Migraine Sufferers Research Articles

Chronic Migraine and Elevated CRP Levels

C-reactive protein (CRP) is a known pro-inflammation biomarker and important predictor of migraine headache. Many studies have detected higher levels of CRP in patients suffering from migraine headache than normal subjects. Etiopathology has been related to ongoing sterile inflammation of intra and extra cerebral blood vessels and the subsequent release of proinflammatory neuropeptides from perivascular nerve endings. The present study was performed on 50 females suffering from chronic migraine (CM) and their CRP levels were compared with normal persons. We intended to find the correlation between CM and CRP levels as such patients are also predisposed to various other associated cardiovascular and cerebrovascular events like stroke and ischemic heart diseases. Therefore, early detection of CRP levels in migraine sufferer may be helpful in treatment of migraine headache and in prevention of cardiovascular and cerebrovascular events. Mean value of C-reactive protein estimation was significantly higher (< 0.001) in patients group as compared to normal controls. On comparing results of sub group A, (migraine with aura) and sub group B (migraine without aura) with control group, differences were significant. On other hand, result of comparison between groups A with B was not significant. Finally, we could conclude that the present study supports that CRP an inflammatory marker was significantly higher in migraineurs in comparison with normal subjects. By these findings, the role of sterile inflammation could explain the cause of onset and progression of migraine headache.

Chronic migraine: Erenumab, new kid on the block

Migraine is a primary headache disorder and causes substantial pain and disability. Migraine sufferers could suffer from episodic migraine or chronic migraine. While both of these adversely affect the quality of life, the management of chronic migraine patients poses many challenges, as it mainly relies on preventive treatment. Till now, we have very limited options for preventive management of chronic migraine; recently, new drug erenumab has been approved by the Food and Drug Administration. It has shown very promising results in the management of chronic migraine as it acts by novel mechanism as calcitonin gene-related peptide receptor blocker.

The Traffic Light of Headache: Simplifying Acute Migraine Management for Physicians and Patients Using the Canadian Headache Society Guidelines.

Migraine is a disabling neurological condition and it is well described that early treatment is more effective and less likely to lead to headache recurrence. While it would seem intuitive for a migraine sufferer to treat early, despite well-established guidelines by the Canadian Headache Society, many sufferers continue to treat late. As a result, acute therapy is less effective, resulting in higher associated disability and a longer lasting attack. Pain scales can help patients determine how to treat; however, we propose a simple, easily recalled traffic light system to help patients determine which drug to use based upon how they feel. The traffic light system is based on the associated disability of the migraine attack, with green being a "I can still go" headache, a yellow being a "I have to slow down" headache, and a red being a "I have to stop" headache. The traffic light system leads to earlier more effective treatment with a reduction in migraine-associated disability.

Can we now say that commonalities between restless leg syndrome and migraine exist?

The recent manuscript by Xinglong Yang and colleagues provided the first relatively reliable estimate of restless leg syndrome (RLS) prevalence among migraine sufferers, which was estimated at 19% (95% CI 14-24%). The implications of the association between the two conditions are wide, and call for further action aimed to address common disease mechanism-associated conditions such as sleep-related ones and associated burden.

Systematic Review of the Effectiveness of Hypnosis for the Management of Headache

Migraine is a complex neurological condition that causes a range of symptoms, the most common of which is a severe headache. The aim of this systematic review of the literature is to determine the efficacy of hypnosis in the treatment of migraine. A systematic search of 4 scientific databases was conducted using the primary search terms migraine, headache, hypnosis, and hypnotherapy. A total of 8 studies were identified that examined hypnotic techniques either alone or in combination with other nonpharmaceutical techniques, such as visual imagery, relaxation, and pain-displacement techniques. This study demonstrates that hypnotherapy and relaxation techniques are effective in reducing short- and long-term headache activity in migraine sufferers.

Patients With Migraine Have Substantial Reductions in Measures of Visual Quality of Life.

Migraine is associated with several important visual symptoms, during both acute attacks and headache-free intervals. The purpose of this investigation was to use validated vision-related quality of life instruments to assess the effect of migraine on visual quality of life. Many migraineurs experience visual aura, increased photophobia during and between headache attacks, and increased symptoms of dry eye with structural changes in corneal nerve endings. Other visual symptoms associated with migraine include positive persistent visual phenomenon (visual snow) and transient vision changes. Previous research looking at the disability associated with migraine has shown that patient-reported quality of life data can be useful in determining the severity of disease burden. Recent published literature has suggested that visual symptoms related to migraine represent a proportionally minor burden to patients, compared to other manifestations of migraine, but no previous studies have assessed how migraine affects visual quality of life. In this cross-sectional quantitative survey, visual quality of life in individuals with chronic and episodic migraine was assessed using the National Eye Institute Visual Function Questionnaire-25, and the 10-item National Eye Institute Visual Function Questionnaire-25 Neuro-Ophthalmic Supplement. Overall headache severity and impact was assessed using the Migraine-specific Quality of Life Questionnaire (Version 2.1) and the Headache Impact Test-6. Participants were recruited from Headache and Neuro-ophthalmology subspecialty clinics. The target sample size was 30 participants per subgroup. The results were compared to those from disease-free controls and to results from other neuro-ophthalmic disease quality of life studies. Among 29 participants with chronic migraine, vision-specific quality of life scores were all statistically significantly decreased compared to disease-free controls. The National Eye Institute Visual Function Questionnaire-25 median composite score was 85 for chronic migraineurs and 96 for controls (P < .001). The 10-item National Eye Institute Visual Function Questionnaire-25 Neuro-Ophthalmic Supplement median score was 72 for chronic migraineurs and 95 for controls (P < .001). Among 37 participants with episodic migraine, vision-specific quality of life scores were also decreased compared to disease-free controls. In the episodic migraine group, decreases in the National Eye Institute Visual Function Questionnaire-25 scores were not statistically significant (median score 91, P = .01 compared to the control group), but decreases in the 10-item National Eye Institute Visual Function Questionnaire-25 Neuro-Ophthalmic Supplement remained statistically significant (median score 85, P = .003 compared to the control group). Chronic migraineurs had decreased visual quality of life scores compared to those with episodic migraines. Participants with chronic migraine had visual quality of life scores that were as poor as those previously published for patients with other neuro-ophthalmic disorders such as multiple sclerosis, myasthenia gravis, and ischemic optic neuropathy. Visual quality of life is significantly adversely affected in migraine sufferers. In fact, patients with chronic migraine may have visual quality of life impacts that are as significant as those associated with other common neuro-ophthalmic disorders. Future studies of the overall disease burden in patients with migraine should include an evaluation of the effects on visual functioning.

Clinical Features of Headache in Patients With Diagnosis of Definite Vestibular Migraine: The VM-Phenotypes Projects.

Migraine is a common neurological disorder characterized by episodic headaches with specific features, presenting familial aggregation. Migraine is associated with episodic vertigo, named Vestibular Migraine (VM) whose diagnosis mainly rely on clinical history showing a temporary association of symptoms. Some patient refers symptoms occurring in pediatric age, defined “episodic symptoms which may be associated with migraine.” The aim of this cross sectional observational study was to assess migraine-related clinical features in VM subjects. For the purpose, 279 patients were recruited in different centers in Europe; data were collected by a senior neurologist or ENT specialist through a structured questionnaire. The age of onset of migraine was 21.8 ± 9. The duration of headaches was lower than 24 h in 79.1% of cases. Symptoms accompanying migrainous headaches were, in order of frequency, nausea (79.9%), phonophobia (54.5%), photophobia (53.8%), vomiting (29%), lightheadedness (21.1%). Visual or other auras were reported by 25.4% of subjects. A familial aggregation was referred by 67.4%, while migraine precursors were reported by 52.3% of subjects. Patients reporting nausea and vomiting during headaches more frequently experienced the same symptoms during vertigo. Comparing our results in VM subjects with previously published papers in migraine sufferers, our patients presented a lower duration of headaches and a higher rate of familial aggregation; moreover some common characters were observed in headache and vertigo attacks for accompanying symptoms like nausea and vomiting and clustering of attacks.

Accessory Nerves of the Forehead: A Newly Discovered Frontotemporal Neurovascular Bundle and Its Implications in the Treatment of Frontal Headache, Migraine Surgery, and Cosmetic Temple Filler Injection.

Surgical decompression of peripheral cranial and spinal nerves at several anatomically studied trigger sites has demonstrated significant efficacy in bringing permanent relief to migraine sufferers. In their experience performing frontal nerve decompression on migraine patients, the authors noticed a previously undescribed accessory nerve and vessel in the frontotemporal area, and report its implication in migraine surgery and cosmetic filler injection. A retrospective review of 113 patients who underwent frontal migraine decompression surgery with the senior author at the University of Texas Southwestern Medical Center from July of 2012 to May of 2016 was performed. For the included 76 patients, measurements of this nerve had been taken intraoperatively using high-definition endoscopic assistance, and topographic measurements were correlated with endoscopic location of the nerve. This frontotemporal nerve (FTN) was present in 55 percent, and the bilateral incidence was 57 percent of those. An accompanying vessel was also present in 81 percent of nerve complexes. Both nerve and vessel varied in size. A large vessel was present in 8 percent of all patients, and a medium vessel was present in 20 percent. Consistently, the nerve exited a foramen in the frontal bone on average 3.4 ± 0.47 cm superior to the lateral canthus. The identification and proper avulsion neurectomy of this newly described sensory FTN may lead to better surgical response rate during migraine surgery. In addition, this nerve should be considered during nerve block and botulinum toxin injections in migraine treatment. The existence of the accompanying vessel could have significant implications in the safety of filler and fat injections to this area.

Effect of Soft Tissue Techniques on Headache Impact, Disability, and Quality of Life in Migraine Sufferers: A Pilot Study.

To determine the efficacy of suboccipital inhibitory techniques in people with migraine compared with a control treatment based on myofascial trigger point (MTrP) therapy and stretching. A randomized, double-blind controlled pilot trial was conducted. University research laboratory. Forty-six adults diagnosed with migraine with over 6 months duration. Participants were randomized to receive either combined MTrP therapy and stretching (control group) or the control treatment plus suboccipital soft tissue inhibition (experimental group). Treatment was applied on four occasions over 8 weeks (one every 15 days), with a duration of 30 minutes per session in the experimental group and 20 min in the control group. The impact of headache was assessed with the Headache Impact Test (HIT-6), disability by the migraine disability assessment (MIDAS), and quality of life by the Short Form Health Survey (SF-36). Both groups were assessed at baseline and 1 week immediately after the end of treatment. The amount of change of the HIT-6 score and MIDAS scores were significantly different between groups (p < 0.05), although the SF-36 scores were not. The change in the HIT-6 score and MIDAS scores was greater in the experimental group. Both groups showed a reduction on the HIT-6 score (p < 0.001), MIDAS scores (p < 0.05), and SF-36 physical subscale, whereas the SF-36 mental subscale improved only in the experimental group (p < 0.001). Soft tissue techniques based on MTrP therapy and stretching were helpful for improving certain aspects of migraine, such as the impact and disability caused by the headache, and the frequency and intensity of headache; however, when combined with suboccipital soft tissue inhibition, the treatment effect was larger.

Has aerobic exercise effect on pain perception in persons with migraine and coexisting tension-type headache and neck pain? A randomized, controlled, clinical trial.

A large subset of persons with migraine suffers from coexisting tension-type headache and neck pain which may adversely affect the prognosis of migraine. Aerobic exercise has been shown to decrease migraine burden in these persons. Therefore, the aim of this study was to investigate whether the effect of aerobic exercise in persons with migraine and coexisting tension-type headache and neck pain can be explained by changes in pain perception. Seventy consecutively recruited persons with migraine and coexisting tension-type headache and neck pain were randomized into exercise group or control group. Aerobic exercise consisted of bike/cross-trainer/brisk walking for 45min, three times/week for 3months. Controls continued their usual daily activities. Pericranial tenderness, pain thresholds, supra-thresholds and temporal summation were assessed at baseline, after treatment and at follow-up (6months from baseline). Fifty-two persons with migraine and coexisting tension-type headache and neck pain completed the study. Aerobic exercise did not induce consistent changes in nociceptive pathways measured by pericranial tenderness, pressure pain thresholds and sensitivity to electrical stimulation. The effect of aerobic exercise cannot be explained by measurable effects on the pain modulation system. Thus, the positive effect on migraine burden may rather be explained by positive alteration of avoidance behaviour. Aerobic exercise can be recommended as a safe and inexpensive migraine treatment strategy. This study adds further knowledge about the positive effect of aerobic exercise for persons with migraine and coexisting tension-type headache and neck pain. This effect cannot be measured by changes in pain modulation, but may rather be explained by positive alteration of avoidance behaviour.

Placebo is not a “sugar pill” but the result of stimulation of neural networks involved in central analgesia and in mood regulation

&lt;div&gt;Placebo was intended as a pill devoid of any active principle &lt;span style="font-size: 10px;"&gt;capable to influence or relieve so called psychosomatic diseases. &lt;/span&gt;&lt;span style="font-size: 10px;"&gt;More recently, it has been shown that placebo can be useful in &lt;/span&gt;&lt;span style="font-size: 10px;"&gt;surgical practice. In fact, sham operation can induce significant&lt;/span&gt;&lt;/div&gt;&lt;div&gt;benefit. Emotions have been shown to play a pivotal role in placebo. &lt;span style="font-size: 10px;"&gt;Present observation concerns an attempt to investigate and &lt;/span&gt;&lt;span style="font-size: 10px;"&gt;therapeutically use scientific evidences in a placebo devoted to &lt;/span&gt;&lt;span style="font-size: 10px;"&gt;sufferers from chronic migraine pain. The present approach has its&lt;/span&gt;&lt;/div&gt;&lt;div&gt;background in the fact that placebo analgesia has been shown to &lt;span style="font-size: 10px;"&gt;largely consist either in the activation both of analgesia pathways &lt;/span&gt;&lt;span style="font-size: 10px;"&gt;and of emotional systems as well as genetic and epigenetic &lt;/span&gt;&lt;span style="font-size: 10px;"&gt;expressions leading to specific behavior. In this perspective &lt;/span&gt;&lt;span style="font-size: 10px;"&gt;placebo has been used to empower a conventional therapy that&lt;/span&gt;&lt;/div&gt;&lt;div&gt;was scored as unsatisfactory by the enrolled chronic migraine &lt;span style="font-size: 10px;"&gt;sufferers. Here proposed placebo seems to transform an ineffective &lt;/span&gt;&lt;span style="font-size: 10px;"&gt;drug therapy into an effective pain relieving approach.&lt;/span&gt;&lt;/div&gt;

Altered Permeability Of The Blood‐CSF Barrier In Chronic Migraine

BackgroundMolecular communication from blood circulation to brain is tightly regulated at multiple biological barriers, but is disrupted in a variety of diseases, disorders, and infections. Recent human and animal data in migraine research has shown conflicting results regarding barrier disruption. These contradictions require resolution because a leaky barrier will expose the brain to potentially harmful components with diverse deleterious effects on brain function.MethodsSince blood‐to‐CSF transfer studies have not yet been performed in migraineurs, we studied surrogate biomarkers of barrier disruption in blood and CSF from non‐headache suffering controls and chronic migraine sufferers.ResultsWhen compared to controls, study participants with chronic migraine had clear evidence of barrier leak based on their higher CSF—blood albumin ratio, CSF fibrinogen levels, and CSF levels of the pericyte biomarker, soluble platelet‐derived growth factor receptor β. To test if other blood components were leaking through this barrier, we examined how CSF and blood lipids relate to the CSF—blood albumin ratio. The CSF—blood ratios of trans palmitoleic acid, linoleic acid, and ceramide were higher in chronic migraine and these lipid ratios correlated significantly with the CSF—blood albumin index, consistent with their derivation, at least partly, from a leaking barrier.ConclusionWe conclude that individuals with chronic migraine have distinct disruption of central nervous system (CNS) barriers that allows leakage into the CNS of multiple blood components, including proteins and lipids, and which likely results from, and contributes to the pathophysiology of migraine. The blood‐brain barrier and molecules that leak into the CNS are potential treatment targets.Support or Funding InformationThe National Institutes of Health, R01 NS043295, Higgins Family TrustsThis abstract is from the Experimental Biology 2018 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

CBT for Pediatric Migraine: A Qualitative Study of Patient and Parent Experience

The goal of this study was to determine which cognitive behavioral therapy (CBT-HA) treatment components pediatric headache patient stakeholders would report to be most helpful and essential to reducing headache frequency and related disability to develop a streamlined, less burdensome treatment package that would be more accessible to patients and families. Pediatric migraine is a prevalent and disabling condition. CBT-HA has been shown to reduce headache frequency and related disability, but may not be readily available or accepted by many migraine sufferers due to treatment burden entailed. Research is needed to determine systematic ways of reducing barriers to CBT-HA. Qualitative interviews were conducted with 10 patients and 9 of their parents who had undergone CBT-HA. Interviews were analyzed using an inductive thematic analysis approach based upon modified grounded theory. Patients were 13-17.5 years of age (M = 15.4, SD = 1.63) and had undergone CBT-HA ∼1-2 years prior to participating in the study. Overall, patients and their parents reported that CBT-HA was helpful in reducing headache frequency and related disability. Although patients provided mixed reports on the effectiveness of different CBT-HA skills, the majority of patients indicated that the mind and body relaxation skills of CBT-HA (deep breathing, progressive muscle relaxation, and activity pacing in particular) were the most helpful and most frequently used skills. Patients and parents also generally reported that treatment was easy to learn, and noted at least some aspect of treatment was enjoyable. Results from these qualitative interviews indicate that mind and body CBT-HA relaxation skills emerged as popular and effective based on patient and parent report. Future research examining the effectiveness of streamlined pediatric migraine nonpharmacological interventions should include these patient-preferred skills.

Surgical Management of Migraine Headache.

Migraine surgery has been recently reported as an alternative to medical management to provide long-term relief in migraine sufferers. A prospective study was designed wherein patients diagnosed with migraine were screened for surgery by injecting botulinum toxin type A at the primary trigger site. Surgery consisted of corrugator supercilii muscle resection to decompress supra-trochlear and supra-orbital nerves with avulsion of zygomaticotemporal branch of trigeminal nerve. Using pre and postsurgery questionnaires, information regarding the degree of reduction of migraines with regard to severity and frequency; and surgical site problems was acquired. Thirty patients volunteered for migraine surgery. Mean migraine headaches reduced from 15.2 ± 6.3 episodes per month to 1.9 ± 2.4 episodes per month (P < 0.0001) postsurgery. The mean intensity of migraine headache also reduced from a preoperative 7.3 ± 3.5 to a postoperative of 1.3 ± 1.4 (P < 0.0001). Fourteen (46.7%) patients reported complete elimination of migraine after surgery while an equal number reported significant relief of symptoms. Two (6.6%) patients failed to notice any significant improvement after surgery. The mean follow-up period was 11.1 ± 2 months with no major surgical complications. Results of the authors' study confirm prior published results that surgical treatment of migraine is a reality. Surgeons can easily incorporate this simple surgical procedure in their armamentarium to offer relief to numerous migraine patients.

Test-Retest Reliability of the Thai Migraine Disability Assessment (Thai-MIDAS) Questionnaire in Thai Migraine Patients

OBJECTIVES: The aim of this study is to evaluate the comprehensibility, internalconsistency, patient-physician reliability, and test-retest reliability of the Thai version ofMigraine Disability Assessment (Thai-MIDAS) questionnaire in Thai migraine sufferers. MATERIAL AND METHODS: Study participants were recruited from patients diagnosedwith migraine headache according to International Classification of Headache Disordersversion 2 (ICHD-2) criteria who attended the Headache Clinic at Bangkok Hospitalheadquarters. Standard forward and backward translation procedures were used totranslate the MIDAS questionnaire into the Thai-MIDAS version. Patients completedthe Thai-MIDAS questionnaire at baseline (visit 1), after meeting the physician (visit 2),and at the two-week follow up (visit 3) to assess disease severity and comprehensibility,internal consistency, as well as test-retest reliability. RESULTS: A total of 82 patients, aged between 15 and 54 years were enrolled in thestudy (71 females and 11 males). At baseline, most of the patients had severe migrainedisability (MIDAS grade IV) and severe pain score. All 5 items of the Thai-MIDASquestionnaire demonstrated excellent internal consistency (ICC 0.95; 95% CI 0.91-0.99).The total Thai-MIDAS score showed good test-retest reliability by Pearson correlationcoefficient (r = 0.81; 95% CI 0.69-0.88, p = 0.05). CONCLUSION: These findings demonstrated that the Thai translation of MIDAS isequivalent to the English version of MIDAS in terms of internal consistency andtest-retest reliability. Physicians can reliably use the self-administered tool, the Thai-MIDAS questionnaire, to assess the severity and disability of migraine in Thai patients. Keywords: MIDAS questionnaire, migraine, reliability

The role of the brainstem in migraine: Potential brainstem effects of CGRP and CGRP receptor activation in animal models.

Migraine is a severe debilitating disorder of the brain that is ranked as the sixth most disabling disorder globally, with respect to disability adjusted life years, and there remains a significant unmet demand for an improved understanding of its underlying mechanisms. In conjunction with perturbed sensory processing, migraine sufferers often present with diverse neurological manifestations (premonitory symptoms) that highlight potential brainstem involvement. Thus, as the field moves away from the view of migraine as a consequence of purely vasodilation to a greater understanding of migraine as a complex brain disorder, it is critical to consider the underlying physiology and pharmacology of key neural networks likely involved. The current review will therefore focus on the available evidence for the brainstem as a key regulator of migraine biology and associated symptoms. We will further discuss the potential role of CGRP in the brainstem and its modulation for migraine therapy, given the emergence of targeted CGRP small molecule and monoclonal antibody therapies. The brainstem forms a functional unit with several hypothalamic nuclei that are capable of modulating diverse functions including migraine-relevant trigeminal pain processing, appetite and arousal regulatory networks. As such, the brainstem has emerged as a key regulator of migraine and is appropriately considered as a potential therapeutic target. While currently available CGRP targeted therapies have limited blood brain barrier penetrability, the expression of CGRP and its receptors in several key brainstem nuclei and the demonstration of brainstem effects of CGRP modulation highlight the significant potential for the development of CNS penetrant molecules.

A Diary Study of Basic Psychological Needs and Daily Headache Experience.

A diary study was conducted to investigate the relationships between headache activity and basic psychological needs satisfaction. One hundred sixteen young adults (M age = 19.17 (SD = 2.90); 81.7% female; 75.9% Caucasian) completed an online daily diary of headache activity and needs satisfaction for 3 weeks. Data were analyzed using hierarchical linear modeling. On days when headache occurred, participants reported decreased needs satisfaction of competence (γ10 = -0.18, P = .014) and relatedness (γ10 = -0.24, P = .003), and a marginal but not significant reduction in autonomy (γ10 = -0.13, P = .067). Additionally, more severe headaches were associated with decreased needs satisfaction in autonomy (γ10 = -0.08, P = .009), competence (γ10 = -0.08, P = .011), and relatedness (γ10 = -0.09, P = .005). Presence of a headache diagnosis did not moderate the relationship between headache occurrence and basic needs satisfaction (all Ps ≥ .24). This preliminary study is the first to show that headache is related to reduced basic psychological needs satisfaction, providing a potential account for one mechanism by which headache may negatively affect quality of life. Further research is needed to extend these findings to larger samples of migraine sufferers to enable more thorough between-group comparisons of headache-related burden on basic needs satisfaction. These findings may be informative for treatment approaches that focus on outcomes beyond mere symptom reduction.

Lipidomic analysis of serum samples from migraine patients

BackgroundMigraine is a prevalent, disabling type of primary headache disorder associated with a high socioeconomic burden. The clinical management of migraine is challenging. This study was to identify potential serum lipidomic biomarkers of migraine.MethodsThe serum lipidomic profile of migraine sufferers was compared with healthy individuals using Liquid Chromatography coupled to Mass Spectrometry (LC-MS). Volcano plot analysis by Student’s t-test was performed to identify the differential metabolites. Receiver operating characteristic (ROC) curves were constructed and the area under ROC curves (AUC) was calculated to evaluate whether the metabolites could be efficiently exploited for constructing a sensitive biomarker of migraine.ResultsA total of 29 serum metabolites from 4 classes of lipids including acylcarnitines, non-alpha-hydroxy-sphingosine ceramides (Cer_NSs), lysophosphatidylcholines (lysoPCs) and lysophosphatidylethanolamines (lysoPEs) were significantly different in migraine patients and controls. Of note, Cer_NSs were significantly elevated and lysoPEs were significantly decreased in migraine patients. LysoPE 18:1, lysoPE 18:2 and lysoPE 22:5 were found to be decreased in both positive and negative ion mode. Moreover, except for lysoPC 20:0, other lysoPCs were decreased in migraine patients. ROC curve analysis indicated that lysoPC 16:0 and lysoPC 20:0 are potential sensitive and specific biomarkers for migraine.ConclusionLysoPC 16:0 and lysoPC 20:0 may be potential biomarkers for migraine. We suggest therapeutic management of these metabolites may be helpful in the prevention and treatment of migraine.

Restless legs syndrome is associated with increased risk of migraine

Migraine and restless legs syndrome (RLS) are common disorders that are associated with a high level of individual suffering and major comorbidities. The aetiologies of the disorders are largely unknown, although both migraine and RLS have been linked to disturbances in the dopaminergic system and sleep issues, suggesting a relationship between the disorders. This study examines the association between RLS and migraine in a large population of otherwise healthy adults who are not taking medication. Cross-sectional study that included 20,938 participants enrolled in the Danish Blood Donor Study from 1 May 2015 to 1 February 2017. The study included complete information on migraines, the Cambridge-Hopkins RLS questionnaire, the Major Depression Inventory Scale, sex, age, body mass index (BMI), educational level, smoking status and alcohol consumption. Associations between RLS and migraine, with and without aura, were examined using multivariable logistic regression analysis. Among the participants, 4827 were self-reported migraine sufferers and 1091 were classified as suffering from RLS. Individuals with RLS had an increased risk of migraine compared to non-RLS sufferers, with an odds ratio (OR) = 1.52 (95% confidence interval: 1.33–1.73). For the investigated subtypes of migraine, this association was found to be OR = 1.55 (1.31–1.83) for migraines with aura and OR = 1.29 (1.09–1.52) for migraines without aura. We found a significantly increased occurrence of migraine in individuals with RLS. This risk was independent of sex, age, BMI, educational level, smoking status, alcohol consumption and depressive disorder. Our findings suggest that RLS and migraine may have a common aetiology.

Prevalence of bipolar spectrum disorders in migraine patients

Comorbidity of migraine and mood disorders has long been recognized. Most of the studies have focused on the relationship between migraine and major depression with only few studies suggesting a special association between migraine and bipolar spectrum disorders. We aimed to evaluate the prevalence of bipolar disorder in migraine patients in a specialized headache outpatient clinic. The sample consisted of 78 consecutive patients with migraine headache presenting to the specialized headache outpatient clinic in a Medical Faculty. Migraine diagnosis was established with the International Headache Society's criteria for migraine. Patients were evaluated with Structured Clinical Interview for DSM-IV for mood disorders. Bipolar spectrum definition was broadened with the presence of Akiskal's criteria for affective temperaments (cyclothymic, hyperthymic, irritable, and depressive). Patients in the bipolar spectrum comprised 10.3% (n=8) of the sample. 11 patients (14.1%) had a diagnosis of unipolar depression and 7 patients (9%) had a diagnosis of dysthymic disorder. 41% of the patients (n=32) had an affective temperament. Bipolar disorder was observed with increased frequency in this migraine sufferer population, supporting previous findings of increased prevalence of bipolar disorders in patients with migraine. Increased frequency of affective temperaments might be considered in the context of a common pathophysiological background for migraine and bipolar disorders where these temperaments are sub-threshold presentations of mood disorders. Therefore, the definition of patients with comorbid migraine and bipolar disorder may serve as a more homogenic subgroup of mood disorders for further studies.