Migraine Sufferers Research Articles

The burden and health care use of patients with migraine and tension-type headache in post-conflict area of Serbia.

The aim of the present study was to assess the burden and health care use of adult patients with migraine and tension type headache in a post-conflict area of Serbia. This cross-sectional study was conducted on a representative sample of adults, living in predominantly Serb communities on the Kosovo and Metohija territory. The required data was obtained through a survey, utilizing a culturally-adapted questionnaire. The study sample comprised of 1,062 adults. In the year preceding the study, 49.7% of included subjects suffering from migraines and 27.5% of those experiencing tension type headache sought medical assistance for their condition. The majority (88.5%) of the respondents utilized non steroid antiinfammatory drugs as analgesic, while 14.2% used prophylactic treatment. Migraine sufferers reported losing on average 11.1 days in a 3-month period, while those experiencing tension type headache lost 4.7 days (p < 0.001) due to headaches, preventing them from partaking in professional, family and social activities. On headache-free days, 24.5% of the respondents were anxious or tense in anticipation of a headache onset, while 30% did not feel that the headache had completely resolved. Moreover, 11.5% of the sample reported never or rarely feeling in control of the headache, while 20% of the respondents were of view that their headaches were not taken seriously by their employer and co-workers and rarely discuss them. Adverse effect of headaches on education is more frequently noted by migraine sufferers than those experiencing tension type headache (p = 0.001), and this disparity persists in relation to career (p < 0.001) and family planning (p = 0.001). In Kosovo and Metohija, primary headaches exert a profound influence on the affected individuals and their community, and thus require recognition as one of the priorities of social initiatives aimed at the enhancement of public health.

Lifestyle Modifications for Migraine Management.

Migraine is a disabling disease that inflicts a heavy burden on individuals who suffer from it. Significant advances are being made in understanding the pathophysiology and treatment of the disease. The role of lifestyle modifications has become increasingly predominant. We reviewed the current and available data on the role of a healthy lifestyle in the management of migraine. Physical activity, management of obesity, a healthy diet, and a better lifestyle, such as adequate sleep and avoidance of drug abuse, significantly contribute to reducing the frequency and severity of attacks. It is important to consider these factors in the overall management strategies for migraine sufferers.

Adjunctive treatment of chronic migraine using an oral dental device: overview and results of a randomized placebo-controlled crossover study

ObjectiveTo assess the nocioceptive input of habitual nocturnal jaw clenching that acts as a contributing factor in migraine pathogenesis.BackgroundHabitual nocturnal jaw clenching has been implicated as a trigger, particularly in those whose headaches are present upon waking or shortly thereafter. Nocturnal EMG studies of patients diagnosed with migraine show nearly twice the temporalis clenching EMG levels and double the bite force as matched asymptomatic controls, leading to the speculation that parafunctional clenching activity may have some role in headache pathogenesis. The NTI (Nociceptive Trigeminal Inhibition) oral device is a dental splint designed to reduce nocturnal jaw clenching intensity and is FDA approved for the prevention of medically diagnosed migraine pain based on open label studies. There are no prior placebo-controlled trials to assess the migraine prevention efficacy of the NTI splint. This is the first placebo-controlled cross-over study to assess the efficacy of the NTI splint in patients with Chronic Migraine.MethodA placebo controlled, single-blinded cross-over study was done with IRB oversight assessing the efficacy of the NTI splint compared to placebo using the change in the HIT-6 score as the outcome measure.Results68% of refractory chronic migraine sufferers using the NTI as measured by sequential HIT 6 scores had at least a one-category improvement (severe to substantial, or substantial to some, or some to none) compared to 12% when using a placebo device. 36% of subjects using the NTI device reported a two-category improvement in their HIT-6 score, compared to 0% when using placebo.ConclusionThe improvement in HIT-6 scores produced by the NTI device, suggests that patients with Chronic Migraine may have intense nocturnal jaw clenching as a contributing factor to their headache related disability. An NTI device is one method of assessing whether jaw-clenching is a contributing factor to ongoing migraine.Trial registrationCurrent Controlled Trials NCT04871581. 04/05/2021. Retrospectively registered.

A unique medium chain triglyceride-containing micronutrient complex: Effects on migraine symptoms compared to quality of lif

Purpose: Migraine headaches and associated symptoms are prevalent medical issues. Medium-chain triglyceride (MCT)/nootropic-based compounds have demonstrated benefits in multiple domains. This study assessed the potential relief provided from a unique, high-concentration MCT/nootropic component blend on migraine frequency, duration, secondary symptoms, and quality of life (QOL) during a 60-day clinical investigation. Methods: Forty (n=40) chronic migraine sufferers [migraineurs] were prospectively randomized to participate in the double-blinded study. Both intervention (n=30) and control (n=10) participants were required to maintain lifestyle patterns for the trial duration. Migraine surveys used electronic response forms to allow subjects increased ease and safety during the COVID-19 pandemic. Results. The intervention subjects experienced reduction in migraine episodes by 53%, from 11.6 to 5.4 per month, after 60 days of supplement use. The average episode duration decreased from 260 minutes to 158 minutes, a 39% improvement. Time lost due to severe migraine effect was reduced from an average of more than five days per month to just over two per month, a decrease of 55%. A combined measure of secondary symptoms, which aggregate to illustrate migraine intensity, also decreased according to subject rating by an average of 37%. Self-assessed QOL scales improved by 43% in the intervention cohort. The control subjects showed no significant changes in any measures. Conclusion: Consumption of a unique, nootropic brain complex significantly improved migraine symptoms, including episode frequency, duration, severity, and lost days due to dysfunction. The formulation also beneficially impacted secondary effects and self-reported QOL.

Visual stress responses to static images are associated with symptoms of Persistent Postural Perceptual Dizziness (PPPD).

Images that deviate from natural scene statistics in terms of spatial frequency and orientation content can produce visual stress (also known as visual discomfort), especially for migraine sufferers. These images appear to over-activate the visual cortex. To connect the literature on visual discomfort with a common chronic condition presenting in neuro-otology clinics known as persistent postural perceptual dizziness (PPPD). Patients experience dizziness when walking through highly cluttered environments or when watching moving stimuli. This is thought to arise from maladaptive interaction between vestibular and visual signals for balance. We measured visual discomfort to stationary images in patients with PPPD (N = 30) and symptoms of PPPD in a large general population cohort (N = 1858) using the Visual Vertigo Analogue Scale (VVAS) and the Situational Characteristics Questionnaire (SCQ). We found that patients with PPPD, and individuals in the general population with more PPPD symptoms, report heightened visual discomfort to stationary images that deviate from natural spectra (patient comparison, F (1, 1865) = 29, p < 0.001; general population correlations, VVAS, rs (1387) = 0.46, p < 0.001; SCQ, rs (1387) = 0.39, p < 0.001). These findings were not explained by co-morbid migraine. Indeed, PPPD symptoms showed a significantly stronger relationship with visual discomfort than did migraine (VVAS, zH = 8.81, p < 0.001; SCQ, zH = 6.29, p < 0.001). We speculate that atypical visual processing -perhaps due to a visual cortex more prone to over-activation -may predispose individuals to PPPD, possibly helping to explain why some patients with vestibular conditions develop PPPD and some do not.

Vestibular Migraine in Adolescents

Migraine is a recurrent throbbing headache that affects one side of the head and is usually related to nausea and decreased vision. Migraine is typically seen in adolescents due to increased use of electronic devices and computers. It is a non communicable disease.10 percent patients with migraine suffer from vestibular migraine. Vertigo in children can lead to migraine and continue in adults too. Preventing the vertigo attacks in children and adolescents can help in the treatment of migraine. Behavioural therapy is an important factor in treatment of migraine in this age. 40% of migraine patients have some associated vestibular symptoms which includes dizziness and disturbed balance. An elevated comorbidity of migraine and vertigo was discovered in several patient categories and later verified at the community level, far exceeding what random chance would predict. Vertigo is substantially more commonly seen in migraine sufferers, particularly those with aura, than in headache-free controls. Migraine is one of the most disturbing diseases in USA, is nearly as common as hypertension and more common than asthma and diabetes. Migraine and vestibular symptoms can coexist with inner ear disorders. It is a difficult condition to diagnose and treat. Multiple temporal patterns are responsible for this. The most common cause of vertigo in children is vestibular migraine (VM). Clinical findings and laboratory test results have been found in a sample of children and adolescents suffering from Vestibular migraine. Recent classification criteria for dizzy children are discussed and their limitations. Migraine is typically seen in adolescents due to increased use of electronic devices and computers. It is a non-communicable disease. 10 percent patients with migraine suffer from vestibular migraine.

The prevalence and characteristics of visceral autonomic symptoms among migraineurs: A population-based study.

There is limited evidence about visceral autonomic symptoms in the different phases of migraine attack. We evaluated the prevalence of these symptoms in migraineurs before, during, and after headache attacks. In addition, the association between migraine characteristics and visceral autonomic symptoms was investigated. A total of 605 participants who met the entry criteria were enrolled prospectively in this cross-sectional study. Participants were 18-60 years old and met the ICHD-3 criteria for migraine with or without aura. Information on the migraine symptoms was gathered from all participants in face-to-face interviews. A structured questionnaire was used to evaluate the related symptoms before, during, and after attacks. Migraine features of frequency, duration, and severity were also assessed. Considering all phases, the most commonly present visceral symptom was nausea (52.9%). About half of participants reported at least one visceral symptom before the onset of attacks. While, during and after attacks, 71% and 36% of participants reported such characteristics, respectively. Notably, the migraine headache in participants with visceral symptoms was longer during attacks compared to participants without them (24.4 ± 29.6 vs. 16.8 ± 19.8; P = 0.008). Additionally, subjects with positive visceral symptoms experienced more severe migraine attacks than participants without symptoms for both the premonitory (8 ± 1.7 vs. 7.6 ± 1.8; P = 0.02) and during-attack (8.01 ± 1.7 vs. 7.09 ± 1.9; P = 0.001) phases. This study demonstrated that visceral symptoms were common in migraine sufferers not only during attacks but also in the premonitory and postdrome phases. Positive visceral symptoms were also associated with more burdensome headache attacks. Therefore, recognizing the phenotypic presentation of associated symptoms of migraine, especially during the pre-attack phase, could aid in early implementation of optimal management.

Quality of Life and Disability Among Migraine Patients: A Single-Center Study in AlAhsa, Saudi Arabia.

BackgroundMigraine is a major public health issue that leads to frequent visits to medical care. It is generally considered a disabling disease among individuals below the age of 50 years old predominantly seen in females. Migraine headache has a strong influence on disability, functional impairments, and psychological effects. The majority of the physicians fail to address the degree and extent of impediment caused by a migraine, which contributes to low quality of life and disability. Thus, this study aims to assess the health-related quality of life (QOL) and disability among migraine sufferers in AlAhsa, Saudi Arabia.Material and methodsThis descriptive cross-sectional study was carried out in the neurology clinics at King Fahad Hospital-Hofuf, AlAhsa, Saudi Arabia, from May to August 2021. The data were collected through a self-administered questionnaire. The migraine-specific quality of life questionnaire (MSQ), version 2.1, was used. MSQ is measured in three domains, including role function restrictive (RR), preventive (RP), and emotional function (EF). Disability related to migraine was assessed by the Migraine Disability Assessment Test (MIDAS). MIDAS classifies disability from no disability to severe disability. Two-tailed with an alpha level of 0.05 considering the significance of a p-value less than or equal to 0.05. The mean scores of QOL domains were compared by one-way analysis of variance (ANOVA) and independent t-tests.ResultsA total of 101 out of 359 participants were identified to have a migraine. Eighty-two participants met the inclusion criteria, 75.6% were females. The age of the participants ranged from 18 to more than 45 years with a mean age of 36.4 ± 11.9 years old. The mean score of QOL in the restrictive, preventive, and emotional domains were 46.3% ± 21.5%, 52.1% ± 24.3%, and 61.5% ± 30.8%, respectively. More than half of the participants (57.3%) suffered from a severe disability caused by migraines as compared to 20.7% with a moderate disability. Low QOL scores were associated with females and a significant relationship was found between migraine-associated disability and patients’ emotional function in QOL.ConclusionClinicians should routinely evaluate disability related to migraine and QOL as a complementary approach to migraine patients to ensure that patients are receiving proper treatment and whether additional strategies are needed or not.

Formulation development and evaluation of Orally Disintegrating Tablets Rizatriptan Benzoate

Formulation research is oriented towards safety, efficacy and quick onset of action of existing drug molecule through novel concepts of drug delivery. Orally disintegrating tablets of Rizatriptan benzoate were prepared by direct compression method to provide faster relief from pain to migraine sufferers. About eleven formulations for the present study were carried out. Croscarmellose sodium, Crospovidone and Sodium starch glycolate (SSG) were used as superdisintegrants, while microcrystalline cellulose was used as diluent. The prepared batches of tablets were evaluated for weight variation, hardness, friability, wetting time, invitro dispersion time, drug content and invitro dissolution studies. The formulation containing combination of Croscarmellose sodium and Sodium starch glycolate showed rapid invitro dispersion time as compared to other formulations. The optimized formulation dispersed in 8 seconds. It also showed a higher water absorption ratio and 99.58% of drug is released within 2 minutes.

COMPLICATED MIGRAINE

Migraine is a chronic paroxysmal neurological disease characterized by attacks of moderate or severe headache accompanied by reversible neurologic and systemic symptoms. Although not life threatening, migraine can cause disability in the productive population. Migraine sufferers generally have a family history of migraine so that migraine is considered a genetic disease. Endogenous psychological factors such as stress or fatigue are the main triggers for migraine. Migraine pathophysiology involves various parts of the brain so that migraine symptoms are complex. Management of acute migraine can be done pharmacologically and non-pharmacologically. Migraine preventive management is needed if the patient has a chronic migraine or does not respond to abortive treatment.

Retinal Neurovascular Structural Changes in Optical Coherence Tomography and the Relationship between These Changes and White Matter Hyperintensities in Patients with Migraine

Introduction: This study aimed to reveal whether retinal nerve fiber layer (RNFL), ganglion cell layer (GCL) inner plexiform layer, and choroidal layer (CL) thicknesses differed in patients with migraine. Optical coherence tomography (OCT) was used to measure these neurovascular structural changes and determine the relationship between these structures and cranial white matter hyperintensities (WMHs). Methods: This retrospective comparative registry study included a total of 155 individuals aged 18–55 (mean, 33.50 ± 8.34), consisting of 110 migraine patients and 45 healthy controls. Results: RNFLs were thinner in the migraine group than the control group but not to a statistically significant degree. However, in both eyes, peripapillary RNLF thickness in some specific quadrants was found to be significantly thinner in the patient group than the control group. GCLs were significantly thinner in the migraine group than the control group. CLs were significantly thicker in the migraine group than in the control group. There was no significant difference between the OCT parameters of patients with and without WMH. An inverse correlation was found between disease duration and CL thickness. CLs were significantly thicker in patients in attack periods than those in attack-free periods. There was no significant difference between the OCT parameters of the migraine with aura and migraine without aura subgroups. Discussion/Conclusions: Retinal neural and vascular structures might be affected in migraine sufferers, including those in subgroups. Rebound vasodilation may cause alterations in CL thickness during a migraine attack. Factors other than hypoperfusion may contribute to the pathophysiology responsible for the formation of WMH.

Multinational descriptive analysis of the real-world burden of headache using the Migraine Buddy application.

Background and purposeA large proportion of headache sufferers do not routinely seek medical care. App‐based technologies permit the collection of real‐world data over time and between countries that can help assess true burden of headache. This study used a mobile phone application to collect information on the real‐world burden of self‐diagnosed headache and to describe its impact on daily life in headache sufferers who do not routinely seek medical advice.MethodsThis retrospective, non‐interventional, cross‐sectional study analysed self‐reported data from users of the ‘Migraine Buddy’ app. The main objective was to describe self‐reported characteristics of headache and migraine (triggers, duration, frequency), treatment patterns and impact on daily activity in headache sufferers from Australia, Brazil, France, Germany and Japan. Data including demographics, self‐diagnosed episode type (headache/migraine), duration, potential triggers and impact on daily activity are reported. All analyses were exploratory and performed per country.ResultsSelf‐reported data were collected from 60,474 users between August 2016 and August 2018. Approximately 90% of users were females; >60% were aged 24–45 years. Over one‐third of users reported having two to five episodes of headache or migraine per month; impact included impaired concentration, being slower and missing work or social activities. Variations across countries were observed; within countries, episode characteristics were very similar for self‐diagnosed headache versus migraine.ConclusionsHeadache tracking was used to describe the experience, impact and self‐management approaches of migraine and headache sufferers in a real‐world setting. Headache disorders present a range of important issues for patients that deserve more study and reinforce the need for better approaches to management.

Age-related differences in resting state functional connectivity in pediatric migraine

BackgroundMigraine affects roughly 10% of youth aged 5–15 years, however the underlying mechanisms of migraine in youth are poorly understood. Multiple structural and functional alterations have been shown in the brains of adult migraine sufferers. This study aims to investigate the effects of migraine on resting-state functional connectivity during the period of transition from childhood to adolescence, a critical period of brain development and the time when rates of pediatric chronic pain spikes.MethodsUsing independent component analysis, we compared resting state network spatial maps and power spectra between youth with migraine aged 7–15 and age-matched controls. Statistical comparisons were conducted using a MANCOVA analysis.ResultsWe show (1) group by age interaction effects on connectivity in the visual and salience networks, group by sex interaction effects on connectivity in the default mode network and group by pubertal status interaction effects on connectivity in visual and frontal parietal networks, and (2) relationships between connectivity in the visual networks and the migraine cycle, and age by cycle interaction effects on connectivity in the visual, default mode and sensorimotor networks.ConclusionsWe demonstrate that brain alterations begin early in youth with migraine and are modulated by development. This highlights the need for further study into the neural mechanisms of migraine in youth specifically, to aid in the development of more effective treatments.

CEREBRAL AND SYSTEMIC ENDOTHELIAL DYSFUNCTION IN MIGRAINE: CURRENT KNOWLEDGE AND PERSPECTIVE

Migraine still causes a high rate of disability and is reported to increase the risk of cardiovascular and cerebrovascular diseases. Endothelial dysfunction is considered to be one of the underlying mechanisms linking migraine and vascular disorders. Investigation of endothelial function in migraine includes a variety of examinations including biomarkers and ultrasonography-based studies. Several proposed biomarkers for endothelial dysfunction are endothelial progenitor cells (EPCs), von Willebrand factor (vWF), nitric oxide (NO), tissue-type plasminogen activator antigen (tPA antigen), C-reactive protein (CRP), endothelin-1 (ET-1), and vascular endothelial growth factor (VEGF). Brachial flow-mediated dilatation (FMD) is quite commonly used to reflect systemic endothelial dysfunction, while cerebral endothelial function can be assessed using breath holding index (BHI) on transcranial Doppler (TCD). The results of most studies in migraine sufferers indicate that endothelial dysfunction is found locally in the cerebral circulation, especially at the posterior circulation, while evidence for endothelial dysfunction in the systemic circulation remains controversial.

Mindfulness Meditation has Benefits for Migraine Sufferers.

According to this study: Mindfulness-based stress reduction may help to manage total migraine burden.

A Tale of Two Peptides: Identifying Targets for Migraine

Calcitonin gene related-peptide (CGRP) and amylin are closely-related peptides that are both reported to be elevated in the plasma of migraine sufferers. CGRP is highly expressed in neural tissues and migraine relevant structures, including the trigeminal ganglia (TG). Amylin is secreted from pancreatic islets in response to food intake, with conflicting reports of expression in the TG. CGRP potently activates two receptors, the CGRP receptor and Amylin 1 (AMY1) receptor, whereas amylin potently activates the AMY1 receptor. CGRP has been proposed to be auto regulated in an autocrine manner in the TG, however CGRP does not colocalise with the CGRP receptor in the TG. The AMY1 receptor is also expressed in the TG, but where it is expressed and whether it is found together with CGRP or amylin is poorly understood. Therefore, our aim was to determine whether amylin is expressed in the TG and the relative distribution of AMY1 receptor components with CGRP or amylin using thoroughly validated antibodies. To study the distribution of CGRP, amylin and the AMY1 receptor component, calcitonin receptor (CTR), in the TG a range of antibodies were validated. Anti-CGRP and amylin antibodies were validated using immunoblotting and rat pancreas histology. Anti-CTR antibodies were validated using transfected HEK293S cells and knock out tissue. Lead antibodies were then applied to mouse, rat and human TG sections with neural markers to investigate their distribution. Anti-amylin antibodies frequently cross-reacted with CGRP, whereas anti-CGRP antibodies displayed no cross-reactivity with amylin. Lead anti-amylin antibodies displayed little or no detection of amylin in rodent and human β-tubulin III-positive neurons, respectively, whereas abundant CGRP-like immunoreactivity was observed across all species. When co-incubated the little amylin-like immunoreactivity observed strongly colocalised with anti-CGRP staining. This was particularly apparently with T4145, the more cross-reactive amylin antibody. The lead anti-CTR antibody, 188/10, displayed robust detection of rodent CTR in transiently transfected HEK293S cells and a marked loss of staining in knock out mouse nucleus accumbens compared to wild type. CTR-like and CGRP-like immunoreactivity frequently colocalised in rat TG sections, primarily in C-fibre neurons, and rarely in NF200-positive A-fibre neurons. These results demonstrate the importance of thoroughly validating antibodies. The data suggest that in the TG, CGRP, rather than amylin, is the endogenous agonist for the AMY1 receptor. Additionally, it suggests that CGRP autocrine signalling occurs via the AMY1 receptor.

Extraction and Analysis of Dynamic Functional Connectome Patterns in Migraine Sufferers: A Resting-State fMRI Study.

Migraine seriously affects the physical and mental health of patients because of its recurrence and the hypersensitivity to the environment that it causes. However, the pathogenesis and pathophysiology of migraine are not fully understood. We addressed this issue in the present study using an autodynamic functional connectome model (A-DFCM) with twice-clustering to compare dynamic functional connectome patterns (DFCPs) from resting-state functional magnetic resonance imaging data from migraine patients and normal control subjects. We used automatic localization of segment points to improve the efficiency of the model, and intergroup differences and network metrics were analyzed to identify the neural mechanisms of migraine. Using the A-DFCM model, we identified 17 DFCPs—including 1 that was specific and 16 that were general—based on intergroup differences. The specific DFCP was closely associated with neuronal dysfunction in migraine, whereas the general DFCPs showed that the 2 groups had similar functional topology as well as differences in the brain resting state. An analysis of network metrics revealed the critical brain regions in the specific DFCP; these were not only distributed in brain areas related to pain such as Brodmann area 1/2/3, basal ganglia, and thalamus but also located in regions that have been implicated in migraine symptoms such as the occipital lobe. An analysis of the dissimilarities in general DFCPs between the 2 groups identified 6 brain areas belonging to the so-called pain matrix. Our findings provide insight into the neural mechanisms of migraine while also identifying neuroimaging biomarkers that can aid in the diagnosis or monitoring of migraine patients.

Protracted hypomobility in the absence of trigeminal sensitization after cortical spreading depolarization: Relevance to migraine postdrome

Migraine sufferers often exhibit photophobia and physical hypoactivity in the postdrome and interictal periods, for which no effective therapy currently exists. Cortical spreading depolarization (CSD) is a neural phenomenon underlying migraine aura. We previously reported that CSD induced trigeminal sensitization, photophobia, and hypomobility at 24 h in mice. Here, we examined the effects of CSD induction on light sensitivity and physical activity in mice at 48 h and 72 h. Trigeminal sensitization was absent at both time points. CSD-subjected mice exhibited significantly less ambulatory time in both light (P = 0.0074, the Bonferroni test) and dark (P = 0.0354, the Bonferroni test) zones than sham-operated mice at 72 h. CSD-subjected mice also exhibited a significantly shorter ambulatory distance in the light zone at 72 h than sham-operated mice (P = 0.0151, the Bonferroni test). Neurotropin® is used for the management of chronic pain disorders, mainly in Asian countries. The CSD-induced reductions in ambulatory time and distance in the light zone at 72 h were reversed by Neurotropin® at 0.27 NU/kg. Our experimental model seems to recapitulate migraine-associated clinical features observed in the postdrome and interictal periods. Moreover, Neurotropin® may be effective in ameliorating postdromal/interictal hypoactivity, especially in a light environment.

Psychological Considerations in the Etiology and Pathophysiology of Migraines

Although studies to understand the pathogenesis of migraines are in progress, no theory has adequately explained the etiology and pathophysiology of migraines to date. This has affected the development of treatment strategies for migraineurs. Currently, the pharmacological treatment for migraines provides both acute and prophylactic options to patients based on a biomedical model of pain. However, patients’ adherence to oral migraine preventive medication (OMPM) is poor, and their persistence is even lower when they cycle through a variety of OMPMs [1]. Although our understanding of the pathophysiology of migraines within the context of the current biopsychosocial model of pain has advanced in recent years, there is a need to better understand the role of social and psychological factors in the pathophysiology of this debilitating disease, which would pave the way for the development and acceptance of more diverse and inclusive treatments. In this review, we provide an overview of the various theories that purport to explain the pathogenesis of the headache phase of migraines, examine the usefulness and shortcomings of these theories, and investigate how psychological considerations may help develop treatments to assist migraine sufferers in managing their headaches better.

The prevalence of migraine in Argentina: A reappraisal.

Argentina has one of the largest territories in the world, which spreads over a lengthy latitudinal span. Its population is mainly composed of a mixture of South American natives and the descendants of numerous waves of European immigrants. Results from a previous study suggested that the prevalence of migraine in Argentina is the lowest in the region. Here we aimed to reassess the prevalence of migraine in Argentina applying a more sensitive and specific screening tool. We conducted a random computer assisted telephonic interview (n= 2500) using the Migraine Screen Questionnaire to evaluate the prevalence of migraine and some of its features among Argentinian adults. The overall prevalence of migraine was 9.5% (14% in females and 5% in males). Estimated migraine prevalence rates ranged between 6.3% and 12% across different regions. The approximated prevalence of high frequency and chronic migraine were 1.9% and 1.5% of the total population respectively. Consumption of analgesics on 10 or more days per month was reported by 18% of migraine sufferers (≈1.7% of the population). The prevalence of migraine in Argentina is higher than previously reported. Prevalence rates vary extensively across the territory. Specifically evaluating the determinants of these variations might be a promising avenue of research.