Migraine Sufferers Research Articles

Urinary albumin excretion as a marker of endothelial dysfunction in migraine sufferers: the HUNT study, Norway

ObjectiveTo investigate urine albumin leakage as a marker of endothelial dysfunction in migraine patients.DesignA population-based health study.Participants303 patients with migraine, 1009 patients with non-migraine headache and 5287 headache-free controls.OutcomesThe association...

Migraine and vascular risk factors in the elderly

The association between migraine and cerebrovascular disease is well documented in younger migraine patients, especially those with aura. Prevalence estimates of vascular risk factors among elderly migraine sufferers are lacking. The present study was designed to estimate the prevalence of vascular risk factors in the elderly population with late onset of migraine without aura. The medical records of 163 patients aged 50 years and older suffering from migraine without aura were assessed for vascular risk factors, including hypertension, elevated serum lipid levels, diabetes mellitus and cardiovascular disease. Prevalence was estimated and compared with age- and sex-matched vascular risk factor estimates for the general population extracted from the 2003-2004 Israeli National Health Interview Survey, and to a group of patients matched by age suffering from migraine with aura. Among women with migraine without aura, hypertension, hyperlipidemia and diabetes mellitus were significantly less prevalent than among women without migraine without aura. Prevalence estimates for vascular risk factors did not differ by migraine among males. The group of older patients suffering from migraine with aura showed a higher incidence of vascular risk factors in respect to the group of migraine patients without aura. The findings of the present study might have an important clinical relevance, suggesting another pathophysiological process in respect to patients suffering from migraine with aura, and this evidence might have different therapeutic implications.

Use of common migraine treatments in breast-feeding women: a summary of recommendations.

Breast-feeding has important health and emotional benefits for both mother and infant, and should be encouraged. While there are some data to suggest migraine may improve during breast-feeding, more than half of women experience migraine recurrence with 1 month of delivery. Thus, a thorough knowledge base of the safety and recommended use of common acute and preventive migraine drugs during breast-feeding is vital to clinicians treating migraine sufferers. Choice of treatment should take into account the balance of benefit and risk of medication. For some of the medications commonly used during breast-feeding, there is not good evidence about benefits. A list of commonly used migraine medications was agreed upon by the 6 authors, who treat migraine and other headaches on a regular basis and are members of the Women's Special Interest Section of the American Headache Society. Each medication was researched by the first author utilizing widely accepted data sources, such as the American Academy of Pediatrics publication "The Transfer of Drugs and Other Chemicals Into Human Milk; Thomas Hale's manual Medications and Mothers Milk; Briggs, Freeman, and Yaffe's reference book Drugs in Pregnancy and Lactation; and the National Library of Medicine's Drugs and Lactation Database (LactMed) - a peer-reviewed and fully referenced database available online. Many commonly used migraine medications may be compatible with breast-feeding based on expert recommendations. Ibuprofen, diclofenac, and eletriptan are among acute medications with low levels in breast milk, but studies of triptans are limited. Toxicity is a concern with aspirin due to an association with Reye's syndrome; sedation or apnea is a concern with opioids. Finally, preventive medications not recommended include zonisamide, atenolol, and tizanidine. Several excellent resources are available for clinicians making treatment decisions in breast-feeding women. Clinicians treating migraine should discuss both acute and preventive treatment options shortly before and within a few months after delivery, keeping in mind the clinical features of the individual patient, and in consultation with their obstetrician and pediatrician. An awareness of the pharmacological data that are currently available and how to access that data may be helpful in making treatment decisions in this population.

Review of 500 migraine cases treated with combination of antidepressant & CBT & specific group of dietary supplement with 6 month follow up

Migraine is a condition which consumes maximum revenue of a family, state & nation & still the suffering goes on. In the world millions are suffering from Migraine .. & having pain killer medicine & suffering from their side effect like kidney failure etc Migraine sufferers may have depression deep down... but psychiatry being a stigma - very few sufferer goes for consultation to psychiatrist. History of migraine needs a long time to listen & the ability to listen ,.... which normally a psychiatrist does not have time to listen the painful past & long details without getting revenue - or fee or financially paid for - so depression goes unnoticed. Depression assessment scale -although available - but very few psychiatrist has a team work in India & most of the countries.

Reflections on NICE Headache Guidelines

The presentation illustrates the process for the development of the recent NICE Headache Guidelines and the importance of careful topic selection. The methodology, timescale, and the role of the Expert Group including patient representatives are described. The Guidelines are intended for the non-specialist in Primary Care where most patients present and can be safely diagnosed and managed. The Guidelines provide support with the diagnosis of primary headache including the value of neuroimaging which evidence suggests should not be used only for reassurance. The importance of excluding secondary causes, in particular medication overuse which is found among migraine sufferers is emphasised. Specific advice is given for management of the three most common types of primary headache; migraine, tension headache and cluster headache. Changes are recommended to current practice including prescribing combination therapy in acute migraine and indications for prophylactic topiramate. The management of female migraine sufferers of child baring potential also receives attention and caution is advised in the use of combined hormonal contraception for patients with aura due to increased risk of stroke. There are also recommendations for perimenstrual prophylaxis with frovatriptan or zolmitriptan. Improved recognition of common headache disorders and better targeting of treatments should reduce the burden of headache without requiring substantial extra resource. Where more specialised advice is required the Guideline recommends referral to a neurologist or GP with special interest in headache.

Overreaction to non noxious vascular stimuli in migraine and effect of NMDA receptor blockade

In ‘94 we enlighten vascular hyperalgesia/allodynia in migraine (M) sufferers [1]. Central pain is defined as “spontaneous pain and painful overreaction to stimulation”. Delayed painful sensation was also described in so called hyperpathia following partial lesions in the CNS. The aim was to stress possible overreaction and its NMDA antagonists blockade after non noxious stimulation of vein walls induced as elsewhere described. Procedure: a sharp stretch of vein walls, innocuous in controls, was induced in M sufferers. Delayed overreaction might be reported and scored on a 0-10 VAS in 189 M sufferers (101 females , 88 males, mean age 32.5 +3.8 SD) reporting 6-10 attacks A3 /month. It was planned to administer ketamine, specific non competitive antagonist at NMDA receptor sites, to M sufferers to observe possible overreaction. Tested M sufferers reported delayed overreaction ranging from 3 to 8 on a 0-1 0 VAS (mean 4.5 + 1.5 SD). Delayed overreaction lasted from 5 min to 4320 min, mean 210.22 min + 623 SD . The majority of sufferers reported overreaction till to 25 min after application of the stimulus revealing their visceral/vascular hyperalgesia/allodynia, 5 reported overreaction lasting 4320 min and 6 were ailed by overreaction for 5 mins. The duration of overreaction was directely related to the severity/ frequency of headache attacks. ANOVA failed in evidencing sex or M duration relationship, whereas a modest significativity (p>0.02) was related to high scores in Wang and Zung tests (cut off = 40). Ten days later the same stimulus was applied after 0,1 mg/Kg/ i.m. administration of ketamine, after a 3 days wash-out period. Patients reported neither allodynia/hyperalgesia or overreaction. The experience indicated the occurrence of overreaction in M. The partial deafferentation condition was inhibited by using a sub-anesthetic dose of ketamine. Thus, the drug likely acted by altering process of neural deafferentation-like related discharge.

Migraine patients should be cautiously followed for risk factors leading to cardiovascular disease

Migraine and ischemic strokes are two of the most prevalent diseases worldwide. Besides having a coincident symptomatology, for long researchers have been searching for a possible causal relation between these diseases. Current evidence based on data suggest that patients with aura migraine could have a doubled risk of developing an ischemic stroke, when compared to the rest of the population. At the same time, migraine sufferers apparently have higher incidences of risk factors for cardiovascular events. The aim of this review was not only to dissect some of the more compelling evidence based on data regarding this association, but also to discuss the possible clinical and therapeutic implications.

Effect of Fasting during Ramadan on Migraine Sufferers

Background: Fasting during Ramadan in Muslim communities is distinct from regular voluntary or experimental fasting. Its consequent caffeine withdrawal, stress and low blood glucose level (hypoglycemia) may trigger headache in patients with migraine. Objectives: The main aim of this study was to evaluate the effect of the Ramadan fasting on the frequency of migraine attacks among observant Muslim migraine sufferers. Material and Methods: This research study was based on fasting Muslims; both genders were aged between 18 and 65 years. Fifty migraineurs were selected, participated and gave consent at Internal Medicine and Neurology Clinics in Riyadh National Hospital, KSA. Those patients were recruited over three consecutive months of Ragab, Shaban and Ramadan during the period of 2010 and 2013. The effect of fasting and special eating pattern during the month of Ramadan compared with the preceding two months (Ragab and Shaban) was studied. The primary parameters used for comparisons were migraine attack count, duration of migraine attacks in days, attack duration and severity of the attacks. Results: Only forty three migraine sufferers completed the current study to the end, 4 patients of them were males (9.3%) and 39 were females (90.7%). They were aged between 18 and 44 years (Mean ± SD, 30.9 ± 6.9 years). Most of the fasting migraineurs during Ramadan were caffeine drinkers (n = 36, 83.7%), cigarette smokers (n = 2, 4.6%), overweight or obese (with BMI ＞ 25) n = 27, 62.8%), under stress (n = 29, 67.4%) and with low to moderate physical activities (No exercise) (n = 31, 72%). The worst time for the fasting individuals was afternoon between 2:00 PM to 4:30 PM because majority of them had headache during these hours. This study showed a significant reduction in migraine attack count, number of headache days, number of attacks with acute medication and total medication intake among migraineurs during the month of Ramadan compared with the two pre-Ramadan months. However, attack severity and attack duration did not change significantly between all three months. Conclusion: In conclusion, the present study did not find any negative effects of fasting during Ramadan on the migraine sufferers.

Migraine Headaches and Sleep Disorders in Children

Copyright: © 2013 Ming X. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. The connection between headaches and sleep disorders has recently come under greater scrutiny as more and more studies are being conducted to elucidate this relationship. Questionnaire studies have shown a significant increase in the sleep disturbances amongst patients with headaches compared to healthy controls [1-4]. This “disturbed sleep” includes insomnias such as difficulty falling and remaining asleep, parasomnias such as restless leg syndrome, sleep paralysis, hypnagogic startles, and bruxism, and disordered breathing such as snoring and trouble breathing [1]. Morning, or “awakening” headache patterns can be signs of a sleep disorder. Snoring and sleep apnea can exacerbate migraine headaches [5]. This relationship has been demonstrated in adults and more recently it has been reported in studies focusing on children [2-4,6]. For example, Heng and Wirrell [2] compared children with migraines to their siblings without migraine and found that the migraine sufferers had a higher occurrence of sleep disorders when compared to their healthy control siblings [2]. Not only did the children with headaches have a higher rate of sleep disorders, but they found that the patients with greater migraine severity had significantly increased sleep disturbances [2].

Migren Hastalarında Korpus Kallozum ve Serebellumun İstatistiksel Şekil Analizi

Objective: The aim of this study was to investigate the shape differences in the corpus callosum and cerebellum of migraine patients compared with healthy controls and to assess whether migraine attack frequency and disease duration are indicators for brain abnormalities in migrain cases. Material and Methods: This study included magnetic resonance imaging scans of 25 control subjects and 38 migraine patients. The data were obtained from the coordinate of landmarks analyzed with statistical shape analysis. A generalized Procrustes analysis was used to investigate shape differences. Witelson subdivision was used to further assess the regional shape differences in corpus callosum. Results: The shape of the corpus callsoum in controls was significantly different from the shape in migraine patients. Migraine patients had deformations in corpus callosum compared to control patients where the most prominent deformations were seen in the posterior midbody of corpus callosum. According to Witelson subdivions deformation in in the rostral body was less prominent. There was no global or regional shape difference between patients with migraine and controls for cerebellum. No significant correlation was recognized between the size and disease duration or frequency of migraine attacks, both for corpus callosum and cerebellum. Conclusion: The data suggest that migraine sufferers have global structural changes in corpus callosum but not in cerebellum, and that deformations did not vary with the disease progress.

CAN RAMADAN FASTING CAUSE RELAPSE and AGGRAVATION of SPONTANEOUS INTRACRANIAL HYPOTENSION?

Chronic headache is known to be aggravated by fasting and fasting even triggers headache among those not suffering from chronic headache. Headache is also aggravated during Ramadan in which Muslim people do not eat, drink, or smoke from dawn to sunset for about one month in a year. Headaches mainly increase in people who are prone to headaches like migraine sufferers. As far as we know there are no reports on specific headache syndromes pointing to precipitating factor of fasting. In this report, we present a 32-year-old man diagnosed with spontaneous intracranial hypotension, treated by conservative means and who relapsed after fasting during Ramadan. We aim to discuss the possible underlying mechanisms of precipitation of orthostatic headache during fasting.

Panic Disorder and Migraine: Comorbidity, Mechanisms, and Clinical Implications

A growing body of literature suggests that comorbid anxiety disorders are more common and more prognostically relevant among migraine sufferers than comorbid depression. Panic disorder (PD) appears to be more strongly associated with migraine than most other anxiety disorders. PD and migraine are both chronic diseases with episodic manifestations, involving significant functional impairment and shared symptoms during attacks, interictal anxiety concerning future attacks, and an absence of identifiable secondary pathology. A meta-analysis of high-quality epidemiologic study data from 1990 to 2012 indicates that the odds of PD are 3.76 times greater among individuals with migraine than those without. This association remains significant even after controlling for demographic variables and comorbid depression. Other less-rigorous community and clinical studies confirm these findings. The highest rates of PD are found among migraine with aura patients and those presenting to specialty clinics. Presence of PD is associated with greater negative impact of migraine, including more frequent attacks, increased disability, and risk for chronification and medication overuse. The mechanisms underlying this common comorbidity are poorly understood, but both pathophysiological (eg, serotonergic dysfunction, hormonal influences, dysregulation of the hypothalamic-pituitary-adrenal axis) and psychological (eg, interoceptive conditioning, fear of pain, anxiety sensitivity, avoidance behavior) factors are implicated. Means of assessing comorbid PD among treatment-seeking migraineurs are reviewed, including verbal screening for core PD symptoms, ruling out medical conditions with panic-like features, and administering validated self-report measures. Finally, evidence-based strategies for both pharmacologic and behavioral management are outlined. The first-line migraine prophylactics are not indicated for PD, and the selective serotonin re-uptake inhibitors used to treat PD are not efficacious for migraine; thus, separate agents are often required to address each condition. Core components of behavioral treatments for PD are reviewed, and their integration into clinical headache practice is discussed.

Hierarchical alteration of brain structural and functional networks in female migraine sufferers.

BackgroundLittle is known about the changes of brain structural and functional connectivity networks underlying the pathophysiology in migraine. We aimed to investigate how the cortical network reorganization is altered by frequent cortical overstimulation associated with migraine.Methodology/Principal FindingsGray matter volumes and resting-state functional magnetic resonance imaging signal correlations were employed to construct structural and functional networks between brain regions in 43 female patients with migraine (PM) and 43 gender-matched healthy controls (HC) by using graph theory-based approaches. Compared with the HC group, the patients showed abnormal global topology in both structural and functional networks, characterized by higher mean clustering coefficients without significant change in the shortest absolute path length, which indicated that the PM lost optimal topological organization in their cortical networks. Brain hubs related to pain-processing revealed abnormal nodal centrality in both structural and functional networks, including the precentral gyrus, orbital part of the inferior frontal gyrus, parahippocampal gyrus, anterior cingulate gyrus, thalamus, temporal pole of the middle temporal gyrus and the inferior parietal gyrus. Negative correlations were found between migraine duration and regions with abnormal centrality. Furthermore, the dysfunctional connections in patients' cortical networks formed into a connected component and three dysregulated modules were identified involving pain-related information processing and motion-processing visual networks.ConclusionsOur results may reflect brain alteration dynamics resulting from migraine and suggest that long-term and high-frequency headache attacks may cause both structural and functional connectivity network reorganization. The disrupted information exchange between brain areas in migraine may be reshaped into a hierarchical modular structure progressively.

Survey of Migraine Sufferers with Dogs to Evaluate for Canine Migraine-Alerting Behaviors

Anecdotal reports suggest that changes in dog behavior might be used to predict impending migraine episodes. This survey was designed to investigate how companion dogs react to migraines that occur in their owners. Online survey was available from January 4-31, 2012. Survey was conducted through SurveyMonkey, with links to the survey posted at Migraine.com and promoted through social media. Adults ≥18 years old who experience migraine episodes and live with a dog were eligible to participate. Participants completed an 18-question online survey that asked about participant demographics, migraines, and their dog's behavior before or during migraine episodes. The survey was completed by 1029 adult migraineurs (94.9% women), with migraines typically occurring ≤8 days per month in 63.4% of participants. A recognized change in the dog's behavior prior to or during the initial phase of migraine was endorsed by 552 participants (53.7%), most commonly unusual attentiveness to the owner (39.9%). Among the 466 participants providing details about their dog's behavior with their migraines, 57.3% were able to identify dog alerting behavior before symptoms of a migraine attack would typically begin, with changes usually noticed within 2 hours before the onset of initial migraine symptoms. The dog's behavior was considered to be often or usually linked with the development of a migraine for 59.2% of migraineurs, and 35.8% of migraineurs endorsed beginning migraine treatments after the dog's behavior was recognized and before migraine symptoms had started. Participant demographics, migraine frequency, and breed of dog in the home were similar between the 470 participants with no alerting behavior endorsed and the 466 participants providing detailed alerting information. About one in four migraineurs living with a companion dog endorsed recognizing a change in their dog's behavior before recognizing initial symptoms of a migraine attack.

A Rhinitis Primer for Family Medicine

Rhinitis and related problems such as facial pressure and nasal congestion are a very common reason people seek medical care. There are four, often overlapping, syndromes or conditions that account for most of what patients perceive as "nose" problems or rhinitis. These conditions are irritant rhinitis, the anterior nasal valve effect, migraine with vasomotor symptoms, and allergic rhinitis. Virtually all patients with allergic rhinitis have some concomitant irritant or nonallergic rhinitis. Many migraine sufferers with vasomotor nasal symptoms will have their nasal congestion, headaches, and runny noses exacerbated by irritant rhinitis, allergic rhinitis, and/or a preexisting nasal valve effect. Failure to consider all of the causes for the symptoms will result in poor clinical outcomes. The work-up and management of these common conditions is discussed in this article.

Self-regulation in disability: Migraine management as action research

Coping with chronic migraine is challenging. Frequently, patients are left with few explanations and little in the way of effective treatment beyond the most popular, current medications. The researcher – an experimental psychologist, who is also a migraine sufferer – proposes that effective migraine management is action research. She utilized participatory action research to manage chronic daily migraine and suggests that others might do the same as they collaborate with stakeholders (e.g. family members, friends, employers, and healthcare specialists) in order to manage their own chronic disease. Ultimately, authentic management of any chronic illness – as action research – is flexible, optimizing, empowering, and liberating.

Complementary and Alternative Medicine Use for Headache and Migraine: A Critical Review of the Literature

CONTEXTS: An evidence base for complementary and alternative medicine (CAM) consumption within general populations is emerging. However, research data on CAM use for headache disorders remain poorly documented. This paper, constituting the first critical review of literature on this topic, provides a synopsis and evaluation of the research findings on CAM use among patients with headache and migraine. A comprehensive search of literature from 2000 to 2011 in CINAHL, MEDLINE, AMED, and Health Sources was conducted. The search was confined to peer-reviewed articles published in English reporting empirical research findings of CAM use among people with primary headache or migraine. The review highlights a substantial level of CAM use among people with headache and migraine. There is also evidence of many headache and migraine sufferers using CAM concurrent to their conventional medicine use. Overall, the existing studies have been methodologically weak and there is a need for further rigorous research employing mixed method designs and utilizing large national samples. The critical review highlights the substantial prevalence of CAM use among people with headache and migraine as a significant health care delivery issue, and health care professionals should be prepared to inquire and discuss possible CAM use with their patients during consultations. Health care providers should also pay attention to the possible adverse effects of CAM or interactions between CAM and conventional medical treatments among headache and migraine patients.

Stress and sleep duration predict headache severity in chronic headache sufferers

The objective of this study was to evaluate the time-series relationships between stress, sleep duration, and headache pain among patients with chronic headaches. Sleep and stress have long been recognized as potential triggers of episodic headache (<15 headachedays/month), though prospective evidence is inconsistent and absent in patients diagnosed with chronic headaches (⩾15days/month). We reanalyzed data from a 28-day observational study of chronic migraine (n=33) and chronic tension-type headache (n=22) sufferers. Patients completed the Daily Stress Inventory and recorded headache and sleep variables using a daily sleep/headache diary. Stress ratings, duration of previous nights’ sleep, and headache severity were modeled using a series of linear mixed models with random effects to account for individual differences in observed associations. Models were displayed using contour plots. Two consecutive days of either high stress or low sleep were strongly predictive of headache, whereas 2days of low stress or adequate sleep were protective. When patterns of stress or sleep were divergent across days, headache risk was increased only when the earlier day was characterized by high stress or poor sleep. As predicted, headache activity in the combined model was highest when high stress and low sleep occurred concurrently during the prior 2days, denoting an additive effect. Future research is needed to expand on current findings among chronic headache patients and to develop individualized models that account for multiple simultaneous influences of headache trigger factors.

Pediatric and Adolescent Migraine

Pediatric and Adolescent Migraine

The characteristics of head pain in response to an experimental cold stimulus to the palate: An observational study of 414 volunteers

The objective of this article is to study the characteristics of headaches following an experimental cold stimulus and evaluate whether the ICHD-II criteria for headache attributed to ingestion or inhalation of a cold stimulus (HICS) are adequate for the diagnosis of the headache induced by ice on the palate area (ice-induced headache (IH)). One hundred and fifty-three out of 414 (37.0%) individuals tested had IH, but only 77/153 (50.3%) satisfied the ICHD-II criteria. The frontal (60.8%) and temporal (48.4%) areas were the most affected ones, with bilateral (77.1%) predominance, often of the pulsatile type (41.2%). One hundred and forty-seven out of 379 (38.8%) individuals who presented with a previous history of primary headache presented with IH, while only six out of 35 (17.1%) who had no history of previous headache reported pain in the test (OR 3.063, 95% CI 1.241-7.557). The ice-induced headache test was positive in 115/240 (47.9%) of the migraine sufferers and in 32/139 (23%) of the tension-type headache sufferers (OR 3.076, 95% CI 1.924-4.918). IH is predominantly frontotemporal, bilateral and throbbing, most commonly affecting migraine sufferers, and the ICHD-II criteria are insufficient for classifying all individuals. We should, however, recommend caution regarding such a generalization from our findings with experimentally provoked cold stimulus headache to cold stimulus headache in general (i.e. HICS, ICHD-II).