Migraine Patterns Research Articles

Deciphering the Symptom Spectrum: A Comprehensive Analysis of Migraine Patterns and Types

Complex neurological diseases like migraine migraine affect a large section of the global population, causing health, social, and economic issues. Migraine causes intense, painful headaches that are usually one-sided and pulsing. Auras, nausea, vomiting, and excessive light and sound sensitivity may precede these episodes. Migraine affect millions worldwide and can be intermittent or persistent, impairing function. Diet and stress may induce it, but the cause is unknown. Prevention and symptom treatment drugs and lifestyle changes are used. Debilitating migraines are hard to diagnose due to their varied presentation and subjective symptom reporting. Traditional migraine diagnosis, based on clinical evaluation, typically fails to classify migraine types, requiring more objective and rigorous instruments. This study proposes a machine learning-based migraine categorization method to address this issue. The dataset includes different patient demographics and clinical variables; thus, we use complex algorithms like Random for Forest, XGBoost, and Extra Trees. These algorithms are great for deciphering migraine patterns because they excel at evaluating complex datasets. The research seeks to close this gap to improve migraine classification accuracy, objectivity, and reliability, enabling tailored migraine management and treatment. This neurology study could im- prove migraine diagnosis and treatment with more effective and personalized plans.

Association between Migraine Patterns and White Matter Hyperintensities in MRI Brain: A Cross-sectional Analytical Study

Introduction: Migraine is a neurological condition characterised by recurrent episodes of headaches. The role of Magnetic Resonance Imaging (MRI) as a diagnostic tool in evaluating migraines is yet to be fully understood. Changes that occur in the blood vessels during a migraine attack lead to hypoperfusion in the brain, causing neurovascular dysfunction and cortical spreading depression. These events are manifested as White Matter Hyperintensities (WMHs) in brain MRI. Aim: To determine the association between migraine patterns and WMHs in the MRI brain scans. Materials and Methods: A cross-sectional analytical study was conducted at Department of Neurology, Mar Baselios Medical Mission Hospital, a tertiary care centre for Neurology and Movement disorders in South India, from June 2021 to June 2022. The study included 100 patients aged between 18 and 50 years who had been diagnosed with migraine. A questionnaire was prepared, which included various parameters such as the presence or absence of aura, duration, frequency, tolerability, disability, intensity of pain, nausea, and resistance to treatment. The severity of migraine in the patients was evaluated using the Migraine Intensity and Severity Evaluation (MIGSEV) scale, which considers parameters such as pain intensity, attack duration, nausea, disability, tolerability, treatment resistance, and attack frequency. Based on this assessment, patients were classified into Grade I, II, or III. After obtaining informed consent, MRI brain scans were performed on all patients. Patients exhibiting WMHs underwent Gadolinium IV contrast, and those with contrast-enhancing lesions underwent whole spine screening and CSF analysis testing. Statistical Package for the Social Sciences (SPSS) version 20.0 was used for data analysis. The statistical tests employed included the MannWhitney test, Kruskal-Wallis test and Spearman coefficient. Results: The mean age of the participants was 28.60±7.0 years. WMHs were present in 47 out of 100 patients (47%). A significant association was observed between WMHs and aura (U=487.50) (p-value<0.001). Multivariate analysis revealed that migraine severity grade, pain intensity during the attack, nausea, disability, tolerability, migraine duration, and resistance to treatment were statistically significant with a p-value of <0.001. Conclusion: WMHs in MRI were more significant in patients with Grade III MIGSEV scores. There was a statistically significant association between the number of WMHs, high intensity of pain, vomiting, severe disability, and tolerability during a migraine attack. Therefore, these parameters can be considered as risk factors for developing WMHs in the brain MRI of migraine patients.

A Low Power Multi-Class Migraine Detection Processor Based on Somatosensory Evoked Potentials

Migraine is a disabling neurological disorder that can be recurrent and persist for long durations. The continuous monitoring of the brain activities can enable the patient to respond on time before the occurrence of the approaching migraine episode to minimize the severity. Therefore, there is a need for a wearable device that can ensure the early diagnosis of a migraine attack. This brief presents a low latency, and power-efficient feature extraction and classification processor for the early detection of a migraine attack. Somatosensory Evoked Potentials (SEP) are utilized to monitor the migraine patterns in an ambulatory environment aiming to have a processor integrated on-sensor for power-efficient and timely intervention. In this work, a complete digital design of the wearable environment is proposed. It allows the extraction of multiple features including multiple power spectral bands using 256-point fast Fourier transform (FFT), root mean square of late HFO bursts and latency of N20 peak. These features are then classified using a multi-classification artificial neural network (ANN)-based classifier which is also realized on the chip. The proposed processor is placed and routed in a 180nm CMOS with an active area of 0.5mm <sup xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sup> . The total power consumption is 249 μW while operating at a 20MHz clock with full computations completed in 1.31ms.

Migraine, headache, and mortality in women: a cohort study

BackgroundMigraine carries a high global burden, disproportionately affects women, and has been implicated as a risk factor for cardiovascular disease. Migraine with aura has been consistently associated with increased risk of cardiovascular mortality. However, published evidence on relationships between migraine or non-migraine headache and all-cause mortality is inconclusive. Therefore, we aimed to estimate the effect of non-migraine headache and migraine as well as migraine subtypes on all-cause and cause-specific mortality in women.MethodsIn total, 27,844 Women’s Health Study participants, aged 45 years or older at baseline, were followed up for a median of 22.7 years. We included participants who provided information on migraine (past history, migraine without aura, or migraine with aura) or headache status and a blood sample at study start. An endpoints committee of physicians evaluated reports of incident deaths and used medical records to confirm deaths due to cardiovascular, cancer, or female-specific cancer causes. We used multivariable Cox proportional hazards models to estimate the effect of migraine or headache status on both all-cause and cause-specific mortality.ResultsCompared to individuals without any headache, no differences in all-cause mortality for individuals suffering from non-migraine headache or any migraine were observed after adjustment for confounding (HR = 1.01, 95%CI, 0.93–1.10 and HR = 0.96, 95% CI: 0.89–1.04). No differences were observed for the migraine subtypes and all-cause death. Women having the migraine with aura subtype had a higher mortality due to cardiovascular disease (adjusted HR = 1.64, 95%CI: 1.06–2.54). As an explanation for the lack of overall association with all-cause mortality, we observed slightly protective signals for any cancer and female-specific cancers in this group.ConclusionsIn this large prospective study of women, we found no association between non-migraine headache or migraine and all-cause mortality. Women suffering from migraine with aura had an increased risk of cardiovascular death. Future studies should investigate the reasons for the increased risk of cardiovascular mortality and evaluate whether changes in migraine patterns across the life course have differential effects on mortality.

Manifestation of migraine in adolescents: Does it change in puberty?

To analyze the association between pubertal stage, menstrual cycle and migraine attacks in girls with migraine. In addition, headache frequency, accompanying symptoms, duration and onset in relation to the specific phase of the cycle were investigated. Girls between 7 and 18 years old, diagnosed with headaches that met "International Classification of Headache Disorders II" diagnostic criteria for migraine without aura, kept a daily headache and menstrual cycle diary over 8 weeks. Ovulatory cycles were identified by weekly progesterone saliva tests. 47 girls participated in the study and were divided into three groups according to Tanner stage and onset of regular menstruation: pre- (n=16), peri- (n=19) and post-pubertal (n=12). A significant difference in migraine frequency was found between pre- and post-pubertal girls (p=0.005). No significant differences with regard to headache characteristics were detected. Interestingly, a higher frequency of attacks in follicular phase occurred compared to luteal phase in peri- and post-pubertal girls (p=0.030). During puberty, migraine patterns in girls change to a typical adult pattern of migraine in a stepwise manner not clearly related to menarche. The first sign of this transition phase could be the higher frequency of migraine attacks in post-pubertal girls.

Using Search Engines to Investigate Shared Migraine Experiences

To investigate migraine patterns in the United States using Google search data and utilize this information to better understand societal-level trends. Additionally, we aimed to evaluate time-series relationships between migraines and social factors. Extensive research has been done on clinical factors associated with migraines, yet population-level social factors have not been widely explored. Migraine internet search data may provide insight into migraine trends beyond information that can be gleaned from other sources. In this longitudinal analysis of open access data, we performed a time-series analysis in which about 12years of Google Trends data (January 1, 2004 to August 15, 2016) were assessed. Data points were captured at a daily level and Google's 0-100 adjusted scale was used as the primary outcome to enable the comparison of relative popularity in the migraine search term. We hypothesized that the volume of relative migraine Google searches would be affected by societal aspects such as day of the week, holidays, and novel social events. Several recurrent social factors that drive migraine searches were identified. Of these, day of the week had the most significant impact on the volume of Google migraine searches. On average, Mondays accumulated 13.31 higher relative search volume than Fridays (95% CI: 11.12-15.51, P ≤ .001). Surprisingly, holidays were associated with lower relative migraine search volumes. Christmas Day had 13.84 lower relative search volumes (95% CI: 6.26-21.43, P ≤ .001) and Thanks giving had 20.18 lower relative search volumes (95% CI: 12.55-27.82, P ≤ .001) than days that were not holidays. Certain novel social events and extreme weather also appear to be associated with relative migraine Google search volume. Social factors play a crucial role in explaining population level migraine patterns, and thus, warrant further exploration.

Migraine comorbidity with cardiac, cardiovascular and cerebrovascular disease

AbstractMigraine has complex relationships with disorders of the heart, the cardiovasculature and the cerebrovasculature. The purpose of this review was to summarize data regarding the relationship of migraine with structural cardiac disease, cardiovascular disease and stroke. There are low‐quality and/or conflicting data regarding a possible association between migraine with patent foramen ovale and other sources of right‐to‐left shunt. If these associations exist, migraine with aura, in contrast to migraine without aura, would likely account for the comorbidity. Although low‐quality evidence suggested that patent foramen ovale closure results in improved migraine patterns, higher‐quality evidence from prospective clinical trials of patent foramen ovale closure failed to achieve their primary end‐points. There are conflicting data regarding an increased risk of cardiovascular disease in people with migraine. Overall, data suggest that migraine with aura is probably associated with an increased risk for cardiovascular disease. Consistently, studies have shown migraine with aura to be associated with an increased risk for ischemic stroke. The explanation for the comorbidity between migraine with aura and cardiovascular and cerebrovascular diseases has yet to be adequately defined. Potential causal relationships and shared underlying risk factors are discussed. Migraine with aura is associated with an increased risk for ischemic stroke. Migraine with aura might be associated with an increased risk for cardiovascular disease and an increased likelihood for structural cardiac disease, such as patent foramen ovale. Further investigations will define the existence and nature of the relationship between migraine with aura and these disorders.

CADASIL: Migraine, Encephalopathy, Stroke and Their Inter-Relationships.

BackgroundMigraine is common in Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) but its treatment responses are not well described, and its relationship to stroke risk unknown. Encephalopathy is a less common presentation; it has been suggested it is related to migraine. We characterised migraine patterns and treatment responses in CADASIL, and examined associations between migraine and both stroke risk and encephalopathy.Methods300 symptomatic CADASIL patients were prospectively recruited from a national referral clinic over a nineteen year period, from 1996 to 2015. Data was collected using a standardised questionnaire. Migraine was classified according to the International Classification of Headache Disorders, 3rd edition (beta version). A cross-sectional analysis was carried out on the data collected.ResultsMigraine was present in 226 (75.3%), and the presenting feature in 203 (67.7%). It was usually accompanied by aura (89.8%). Patients showed variable responses to a variety of drugs for migraine. Of 24 given triptans, 45.5% had consistent or partial responses. None had complications following triptans. Thirty-three (11.0%) patients experienced encephalopathy lasting on average 8.1 ± 3.4 days. Patients with migraine with aura had higher odds of encephalopathy (OR = 5.4; 95%CI 1.6–28.4; p = 0.002). Patients with confusional aura had higher odds of encephalopathy than those with other aura types (OR = 2.5, 95%CI = 1.0–5.8, p = 0.04). There was also no increase in risk of encephalopathy with sex or age at onset of migraine. Migraineurs had a lower stroke risk than non-migraineurs (HR = 0.46, 95%CI 0.3–0.6, p = 2.1x10-6).ConclusionsMigraine with aura is a prominent feature of CADASIL. Treatment responses are similar to those seen in the general migraine population and no complications were observed with triptans. Migraine with aura was associated with increased risk of encephalopathy suggesting they may share pathophysiological mechanisms. There was no increased stroke risk associated with migraine, but risk appeared to be reduced although this finding needs confirming.

Progestin-only contraception compared with extended combined oral contraceptive in women with migraine without aura: a retrospective pilot study

ObjectiveTo evaluate the effect of a desogestrel progestogen-only pill (POP) compared to continuous combined oral contraception (COC) on migraine patterns in women with migraine without aura. Study designA retrospective analysis of prospective headache charts from migrainous women who used the POP or COC in our clinic between July 2009 and July 2013. The quality and quantity of migraine attacks and use of medications were evaluated at three and six months. Health related quality of life was evaluated after 6 months’ treatment. ResultsFifty-three patients were evaluable for the analysis (22 in the COC group and 31 in the POP group). Six months’ POP treatment led to a statistical reduction in migraine days; headache days; pain intensity; number of days with severe pain and days with pain medication. The only statistical difference between the two groups was a reduction in the number of days with pain medication in the POP group compared to the COC group (p=0.044). After 6 months’ treatment a quality of life improvement was seen only in the POP group, but no statistical differences were found when comparing the two groups. ConclusionsOur preliminary data confirm that POP therapy improves migraine patterns and quality of life after 6 months’ treatment in women with migraine without aura and it decreases the analgesic consumption with respect to an extended COC therapy. As POP represents a healthier opportunity, in terms of vascular risk, than combined contraception, its role in migrainous women deserves to be further investigated.

Foramen ovale perméable et migraine

Observational studies indicate an increased prevalence of patent foramen ovale (PFO) in migraineurs with aura and an increased prevalence of migraine and migraine with aura in patients with PFO but a recent stratified meta-analysis does not support pairwise association between PFO and migraine. There are conflicting data regarding causal relationship between these two conditions. According to recent studies, microembolization might provoke a decrease in cerebral oxygen saturation, thus triggering cortical spreading depression and, thereafter, migraine with aura attack. Release of vasoactive substances by activated platelets or atrial natriuretic factor are other pathophysiological explanations. Retrospective analyses of PFO closure suggest clinically significant improvements in migraine patterns. The MIST study is the only prospective study available with a good design but this study gave a negative response about cure of migraine with aura and revealed a high morbidity for such a benign condition. Although PFO closure sometimes appears to affect migraine patterns favorably, the very low grade of available evidence to support this association precludes definitive conclusions. To date, PFO closure in migraineurs with aura is not recommended in daily practice.

Migraine in Women

This article discusses hormonal milestones and the influence that hormonal fluctuations make in the frequency and severity of migraine in women and includes information on acute, short-term, and preventive strategies for hormonally influenced migraine and the situations in which hormonal therapies may be offered. Genomic patterns in adolescent girls differentiate between menstrually related migraine and non-menstrually related migraine. The age at initiation of estrogen replacement therapy appears to be significant with respect to stroke. No increase in stroke occurred in women on low-dose (50 µg or less) transdermal estrogen replacement compared to women not using estrogen replacement. Childhood maltreatment is more common in women with migraine and depression than in women with migraine alone. Management of hormonally influenced migraine involves a clear identification of the relationship between migraine and hormone change. A thorough history and detailed diary are critical in identifying this relationship and in predicting response or following response to hormonal therapies. The evolution of migraine in an individual may be strongly driven by hormonal shifts. Although limited, clinical evidence suggests that oral contraceptive use in young women with episodic migraine may transform their pattern into chronic migraine. Thus, particular attention to changes in migraine patterns following either endogenous or exogenous hormonal changes is crucial. Providing reassurance and education that migraine is a biological disorder and providing an understanding of the role of estrogen in the frequency and severity of migraine can guide treatment choices. Pharmacologic treatments include acute therapy, with short-term and standard prevention offered where appropriate. Hormonal therapies are not first-line therapies but may be important choices for a woman with migraine whose estrogen fluctuation is continually exacerbating migraine attacks. Given the many hormonal stages during the life of a woman with migraine, therapies may vary according to hormonal stage and status. Overall wellness should also be emphasized; regular exercise, balanced diet, smoking cessation, weight control, and sleep hygiene are important in the management of migraine.

Patent Foramen Ovale and Migraine: A Quantitative Systematic Review

Initial studies indicate an increased prevalence of patent foramen ovale (PFO) in migraineurs with aura, and an increased prevalence of migraine and migraine with aura in persons with PFO. Retrospective analyses of PFO closure suggest clinically significant improvements in migraine patterns. The aim of this study was to examine the prevalence of migraine in patients with PFO, the prevalence of PFO in migraineurs, and the effect of PFO closure on migraine. We conducted a quantitative systematic review of articles on migraine and PFO that met inclusion criteria, then reviewed, appraised, and subjected them to data extraction. Of 134 articles identified, 18 met a priori selection criteria. The estimated strength of association between PFO and migraine, reflected by summary odds ratios (ORs), was 5.13 [95% confidence interval (CI) 4.67, 5.59], and between PFO and migraine with aura the OR was 3.21 (95% CI 2.38, 4.17). The grade of evidence was low. The association between migraine and PFO was OR 2.54 (95% CI 2.01, 3.08). The grade of evidence was low to moderate. Six studies of PFO closure suggested improvement in migraine, but had a very low grade of evidence. The low-to-moderate grade of evidence from observational studies supports an apparent association between PFO and migraine. Although PFO closure seemed to affect migraine patterns favourably, the very low grade of available evidence to support this association precludes definitive conclusions.

Recognition and Treatment of Menstrual Migraine

Menstrual migraine is a chronic disorder affecting approximately 12.6 million women in the United States. In spite of its widespread prevalence, menstrual migraine often goes undiagnosed. Characteristics of menstrual migraine, which include functional disability, increased headache severity, and lack of aura, are often overlooked, and therefore menstrual migraine is often underdiagnosed. Use of a 3-month diary to record migraine patterns can reveal the predictable patterns associated with menstrual migraine, and a diary is demonstrated to be a useful tool in diagnosis. Optimal treatment of menstrual migraine takes advantage of the predictability of the disorder. Treatment alternatives for menstrual migraine include acute therapy and short- or long-term preventive therapies. Acute therapy is given shortly after the migraine begins. Short-term preventive therapies are effective when administered during the time that menstrual migraine is most likely to occur; the treatment window is typically 2 days prior up to 3 days after the onset of menstruation. Providing triptans, nonsteroidal anti-inflammatory drugs, or estrogen supplements (gel or patches) during this window has been demonstrated to provide effective protection during the days when patients are at greatest risk for menstrual migraine. Alternatively, long-term preventive therapy may be required for recurrent headaches in patients with concomitant medical conditions for whom migraine therapy could serve a dual purpose. By recognizing the patterns associated with menstrual migraine, prompt, acute, or preventive therapy can be used to effectively manage the disorder and reduce its related disability.