Migraine Status Research Articles

Migraine in gulf war illness and chronic fatigue syndrome: prevalence, potential mechanisms, and evaluation

Objective: To assess the prevalence of headache subtypes in Gulf War Illness (GWI) and Chronic Fatigue Syndrome (CFS) compared to controls.Background: Approximately, 25% of the military personnel who served in the 1990–1991 Persian Gulf War have developed GWI. Symptoms of GWI and CFS have considerable overlap, including headache complaints. Migraines are reported in CFS. The type and prevalence of headaches in GWI have not been adequately assessed.Methods: 50 GWI, 39 CFS and 45 controls had structured headache evaluations based on the 2004 International Headache Society criteria. All subjects had history and physical examinations, fatigue and symptom related questionnaires, measurements of systemic hyperalgesia (dolorimetry), and assessments for exclusionary conditions.Results: Migraines were detected in 64% of GWI (odds ratio = 11.6 [4.1–32.5]) (mean [±95% CI]) and 82% of CFS subjects (odds ratio = 22.5 [7.8–64.8]) compared to only 13% of controls. There was a predominance of females in the CFS compared to GWI and controls. However, migraine status was independent of gender in GWI and CFS groups (x2 = 2.7; P = 0.101). Measures of fatigue, pain, and other ancillary criteria were comparable between GWI and CFS subjects with and without headache.Conclusion: The high prevalence of migraine in CFS was confirmed and extended to GWI subjects. GWI and CFS may share dysfunctional central pathophysiological pathways that contribute to migraine and subjective symptoms. The high migraine prevalence warrants the inclusion of a structured headache evaluation in GWI and CFS subjects, and treatment when present.

Do Episodic Migraineurs Selectively Attend to Headache‐Related Visual Stimuli?

To assess pain-related attentional biases among individuals with episodic migraine. Prior studies have examined whether chronic pain patients selectively attend to pain-related stimuli in the environment, but these studies have produced largely mixed findings and focused primarily on patients with chronic musculoskeletal pain. Limited research has implicated attentional biases among chronic headache patients, but no studies have been conducted among episodic migraineurs, who comprise the overwhelming majority of the migraine population. This was a case-control, experimental study. Three hundred and eight participants (mean age = 19.2 years [standard deviation = 3.3]; 69.5% female; 36.4% minority), consisting of 84 episodic migraineurs, diagnosed in accordance with International Classification of Headache Disorders (2(nd) edition) criteria using a structured diagnostic interview, and 224 non-migraine controls completed a computerized dot probe task to assess attentional bias toward headache-related pictorial stimuli. The task consisted of 192 trials and utilized 2 emotional-neutral stimulus pairing conditions (headache-neutral and happy-neutral). No within-group differences for reaction time latencies to headache vs happy conditions were found among those with episodic migraine or among the non-migraine controls. Migraine status was unrelated to attentional bias indices for both headache (F [1,306] = 0.56, P = .45) and happy facial stimuli (F [1,306] = 0.37, P = .54), indicating a lack of between-group differences. Lack of within- and between-group differences was confirmed with repeated measures analysis of variance. In light of the large sample size and prior pilot testing of presented images, results suggest that episodic migraineurs do not differentially attend to headache-related facial stimuli. Given modest evidence of attentional biases among chronic headache samples, these findings suggest potential differences in attentional processing between chronic and episodic headache subforms.

Olanzapine as an add-on treatment in migraine status: A randomized double-blind, placebo-controlled, pilot study

Background and Objectives: The authors assessed the effectiveness of olanzapine as an adjunctive treatment in migraine status. Methods: Randomized, double-blind, placebo-controlled study. Subjects consecutively admitted to a day program of tertiary referral (97 % women; age: 35.8 �} 11.8 yrs.) were assigned to olanzapine (n = 14, 5-10 mg/day) or placebo (n = 17), added to the standard neurological treatment during 4 days. Primary measures were the change in pain and the return to regular daily activities. Secondary and safety measures were the magnitude of sedation, constipation and glucose level changes. Results: No significant differences were observed in the overall analysis of the primary measures. However, change in pain significantly correlated with age in the olanzapine group (p = 0.03). In the . 40 year-old group, olanzapine (n = 5) displayed a significantly higher reduction in pain than placebo (n = 4) at days 1 (p = 0.048) and 3 (p = 0.045). No significant differences were observed in the change of serum glucose levels. Conclusions: Olanzapine was well tolerated and sedation was welcomed by most subjects. The positive effect in subjects aged . 40 years awaits replication.

Migraine and cognitive decline among women: prospective cohort study

Objective To evaluate the association between migraine and cognitive decline among women.Design Prospective cohort study.Setting Women’s Health Study, United States.Participants 6349 women aged 65 or older enrolled in the Women’s...

Migraine and risk of incident diabetes in women: A prospective study

Previous cross-sectional studies evaluating the relationship between diabetes prevalence and migraine status have found conflicting results. We examined the relationship between migraine and incident type 2 diabetes (T2D) in a cohort of adult women. Prospective cohort study conducted among participants in the Women's Health Study who provided information on migraine and did not have diabetes at baseline. Our four exposure groups were migraine with aura, migraine without aura, past history of migraine and no history of migraine. Cox proportional hazards models were used to determine the hazard ratio for incident T2D. Among the 38,620 women included in this study, 5062 (13.1%) women had migraine, of whom 2014 (39.8%) reported migraine with aura, and 2087 (5.4%) women had a past history of migraine. During a mean of 14.6 years of follow-up, there were 3032 cases of incident T2D. After adjustment for confounders, the hazard ratio (95% confidence interval) for developing diabetes was 1.06 (0.91-1.24) for women with migraine with aura, 1.01 (0.89-1.16) for women with migraine without aura, and 1.13 (0.98-1.30) for women with a past history of migraine compared with women with no history of migraine. Results of this prospective study in women do not support an association between migraine and incident T2D.

Cost of healthcare for patients with migraine in five European countries: results from the International Burden of Migraine Study (IBMS).

Migraine is a disabling neurological disease that affects 14.7 % of Europeans. Studies evaluating the economic impact of migraine are complex to conduct adequately and with time become outdated as healthcare systems evolve. This study sought to quantify and compare direct medical costs of chronic migraine (CM) and episodic migraine (EM) in five European countries. Cross-sectional data collected via a web-based survey were screened for migraine and classified as CM (≥15 headache days/month) or EM (<15 headache days/month), and included sociodemographics, resource use data and medication use. Unit cost data, gathered using publicly available sources, were analyzed for each type of service, stratified by migraine status. Univariate and multivariate log-normal regression models were used to examine the relationship between various factors and their impact on total healthcare costs. This economic analysis included data from respondents with migraine in the UK, France, Germany, Italy, and Spain. CM participants had higher level of disability and more prevalent psychiatric disorders compared to EM. CM participants had more provider visits, emergency department/hospital visits, and diagnostic tests; the medical costs were three times higher for CM than EM. Per patient annual costs were highest in the UK and Spain and lower in France and Germany. CM was associated with higher medical resource use and total costs compared to EM in all study countries, suggesting that treatments that reduce headache frequency could decrease the clinical and economic burden of migraine in Europe. Comparing patterns of care and outcomes among countries may facilitate the development of more cost-effective care, and bring greater recognition to patients affected by migraine.

Discrete progression of migraine-induced focal cerebral infarction

Migraine-induced infarction is rare and possibly overdiagnosed [1]. Although the relationship between migraine and stroke has historically been a subject of controversy, recent evidence has lent support to the notion that migraine and stroke are co-morbid conditions linked by complex pathophysiological processes [2]. Migraine with aura is more clearly associated with increased stroke risk than is common migraine, with studies implicating smoking [3] and elevated plasma homocysteine [4], among a host of factors, as mediating risk. There appears to be a predilection for stroke localization within the posterior cerebral artery (PCA) territory [5]. The patient reported herein represents an example of migraine-induced infarction. A 66-year-old man with a history adolescent-onset classic migraine presented with prolongation of his typical symptoms, consisting of scintillating scotoma in the right visual field, followed by perioral parethesia, mild dysarthria, and anomic aphasia, and concluding with relatively mild occipital headache. Typical frequency was one to four episodes monthly with a duration of 3–4 h each. In contrast, the duration of the presenting episode was protracted, lasting between 48 and 72 h. Symptoms responded briskly to solumedrol 125 mg IV and subcutaneous sumatriptan 6 mg. The patient reported one other life-time episode suggesting migraine status several years previously with no residual symptoms. The neurological examination was unremarkable; subjectively, however, the patient reported persisting visual scotoma located 10 –15 to the right of foveation. Since the event, he also complained of increased forgetfulness requiring the use of compensatory lists and which contributed to his decision to delegate responsibility for managing the family finances to his spouse. Neuropsychological evaluation revealed deficits in memory for verbal material and confrontation naming; his MMSE score was 27/30. MRI with contrast revealed a focal gyral pattern of signal hyperintensity on T1-, T2-weighted, and FLAIR sequences, with associated heterogeneous enhancement consistent with laminar necrosis from evolving subacute to chronic infarction in the left PCA distribution, affecting the mesial occipital region. Scattered, punctate areas of T2 and FLAIR hyperintensity were also noted in subcortical white matter (Fig. 1). Mass lesion, vascular malformation, and focal cerebritis were excluded. EEG obtained 2 years prior to that event was normal, effectively ruling out seizure disorder. Carotid Doppler study showed mild stenosis (16–49 %) of the internal carotid arteries bilaterally. Pertinent laboratory studies including ESR (10) and CRP (0.411) were normal, but homocysteine was elevated (15.1). TSH, vitamin B12, folate, and RPR were unremarkable. Migraine status with characteristic aura recurred 21 months later. Neurological examination following that event was remarkable only for a homonymous right superior quandrantanopia. Follow-up neuropsychological evaluation showed interval decline in memory, speed of visual search, cognitive flexibility, problem solving, and S. P. Cercy (&) Department of Psychiatry, New York University School of Medicine, 423 E 23rd Street, New York, NY 10010, USA e-mail: Steven.Cercy@va.gov

Migraine and Risk of Depression among Women (P04.232)

Objective: To evaluate the association between migraine and incident depression in a large cohort of women without a history of depression at baseline. Background Studies have shown cross-sectional relationships between migraine and depression. However, few studies have been able to evaluate the association between migraine and incident depression. Design/Methods: Prospective cohort study among 36,154 women enrolled in the Women9s Health Study who provided information about migraine status at baseline, did not have a history of depression prior to baseline and who provided information about depression diagnoses during follow-up. Women were classified as either having active migraine with aura, active migraine without aura, past history of migraine (report of migraine history but no active migraine in the year prior to baseline) or no history of migraine. During follow-up, women provided information on the dates of new diagnoses of depression. Cox proportional hazards models were used to evaluate the association between migraine status and incident depression. Results: At baseline, 6456 women reported any history of migraine, of whom 1815 (28.1%) reported active migraine with aura. During a mean of 14.3 years of follow-up, 3971 incident cases of depression occurred. Women with any history of migraine had 1.36 times the risk of developing depression compared to women without a history of migraine (95% CI: 1.27, 1.47). Presence of migraine aura did not modify this association (RR=1.43, 95% CI: 1.26, 1.62 for migraine with aura compared to RR=1.29, 95% CI: 1.16, 1.44 for migraine without aura). Women with a past history of migraine had 1.41 times the risk of developing depression (95% CI: 1.24, 1.59). Conclusions: Women with active migraine or past history of migraine are at increased risk of developing depression compared to women with no history of migraine. Supported by: The Women9s Health Study is supported by the National Heart, Lung, and Blood Institute (grants HL-043851, HL-080467, HL-082740, and HL-075771) and the National Cancer Institute (grant CA-047988). Disclosure: Dr. Rist has nothing to disclose. Dr. Buring has nothing to disclose. Dr. Kurth has received personal compensation for activities with Merck & Co. & MAP Pharmaceuticals as a speaker and participant on an expert panel. Dr. Kurth has received personal compensation in an editorial capacity for the British Medical Journal.

Migraine and behavior in children: influence of maternal headache frequency

We took advantage of a large population study in order to measure child behavior, as captured by the Child Behavior Checklist (CBCL) as a function of headache status in the children and their mothers. Of the target sample, consents and analyzable data were obtained from 1,856 families (85.4 %). Headache diagnoses were defined according to the second edition of the International Classification of Headache Disorders, and behavioral and emotional symptoms were assessed by the validated Brazilian version of the CBCL. We calculated the relative risk of abnormalities in the CBCL domains as a function of headache status in the children, after adjusting by a series of main effect models. Children with migraine were more likely to present abnormal scores in several of the CBCL scales, relative to children without migraine, and maternal migraine status contributed little to the model. However, when the mother had daily headaches, both children with and without migraine had similar CBCL scores. In multivariate analyses, migraine status in the children predicted CBCL scores (p < 0.01). Headache status and headache frequency in the mother did not predict CBCL scores in children with migraine but predicted in children without migraine (p < 0.01). The burden of migraine to the family is complex. Children with migraine are more likely to have behavioral and emotional symptoms than children without migraine. Children without migraine may be affected, in turn, by frequent headaches experienced by their mothers.

Migraine-Asthma Comorbidity and Risk of Hypertensive Disorders of Pregnancy

Background. To evaluate the association of migraine and asthma and to estimate the risk of hypertensive disorders of pregnancy in relation to maternal comorbid migraine and asthma. Methods. Reproductive age women (N = 3.731) were interviewed during early pregnancy. At the time of interview, we ascertained participants' migraine and asthma status. From medical records, we collected information to allow the diagnosis of pregnancy-induced hypertension (PIH) and preeclampsia. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using logistic regression procedures. Results. After adjusting for confounders, migraineurs had 1.38-fold increased odds of asthma as compared with nonmigraineurs (95% CI 1.09–1.38). The odds of hypertensive disorders of pregnancy were highest among women with comorbid migraine-asthma. The ORs for PIH preeclampsia and the two disorders combined were 2.53 (95% CI 1.39–4.61), 3.53 (95% CI 1.51–8.24), and 2.64 (95% CI 1.56–4.47), respectively, for women with comorbid migraine-asthma as compared with those who had neither disorder. Conclusion. These findings confirm prior reports and extend the literature by documenting particularly high odds of pregnancy-induced hypertension and preeclampsia among women with comorbid migraine-asthma. Increased knowledge about the prevalence and sequelae of comorbidities during pregnancy may lead to improved symptom management and perinatal outcomes.

Combat Exposure and Migraine Headache: Evidence from Exogenous Deployment Assignment

Migraine headache is a growing problem for U.S. servicemen deployed in the Global War on Terrorism and has been linked to substantial negative socioeconomic consequences. However, there has been no comprehensive examination of the relationship between combat exposure and migraine headache or its stress-related triggers. Using data drawn from the National Longitudinal Study of Adolescent Health, we exploit exogenous variation in deployment assignment to estimate the effect of combat exposure on migraine headache. We find that those deployed to a combat zone with enemy firefight are at substantially increased risk for migraine headache relative to those deployed to non-combat zones outside the United States or to combat zones without enemy firefight. This relationship is robust to controls for pre-deployment migraine status and is largest for those serving in the Army in the post-9/11 period. We find that combat-induced sleep disorders, stress-related psychological problems, and physical injuries in combat explain 47 to 60 percent of the relationship between combat exposure and migraine headache.

Combat Exposure and Migraine Headache: Evidence from Exogenous Deployment Assignment

Migraine headache is a growing problem for U.S. servicemen deployed in the Global War on Terrorism and has been linked to substantial negative socioeconomic consequences. However, there has been no comprehensive examination of the relationship between combat exposure and migraine headache or its stress-related triggers. Using data drawn from the National Longitudinal Study of Adolescent Health, we exploit exogenous variation in deployment assignment to estimate the effect of combat exposure on migraine headache. We find that those deployed to a combat zone with enemy firefight are at substantially increased risk for migraine headache relative to those deployed to non-combat zones outside the United States or to combat zones without enemy firefight. This relationship is robust to controls for pre-deployment migraine status and is largest for those serving in the Army in the post-9/11 period. We find that combat-induced sleep disorders, stress-related psychological problems, and physical injuries in combat explain 47 to 60 percent of the relationship between combat exposure and migraine headache.

Neuropsychological functioning in migraine: Clinical and research implications

We review the research literature examining neuropsychological performance in migraine. Findings were organized by neuropsychological construct assessed and results were reported using effect size conventions. Factors considered in explaining results included sample characteristics, migraine factors, and control for non-migraine variables. There is weak evidence for deficits in processing speed, attention, verbal memory, verbal skills, working memory, sustained attention, and inhibition in migraine relative to healthy controls. There are mixed results regarding deficits in visual memory, motor dexterity, visuospatial/constructional skills, visual reasoning, and mental flexibility in migraine relative to healthy controls. Mixed findings do not seem to be consistently related to study characteristics or presence of aura; other important migraine factors (such as migraine severity or presence of neuroradiological findings) remain understudied. Relative to non-healthy control groups, however, there is weak evidence for an effect of migraine in any cognitive domain. Longitudinal studies provide little evidence that neuropsychological functioning worsens over time in migraine or that migraine is a risk factor for Alzheimer's disease. It remains possible that cognitive dysfunction is seen in only a subset of migraine sufferers, perhaps those with more severe illness or neurological involvement; however, more research is needed to examine this issue. Non-migraine differences among migraine sufferers, including medical and psychiatric comorbidities and variables associated with treatment seeking, may partially account for inconsistent findings and should be evaluated for in future research. Clinicians should refer migraine patients for comprehensive neuropsychological evaluation only when there is sufficient evidence for concern. Such evaluations should include consideration of other psychological, neurological, and medical contributors to both migraine and cognitive status.

Exercise as migraine prophylaxis: a randomized study using relaxation and topiramate as controls.

Aim: Scientific evidence regarding exercise in migraine prophylaxis is required. Therefore this study aimed to evaluate the effects of exercise in migraine prevention. Methods: In a randomized, controlled trial of adults with migraine, exercising for 40 minutes three times a week was compared to relaxation according to a recorded programme or daily topiramate use, which was slowly increased to the individual’s highest tolerable dose (maximum 200 mg/day). The treatment period lasted for 3 months, and migraine status, quality of life, level of physical activity, and oxygen uptake were evaluated. The primary efficacy variable was the mean reduction of the frequency of migraine attacks during the final month of treatment compared with the baseline. Results: Ninety-one patients were randomized and included in the intention-to-treat analysis. The primary efficacy variable showed a mean reduction of 0.93 (95% confidence interval (CI) 0.31–1.54) attacks in the exercise group, 0.83 (95% CI 0.22–1.45) attacks in the relaxation group, and 0.97 (95% CI 0.36–1.58) attacks in the topiramate group. No significant difference was observed between the groups (p = 0.95). Conclusion: Exercise may be an option for the prophylactic treatment of migraine in patients who do not benefit from or do not want to take daily medication.

Migraine and cognitive decline in the population-based EVA study

Previous studies on migraine and cognition have shown mixed results. However, many could not assess the relationship between migraine and change in cognitive function or only used a limited number of cognitive tests. Prospective cohort study among 1170 participants of the Epidemiology of Vascular Ageing Study who provided information about migraine status and completed cognitive testing. Participants were classified as having no severe headache, non-migraine headache and migraine. Cognitive functioning was measured at up to four time points using nine different cognitive functioning tests. Linear mixed effects models were used to evaluate the relationship between migraine status and change in cognitive function. Of the 1170 participants, 938 had no severe headache, 167 had migraine, and 65 had non-migraine headache. After adjusting for age, gender, education and smoking status, people with migraine or non-migraine headache did not experience a greater rate of cognitive decline than those without headache or migraine in any domain (for the Mini Mental State Examination (MMSE), p-values were 0.68 for the non-migraine headache and time interaction and 0.85 for the migraine and time interaction) during 4-5 years of follow-up. For the Wechsler Adult Intelligence Scale-Revised, those with migraine declined less over time (p-value=0.02). Migraine was not associated with faster cognitive decline over time.

Individual heterogeneity and reverse causality in the relationship between migraine headache and educational attainment

A recent study by Rees and Sabia (2011) found migraine headache was negatively related to educational attainment even after accounting for the influence of family-level unobservables. The current study explores whether this relationship is attributable to unmeasured individual heterogeneity in the form of personality by using non-migraine headache as a placebo. In addition, it explores the degree to which the negative relationship between migraine headache and educational attainment can be explained by reverse causality using mother's migraine status as an instrument. We conclude that the estimates reported by Rees and Sabia (2011) likely reflect the causal effect of migraine headache on educational attainment.

Adult attention deficit hyperactivity disorder is associated with migraine headaches

Attention deficit hyperactivity disorder (ADHD) is now recognized as a common disorder both in child and adult psychiatry. Adult patients with a diagnosis of ADHD (n = 572) and community controls (n = 675) responded to auto-questionnaires rating past and present symptoms of ADHD, co-morbid conditions, including migraine, treatment history and work status. The prevalence of migraine was significantly higher in the patient group compared to the controls (28.3% vs. 19.2%, P < 0.001, OR = 1.67, CI 1.28–2.17). The difference from controls was particularly marked for men (22.5% vs. 10.7%, P < 0.001, OR = 2.43, CI 1.51–3.90) but was also significant for women (34.4% vs. 24.9%, P = 0.008, OR = 1.58, CI 1.13–2.21). In both patients and controls, migraine was associated with symptoms of mood and anxiety disorders. These findings point to a co-morbidity of migraine with ADHD, and it is possible that these patients represent a clinical and biological subgroup of adult patients with ADHD.

Circulation : Clinical Summaries

<i>Circulation</i> : Clinical Summaries

Association Between Intimate Partner Violence, Migraine and Probable Migraine

Intimate partner violence (IPV) among women is a global public health problem. The association between childhood maltreatment and migraine is well established, but not the association between IPV and migraine. The aim of this cross-sectional study was to evaluate the relationship between type and severity of IPV and migraine in a large cohort of Peruvian women. Women who delivered singleton infants (n = 2066) at the Instituto Nacional Materno Perinatal, Lima, Peru were interviewed during their postpartum hospital stay. Participants were queried about their lifetime experiences with headaches and migraine, and with physical and sexual violence. The International Classification of Headache Disorders (ICHD-2) diagnostic criteria were used to classify participants according to their migraine status. Questions on physical and sexual violence were adapted from the protocol of Demographic Health Survey Questionnaires and Modules: Domestic Violence Module and the World Health Organization (WHO) Multi-Country Study on Violence against Women. Depressive symptoms were assessed using a modified version of the Patient Health Questionnaire-9. Logistic regression was used to estimate multivariate adjusted odds ratios (aOR) and 95% confidence intervals (CI). Compared with women without a history of violence, women with experiences of lifetime physical or sexual violence (aOR = 1.44, 95% CI 1.19-1.75), physical violence only (aOR = 1.36, 95% CI 1.10-1.68), sexual violence only (aOR = 1.76, 95% CI 0.97-3.21), and both physical and sexual violence (aOR = 1.61, 95% CI 1.12-2.31) had increased odds of any migraine after adjusting for maternal age, parity, and access to basic foods. There was no gradient of increased odds of any migraine with severity of physical violence. The relationship between IPV and any migraine was strongest among women with moderate to severe levels of depressive symptoms. The odds of any migraine was increased 2.25-fold (95% CI 1.75-2.28) among abused women who also had moderate to severe levels of depressive symptomology compared with women who were not abused and had none or mild levels of depressive symptomology. Associations from sensitivity analyze that segregated women according to probable migraine (ICHD-2 category 1.6.1) and migraine (ICHD-2 category 1.1) diagnoses were of similar magnitudes as those reported here for women with any migraine diagnoses. IPV, particularly sexual violence, appears to be a risk factor for migraine. Our findings suggest the potential importance of considering a history of violence among migraineurs.

Disability, HRQoL and resource use among chronic and episodic migraineurs: Results from the International Burden of Migraine Study (IBMS)

Migraine imposes significant burden on patients, their families and health care systems. In this study, we compared episodic to chronic migraine sufferers to determine if migraine status predicted headache-related disability, health-related quality of life (HRQoL) and health care resource utilization. A Web-based survey was administered to panelists from nine countries. Participants were classified as having chronic migraine (CM), episodic migraine (EM) or neither using a validated questionnaire. Data collected and then analyzed included sociodemographics, clinical characteristics, Migraine Disability Assessment, Migraine-Specific Quality of Life v2.1, Patient Health Questionnaire and health care resource utilization. Of the respondents, 5.7% had CM and 94.3% had EM, with CM patients reporting significantly more severe disability, lower HRQoL, higher levels of anxiety and depression and greater health care resource utilization compared to those with EM. These results provide evidence that will enhance our understanding of the factors driving health care costs and will contribute to development of cost-effective health care strategies.