Migraine Symptoms Research Articles

Recognising and managing migraine.

Migraine is a common neurological disorder characterised by a severe, pulsating headache, sometimes accompanied with photophobia or phonophobia and nausea and/or vomiting. The symptoms of migraine can have a significant adverse effect on a person's ability to undertake normal activities. Nurses have an important role in assisting patients in identifying migraine triggers and in supporting them to manage the symptoms of migraines through lifestyle changes and pharmacological treatments. This article describes different types of migraines and some differential diagnoses and 'red flag' symptoms that could indicate a more serious condition. The author also discusses non-pharmacological and pharmacological management strategies and treatments.

Sinonasal symptoms in migraine without aura: results from the cross-sectional 'Migraine in Poland' study.

Migraine without aura (MwoA) is often mistaken for rhinosinusitis. The purpose of this study was to assess the prevalence of sinonasal symptoms, sinusitis-targeting medication use and burden of migraine in a large group of people with MwoA attacks accompanied by rhinologic symptoms. Data was collected in a cross-sectional online survey based on an adapted population-based study questionnaire. The analysis included the prevalence of rhinorrhea, mucopurulent nasal discharge, nasal congestion, facial pressure and tenderness to palpation, hyposmia/anosmia and osmophobia. 1,679 (52.73%) MwoA people were identified among 3,225 respondents (women n = 2,809, 87.10%) aged 13-80 years (median age 39; standard deviation 10.4). 1004/1679 (59.8%) migraine patients reported one or more rhinologic symptoms and 341/1679 (20.3%) MwoA respondents had symptoms that met rhinosinusitis clinical diagnostic criteria during their headache attacks. In migraine patients, osmophobia was associated with hyposmia [n = 141 (12.7%) vs. n = 41 (7.2%); p = 0.001] and a sensation of unpleasant smells [n = 216 (19.4%) vs. n = 45 (8.5%); p = 0.001], while facial tenderness to palpation was associated with facial allodynia [n = 532 (50.4%) vs. n = 211 (33.9%); p < 0.001]. People with migraine accompanied by rhinosinusitis-like symptoms experienced more disease burden and used 'sinus medications' more often. MwoA patients with rhinosinusitis-like symptoms during migraine attacks require cautious assessment, especially that some symptoms seem to have little value in distinguishing between these disorders (i.e., facial tenderness, hyposmia), while many of these patients have a greater disease burden and therefore often choose medications targeting rhinologic instead of neurologic mechanisms.

Efficacy and safety of transesophageal ultrasound-guided patent foramen ovale closure for migraine in adolescents.

This retrospective analysis aims to assess the efficacy of transesophageal ultrasound-guided patent foramen ovale (PFO) closure in treating migraine in adolescents and compare the therapeutic outcomes of PFO closure for migraine with and without aura. We conducted a retrospective analysis of 86 cases of adolescents (12-20 years old) who underwent PFO closure for migraine at our institution over the past 3 years. The efficacy was evaluated using the visual analogue scale (VAS), headache impact test (HIT)-6, and pediatric migraine disability assessment (PedMIDAS) scores, as well as by assessing the monthly frequency of migraine attacks, duration of each attack, and overall migraine burden. The patients were divided into two groups: an aura group (55 cases) and a non-aura group (31 cases) to investigate difference in therapeutic efficacy between the groups. The effect of residual shunt on migraine burden was assessed. Among the 86 patients, 46 (54%) experienced complete remission of migraine, while 71 (83%) achieved a >50% reduction in migraine burden during the one-year follow-up period. Patients in the aura group showed more significant improvements in VAS, HIT-6, and PedMIDAS scores, as well as in monthly migraine attack frequency, duration of each attack, and overall migraine burden, than patients in the non-aura group. Moreover, patients with residual shunt did not exhibit statistically significant differences in therapeutic efficacy compared to patients with complete closure. PFO closure can effectively alleviate migraine symptoms in adolescents with migraine with concomitant PFO. The therapeutic efficacy is particularly pronounced for migraine with aura. Furthermore, minor levels of residual shunt have no effect on the improvement in migraine symptoms.

Unveiling the Role of Contingent Negative Variation (CNV) in Migraine: A Review of Electrophysiological Studies in Adults and Children.

Migraine has been considered a chronic neuronal-based pain disorder characterized by the presence of cortical hyperexcitability. The Contingent Negative Variation (CNV) is the most explored electrophysiological index in migraine. However, the findings show inconsistencies regarding its functional significance. To address this, we conducted a review in both adults and children with migraine without aura to gain a deeper understanding of it and to derive clinical implications. The literature search was conducted in the PubMed, SCOPUS and PsycINFO databases until September 2022m and 34 articles were retrieved and considered relevant for further analysis. The main results in adults showed higher CNV amplitudes (with no habituation) in migraine patients. Electrophysiological abnormalities, particularly focused on the early CNV subcomponent (eCNV), were especially prominent a few days before the onset of a migraine attack, normalizing during and after the attack. We also explored various modulatory factors, including pharmacological treatments-CNV amplitude was lower after the intake of drugs targeting neural hyperexcitability-and other factors such as psychological, hormonal or genetic/familial influences on CNV. Although similar patterns were found in children, the evidence is particularly scarce and less consistent, likely due to the brain's maturation process during childhood. As the first review exploring the relationship between CNV and migraine, this study supports the role of the CNV as a potential neural marker for migraine pathophysiology and the prediction of pain attacks. The importance of further exploring the relationship between this neurophysiological index and childhood migraine is critical for identifying potential therapeutic targets for managing migraine symptoms during its development.

Comparison of Effectiveness of Transdiagnostic Treatment and Schema Therapy in Sleep Quality and Clinical Symptoms in Women with Migraine

Background: Headache in migraine patients plays an important role in their quality of life. Objectives: This study aimed to compare the effectiveness of transdiagnostic treatment and schema therapy in sleep quality and clinical symptoms of migraine in women with migraines in 2022. Methods: This semi-experimental study was conducted with a pre-test, mid-test, post-test, and follow-up with a control group. The statistical population included all women aged 20 to 40 years diagnosed with migraine in Shahrekord, Iran, in 2022. A total of 45 individuals were selected as the sample from the women referring to specialized clinics in Shahrekord using the available sampling method and taking into account the inclusion criteria of the subjects. Moreover, the subjects were randomly assigned into two experimental groups and one control group (each group with 15 subjects). The research tools included the Ahvaz Migraine Questionnaire (Najarian, 1997), the Sleep Quality Scale (Buysse et al., 1989), the transdiagnostic treatment protocol (Barlow et al., 2017), and the schema therapy protocol (Young et al., 2003). To analyze the data, multivariate and univariate analysis of covariance was used using SPSS software (version 27). Results: The results showed that there was a significant difference in the overall mean scores of migraine clinical symptoms and sleep quality between the two groups of transdiagnostic treatment and schema therapy (P = 0.001). In general, it can be concluded that the transdiagnostic treatment method had a greater effect on the clinical syndrome scores of migraine and sleep quality than the schema therapy method (P = 0.001). Conclusions: The results supported the effect of transdiagnostic treatment and schema therapy, and paying attention to these two treatment methods is of particular importance for women with migraines. Therefore, the results of this study can become the basis for interventions to help migraine patients.

Zavegepant Intranasal Spray for Migraines.

The objective is to review the pharmacology, efficacy, and safety of intranasal zavegepant in the acute treatment of migraine with or without aura. PubMed, Embase database, and ClinicalTrials.gov were searched using the following terms: Zavzpret, Zavegepant, BHV-3500, and migraine. Articles published in English from January 2013 to September 2023 related to pharmacology, safety, efficacy, and clinical trials were assessed. In a phase 2/3 trial, zavegepant 10 and 20 mg were more effective than placebo on primary endpoints of freedom of pain (22.5%, 23.1%, and 15.5%, respectively), and freedom from most bothersome symptoms (MBSs) (41.9%, 47.9%, and 33.7%, respectively) 2 hours after treatment. The incidence of adverse effects for both doses was similar to placebo. In a phase 3 trial, zavegepant 10 mg was compared with placebo. Two hours after treatment, more patients in the zavegepant group achieved pain freedom (24% vs 15%) and relief from MBSs (40% vs 31%) compared with placebo. Common adverse events included dysgeusia (21% zavegepant vs 5% placebo) and nasal discomfort (5% zavegepant vs 1% placebo). Zavegepant is indicated for acute treatment of migraine with or without aura in adults. Zavegepant method of administration and prompt relief of migraine symptoms may be an attractive alternative to triptans for those in need of relief. Zavegepant may be a convenient and useful acute treatment option for migraines with and without aura.

A - 158 The Effects of Migraine and Traumatic Brain Injury on Subjective Cognitive Functioning in Veterans in the Million Veteran Program.

The relationship between migraine and cognitive symptoms in Veterans is a complex issue, made more challenging by the high prevalence of traumatic brain injury (TBI) in this population. This study examined the relationship between migraine, TBI, and subjective cognitive function. Participants included 338,217 Veterans enrolled in the Million Veteran Program who completed the Medical Outcomes Study Cognitive Functioning Scale Revised (MOS-Cog-R), a self-report measure of cognitive functioning. Veterans were categorized into the following groups: (1) both migraine and TBI history (n = 7828), (2) migraine-only (n = 22,252), (3) TBI-only (n = 24,078), and (4) no history of migraine or TBI (n = 284,059). MOS-Cog-R scales were compared across groups using the Kruskal-Wallis Test for omnibus differences and Dunn's test and Cliff's Delta for effect size calculations of differences between groups. The migraine/TBI group reported the highest prevalence of cognitive symptoms across all domains (range: 76.1% for confusion to 90.5% for forgetfulness). In contrast, the no migraine/TBI group had the lowest prevalence of cognitive problems (range: 32.0% for confusion to 63.7% for forgetfulness). All omnibus group differences were statistically significant (p < 0.001), and nearly all pairwise comparisons were significant, except for some of the migraine-only vs. TBI-only group comparisons. Results showed a "dose-response" relationship between diagnostic group and subjective cognitive symptoms, such that the migraine/TBI group fared the worst, followed by the TBI-only and migraine-only groups, and finally the no migraine/TBI group. Findings set the stage for follow-up work to be conducted within MVP that will address the neurobiological underpinnings of cognitive distress in this population.

B - 91 Cognition as a Premonitory Symptom of Migraine.

Migraine is often accompanied by premonitory symptoms (neurologic symptoms preceding migraine pain) which serve as "warning signs." Cognition changes are commonly described during the premonitory period (period preceding pain onset). Ecological momentary assessment can be utilized to understand if perceived cognitive changes are a symptom patients use as an indicator of the premonitory period. Participants with episodic migraine were recruited through a large urban health system and online advertising (n = 43). Individuals participated in a three-month, three-times-a-day electronic diary answering questions regarding migraine attack symptoms, including perception of being in a premonitory period, and the presence of premonitory symptoms, including "difficulty thinking or concentrating." The frequency of perceived cognitive difficulties was analyzed during the perceived premonitory period (endorsing "I think I might get a headache") vs. the perceived interictal period (endorsing "I do not anticipate a headache"). Cross tabs evaluated the frequencies of perceived cognitive difficulties during different migraine phases. Participants were predominantly White (n = 33, 76.7%), non-Hispanic (n = 33, 76.7%) women (n = 36, 83.7%). Thirty-three participants endorsed subjective cognitive difficulties at least once during the premonitory phase (n = 33; 76.75%). Difficulty thinking and concentrating was endorsed 35.16% of the time when participates also reported anticipating a headache in the morning and only 8.36% of the time when participants reported not anticipating a headache. Participants perceived cognitive decline as a premonitory symptom. Difficulty concentrating and thinking was endorsed more when participants anticipated getting a headache vs. when not. Assessing subjective cognitive decline as a premonitory symptom can guide individualized interventions for migraine and elucidate the relationship between cognition and migraine.

PACAP-38 related modulation of the cranial parasympathetic projection: A novel mechanism and therapeutic target in severe primary headache.

Little is known of how cranial autonomic symptoms (CAS) in cluster headache and migraine may contribute to their severe headache phenotype. This strong association suggests the involvement of the cranial parasympathetic efferent pathway. To investigate its contribution, we studied the role of pituitary adenylate cyclase activating polypeptide-38 (PACAP-38), a potent sensory and parasympathetic neuropeptide, in modulating pre- and post-ganglionic cranial parasympathetic projectionneurons, and their influence on headache-related trigeminal-autonomic responses. Using PACAP-38 and PACAP-38 responsive receptor antagonists, electrophysiological, behavioural and facial neurovascular-blood flow was measured in rats to probe trigeminal- and parasympathetic-neuronal, periorbital thresholds and cranial-autonomic outcomes, as they relate to primary headaches. Sumatriptan attenuated the development of PACAP-38 mediated activation and sensitization of trigeminocervical neurons and related periorbital allodynia. PACAP-38 also caused activation and enhanced responses of dural-responsive pre-ganglionic pontine-superior salivatory parasympathetic neurons. Further, the PACAP-38 responsive receptor antagonists dissected a role of VPAC1 and PAC1 receptors in attenuating cranial-autonomic and trigeminal-neuronal responses to activation of the cranial parasympathetic projection, which requires post-ganglionic parasympathetic neurotransmission. Given the prevailing view that sumatriptan acts to some degree via a peripheral mechanism, our data support that PACAP-38 mediated receptor activation modulates headache-related cranial-autonomic and trigeminovascular responses via peripheral and central components of the cranial parasympathetic projection. This provides a mechanistic rationale for the association of CAS with more severe headache phenotypes in cluster headache and migraine, and supports the cranial parasympathetic projection as a potential novel locus for treatment by selectively targeting PACAP-38 or PACAP-38 responsive VPAC1 /PAC1 receptors.

What proportion of people with migraine report postdromal symptoms? A systematic review and meta-analysis of observational studies.

Postdromal symptoms, following headache resolution, are said to constitute a distinct phase of the migraine attack. We question the evidence for this, with regard both to the nature of such symptoms and to how often they are reported to occur. We searched the Pubmed and Embase databases for relevant articles from their inception until 25 May 2023. We included observational studies recording the proportions of participants with migraine reporting one or more postdromal symptoms or specific individual symptoms. Two reviewers independently screened studies for relevance (agreeing on those to be included), extracted data and assessed risk of bias. Data were analyzed using random-effects meta-analysis to establish the proportions of those with migraine reporting one or more postdromal symptoms, whether among the general population or patients in clinic-based samples. Large majorities of participants in either case reported postdromal symptoms: 97% in the only population-based study, and a mean of 86% (95% CI: 71-94%) in four clinic-based studies. The most commonly reported specific symptoms were fatigue (52%; 95% CI: 44-60%), concentration difficulties (35%; 95% CI: 14-65%) and mood changes (29%; 95% CI: 9-64%), none of these being clearly described. These estimates could not be considered reliable: they were subject to substantial study heterogeneity, none of the studies applied International Classification of Headache Disorders definitions of postdromal symptoms, and all had high risk of bias. Postdromal symptoms in migraine appear to be very commonly reported, but the data are unreliable with regard both to their nature and to how often they occur. Further studies are needed to conclude that they constitute a distinct phase of migraine.

Premonitory symptoms of migraine

Premonitory symptoms of migraine

Supporting the Young Adulthood Transitions in Women With Migraine

Migraine is a painful neurological disorder that disproportionately affects women and has a significant impact on quality of life. This article summarizes the critical role of women's health nurses in supporting young adult women with migraine during major life transitions. Nurses can advocate for workplace or school disability accommodations for women with migraine. Nurses can also support young adult women with migraine by providing education about available treatment that becomes available after an individual’s 18th birthday. Women’s health nurses can also provide counseling on healthy lifestyle habits to sustain through life transitions, such as guidance on safe alcohol consumption and wellness approaches to migraine management. Through these interventions, women’s health nurses can help women with migraine to succeed personally, professionally, and academically while effectively managing migraine symptoms.

Efficacy and Safety of Percutaneous Closure in Patients with Patent Foramen Ovale and Migraine

Objective: To analyze the therapeutic effect of percutaneous closure of patent foramen ovale (PFO) and migraine. Methods: A total of 150 patients with PFO and migraine who were admitted to the hospital from January 2021 to May 2023 were recruited and divided into groups by random number table, the study group took percutaneous closure and drug treatment, and the control group took conventional drug treatment. The treatment effects between the groups were compared. Results: The total effective rate of the study group was higher than that of the control group (P &lt; 0.05). Before treatment, there was no difference in migraine quantitative evaluation indicators between the groups (P &gt; 0.05). After treatment, the migraine quantitative evaluation indicators in the study group were better than those in the control group (P &lt; 0.05). The complication rate of the study group was lower than that of the control group (P &lt; 0.05). Followed up for 1 to 3 months, the recurrence rate of the study group was lower than that of the control group (P &lt; 0.05). Conclusion: Percutaneous closure for patients with PFO and migraine can improve the symptoms of migraine, enhance the curative effect, and have fewer postoperative complications.

Migraine Management in Community Pharmacies: Knowledge, Attitude and Practice Patterns of Pharmacists in Saudi Arabia.

In Saudi Arabia, community pharmacies offer healthcare services for different conditions. However, clarity of the competence of pharmacists in managing migraines is lacking. This study aimed to explore the current knowledge, attitude, and practice patterns of community pharmacists concerning migraine management in the northwestern part of Saudi Arabia. A cross-sectional study was carried out between June and September 2022 among 215 Saudi community pharmacists. Data analysis was performed by descriptive and inferential statistics using SPSS version 27. Most community pharmacists (87.9%) feel that migraine management is essential to their practice, and 83.3% suggest between one and five over-the-counter (OTC) migraine products daily. Among the study pharmacists, 83.7% feel migraine patients should try OTC before prescription medications. Only 9.3% of the community pharmacists do not believe that migraine is a neurological disorder. The medications most prescribed for migraine were triptans, representing 52.1% of prescriptions. There were significant differences between the gender of the pharmacists and their knowledge, attitude, and practice overall score (p-value = 0.04). Male pharmacists exhibited higher knowledge, attitude, and practice scores than female pharmacists. Although many community pharmacists acknowledge their expertise and involvement in managing migraines, there is a requirement for further education and training to enhance their capacity to offer complete care to migraine patients. Pharmacists should also consider non-pharmacological interventions and complementary therapies when treating migraine symptoms.

Clinical Outcomes and Quality of Life after Patent Foramen Ovale (PFO) Closure in Patients with Stroke/Transient Ischemic Attack of Undetermined Cause and Other PFO-Associated Clinical Conditions: A Single-Center Experience.

The aim of this study was to assess clinical outcomes and quality of life after PFO closure in patients with previous stroke/TIA of undetermined cause and in patients with other complex PFO-associated clinical conditions. Between July 2009 and December 2019 at our University Cardiology Department, 118 consecutive patients underwent a thorough diagnostic work-up including standardized history taking, clinical evaluation, full neurological examination, screening for thrombophilia, brain magnetic resonance imaging (MRI), ultrasound-Doppler sonography of supra-aortic vessels and 24 h ECG Holter monitoring. Anatomo-morphological evaluation using 2D transthoracic/transesophageal echocardiography (TTE/TEE) color Doppler and functional assessment using contrast TTE (cTTE) in the apical four-chamber view and contrast transcranial Doppler (cTCD) using power M-mode modality were performed to verify the presence, location and amount of right-to-left shunting via PFO or other extracardiac source. Completed questionnaires based on the Quality-of-Life Short Form-36 (QoL SF-36) and Migraine Disability Assessment (MIDAS) were obtained from the patients before PFO closure and after 12 months. Contrast TTE/TEE and cTCD were performed at dismission, 1, 6 and 12 months and yearly thereafter. Brain MRI was performed at 1-year follow-up in 54 patients. Transcatheter PFO closure was performed in 106 selected symptomatic patients (mean age 41.7 ± 10.7 years, range 16-63, 65% women) with the following conditions: ischemic stroke (n = 23), transient ischemic attack (n = 22), peripheral and coronary embolism (n = 2), MRI lesions without cerebrovascular clinical events (n = 53), platypnea-orthodeoxia (n = 1), decompression sickness (n = 1) and refractory migraine without ischemic cerebral lesions (n = 4). The implanted devices were Occlutech Figulla Flex I/II PFO (n = 99), Occlutech UNI (n = 3), Amplatzer PFO (n = 3) and CeraFlex PFO occluders (n = 1). Procedures were performed under local anesthesia and rotational intracardiac monitoring (Ultra ICE) alone. The devices were correctly implanted in all patients. The mean fluoroscopy time was 15 ± 5 min (range = 10-45 min) and the mean procedural time was 55 ± 20 min (range = 35-90 min). The total occlusion rate at follow-up (mean 50 months, range 3-100) was 98.1%. No recurrent neurological events were observed in the long-term follow-up. The data collected in this study demonstrate that percutaneous PFO closure is a safe and effective procedure, showing long-term prevention of recurrent cerebrovascular events, significant reduction in migraine symptoms and substantial improvement in quality of life.

Development and Validation of a Japanese-Language Questionnaire to Screen for Tension-Type Headaches and Migraines.

Introduction Migraine and tension-type headache (TTH) are chronic diseases associated with significant socioeconomic losses and social and psychological impact (current global prevalence: 10% and 38%, respectively). Thus, they require accurate identification and classification. In clinical practice, validated screening tools able to quickly determine migraine and TTH with high sensitivity and specificity help provide an objective and multifaceted understanding of patients' headache symptoms. However, no tool has been developed or validated yet in Japan to ask multifaceted questions about headache-related symptoms in order to identify migraine and TTH and understand these symptoms. This study aimed to develop a questionnaire for screening TTH and migraine. Methods The study was conducted from March to June 2022 at a medical institution in Osaka, Japan. The questionnaire - comprising 24 questions that were generated based on the 3rd edition of the International Classification of Headache Disorders - was used to screen for migraine and TTH, aiming for a deeper understanding of related symptoms. The participants were patients aged ≥18 years with at least one of the following diagnoses: migraine, TTH. The participants were asked to respond in writing or online. The inclusion criteria were age ≥18 years; headache patients attending a hospital; and diagnoses of at least one of the following: migraine, TTH. The informativeness and discriminating ability of the screening items were evaluated using the item response theory. Items with a calculated discrimination ≥1.35 (high or very high) were retained for screening purposes. Basic questions required to screen for primary headaches were retained, despite their limited computational discrimination power. Ultimately, nine and eight screening items were finalized for migraine and TTH, respectively. The previous neurologists' clinical diagnosis of each patient was used as the gold standard reference for calculating sensitivity, specificity, and positive and negative predictive values regarding the screening items. Cohen's kappa coefficients with 95% CIs were also calculated to determine the agreement between the neurologists' clinical diagnosis and the questionnaire results. Results The study population comprised 69 patients aged 19-89 years who were assisted at a hospital division specializing in headache medicine and diagnosed by neurologists. Of these, 22 patients had migraine, 30 had TTH, and 17 had migraine/TTH. Comparing the neurologists' clinical diagnosis with our screening questionnaire results, the sensitivity and specificity were 72.7% and 86.7% for migraine and 50.0% and 86.4% for TTH, respectively. Conclusions Our brief screening tool was highly specific for diagnosing migraine and TTH in individuals with headache symptoms but lacked sufficient sensitivity, especially for TTH. The high specificity for migraine and TTH suggests that the screening tool we developed in this study can correctly identify those who do not have migraine and TTH. The sensitivity was also relatively high for migraine, suggesting that the tool can correctly identify migraine-positive individuals. However, the sensitivity for TTH was low. This tool could help clinicians in providing detailed course assessment of migraine symptoms and TTH symptoms; however, the issue of low sensitivity for TTH needs to be addressed.

Spinning Through History: Evolution of the Concept of Vestibular Migraine.

Vestibular migraine represents a growing public health problem, imposing enormous societal burdens in the form of patient suffering, loss of productivity, and direct healthcare costs. This raises the question of how we developed our ideas about vestibular migraine and how these ideas shape how we treat it. This review walks through the history of how our conceptualization of migraine and vestibular symptoms evolved, starting with clinical observations in ancient times, inclusion under the umbrella of Meniere's disease, and then separation from Meniere's disease with its own identity. Tradition, clinical observations, and diagnostic criteria developed by professional societies have played prominent roles in building our current concept of vestibular migraine. A review of the ideas that have shaped our current conception of vestibular migraine may help us to see which ones have stood the test of time and which ones should continue to evolve. As in other disciplines, we study history in medicine to be inspired, warned, and sometimes, to be freed.

"Growing pains" in children and adolescents as an early symptom of migraine: A prospective study.

Children and adolescents may experience pain in the lower limbs, predominantly at the end of the day or during the night, without any relation to organic disease. These pains are often called "growing pains" (GP) by pediatricians and orthopedists. They are commonly attributed to rapid growth. The aim of this study was to review and characterize GP in children and adolescents as a precursor/comorbidity with migraine. The study was of a cross-sectional, prospective, longitudinal cohort, with group comparison. A sample of 100 children/adolescents born to mothers with migraine seen at a headache clinic was recruited in a random order chosen by lot, maintaining the ratio of 1:1 for the group with GP and the controls. Both groups were followed for a period of 5 years. After 5 years of follow-up, 78 patients completed the study, of which 42 were from the GP group and 36 were from the control group. Headache fulfilling the International Classification of Headache Disorders, 3rd edition diagnostic criteria for migraine without aura or probable migraine occurred in 32/42 (76%) of patients with GP and in 8/36 (22%) of controls (p < 0.001). In the sample that initially had "growing pains," these pains persisted in 6/42 (14%) and appeared in 14/36 (39%) of those who were previously asymptomatic (p = 0.026). Pain in the lower limbs of children and adolescents, commonly referred to as GP by pediatricians and orthopedists, may reflect a precursor or comorbidity with migraine.

Clinical and VEMPS Characteristics of Benign Recurrent Vertigo With Cochlear Symptoms and Migraine.

Objectives: To explore the clinical manifestations and vestibular-evoked myogenic potential (VEMP) characteristics in patients diagnosed with benign recurrent vertigo (BRV) accompanied by cochlear symptoms or migraine history. Methods: A total of 34 patients were diagnosed with BRV (57 ears) and 30 healthy volunteers (60 ears) were recruited. They were divided into 4 groups: Group A consisted of 17 patients diagnosed as BRV with cochlear symptoms (21 ears), Group B consisted of 11 patients diagnosed as BRV with migraine history (22 ears), and Group C consisted of 7 patients with BRV without cochlear symptoms and migraine history (14 ears). Group D, as a Normal control (NC) group, consisted of 30 healthy volunteers without a history of migraine and cochlear symptoms. Detailed consultations and VEMP testing were performed separately. The VEMPs elicitation rate, amplitude ratio at different frequencies and amplitude statistics were compared and analyzed among the 4 groups. Results: The amplitudes of cervical vestibular evoked myogenic potential (cVEMP) have significant differences between Groups D and A, and Group C, under 500 Hz (PAD = .017, PBD = .052, PCD = .044), but the amplitudes of cVEMP have significant differences between Groups D and A, and Group B under 1000 Hz, respectively (PAD = .008, PBD = .020, PCD = .119). The amplitudes of ocular vestibular evoked myogenic potential (oVEMP) have significant differences between Groups D and A, and Group B, under 500 Hz, respectively (PAD = .029, PBD = .005, PCD = .198). oVEMP amplitudes significantly differ between Groups D and A under 1000 Hz (PAD = .049, PBD = .079, PCD = .103). The statistical difference was absent in elicit rates of cVEMP and oVEMP between the NC and experimental groups (cVEMP: PAD = .525, PBD = .917, PCD = .374; oVEMP: PAD = .678, PBD = .523, PCD = .427). Moreover, there is no significant difference between the NC group and experimental groups among VEMPs and VEMP frequency amplitude ratio (P > .05). Conclusion: VEMPs could be a diagnostic indicator for BRV patients with cochlear symptoms. The pathogenesis of BRV may be related to damage to the otolithic apparatus.

Understanding the gaps in headache and migraine treatment with psychological and behavioral interventions: A narrative review.

In this narrative review, we summarize relevant literature pertaining to psychosocial risk factors for headache and migraine progression, current behavioral and psychological treatments, and consider promising treatments. Headache and migraine are common and associated with significant burden and disability. Current treatments targeting psychosocial risk factors show modest outcomes and do not directly address the impact of early life adversity, including the development of maladaptive emotional processing. An intervention that could address these factors and include components of current evidence-based interventions may lead to improved outcomes. We searched PubMed and Google Scholar for articles through December 2022. Search terms included headache, migraine, psychological interventions, behavioral interventions, cognitive-behavioral therapy, mindfulness, psychiatric comorbidities, adverse childhood experiences, trauma, and emotional processing. Trauma and childhood adversity show a correlation with headache and migraine progression. Developmental adversity and trauma interfere with adaptive emotional processing, which may worsen headache and migraine symptoms, while adaptive ways of experiencing emotions are shown to improve symptoms. Current behavioral and psychological interventions, such as cognitive-behavioral and mindfulness therapies, are effective treatments for headache, but they produce small to medium effect sizes and do not directly address the impact of trauma and emotional conflicts-common factors that contribute to chronicity and disability, especially among certain subpopulations of headache patients such as those with migraine. Thus, there exists a gap in current treatment. There is a gap in headache and migraine treatment for those patients who have a history of trauma, childhood adversity, and maladaptive emotional processing. We suggest that an integrated psychological treatment that includes components of current evidence-based interventions and addresses gaps by focusing on processing trauma-related emotions may improve chronic and debilitating symptoms.