Non-migraine Headache Research Articles

Impact of migraine on the clinical presentation of insomnia: a population-based study

BackgroundInsomnia and migraine are closely related; insomnia aggravates migraine symptoms. This study was conducted to investigate the impact of migraine on the clinical presentation of insomnia symptoms.MethodsThe data of the Korean Headache-Sleep Study (KHSS) were used in the present study. The KHSS is a nation-wide cross-sectional population-based survey regarding headache and sleep in Korean adults aged 19 to 69 years. If a participant’s Insomnia Severity Index (ISI) score ≥ 10, she/he was classified as having insomnia. The clinical presentation of insomnia symptoms was assessed using total and subcomponent scores of the ISI.ResultsOf 2695 participants, 290 (10.8%) and 143 (5.3%) individuals were assigned as having insomnia and migraine, respectively. The proportions of migraine (12.8% vs. 4.4%, p < 0.001) and non-migraine headache (59.0% vs. 39.9%, p < 0.001) were higher among individuals with insomnia compared to those without insomnia. Among participants with insomnia, total ISI scores were not significantly different among participants with migraine, non-migraine, and non-headache [median and interquartile range: 13.0 (11.0–17.5) vs. 13.0 (11.0–17.5) vs. 12.0 (11.0–16.0), p = 0.245]. ISI scores for noticeability of sleep problems to others were significantly higher among participants with migraine [3.0 (2.0–4.0) vs. 2.0 (2.0–3.0), p = 0.011] and non-migraine headache [3.0 (2.0–4.0) vs. 2.0 (2.0–3.0), p = 0.001] compared to those without headache history. Other ISI subcomponent scores did not significantly differ between headache status groups.ConclusionsParticipants with insomnia had an increased risk of migraine and non-migraine headache compared to those without insomnia. Among participants with insomnia, overall insomnia severity was not significantly influenced by the headache status.

Association between epilepsy and headache

Similar clinical characteristics of epilepsy and migraine and the prevalence of their comorbidity have been investigated for years. The present study investigated the relationship between epilepsy and headache. A total of 420 epilepsy patients, who visited epilepsy outpatient clinic within 6-month period between January 2016 and June 2016, were questioned whether they have headache. Age, gender, duration of epilepsy, type of seizures, and temporal relationship of headache with seizure were investigated in the patients with headache. Headache was detected in 111 (26%) of 420 epilepsy patients. The prevalence of migraine was 15%. When the temporal relationship of headache with seizure was evaluated, interictal headache was found to be the most common type with a percentage of 74.8%. No significant difference was determined between the patients with migraine and non-migraine headache in terms of age, gender, duration of epilepsy, age at the onset of epilepsy, type of seizure, and electroencephalography findings. The prevalence of interictal headache was statistically significantly higher in migraine patients as compared to that of non-migraine patients (p < 0.001); however, the prevalence of preictal headache and the prevalence of postictal headache were significantly lower (p = 0.001 and p < 0.001, respectively). The prevalence of headache and the prevalence of migraine, which are considered to be pathogenetically linked to epilepsy, were not different in epilepsy patients as compared to that of the general population. Different outcomes and percentages in other studies suggest that pathogenesis of headache is multifactorial and that different diagnostic criteria might have been taken into consideration.

Characteristics of Headache and Relationship to Acute Mountain Sickness at 4559 Meters

The goals of this study were to characterize headache at high altitude in relation to the severity of acute mountain sickness (AMS), to investigate whether a history of migraine or nonmigrainous headache at low altitude is a risk factor for AMS and to estimate its effect size in relation to established major risk factors. We performed a secondary, extended analysis of data obtained from 1320 mountaineers staying overnight at the Capanna Margherita (4559 m). Headache at low and high altitude was classified according to the criteria of the International Headache Society. About 45% of the mountaineers suffered from headache in the evening of the arrival day at 4559 m. In those with headache, tension type headache decreased from 62% to 29% and 13% with no AMS (AMS-C <0.70), moderate AMS, and more severe AMS (AMS-C ≥1.5), while headache fulfilling the criteria of migraine increased correspondingly from 14% to 34% and 69%. A history of migraine or any type of headache at low altitude is a minor predictor of AMS that does not significantly contribute to AMS risk in a multivariate analysis including the major risk factors such as history of AMS, rate of ascent, and degree of preacclimatization in this population of alpine mountaineers. The association between more severe AMS and migrainous headache may be due to common nonspecific symptoms but a common underlying pathophysiology of AMS and migraine cannot be excluded. Despite this association a history of migraine or other headache at low altitude is not a major risk factor for AMS.

The causal role of smoking on the risk of headache. A Mendelian randomization analysis in the HUNT study.

Headache has been associated with various lifestyle and psychosocial factors, one of which is smoking. The aim of the present study was to investigate whether the association between smoking intensity and headache is likely to be causal. A total of 58 316 participants from the Nord-Trøndelag Health (HUNT) study with information on headache status were genotyped for the rs1051730 C>T single-nucleotide polymorphism (SNP). The SNP was used as an instrument for smoking intensity in a Mendelian randomization analysis. The association between rs1051730 T alleles and headache was estimated by odds ratios with 95% confidence intervals. Additionally, the association between the SNP and migraine or non-migrainous headache versus no headache was investigated. All analyses were adjusted for age and sex. There was no strong evidence that the rs1051730 T allele was associated with headache in ever smokers (odds ratio 0.99, 95% confidence interval 0.95-1.02). Similarly, there was no association between the rs1051730 T allele and migraine or non-migrainous headache versus no headache. The findings from this study do not support that there is a strong causal relationship between smoking intensity and any type of headache. Larger Mendelian randomization studies are required to examine whether higher smoking quantity can lead to a moderate increase in the risk of headache subtypes.

Volume and shape of subcortical grey matter structures related to headache: A cross-sectional population-based imaging study in the Nord-Trøndelag Health Study.

The relationship between subcortical nuclei and headache is unclear. Most previous studies were conducted in small clinical migraine samples. In the present population-based MRI study, we hypothesized that headache sufferers exhibit reduced volume and deformation of the nucleus accumbens compared to non-sufferers. In addition, volume and deformation of the amygdala, caudate, hippocampus, pallidum, putamen and thalamus were examined. In all, 1006 participants (50-66 years) from the third Nord-Trøndelag Health Survey, were randomly selected to undergo a brain MRI at 1.5 T. Volume and shape of the subcortical nuclei from T1 weighted 3D scans were obtained in FreeSurfer and FSL. The association with questionnaire-based headache categories (migraine and tension-type headache included) was evaluated using analysis of covariance. Individuals not suffering from headache were used as controls. Age, sex, intracranial volume and Hospital Anxiety and Depression Scale were used as covariates. No effect of headache status on accumbens volume and shape was present. Exploratory analyses showed significant but small differences in volume of caudate and putamen and in putamen shape between those with non-migrainous headache and the controls. A post hoc analysis showed that caudate volume was strongly associated with white matter hyperintensities. We did not confirm our hypothesis that headache sufferers have smaller volume and different shape of the accumbens compared to non-sufferers. No or only small differences in volume and shape of subcortical nuclei between headache sufferers and non-sufferers appear to exist in the general population.

Obesity and Migraine: Effect Modification by Gender and Perceived Stress

Background: The association between obesity and migraine has been established; however, it is unclear whether it varies by perceived stress within each gender. Methods: This cross-sectional study used data from the ongoing NutriNet-Santé e-cohort with enrollees from the general population. Anthropometric and migraine data were provided via self-report questionnaires (2013–2016). Migraine was defined using established criteria. Perceived stress was assessed with Cohen’s Perceived Stress Scale-10. Associations were estimated via gender- and stress-stratified multivariable polytomous logistic regression models. Results: Among 32,835 participants with complete data (75% women; mean age = 51.9 ± 13.8 years), 34% reported no headache, 44% non-migraine headache, and 22% migraine with or without aura during one’s lifetime. In these groups, obesity was present in 8.6, 9.9, and 11.6%, respectively. Stress was a significant moderator of the obesity-migraine association only among women. The largest significant adjusted odds ratio (aOR) was found between obesity and migraine in women with high stress (aOR 1.61, 95% CI 1.35–1.91). Conclusions: We found support for gender- and stress-dependent associations between obesity and migraine using a large, heterogeneous adult sample. This underscores the need for evidence-based strategies for weight loss and stress reduction for female migraineurs.

What is the actual prevalence of migraine?

ObjectivesPopulation prevalence studies of migraine report prevalence rates of between 2.6 and 21.7%, with an average of ~12%. However, migraine prevalence among neurologists is reported to be significantly higher, between 27.6% and 48.6%. Increasing knowledge of the protean manifestations of migraine may explain this difference. Similarly, under‐recognition of migraine in control groups may explain the lack of genetic and biomarker findings in this disorder. We therefore sought to determine the prevalence of migraine in an admixed group of individuals with varied knowledge of migraine symptomatology.MethodsAttendees at the Australian and New Zealand Association of Neurologists Annual Scientific Meeting (ANZAN ASM) 2017 were surveyed anonymously. Those surveyed included three groups: neurologists, neurology trainees, and others including nonclinical researchers, members of lay organizations, and representatives of the pharmaceutical industry.ResultsIn total, 313 of 606 attendees responded (51.7%). 65.9% of neurologist, 57.4% of trainee, and 52.5% of others respondents had a personal history of migraine, with the difference between neurologists and others being statistically significant (p = .03). Migraine in migraineurs and nonmigraine headache in nonmigraineurs were nearly all self‐diagnosed. Among neurologist migraineurs, 51.2% experienced migraine with aura and 43% migraine without aura.ConclusionsMigraine prevalence is significantly higher in neurologists compared to non‐neurologists and at least 2–3 times higher than reported in population prevalence studies. This may be due to significant under‐recognition of migraine in non‐neurologists. This under‐recognition of migraine may significantly influence the search for genetic predictors and biomarkers of migraine.

The Role of Onabotulinum Toxin Type A in the Management of Chronic Non-Migraine Headaches (P4.137)

The Role of Onabotulinum Toxin Type A in the Management of Chronic Non-Migraine Headaches (P4.137)

Neuropsychiatric comorbidity among adolescents with psoriasis

Psoriasis is a known risk factor for neuropsychiatric diseases among adults. Less is known about the impact on adolescents. To investigate the association between psoriasis and neuropsychiatric comorbidity and social skills among adolescents. A population-based cross-sectional study between 1 January 1999 and 1 January 2014 was conducted. The study included 1746 and 1366 adolescents (aged 16 to 18) with mild and moderate-to-severe psoriasis, respectively. The psoriasis patients were diagnosed by a dermatologist. Neuropsychiatric diseases were diagnosed by a neurologist and a psychiatrist, as appropriate. Social skills were evaluated using psychosocial assessment. Patients with psoriasis were compared with 884 653 healthy controls by a multivariate analysis adjusted for age, sex, country of origin, socioeconomic status, cognitive skills and body mass index. A subgroup evaluation was done for comorbidity that could only be evaluated for part of the recruitment years, using a univariate analysis. Overall chronic headaches (8·1% vs. 3·4%), intermediate frequency migraine (4·8% vs. 1·6%), low-frequency migraine and nonmigraine headaches (3·4% vs. 1·8%) were associated with moderate-to-severe psoriasis only compared with healthy controls [adjusted odds ratios (OR) 1·9, 95% confidence interval (CI) 1·6-2·4; 2·3, 95% CI 1·8-3·0 and 1·5, 95% CI 1·1-2·1, respectively]. Anxiety disorders (2·1% vs. 0·8%) and impaired social adjustment skills (7·5% vs. 4·2%) were also associated with moderate-to-severe psoriasis only compared with healthy controls [adjusted ORs 2·9, 95% CI 1·6-5·5 and 1·9, 95% CI 1·3-2·6 (of 466 vs. 265 023), respectively]. Psoriasis among adolescents is associated with neuropsychiatric comorbidity and impaired adjustment skills, depending on disease severity.

Neuropsychiatric comorbidity among adolescents with psoriasis

Summary Psoriasis is a common skin disease, typically presenting as a red scaly rash. In mild cases it can be treated with creams, while in patients with so called “moderate to severe psoriasis”, where it is extensive or cannot be controlled with creams only, a systemic treatment, such as pills and phototherapy, is necessary. Psoriasis affects about 2% of adults. It commonly develops in adulthood, but can also be seen in children and adolescents. As might be expected, psoriasis may be physically and emotionally disabling. Growing data suggests that psoriasis patients are at risk of suffering from multiple medical conditions, including mental health disorders (e.g depression) and neurological disorders (e.g migraine). This study, from Israel, aimed to find out whether psoriasis carries a risk of suffering from mental health and neurological disorders, focusing on adolescents, an age group which was previously less studied for these conditions. Data were retrieved from records of recruits evaluated for military service. The study included 1746 and 1366 adolescents (aged 16 to 18) with mild and moderate to severe psoriasis, respectively, and compared them to 884653 healthy adolescents. Differences in the prevalence of the following medical conditions were found between adolescents with moderate to severe psoriasis and healthy adolescents: Overall chronic headaches (8.1% vs. 3.4%), intermediate frequency migraine (4.8% vs. 1.6%), low frequency migraine and non-migraine headaches (3.4% vs. 1.8%), anxiety (2.1% vs. 0.7%) and social adjustment disabilities (7.5% vs. 4.2%). Interestingly, mild psoriasis was not shown to carry a risk for these conditions. The authors conclude that adolescents with psoriasis, especially those with a moderate to severe disease, are at risk of neurological and mental health disorders. The authors call for physicians’ awareness of these conditions, alongside the need for psychological counselling.

Association of depression, anxiety and post-traumatic stress disorder with migraine: Data from Kosovo

IntroductionMigraine is ranked as the seventh leading cause of disability worldwide, and it is characterized by a manifestation of combined neurological, gastrointestinal, and autonomic symptoms linked with different provoking factors. Aim of the studyThis study investigates the association between migraine and PTSD, depression and anxiety in the Kosovo population during the post-war period. Material and methods273 war survivors with headache were enrolled in the study and were divided into two groups: 153 individuals with confirmed migraine (the study group) and 120 individuals with non-migraine headaches (control group). All individuals were evaluated using the ICHD-II 2004 diagnostic criteria for migraine, as well as the mini-test for PTSD, MMPI (Minnesota Multiphasic Personality Inventory) for psychological evaluation, PAI (Personality Assessment Inventory) and Hamilton Scale for Depression. ResultsAmong migraine patients, depressive disorders were present in 27.5% of patients, anxiety was found in 60.8%, and PTSD was present in 39.2%. While the prominence of depression was not different between groups, anxiety was significantly more common (p<0.05) in women from the control group. PTSD was significantly more common (p<0.001) in migraine patients overall, whereas the difference in PTSD prevalence between women from the migraine and control groups came close to significance (p=0.05). Females in the migraine group had higher incidences of aura (50% vs. 25.5%), whereas the incidence of aura in males in each group was approximately equal (9.8% vs. 7.84%). ConclusionBased on our data, we can confirm an association between PTSD and migraine in a sample of patients from Kosovo.

Migraine and Headache Prevalence and Associated Comorbidities in a Large Saudi Sample

Background: We aimed to assess the prevalence of headache and migraine, along with comorbidities, in a large ­Saudi sample. Methods: Self-reported information was collected about headache, migraine and migraine comorbidities including depression, restless legs syndrome (RLS), syncope, bruxism, hypertension and ischaemic disease. The OR was estimated using logistic regression for any associations with headache and migraine. We then analyzed to find a trend of increasing migraine symptoms for each significant comorbidity. Results: Out of 4,943 respondents, 4,158 (84.12%) had recurring headaches. Migraine was present in 1,333 (26.97%), with female predominance (ratio of 1: 2.9). There were statistically significant ORs between migraine and female sex, current smokers, higher income, hypertension, depression, syncope, RLS and bruxism. Non-migraine headaches were significantly associated with female sex, age, RLS and ischaemic disease. Migraine with aura was significantly associated with syncope, ischaemic disease, higher income and BMI. There was an overall significant trend of increasing migraine features in the presence of depression, syncope, RLS, bruxism and hypertension. Conclusions: Headache in general and migraine in particular are associated with multiple comorbidities in comparison to non-headache participants in our cohort, with an estimated prevalence similar to that of western countries.

Abstract TP156: Migraine and Non-migraine Headaches Following Diagnostic Catheter Based Cerebral Angiography: A Prospective Study

Background: No reliable estimates of headaches following catheter based cerebral angiography are available. We performed a prospective study to ascertain the frequency and type of headaches following cerebral angiography including time to resolution. Methods: Consecutive patients who underwent diagnostic catheter based cerebral angiography through the transfemoral (or infrequently radial) route using iodixanol (270 mg/ml) injection were included. Each patient underwent a brief neurological assessment after the procedure by a board-certified neurologist and more detailed assessment was performed if any patient reported occurrence of any headache. The headaches were classified as migraine if the diagnostic criteria specified by International Headache Society were met. The severity of headache was classified using a visual analog scale rating from 0-10. Another endpoint was the time to reach pain free status for two consecutive hours. Results: A total of 168 patients (mean age 60.5 ±SD 16.2 years; 90 were men) underwent diagnostic cerebral angiography. Of the 168 patients, 5 (3.0%, 95% confidence interval [CI]1.1%-6.6%) reported occurrence of migraine headaches and14 (8.3%, 95% CI 4.7%-13.7%) reported occurrence of non-migraine headaches. The median severity of migraine headaches was 10/10 and time (in minutes) to resolution of headaches was 140 minutes (range 60-360); two patient did not have complete resolution within 48 hrs of procedure. Of the patients with history of migraine, 3 (1.8%, 95% CI 0.5%-4.9%) reported occurrence of migraine headaches and 5 (3.0% 95% CI 1.0%-6.6%) reported occurrence of non-migraine headaches. Occurrence rates for migraine headaches in men and women were 1.1% (95% CI 0.1%-5.5%) and 3.9% (95% CI 1.0%-10.7%), respectively. Occurrence rates for migraine headaches was very high among patients with arterial dissections: 22.2 %, (95% CI 3.7% - 73.4%), although numbers were small. Conclusions: We provide occurrence rates of migraine and non-migraine headaches, an under recognized adverse event, in patients undergoing catheter based cerebral angiography.

Anamnestic headache in patients with cervical artery dissection: clinical characteristics and pathogenetic mechanisms

To study the frequency and characteristics of headache which is in the past history (HPH) of patients with cervical artery dissection (CeAD) and evaluate with the help of EEG and visual evoked potentials (VEP) the role of central mechanisms in its development. Two hundred and twenty-seven patients with CeAD verified by neuroimaging were studied. All patients were interviewed about the presence of a headache in the past history and its features. The comparison group comprised 35 patients (mean age - 32,3±8,9 years, 77% female) with migraine. Thirty-five patients with HPH and 35 patients of the comparison group underwent EEG and VEP. HPH was found in 101 patients (average age of 38.5±8.5 years, 70% female) (44.5%) out of 227 patients. In 35 patients (15.4%), HPH met the International Criteria for migraine (with aura - 3.1%, without aura - 12.3%) and in 66 patients (29.1%) did not (non-migraine headache). The latter started at the age of 24.5±10.2 years, had mild/ moderate intensity (95%), diffuse localization (68%), dull/pressing/squeezing character (53%), never accompanied by vomiting and rarely by nausea (8%), photo- phonophobia (11%). HPH, which met the migraine criteria unlike migraine in the comparison group began at a later age (19.9±9.6 vs 16.2±4.4 years, p<0.03), more frequently did not have aura (80% vs 48%, p<0.003), less often was unilateral (31% vs 71%, p<0,004) and had less intensity. The visual EEG analysis less often found rhythmic disorganization in CeAD patients with HPH than in comparison group with migraine. The hyperventilation caused a slight increase in the spectral power of Teta, Delta waves in HPH patients and significant enhancement in comparison group with migraine (p<0.05). Pattern reversal VEP in patients with HPH had a greater latency and smaller amplitude of cortical responses than in comparison group with migraine (p=0.028 and =0.037, respectively). The flash VEP amplitude was lower in HPH patients than in migraine (p=0.01). HPH in patients with CeAD meets criteria of migraine in 15.4% (with aura - 3.1%, without aura - 12.3%), 29.1% patients have nonmigraine HPH. Central mechanisms, namely, the hypersensitivity of the cerebral cortex playing the main role in migraine pathogenesis, are not significant in HPH genesis. The main role appears to have peripheral mechanisms - dysplastic changes in the wall of extra- and intracranial arteries that predispose both to headache and dissection.

Anything but a shocking solution – the effectiveness of Cefaly® in non-migrainous headache

Background: The transcutaneous supraorbital nerve stimulation with the Cefaly® device has demonstrated safety and efficacy for the prevention of episodic migraine. However, there isn't description of its efficacy in other headaches. Case report: A 78-year-old man was seen because of a 55-year history of daily headache. His medical history revealed Parkinson's disease, dyslipidemia and mild cognitive impairment. Physical examination revealed bradykynesia and asymmetric resting tremor of both arms, the right more affected than the left. There was mild pain on palpation of both upper trapezius muscles adjacent to the occipital bone. Cervical spine X-ray, CT and MRI: no findings. Various therapeutic approaches were done, but without success, so it was decided to prescribe Cefaly®. At his three-month follow-up, he reported an improvement of about 80%. Conclusion: The case described here shows that Cefaly® may be effective in headaches other than migraine.

Six-month clinical course and factors associated with non-improvement in migraine and non-migraine headaches.

Background Evidence on the medium-term clinical course of recurrent headaches is scarce. This study explored the six-month course and factors associated with non-improvement in migraine compared with tension-type headache and cervicogenic headache. Methods In this longitudinal cohort study, the six-month course of headaches was prospectively examined in participants (n = 37 with migraine; n = 42 with tension-type or cervicogenic headache). Participants underwent physical examination for cervical musculoskeletal impairments at baseline. Participants also completed questionnaires on pain, disability and other self-report measures at baseline and follow-up, and kept an electronic diary for 6 months. Course of headaches was examined using mixed within-between analyses of variance and Markov chain modeling. Multiple factors were evaluated as possible factors associated with non-improvement using regression analysis. Results Headache frequency, intensity, and activity interference in migraine and non-migraine headaches were generally stable over 6 months but showed month-to-month variations. Day-to-day variations were more volatile in the migraine than the non-migraine group, with the highest probability of transitioning from any headache state to no headache (probability = 0.82-0.85). The odds of non-improvement in disability was nearly six times higher with cervical joint dysfunction (odds ratio [95% CI] = 5.58 [1.14-27.42]). Conclusions Headache frequency, intensity, and activity interference change over 6 months, with day-to-day variation being more volatile in migraine than non-migraine headaches. Cervical joint dysfunction appears to be associated with non-improvement for disability in 6 months. These results may contribute to strategies for educating patients to help align their expectations with the nature of their headaches.

Common Pediatric Pain Disorders and Their Clinical Associations

Common childhood pain conditions (nonmigraine headache, migraine, recurrent abdominal pain, growing pains, low back pain) and persistent pains are often associated with each other and have significant implications in later life. Emerging evidence suggests additional associations between these pain conditions and restless legs syndrome, iron deficiency, anxiety, and depression. The aim of this cross-sectional study in pediatric twin individuals and their siblings was to investigate these associations. Surveys were sent to Australian twin families via the Australian Twin Registry, yielding responses from 2530 pediatric individuals. The lifetime prevalence of the common pain disorders of childhood and of other persistent pains, restless legs syndrome and iron deficiency, and anxious/depressed score were determined by questionnaires. Random-effects logistic regression modeling was used to investigate univariate and multivariate associations between conditions. Univariate associations were found between each of the pain conditions and persistent pain, and between the pain conditions with restless legs syndrome, iron deficiency, and anxious/depressed score. Derivative multivariate analyses retained statistically significant associations between each of the pain disorders included in the respective models (odds ratios [OR], 1.69-7.04) with the exception of growing pains with persistent pain. Of the nonpain conditions included in the multivariate analyses, restless legs syndrome remained associated with growing pains (OR, 8.50) and persistent pain (OR, 2.01). Iron deficiency remained significantly associated with migraine (OR, 2.38), persistent pain (OR, 3.70), and restless legs syndrome (OR, 5.10). In light of their extensive associations, the common pain conditions, persistent pain, restless legs syndrome, iron deficiency, anxiety and depression, are likely to involve common etiological mechanisms that warrant further investigation.

Comorbidities in a community sample of narcolepsy

Study objectiveTo assess comorbidities in a community-based cohort of narcolepsy. MethodsA 2000–2014 community-based narcolepsy cohort was identified in Olmsted County, Minnesota. Records were reviewed by a certified sleep specialist for accuracy of diagnosis, and comorbidities were extracted and analyzed. Comorbidities in narcolepsy subjects, both at diagnosis and upon follow-up, were compared with those in unaffected and age- and sex-matched cohort using conditional logistic regression. ResultsAt diagnosis, there was increased association of narcolepsy with anxiety (OR 4.56, 95% CI 1.99–10.44), thyroid disease (3.07, 1.19–7.90), hypertension (2.69, 1.22–5.93), and hyperlipidemia (2.49, 1.05–5.92). At the end of the prolonged observation period of 9.9 years (SD 7.27 years), there was increased association of narcolepsy with peripheral neuropathy (11.21, 1.16–108.11), non-migrainous headache (6.00, 1.73–20.83), glucose intolerance (2.39, 1.05–5.45), and automobile-related trauma (2.43, 1.08–5.45). Persistently increased both at diagnosis and after a prolonged observation period were associations of narcolepsy with obstructive sleep apnea (OSA) (69.25, 9.26–517.99 decreasing to 13.55, 5.08–36.14), chronic low back pain (5.46, 2.46–12.11 to 2.58, 1.39–4.77), depression (4.88, 2.45–9.73 to 3.79, 2.12–6.79), psychiatric disorders in general (4.73, 2.49–9.01 to 3.40, 1.94–5.98), endocrinopathies (4.15, 1.81–9.56 to 2.45, 1.33–4.49), and obesity (2.27, 1.13–4.56 to 2.07, 1.15–3.7). ConclusionsIn this community-based study of narcolepsy comorbidities, both at diagnosis and after prolonged follow-up, persistent comorbidities were revealed, including OSA, chronic low back pain, psychiatric disorders in general, endocrinopathies, and obesity. The comprehensive management of narcolepsy requires monitoring for and managing these important associated health conditions.

Evidence of Diplopia in Children's Headache Drawings Helps to Differentiate Pseudotumor Cerebri From Migraine

ObjectiveThis study aimed to determine whether children's headache drawings can distinguish between pseudotumor cerebri and migraine. BackgroundHeadache features associated with pseudotumor cerebri (pseudotumor; idiopathic intracranial hypertension) are nonspecific and are difficult to distinguish clinically from migraines. Children's headache drawings have a high predictive value for migraine versus nonmigraine headaches. We hypothesized that drawings could help to differentiate pediatric headaches due to pseudotumor cerebri from those associated with migraines. MethodsChildren aged six to 18 years old attending university hospital pediatric neurology clinics were asked to draw a picture of how their headache feels. From our database of children's headache drawings, pictures by children with clinically diagnosed pseudotumor were compared with migraine drawings. ResultsHeadache drawings of 21 children (16 females) with pseudotumor were compared with those of 518 children with migraine. Pseudotumor drawings depicted a variety of symptoms including pounding pain (n = 11), pressure-like pain (n = 3), photophobia (3), dizziness (1), and recumbency (1). Severe pain indicators included hammers, bombs, anvil, and vise grip. Positive visual phenomena included scintillations, scotomata, or blurring (n = 8). Negative visual phenomena included field defects (n = 2). Pseudotumor drawings were similar to migraine drawings except that 6 of 21 pseudotumor drawings (28.6%) depicted diplopia (crossed eyes, double images), whereas only three of 518 migraine drawings (0.6%) depicted diplopia (P < 0.000001). ConclusionsDiplopia was depicted in a significantly higher percentage of pseudotumor drawings than migraine drawings. In all other respects, headache drawings by children with pseudotumor cerebri were similar to those drawn by children with migraine.

Migraine and cognitive function: Baseline findings from the Brazilian Longitudinal Study of Adult Health: ELSA-Brasil.

Background The association between migraine and cognitive performance is unclear. We analyzed whether migraine is associated with cognitive performance among participants of the Brazilian Longitudinal Study of Adult Health, ELSA-Brasil. Methods Cross-sectional analysis, including participants with complete information about migraine and aura at baseline. Headache status (no headaches, non-migraine headaches, migraine without aura and migraine with aura), based on the International Headache Society classification, was used as the dependent variable in the multilinear regression models, using the category "no headache" as reference. Cognitive performance was measured with the Consortium to Establish a Registry for Alzheimer's Disease word list memory test (CERAD-WLMT), the semantic fluency test (SFT), and the Trail Making Test version B (TMTB). Z-scores for each cognitive test and a composite global score were created and analyzed as dependent variables. Multivariate models were adjusted for age, gender, education, race, coronary heart disease, heart failure, hypertension, diabetes, dyslipidemia, body mass index, smoking, alcohol use, physical activity, depression, and anxiety. In women, the models were further adjusted for hormone replacement therapy. Results We analyzed 4208 participants. Of these, 19% presented migraine without aura and 10.3% presented migraine with aura. All migraine headaches were associated with poor cognitive performance (linear coefficient β; 95% CI) at TMTB -0.083 (-0.160; -0.008) and poorer global z-score -0.077 (-0.152; -0.002). Also, migraine without aura was associated with poor cognitive performance at TMTB -0.084 (-0.160, -0.008 and global z-score -0.077 (-0.152; -0.002). Conclusion In participants of the ELSA-study, all migraine headaches and migraine without aura were significantly and independently associated with poorer cognitive performance.