine is a prevalent and chronic disease associated with high rates of disability and significant financial and socioeconomic burden. Current acute treatments for migraine attacks include both migraine-specific (e.g., triptans, ergotamines) and nonspecific (e.g., nonsteroidal anti-inflammatory drugs) medications; however, significant unmet treatment needs remain. The authors sought to characterize the nature and drivers of unmet treatment needs in the acute treatment of migraine attacks and describe emerging migraine-specific treatments, that is, calcitonin gene-related peptide (CGRP) receptor antagonists. PubMed searches were conducted using search terms for studies of unmet migraine treatment needs and CGRP receptor antagonists. Additionally, studies presented at recent headache-focused congresses were included. Forty percent of people with migraine report at least 1 unmet treatment need. Many people are unable to use migraine-specific or nonspecific agents because of contraindications, precautions, and tolerability issues. Disease burden (disability, headache severity/frequency) remains high even in those receiving migraine-specific medications. The oral CGRP receptor antagonists, ubrogepant and rimegepant, demonstrated efficacy in reducing migraine pain, migraine-associated symptoms, and disability, with a low adverse event profile, similar to placebo. The availability and use of CGRP receptor antagonists may help reduce the extent of unmet needs in the treatment of migraine attacks, resulting in more patients receiving treatment and better outcomes for people with migraine. Nurse practitioners are well positioned to increase rates of migraine diagnosis/treatment (another key unmet need), using consensus guidelines to guide their approach.

Mindfulness as an Adjunctive Treatment Strategy for Reduction of Migraine Pain During a Single Office Visit (773)

Mindfulness as an Adjunctive Treatment Strategy for Reduction of Migraine Pain During a Single Office Visit (773)

Transcranial Direct Current Stimulation of the Occipital Cortex in Medication Overuse Headache: A Pilot Randomized Controlled Cross-Over Study.

Background: Medication overuse headache (MOH) is a chronic pain syndrome that arises from the frequent use of acute antimigraine drugs. Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique with a possible therapeutic effect in this particular context. Methods: This was a randomized, sham-controlled, cross-over study. Eighteen patients with MOH (17 women, age range: 20–38 years) received three sets of three consecutive daily sessions of tDCS: anodal tDCS over the prefrontal cortex, cathodal tDCS over the occipital cortex ipsilateral to the dominant side of migraine pain, and sham. The order in which the tDCS blocks were delivered was randomly defined based on a 1:1:1 ratio. Patients filled in a migraine diary that allowed recording of the pain intensity (visual analogue scale) and the daily consumption of analgesic pills from one week before to two weeks after each condition. Results: Both prefrontal and occipital tDCS lowered the total number of migraine days and the number of severe migraine days per week at week 1, but only the effects of occipital tDCS on these two outcomes lasted until week 2. Only occipital tDCS decreased the daily analgesic pills consumption, at weeks 1 and 2. Conclusion: Three consecutive days of cathodal occipital tDCS appear to improve the clinical outcomes in patients with MOH.

Relationship Between Waist Circumference with Frequency of Attack and Pain Intensity in Malaysian Students Who Have Migraine

Background: Obesity can be intergreted as an excessive accumulation of body fat which leads to health problems, including migraine. Obesity is associated with the metabolic syndrome, a pro-inflammatory, pro-thrombotic state that may contribute to headache development and progression. Stimulation of trigeminal nociceptor induced the release of pro inflammation substances especially calsitonin-gene related peptide (CGRP) and P substance. Those substances are found higher in migraine and obesity person. Neurogenic inflammation state was known has a big role on migraine pain. To evaluate the relationship between waist circumference with frequencies and pain intensity in Malaysian students with migraine at the University of Sumatera Utara. Method: Observational analytic with cross sectional approach. A sample of 94 people was taken based on the total sampling technique. The data obtained are presented in tabular form and then analyzed using the Chi-square Test. Result: Data were analyzed using univariate and bivariate with the Chi-square test. From 77 subjects of the study consisting of 11 people with migraine aura and 66 people with migraine without aura. Most of the study samples were female (77.9%) and an average age of 20.97 years. The majority of race obtained was Malay (50.6%), BMI whose majority was normal (58.4%). From a 11 people with migraine aura, 7 of them had normal waist circumference and of 66 people with migraine without aura 40 of them had normal waist circumference. From Univariate and Bivariate analysis showed no significant relationship between waist circumference with the frequency of migraine attacks (p = 0.489) and there was no significant relationship between waist circumference and the intensity of migraine pain (p = 0.245). Conclusion: There is no significant relationship between waist circumference with the frequency of attacks and pain intensity in Malaysian students who experience migraine.

The Role of Pulsed Radiofrequency for Greater and Lesser Occipital Nerves in the Treatment for Migraine

Background: Migraine pain is a primary headache disorder characterized by recurrent headaches that are moderate to severe. Objective: To evaluate the effect of noninvasive pulsed radio frequency (pulsed RF) in Migraine. Methods: In a prospective study of the intervention performed in adult population with Migraine (Diagnosed by specialists) carried on (30) patients undergone pulsed RF for greater and lesser occipital nerves to control recurrent migraine not responding to conventional treatment (resistant) in a period from Jan. 2017 to Jan 2019 in Al Safeer Hospital for surgical specialties and Alkafeel Hospital for surgical specialties both in Karbala / Iraq. The patients got in prone position under local anesthesia with goal positions with the target sites obvious out using anatomical breakthroughs and the position of greatest ache. Pulsed RF by RF needle to the affected side to reach greater and lesser occipital nerves then got 3 sessions (each for 3 minutes, temperature 42 C, voltage 42 V, resistance with 100 Ohms, Current with 230 mA) Patients monitored post-operatively for 2 hours then discharged. Follow up at intervals of 30 days, 6 months and 1 year by phone call or direct interview to assess the post procedure pain scale. Result: Significant pain relieve by means of no or little pain medication and actual life pattern change and performance in 1-year post procedure. Conclusion: A single trial of pulsed RF is effective for pain reliever.

Neuromodulation of afferent fibers for Postural Orthostatic Trachycardia Syndrome (POTS)

Postural Orthostatic Trachycardia Syndrome, or POTS, is characterized by low arterial blood pressure, inappropriate cardiovascular and breathing responses to tilt, dizziness and syncope to sudden standing, and a range of other autonomic signs, including thermoregulatory issues in the periphery and frequent manifestations of migraine pain. Interventions are few, and typically include volume repletion by saline and enhanced fluid intake. In the course of evaluating neuromodulatory procedures for migraine pain (n=62), several subjects showed classic POTS symptoms, many of which spontaneously resolved with the intervention for migraine. Non‐invasive neuromodulation of two different areas, one being the auditory canal containing mandibular nerve V3, cranial nerves VII, IX, and X and cervical nerves C2 and C3; and the other being regional stimulation of V1 and V2, together with C2 and C3 sensory areas, caused significant declines in dizziness, hand cooling, and other POTS symptoms. The neuromodulatory device stimulating the auditory canal consisted of bilateral silicon impressions of the auditory canals, each containing a mechanical vibratory device which reached a range of cranial nerves, and especially the IXth (glossopharyngeal) nerve to the carotid baroreceptors. The other neuromodulatory device applied vibrating signals to the cutaneous surface over areas innervated by V1 and V2. The trials consisted of a 10‐min control period, followed by 25‐min stimulation, and finished with a 10‐min control period. Continuous thoracic wall movement, pulse oximetry, and ECG were collected, and beat‐by‐beat blood pressure values were inferred from the pulse transit time of the cardiac R wave and oximetry signal. All procedures were approved by the UCLA Institutional Review Board. Subjects who began the trial with low blood pressure increased systolic and diastolic pressures. In two subjects, repeated trials benefitted critical signs (hand warming, dizziness, syncope to sudden movement). These findings suggest that repeated activation of afferent input to baroreceptors can elicit both short‐ and long‐term effects on blood pressure control. The means by which this “learning" or adaptation of cardiovascular regulatory systems remain unknown, but raise the possibility that a low‐cost, non‐invasive intervention can provide another means to restore effective blood pressure control in a syndrome with few options for treatment approaches.Support or Funding InformationThis research was supported in part by the Fidelity Charitable Nancy Adams and Scott Schoen Fund and the Kraig and Linda Kupiec Family Trust.

An Evidence-Based Review of Fremanezumab for the Treatment of Migraine.

Migraine headache is a common, chronic, debilitating disease with a complex etiology. Current therapy for migraine headache comprises either treatments targeting acute migraine pain or prophylactic therapy aimed at increasing the length of time between migraine episodes. Recent evidence suggests that calcium gene-related peptide (CGRP) is a critical component in the pathogenesis of migraines. Fremanezumab, a monoclonal antibody against CGRP, was recently approved by the Food and Drug Administration (FDA) after multiple studies showed that it was well-tolerated, safe, and effective in the treatment of migraines. Further research is needed to elucidate the long-term effects of fremanezumab and CGRP-antagonists in general, and additional data is required in less healthy patients to estimate its effects in these populations and potentially increase the eligible group of recipients. This is a comprehensive review of the current literature on the efficacy and safety of fremanezumab for the treatment of chronic migraine. In this review we provide an update on the epidemiology, pathogenesis, diagnosis, and current treatment of migraine, and summarize the evidence for fremanezumab as a treatment for migraine.

Botulinum neurotoxin injections for muscle-based (dystonia and spasticity) and non-muscle-based (neuropathic pain) pain disorders: a meta-analytic study.

Apart from the known efficacy of Botulinum Neurotoxin Type A (BoNT/A) in hyperactive striated and smooth muscles, different pain states have become potential targets of toxin effects. This present study determined the comparative toxin effectiveness in pain reduction among those patients injected with BoNT/A in muscle-based and in non-muscle-based conditions. Randomized controlled trials (RCTs) on the effect of BoNT/A on selected pain conditions were included. The conditions were spasticity and dystonia for muscle-based pain. For non-muscle-based pain, conditions included were painful diabetic neuropathy (PDN), post-herpetic neuralgia (PHN), trigeminal neuralgia (TN), complex regional pain syndrome (CRPS), and spinal cord injury (SCI). In view of possibly differing pathophysiology, myofascial pain, temporomandibular joint (TMJ), other joint or tendon pains, cervicogenic and lumbar pains, migraine and visceral pain syndromes were excluded. Standardized mean difference was used as the effect measure and computed with STATA. 25 RCTs were analyzed. Pooled estimates showed significantly lower pain score in the Treatment group (z = 5.23, p < 0.01, 95% CI = - 0.75, - 0.34). Subgroup analyses showed that BoNT/A significantly reduced both muscle-based (z = 3.78, p < 0.01, 95% CI = - 0.72, - 0.23) and non-muscle-based (z = 3.37, p = 0.001, 95% CI = - 1.00, - 0.27) pain. Meta-regression using four covariates namely dosage, route, frequency and duration was done which revealed that dosage significantly affects standardized mean differences, while the other three covariates were insignificant. The joint F-test was found to be insignificant (p value = 0.1182). The application of the model with these covariates does not significantly explain the derived heterogeneity of standardized mean differences. In conclusion, BoNT/A can be effectively used in muscle-based and non-muscle-based pain disorders. We detected no difference between the presence and magnitude of pain relief favoring muscle-based compared to non-muscle-based pain. Thus, we cannot say whether or not there might be independent mechanisms of toxin-induced pain relief for pain generated from either muscle or nerve hyperactivity.

The effects of vitamin D supplementation on interictal serum levels of calcitonin gene-related peptide (CGRP) in episodic migraine patients: post hoc analysis of a randomized double-blind placebo-controlled trial

BackgroundEmerging evidence showed promising effects of vitamin D on headaches characteristics. Thus, it seems there is still a need for more researches to clarify the mechanisms by which this vitamin exerts anti-migraine effects.MethodsThe present study was conducted as a 16-week randomized double-blind placebo-controlled trial on 80 episodic migraine patients allocated in 2 parallel groups each consisted of 40 patients who received vitamin D 2000 IU/d or placebo. At baseline and after the intervention completion, headache diaries and migraine disability assessment questionnaire (MIDAS) were used to assess migraine related variables in patients. Also, interictal serum concentration of calcitonin gene-related peptide (CGRP) (as the dominant mediator of migraine pain pathogenesis) was evaluated using ELISA method.ResultsThe mean (SD) of age in the vitamin D and placebo groups was 37 (8) and 38 (12) years, respectively. ANCOVA test adjusted for baseline values, and confounders showed vitamin D supplementation resulted in a significant improvement in MIDAS score after 12 weeks in the intervention group (21.49 (16.22–26.77)) compared to placebo (31.16 (25.51–36.82) P value: 0.016). Moreover, after controlling for baseline levels, and other variables using ANCOVA, CGRP level was appeared to be significantly lower following vitamin D supplementation (153.26 (133.03–173.49) ng/L) than the patients in the placebo arm (188.35 (167.15–209.54) ng/L) (P value = 0.022).ConclusionAccording to the current findings, vitamin D supplementation in episodic migraineurs, particularly in those with migraine with aura, may potentially improve migraine headache characteristics and disability probably through attenuating CGRP levels. Therefore, these results could provide a new insight into anti-nociceptive effects of vitamin D; however, more studies are required to confirm our findings.Trial registrationThe trial is registered in the Iranian registry of clinical trials (IRCT) at 11 July 2018, with IRCT code: IRCT20151128025267N6.

Hijama Practices and the Perceived Health Benefits among the People of Al-Qassim Region, Saudi Arabia

Introduction: Hijama (wet cupping therapy) is a form of traditional alternative medicine that has been in practice for thousands of years and was adopted by many different cultures. Hijama practice in the Arabic medical literature has been reported to treat many diseases differing in etiology and pathogenesis. The aim objective of this study was to determine the knowledge, attitude, and practice of Hijama among the Qassim population in Saudi Arabia. To create awareness regarding good practices and to assess the effectiveness of Hijama.&#x0D; Methods: This observational type of cross-sectional survey included 201 participants who were all practising Hijama and were from the Qassim region. Data was collected using the self-administered online questionnaire and entered in Excel and analyzed using EpiInfo7 statistical software. &#x0D; Results: Most of the study participants were female 70%. About 39% of them have a bachelor's degree. 61% know Hijama contradictions. Hijama was performed by traditional healers in 14% of the participants and at Hijama centers by 64% of the participants. About 72% of the participants notice effectiveness by practising Hijama. Only 7% of them had suffered complications.&#x0D; Conclusion: The study revealed Hijama can be a simple effective economic alternative treatment that can be used to treat many ailments like back, shoulder, neck pain, headache and migraine pain. It is associated with a minimal side effect. There is still a need to create awareness among the people to go for clinical centres to perform Hijama. Future research is needed to support its therapeutic benefits.

Longitudinal Neuroimaging over 30 Days: Temporal Characteristics of Migraine.

Although migraine is defined by the headache and headache-associated symptoms, the true beginning of a migraine attack lies in the premonitory phase. To understand the generation of attacks, one needs to investigate the phase before headache starts. The premonitory phase of migraine is characterized by a well-described complex of symptoms. Its duration, however, is not clearly defined, and there are no biomarkers to help define when this phase starts. Here, we used functional magnetic resonance imaging (MRI) to elucidate the duration of the premonitory phase in spontaneous human migraine attacks. Because migraine attacks are hardly predictable and thereby the premonitory phase is difficult to catch, we scanned 9 patients daily over a minimum period of 30 days using a well-established paradigm for functional MRI of trigeminal nociception. Seven patients were included in the analysis, thus providing cumulative data of 27 spontaneous human migraine attacks including scans before, during, and after migraine pain as well as interictal scans. As a response to painful trigeminal stimulation, activation of the hypothalamus was present within the last 48 hours before headache onset but not earlier. Using hypothalamic activation as a potential marker for the premonitory phase of migraine in this unique dataset, our data corroborated a duration of 48 hours for the premonitory phase of migraine. We suggest applying this time criterion in future studies when focusing on this phase of the migraine cycle. ANN NEUROL 2020;87:646-651.

Effectiveness of cathodal tDCS of the primary motor or sensory cortex in migraine: A randomized controlled trial

ObjectivesTranscranial Direct Current Stimulation (tDCS) is a new technology that is extensively used for migraine treatment. The present study aims to examine the effectiveness of cathodal-tDCS (c-tDCS) in decreasing migraine pain frequency, duration, and intensity at the right primary motor cortex (M1) or sensory cortex (S1) in individuals with episodic or chronic migraine. MethodsThe present study has a randomized, single-blind, and sham-controlled design. It tests the effectiveness of 22 sessions of c-tDCS (20min/1000 μA) in 45 migraine patients (episodic = 35; chronic = 10/with aura = 28; without aura = 17). Spread over 10 consecutive weeks, the sessions started with three sessions per week and ended with one session per week. Participants were tested at the baseline, at the end of intervention, and at 12-month follow-up. The migraine diagnosis was based on criteria set by International Headache Society (IHS) and patients were allocated to two experimental (nm1 = 15; ns1 = 15) and a sham intervention group (nc = 15). ResultsThe results of a series of MANCOVAs showed a significant reduction (p < 0.05) in all hypothesized symptoms of migraine pain in both experimental groups compared to the sham intervention group at the posttest and follow-up. ConclusionThe application of c-tDCS to M1 or S1 can be used as a technological intervention for the prophylactic and therapeutic treatment of episodic or chronic migraine. Ethical committee registration numberIr.mums.fm.rec.1396.362.

Acute Reversible Cerebral Vasoconstriction Syndrome With Low-Dose Dihydroergotamine Possibly Potentiated by Valproic Acid and Erenumab: A Case Report

Dihydroergotamine (DHE), in the setting of polypharmacy, may increase the possibility of reversible cerebral vasoconstriction syndrome (RCVS). A 64-year-old woman with chronic migraine and medication-overuse headache (on amitriptyline, duloxetine, erenumab) was electively admitted for 5 days of intravenous (IV) ketamine (up to 55 mg/h) to treat intractable migraine pain. On the seventh day, upon receiving her forth dose of IV DHE (0.25 mg) and the first of IV valproic acid (VPA) (500 mg) adjunctively, she developed acute bilateral decreased visual acuity, bitemporal visual field deficit, and unsteady gait. Brain magnetic resonance imaging/magnetic resonance angiography (MRI/MRA) showed confluent bilateral T2 hyperintensities with punctate restricted diffusion in the occipital lobes associated with multi-segmental narrowing involving anterior, middle, posterior cerebral, and basilar arteries consistent with RCVS. Verapamil was initiated, whereas DHE, neuroleptics, and serotonergic agents were discontinued. Though she continued to have constant, non-thunderclap migrainous headache, her other neurologic symptoms resolved in 24 h. Concomitant use of VPA and erenumab with DHE may result in RCVS. VPA likely displaces the protein-bound DHE causing a transient surge of free DHE level in the serum. Erenumab may have impaired the protective vasodilatory mechanism, augmenting DHE’s vasoconstrictive effect. This case report highlights the importance and awareness of such a drug-drug interaction with DHE. J Neurol Res. 2020;10(1):20-24 doi: https://doi.org/10.14740/jnr558

The Integrative Migraine Pain Alleviation through Chiropractic Therapy (IMPACT) trial: Study rationale, design and intervention validation

IntroductionApproximately 15% of the US population experiences migraine, with women afflicted three times as often as men. While medications are often used as first-line treatments, up to 50% of people with migraine pursue complementary and integrative medicine. One promising non-pharmacological approach for migraine is chiropractic care, due to the co-occurrence of migraine disease and musculoskeletal tension and pain. To date, no large-scale trials have evaluated the impact of a comprehensive model of chiropractic care on migraine. MethodsThe Integrative Migraine Pain Alleviation through Chiropractic Therapy (IMPACT) study is a two-arm pilot pragmatic randomized clinical trial evaluating a multimodal chiropractic care intervention plus enhanced usual care (UC) vs. enhanced UC alone for adult women with episodic migraine. A total of 60 women aged 20–55 who meet criteria for episodic migraine will be randomly assigned to an evidence-informed, musculoskeletal focused multimodal chiropractic care (10 sessions over 14 weeks) plus enhanced UC vs. enhanced UC alone. Enhanced UC includes conventional care, migraine education materials, and biweekly check-in phone calls. Study specific aims include: 1) Determine safety and feasibility of the study design; 2) Provide preliminary data on the effectiveness of chiropractic care on migraine frequency, severity, duration and medication use; and 3) Provide preliminary estimates of the effects of chiropractic care on disability, health-related quality of life, and psychosocial well-being. DiscussionFindings will be used to inform the design of a full-scale trial evaluating chiropractic care for women with episodic migraines.

The Emerging Role of Mechanosensitive Piezo Channels in Migraine Pain.

Recently discovered mechanosensitive Piezo channels emerged as the main molecular detectors of mechanical forces. The functions of Piezo channels range from detection of touch and pain, to control of the plastic changes in different organs. Recent studies suggested the role of Piezo channels in migraine pain, which is supposed to originate from the trigeminovascular nociceptive system in meninges. Interestingly, migraine pain is associated with such phenomenon as mechanical hypersensitivity, suggesting enhanced mechanotransduction. In the current review, we present the data that propose the implication of Piezo channels in migraine pain, which has a distinctive pulsatile character. These data include: (i) distribution of Piezo channels in the key elements of the trigeminovascular nociceptive system; (ii) the prolonged functional activity of Piezo channels in meningeal afferents providing a mechanistical basis for mechanotransduction in nociceptive nerve terminals; (iii) potential activation of Piezo channels by shear stress and pulsating blood flow; and (iv) modulation of these channels by emerging chemical agonists and modulators, including pro-nociceptive compounds. Achievements in this quickly expanding field should open a new road for efficient control of Piezo-related diseases including migraine and chronic pain.

The Endogenous Analgesia Signature in the Resting Brain of Healthy Adults and Migraineurs

Altered pain modulation and resting state functional connectivity (rsFC) were found to be related to migraine pathology and clinical manifestation. We examined how pain modulation psychophysical measures are related to resting-state networks and rsFC between bottom-up and top-down pain modulation areas. Thirty-two episodic migraineurs and 23 age-matched healthy individuals underwent temporal summation of pain (TSOP) and conditioned pain modulation (CPM) tests, followed by a resting-state imaging scan. No differences in temporal summation of pain and CPM were found between groups. However, in healthy individuals, more efficient CPM was correlated with 1) stronger rsFCs of the posterior cingulate cortex, with the ventromedial prefrontal cortex and with the pregenual anterior cingulate cortex; 2) weaker rsFC of the anterior insula with the angular gyrus. Conversely, in migraineurs, the association between CPM and rsFC was altered. Our results suggest that the functional connectivity within the default mode network (DMN) components and the functional coupling between the DMN and pain inhibitory brain areas is linked with pain inhibition efficiency. In migraineurs, this interplay is changed, yet enables normal pain inhibition. Our findings shed light on potential functional adaptation of the DMN and its role in pain inhibition in health and migraine. PerspectiveThis article establishes evidence for the relationship between the resting-state brain and individual responses in psychophysical pain modulation tests, in both migraine and healthy individuals. The results emphasize the significant role of the default mode network in maintaining pain inhibition efficiency in health and in the presence of chronic pain.

Changes in inter-network functional connectivity of large-scale brain networks in patients with chronic migraine

Migraine is a neurovascular disease characterized by headache and accompanied by mood disorders and impaired attention. Functional magnetic resonance imaging (fMRI) at rest allows to identify changes in the functional connectivity (FC) of various neural networks of the brain associated with the pathogenesis of pain in migraine. Previous studies of patients with migraine describe a change in FC only in certain brain structures or within some of its neural networks. However violation of the interconnected functioning of neural networks is of predominant importance within the framework of a developing theory of the common nature of the neuro- and psychopathological process. The aim of the study is to consider pathogenetic mechanism of migraine and concomitant psychopathology in the aspect of changes in the inter-network functional connectivity. Methods and patients. FMRI scanning of 25 healthy people as a control group and of 25 patients at rest between migraine attacks was performed. Post-processing and secondary analysis were performed using the CONN functional connectivity toolbox version 18b software based on an unpaired t-test and regression analysis, taking into account the Benjamini-Hochberg correction. A set of questionnaires and tests was used to clarify the qualitative characteristics of pain and the accompanying psychopathology in the patients. Results. An increase in FC in patients was observed in comparison with the control group between the salience and sensorimotor networks, the salience and default mode networks, and also within default mode networks; a decrease in FC was observed between the salience network and the dorsal attention network and within dorsal attention network. Conclusion. The obtained results indicate a common nature of pain and affective disorders in patients with migraine and identify a possible mechanism of developing chronicity. The data of the study can be used to objectify the patient’s condition in the process of clinical diagnosis.

The Effectiveness of Complex Non-Pharmacological Treatment in Patients with Episodic Migraine and Neck Pain

Introduction: Comorbidities and co-occurring conditions contribute to the overall burden of migraine. Treatment co-occurring condition is an important part in providing optimal care. Aim: To investigate the effectiveness of complex non-pharmacological treatment and impact it on daily activities and concomitant anxiety and depression in patients with episodic migraine and co-occurring neck pain. Materials and Methods: We evaluated 56 patients with episodic migraine (with aura 18 and 38 without aura) and co-existing neck pain, 21 men, 35 women, age from 18 to 55 years. Examination including radiography of the cervical spine, visual analogue scale for the pain, “HIT-6”, Beck Depression Inventory and Spilberger-Hanin’s anxiety scale. The Kolmogorov-Smirnov test was used to compare the data. Results: Patients were divided into two treatment groups: the first group of patients 28 patients received only the specified complex of manual therapy, second group - 28 patients underwent a set of manual therapy and acupuncture. After treatment in first group observed decrease of frequency and severity of migraine attacks and a reduce number of days with a headache, but level of anxiety and depressive manifestations less decreased. In second group was more significant reduce the intensity, duration and frequency of migraine, more significant dynamics of anxiety disorders and general well-being. Conclusions: Non-pharmacological treatment neck-pain syndrome in patients with episodic migraine not only to be effective in symptomatic control of pericranial muscles tension but influence on decrease of frequency and severity migraine attacks. Adding acupuncture to manual techniques more significant reduce pain syndrome and psychological disorders that possible lead to reduce drug intake.

Effects of Perceived Social Support, Depression and Anxiety Levels on Migraine.

The aim of the current study was to assess the levels of anxiety and depression and to determine relationships between perceived social support and other factors in migraine patients and to compare with the control group. The study was a cross-sectional study with 37 migraine patients and 40 control patients. The diagnosis of migraine was established according to the International Headache Society criteria. Patients completed a questionnaire comprised of sociodemographic characteristics, migraine severity (frequency and visual analogue scale score) and scales which are used for the determination of depression, anxiety and social support. Correlation analyses revealed that Beck Depression Inventory (BDI) scores were positively correlated with anxiety scores; however, they were not correlated with the clinical characteristics of migraine. Whereas, anxiety scores were correlated with the number of days with migraine pain and the number of migraine attacks in a month. However, VAS scores were not correlated with anxiety scores. Furthermore, social support scores were found to be negatively correlated with depression and anxiety scores. In the migraine group, median BDI score was 10.0 (0.0-44.0), median STAI score was 81.0 (44.0-131.0), in the control group, median BDI score was 6.0 (0.0-24.0), median STAI score was 75.0 (62.0-95.0). BDI, STAI-Trait and STAI-Total scores were higher in the migraine group than in the control group. The MSPSS score was found to be lower in the migraine group than in the control group. Depression and anxiety scores higher in the migraine group than control group. We believe our results support the suggestion that anxiety and depression are associated with migraine. Additionally, social support may be critical in the prevention or reduction of migraine attacks as it was found to affect the anxiety and depression scores of patients with migraine.