Migraine Type Headache Research Articles

Epidemiological and clinical aspects of migraine in users of combined oral contraceptives

Background Migraine was assessed in users of combined oral contraceptives (COCs). Study Design This study had a cross-sectional design. Women with headaches were evaluated according to International Headache Society criteria and subsequently allocated to a “migraine” or “non-migraine” group. Results Migraine was detected in 80/480 women (16.6%), while other types of headache not classified as migraine were observed in 400 women (83.4%). Following COC use, headaches worsened in 32.5% and 19.3% [odds ratio (OR)=3.02; 95% confidence interval (CI)=1.68–5.4] and improved in 30% and 13.8% (OR=3.9; 95% CI=2.12–7.18) of the “migraine” and “non-migraine” groups, respectively. In the migraine group only, headache episodes occurred predominantly during or around the hormone-free interval (OR=2.05; 95% CI=1.26–3.35). The combination of ethinylestradiol (EE) and drospirenone (DRS) was significantly associated with an improvement in the frequency and/or intensity of migraine-type headaches, compared with other types of COCs. Conclusions The prevalence of migraine in COC users appears similar to that found in the general population. Migraines, but not other types of headache, were significantly affected by COCs. The EE/DRS combination was associated with a greater likelihood of improvement in migraine compared with other types of COCs.

A rarely seen syndrome in rehabilitation of hemiplegia: antiphospholipid antibody-negative Sneddon’s syndrome

Sneddon's syndrome is a rarely seen disorder and it is characterized by livedo reticularis (LR) and neurologic findings. Some systematic findings may also be seen with neurologic and cutaneous findings. In this case, we aimed to present a 28-year-old female patient with diffuse LR, cardiac valve disease and migraine-type headache who had a right hemiplegic attack.

Plasma calcitonin gene-related peptide concentration is comparable to control group among migraineurs and tension type headache subjects during inter-ictal period

Calcitonin gene-related peptide (CGRP) is known to increase during acute attack of migraine and tension type headache (TTH). However, its concentration during inter-ictal period is not known. This may help us to understand the pathophysiology of these headaches. The objectives of this study are to find out the concentration of CGRP in plasma during inter-ictal period among migraineurs and TTH and to compare it with control group through cross-sectional study from headache clinic of a tertiary centre. Study sample comprised of three groups: migraineurs, TTH subjects as well as a healthy control group. Fifty subjects in each group were included after screening for the respective inclusion criteria and exclusion criteria. None of the subjects was blood relatives of other subject. Their venous blood was drawn and plasma was separated to be kept at −70°C. CGRP was analysed with commercially available ELISA kit. Data were analysed with the help of SPSS V 11.0 for Windows. Chi-square, independent sample t test and one-way ANOVA with post hoc Tukey and univariate regression were performed. Plasma CGRP concentration was not different among three diagnostic groups (F = 0.78; P = 0.49). Similarly, plasma CGRP concentration was not different among episodic TTH and chronic TTH groups (t = 0.32; P = 0.97) and comparison of episodic and chronic migraine groups also revealed similar results in this study (1.14 vs. 0.94 ng/ml; P = 0.23). The presence of aura did not affect the inter-ictal CGRP levels among migraineurs (F = 0.16; P = 0.85). In conclusion, this study suggests that migraine and TTH could be episodic disorders and subjects have comparable CGRP levels during inter-ictal period.

Behavioral Dependence in Patients With Medication Overuse Headache: A Cross‐Sectional Study in Consulting Patients Using the DSM‐IV Criteria

The aim of this study was to assess behavioral dependence on migraine abortive drugs in medication-overuse headache (MOH) patients and identify the predisposing factors. It is common occurrence that MOH patients relapse after medication withdrawal. Behavioral determinants of medication overuse should therefore be identified in MOH patients. This was a cross-sectional, multicenter study that included 247 MOH patients (according to International Classification of Headache Disorders, 2nd edition criteria) consulting in French headache specialty centers. Face-to-face interviews were conducted by senior neurologists using a structured questionnaire including the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria for the evaluation of dependence, Hospital Anxiety and Depression Scale for the evaluation of anxiety and depression, and 6-item short-form Headache Impact Test scale for the determination of functional impact. Most MOH patients had pre-existing primary migraine (87.4%) and current migraine-type headaches (83.0%). Treatments overused included triptans (45.8%), opioid analgesics alone or in combination (43.3% of patients), and analgesics (27.9%). Nonmigraine abortive substances (tobacco, caffeine, sedatives/anxiolytics) were overused by 13.8% of patients. Two-thirds of MOH patients (66.8%) were considered dependent on acute treatments of headaches according to the DSM-IV criteria. Most dependent MOH patients had migraine as pre-existing primary headache (85.7%) and current migraine-type headaches (87.9%), and most of them overused opioid analgesics. More dependent than nondependent MOH patients were dependent on psychoactive substances (17.6% vs 6.1%). Multivariate logistic analysis indicated that risk factors of dependence on acute treatments of headaches pertained both to the underlying disease (history of migraine, unilateral headaches) and to drug addiction (opioid overuse, previous withdrawal). Affective symptoms did not appear among the predictive factors of dependence. In some cases, MOH thus appears to belong to the spectrum of addictive behaviors. In clinical practice, behavioral management of MOH should be undertaken besides pharmacological management.

Rebound Abdominal Pain: Noncephalic Pain in Abdominal Migraine is Exacerbated by Medication Overuse

Abdominal migraine usually has its onset during childhood or adolescence and resolves in adulthood, often being replaced by typical migraine headaches. Rarely, migraine headache and recurrent abdominal pain coexist in some patients during adulthood. We report a patient who developed abdominal migraine without headaches beginning for the first time at the age of 22 years. The abdominal symptoms increased in frequency coincident with medication overuse and resolved after the overuse was treated. Analgesic overuse may cause a worsening of noncephalic pain in patients with extra-cephalic variants of migraine.

Prevalence of migraine diagnosis using ID Migraine among university students in southern Turkey

In this prospective study, we aimed to determine the prevalence of migraine and non-migraine headaches using a questionnaire, including ID Migraine™, for university students. The study was designed cross-sectionally and a questionnaire consisting of 43 questions was applied to 1,256 students. The questionnaire consisted of questions related to demographic, social, curriculum, housing and headache characteristics of the subjects. Three-item screening questions of the ID Migraine™ test were included at the end of the questionnaire aimed at migraine diagnosis. The mean age of 1,256 students (529 females and 727 males) enrolled in this study was 21.9 ± 2.1 years (17–31 years). Migraine-type headache was detected in 265 subjects (21.9%) based on the ID Migraine™ evaluation. Of these, 145 (54.7%) were female and 120 (45.3%) were male (female/male ratio: 1.2/1). Non-migraine-type headache was identified in 864 subjects, with 357 females and 507 males. As a conclusion, ID Migraine™ screening test might be practical and beneficial when a face-to-face interview is not possible or to pre-determine the subjects for a face-to-face interview for migraine diagnosis in larger populations.

Force production and EMG activity of neck muscles in adolescent headache

Purpose. This study compared the maximal force, EMG/force ratio and co-activation characteristics of the neck-shoulder muscles between 30 adolescents with migraine-type headache, 29 with tension-type headache, and 30 headache-free controls.Method. Force was measured with surface electromyography (EMG) from the cervical erector spinae (CES), the sternocleidomastoid (SCM) and trapezius muscles during the maximal isometric neck flexion, neck extension and shoulder flexion.Results. Girls with migraine-type headache had higher EMG/force ratios between the EMG of the left agonist SCM muscle and the corresponding maximal neck flexion (p = 0.030) and neck rotation force to the right side (p = 0.024) than the girls with tension-type headache. Migrainous girls had more co-activation of right antagonist CES muscle during maximal neck flexion force than the girls without headache (p = 0.015). Neck force production showed no significant differences between girls. Girls with tension-type headache displayed lower left shoulder flexion force than girls with migraine-type headache (p = 0.005) or with no headache (p = 0.005). In boys, no significant differences were observed.Conclusions. Girls with tension-type headache and migraine-type headache have differences in neuromuscular function in the neck-shoulder muscles. The data amplify our knowledge of the neck-shoulder muscle dysfunction in adolescent headache, and may encourage the use of specific rehabilitation methods in the management of different types of headache.

Headache in children and adolescents

Headache is a common problem in children and adolescents. Migraine and tension type headache are most common causes of headache and only occasionally chronic headache is the main presenting feature of a serious brain disease or a brain tumour. Full clinical history, physical examination and headache diary recordings are essential requirement in the assessment of children with headache and the assessment of the impact of headache on child’s education, social and family life. Management of headache includes the promotion of healthy life style with regular meals, sleep and exercise. Painkillers are used in appropriate dose, as early as possible after the onset of headache and the use of most appropriate route of administration.

Multiple cavernous malformations with supravermian arachnoid cyst

Cerebral cavernous malformation are congenital vascular abnormalities that have been reported in 0.4% of the population; they represent 5-13% of all cerebrovascular malformations. Onset of cerebral cavernous malformations may be associated with seizures, intracranial hemorrhages, focal neurological deficit or migraine-type headaches. Some patients may require surgical intervention due to hemorrhage. Multiple cavernomas in childhood have been reported in the literature, but they are rare. This manuscript presents a 12-year-old girl with multiple cavernomas accompanied by supravermian arachnoid cyst detected by neuroimaging techniques. This is the first report that demonstrates a case of pediatric multiple cavernous malformation coexisting with arachnoid cyst of the supravermian cistern.

Ätiologie und Diagnostik von Kopf- und Gesichtsschmerzen aus neurologischer Sicht

Headaches are one of the most frequent outpatient complaints. Patients may describe a symptom indicating an underlying disease, which can range from an ordinary indisposition to a medical emergency. Despite these secondary headaches, there exist idiopathic forms, such as migraine and tension type headaches, which represent the most common types. In order to develop a specific treatment, the diagnosis of headaches and the knowledge of their etiology are very important for physicians. While headaches remain a neurological domain, facial pain syndromes are often seen and treated in other medical fields. Here clinically important facial pain syndromes are reported from a neurological point of view.

Habituation of sympathetic skin response in migraine and tension type headache

This study aimed to investigate the changes of habituations in the autonomic function of patients suffering from migraine or tension type headache through sympathetic skin responses. Patients with migraine without aura ( n = 26), with episodic tension type headache without migraine ( n = 28) and 30 healthy controls were studied. During continuous stimulation, four blocks of 20 responses were sequentially recorded. Mean amplitude changes in the second, third and fourth blocks are expressed as the percentages of the first block. In both headache groups, there was a lack of habituation compared to the control group.

Neck flexor muscle fatigue in adolescents with headache – An electromyographic study

Background Muscular disorders of the neck region may be of importance for the etiology of tension-type headache. However, in adolescents, there are no data on the association between neck muscle fatigue and headache. Aim To study differences in fatigue characteristics of the neck flexor muscles in adolescents with and without headache. Methods A population-based sample of 17-year-old adolescents with migraine-type headache ( N = 30), tension-type headache ( N = 29) and healthy controls without headache ( N = 30) was examined. Surface EMG data were recorded from the sternocleidomastoid (SCM) muscles bilaterally during an isometric neck flexor endurance test. The spectral median frequency (MF) change during the total endurance time (TMF) and the initial time of 30 s (IMF) was calculated. The intensity of discomfort in the neck area was assessed with the visual analogue scale (VAS). Results The rate of decline in TMF of both SCM muscles was significantly increased in the tension-type headache group compared with controls (right SCM, P = 0.030, OR 2.0, 95% 1.2–3.7; left SCM, P = 0.009, OR 2.5, 95% 1.4–4.9), while no significant differences were found between controls and subjects with migraine. The rate of decline in IMF, the total endurance time ( P = 0.050), and VAS did not differ significantly among the study groups. Conclusions This preliminary finding shows that increased neck flexor muscle fatigue in adolescents seems to be associated with tension-type headache.

Pneumatized superior turbinate as a cause of headache

BackgroundA pneumatized superior turbinate is a rare cause of headache. Nasal endoscopy alone, does not provide us with adequate information for this inaccessible area of the superior nasal cavity. A coronal computed tomography (CT) must be obtained to confirm the diagnosis.Case presentationWe present a 40-year-old female with migraine-type headache and nasal obstruction. Nasal endoscopy revealed a mild septal deviation, a right middle concha bullosa and a paradoxically curved middle turbinate on the left side. Coronal CT-scan showed also the presence of a superior concha bullosa on the left, which was in close contact with the nasal septum. The patient underwent septoplasty and bilateral endoscopic sinus surgery, including partial removal of both the pneumatized middle turbinates in conjunction with gentle lateralization and resection of the lower half of the left superior turbinate. Prompt relief from headache and nasal symptoms was obtained.ConclusionPneumatized superior concha causing migrainous headache is a rare finding. Endoscopic surgery may provide permanent relief of symptoms.

Efficacy of Eletriptan in Migraine‐Related Functional Impairment: Functional and Work Productivity Outcomes

To provide a multidimensional assessment of the extent of functional impairment during an acute migraine attack, and of the improvement in functioning in response to treatment, using 4 concurrently administered scales: the 7-item work productivity questionnaire (PQ-7), the functional assessment in migraine (FAIM) activities and participation (FAIM-A&P) subscale, the FAIM-impact of migraine on mental functioning (FAIM-IMMF) subscale, and the traditional 4-point global functional impairment scale (FIS). Outpatients with an International Classification of Headache Disorders diagnosis of migraine were randomized to double-blind treatment of a single attack with either oral eletriptan 20 mg (n = 192) once-daily, eletriptan 40 mg (N = 213) once-daily, or placebo (n = 208). Patients were encouraged to take study medication as soon as they were sure they were experiencing a typical migraine headache, after the aura phase (if present) had ended. Patients with moderate-to-severe functional impairment were identified on each of the 4 disability scales, and 2-hour functional response was compared between treatments. At baseline, the PQ-7 and FAIM-IMMF items that assessed ability to perform tasks requiring concentration, sustained work or attention, and ability to think quickly or spontaneously, were especially sensitive to the effects of mild headache pain, with 27% to 48% of patients (n = 92-112) reporting moderate-to-severe impairment. Only 11.3% of patients (n = 112) reported this level of impairment due to mild pain on the FIS. Functional response at 2 hours was significantly higher on eletriptan 40 mg versus placebo on the FAIM-A&P (63% vs 36%; n = 218; P < .0001); on the PQ-7 (56% vs 34%; n = 116; P= .0052); and on the FAIM-IMMF (50% vs 34%; n = 215; P= .017). These rates were all lower than the functional response rates on the FIS for eletriptan 40 mg (75%) and eletriptan 20 mg (70%) versus placebo (45%; P < .001). Conclusions.-In this exploratory analysis, use of multidimensional scales was found to provide a sensitive measure of headache-related functional impairment, especially for detecting clinically meaningful cognitive effects, and for detecting drug versus placebo differences.

Repeatability of electromyography and force measurements of the neck muscles in adolescents with and without headache

Background Reliable measurements are needed to study the dysfunction of the neck muscles. The aim of this study was to determine the intra-tester repeatability of EMG and isometric force measurements of the neck muscles in adolescents with headache and headache-free controls. Methods A group of 30 adolescents with migraine-type headache, 29 with tension-type headache, and 30 headache-free controls were recruited. Maximal isometric neck muscle force with simultaneous recording of surface EMG from the cervical erector spinae and the sternocleidomastoideus muscles was measured twice during one day. Findings For all groups, intra-class correlation coefficients (ICC) and coefficients of variation (CV) showed acceptable repeatability of all measurements. (Force measurements: ICC 0.98–0.99, CV 0.7–3.7%; EMG measurements: ICC 0.95–0.99, CV 4.9–10.1%.) On the individual level, variation between the consecutive measurements was found to be low in all groups. Interpretation The present EMG and force measurements of neck muscles indicate acceptable intra-tester repeatability in adolescents. The repeatability was comparable in migraine- and tension-type headache and headache-free groups. The EMG and the force measurements offer the possibility to investigate neck muscle dysfunction in adolescent headache.

The extent of right-to-left shunt fails to correlate with severity of clinical picture in migraine with aura

Several investigations have documented an increased incidence of right-to-left shunt (RLS) in migraine with aura (MA) and have emphasised its role in the physiopathology of aura; so far, however, no data are available concerning a possible correlation between the extent of the RLS and the clinical picture of MA patients. To investigate the possible relationship between the extent of the RLS, revealed by the number of microbubbles (MB) detected during transcranial Doppler with IV injection of ultrasound contrast (TCDc), and the clinical characteristics of MA (age at first onset of migraine, mean annual frequency of attacks and mean duration of the aura phase), 30 consecutive patients with typical aura and migraine headache positive on TCDc evaluation for RLS were enrolled. Permanent RLS was found in 12 patients and latent RLS was found in 18 patients; of these, 6 had a high-grade RLS, 5 medium-grade RLS and 7 low-grade RLS. No correlation has been documented between the number of MBs and the clinical parameters of both patients with latent shunts and those with permanent ones, nor between the clinical parameters of the two groups of patients. These data show that RLS does not seem to affect the clinical manifestation of MA and that the extent of RLS fails to correlate with the severity of the clinical picture of the disorder.

The presence of four simple history features can diagnose migraine accurately

Can the clinical assessment distinguish patients with migraine from those with other types of headache? Systematic review of diagnosis studies. The MEDLINE database was searched for the years 1966 to November 2005. This was supplemented by citation tracking and inspection of bibliographies of texts. Two authors independently assessed study eligibility, study quality, and extracted data. Studies were eligible for inclusion if they assessed diagnostic accuracy of history and physical examination tests, alone or in combination, and the reference standard was the diagnosis of a migraine-type headache made by a neurologist following the International Headache Society criteria. Diagnostic accuracy was expressed as likelihood ratios (LR) with 95% CI. Four eligible studies were located, two studying patients referred to headache specialists and two studying primary care patients. The two specialist studies were of very low methodological quality and there were concerns about data analysis and adequacy of the reference standard. The first primary care study was of high quality and evaluated a screening tool comprising five criteria: P ulsatile quality, duration 4–72 h O urs, U nilateral location, N ausea/vomiting, D isabling intensity (mnemonic = POUND ). The presence of four or more features provided a LR of 24 (95% CI 1.5 to 388) in diagnosing definite or possible migraine and a LR of 5.8 (95% CI 2.7 to 12) for a diagnosis of definite migraine. Including the features photophobia, phonophobia, and exacerbation with the five POUND criteria algorithm did not improve diagnostic accuracy. The other primary care study was of fair quality and found that the presence of two or more of the features: disabling headache, nausea, and sensitivity to light, gave a LR+ of 3.2 (95% CI 2.7 to 3.9) and LR– of 0.25 (95% CI 0.22 to 0.28). A screening tool comprising five criteria: P ulsatile quality, duration 4–72 h O urs, U nilateral location, N ausea/vomiting, D isabling intensity, remembered using the mnemonic ‘POUND’, can accurately diagnose migraine.

Migrainous scintillating scotoma and headache is ocular in origin: A new hypothesis

Brain neuronal dysfunction has been implicated in pathogenesis of migraine but direct evidence is lacking. Scintillating scotoma of migraine is generally believed to originate at the visual cortex. While cortical spreading depression is a relatively late physiological alteration in migraine, its protective role in neuronal ischaemia is increasingly being recognized. Atenolol, nadolol, or verapamil prevent migraine but do not readily cross the blood-brain barrier or critically influence any brain or peripheral neuronal function. Typical migraine headache, aura, or scintillating scotoma has not been reported following enucleation or evisceration of the eye. In humans, pain and temperature fibres from only the ophthalmic division of the trigeminal nerve reach the upper cervical spinal segments. Pain in migraine attacks including occipital and nuchal discomfort reflects selective involvement of the ophthalmic nerve. Photophobia is largely a retinal reflex involving the ophthalmic division of the trigeminal nerve. Key clinical features of the migrainous scintillating scotoma are consistent with retinal origin. Spreading depression in the retina is well-established. A subtle regional ocular sympathetic deficit prevails in migraine patients and possibly impairs regulation of intraocular choroidal blood volume and intraocular pressure. Several first-line migraine prophylactic agents lower the intraocular pressure. The neuro-ophthalmological basis for a monocular origin of migrainous scintillating scotomata due to mechanical deformation of the posterior segment of the corneo-scleral envelope consequent to choroidal venous congestion and rise in intraocular pressure is presented. Study of distribution and displaceability of the migrainous scintillating scotoma can settle its site of origin. Headache of migraine possibly arises from a similar mechanical deformation of the anterior eye segment followed by antidromic discharge in the trigeminovascular system. Lateralizing negative deficits such as homonymous hemianopia probably reflect vasospastic complications of migraine. A rational explanation for the most characteristic clinical features of migraine and a new template to elucidate the pharmacological basis of anti-migraine drugs is offered.

Prevalence of Migraine in Patients With a History of Self-Reported or Physician-Diagnosed “Sinus” Headache

Schreiber CP, Hutchinson S, Webster CJ, Ames M, Richardson MS, Powers C. Arch Intern Med. 2004;164:1769–1772Symptoms referable to the sinus area are frequently reported during migraine attacks but are not recognized in diagnostic criteria. Underrecognition of migraine may be partly attributed to a variable clinical presentation, and migraines with “sinus” symptoms contribute to this problem. This study was conducted to determine the prevalence of migraine-type headache (International Headache Society [IHS]-defined migraine without aura [IHS 1.1], migraine with aura [IHS 1.2], or migrainous disorder [IHS 1.7]) in patients with a history of self-described or physician-diagnosed “sinus” headache.During a clinic visit, patients with a history of “sinus” headache, no previous diagnosis of migraine, and no evidence of infection were assigned an HIS headache diagnosis on the basis of headache histories and reported symptoms.A total of 2991 patients were screened. The majority (88%) of these patients with a history of self-described or physician-diagnosed “sinus” headache were diagnosed at the screening visit as fulfilling IHS migraine criteria (80% of patients) or migrainous criteria (8% of patients). The most common symptoms referable to the sinus area reported by patients at screening were sinus pressure (84%), sinus pain (82%), and nasal congestion (63%).In this study, 88% of patients with a history of “sinus” headache were determined to have migraine-type headache. In patients with recurrent headaches without fever or purulent discharge, the presence of sinus-area symptoms may be part of the migraine process. Migraine should be included in the differential diagnosis of these patients.There is not much question that patients with chronic rhinosinusitis can have facial pain and headache. However, as allergists, we are often presented with patients who have little or minimal nasal symptoms and/or normal sinus radiographs who complain of “sinus pain.” This study confirms the results of at least one earlier report, strongly suggesting that, in this context, the overwhelming majority of sinus pain really is a form of migraine. Because activation and sensitization of the trigeminal vascular system is the primary mechanism of pain in migraines, nasal congestion, rhinorrhea, and ocular symptoms can accompany the headaches.

Multiple Meningiomas

A 57-year-old woman with hyperthyroid ophthalmopathy underwent somatostatin receptor scintigraphy with In-111 pentetreotide. She also reported migraine-type headaches over the previous 3 months, without any other obvious neurologic symptoms and signs. The study revealed an increased uptake of the radiopharmaceutical in both periorbital areas and the right lobe of the thyroid gland. Multiple foci of marked tracer uptake were also detected in the right half of the head. A brain MRI scan subsequently revealed multiple lesions consistent with meningiomas on the surface of the right cerebral hemisphere.