Pediatric Migraine Patients Research Articles

An Evaluation of White Matter Intensities in Patients with Pediatric Migraine

Background and Objectives: This study aims to assess white matter hyperintensities (WMHs) in pediatric migraine patients and to elucidate the pathophysiology of the disease. Materials and Methods: A total of 30 patients diagnosed with migraine and 28 healthy individuals undergoing magnetic resonance imaging (MRI) scans for various reasons in our hospital between September 2019 and April 2023 were included in the study. We evaluated the presence, number, locations, and volumetric measurement of WMHs and the relationship between hyperintensity and attack profiles in migraine patients. Results: WMHs were observed at MRI in 18 (60%) of the 30 migraine patients and in 8 (28.6%) of the 28 controls. One hyperintense lesion was detected in nine members of the patient group, two in six patients, five in one patient, eight in one patient and nine in one. One hyperintense lesion was detected in eight healthy control group members. WMHs were significantly more common in the migraine patients than in the control group (p = 0.016). There was no significant relationship between hyperintensity in migraine patients and attack duration or frequency. Analysis also revealed no significant difference in terms of hyperintensity volumes (mm3) between the study group (19.73 ± 24.26) and the control group (5.62 ± 1.83). Conclusions: This study set out to show that migraine exerts neurological effects that are not solely limited to pain by emphasizing the pronounced differences observed on the brain MRIs of migraine patients. These findings may help us achieve a better understanding of the effects of migraine on cerebral structures and functions and identify therapeutic strategies in the future.

Assessment of Micronutrient Levels in Pediatric Migraine Patients.

We aimed to evaluate the relationship between attack frequency and severity and serum levels of micronutrient in pediatric migraine patients. Children at 2 hospitals from February to December 2022 diagnosed with migraine were reviewed. A total of 171 patients with a mean age of 14.3 ± 2.9 years were included in the study. The median 25(OH) vitamin D level was 15.6 μg/L in patients with an attack frequency of 1-3 per month versus 11.9 μg/L in those with more than 3 attacks per month (P = .005). The median vitamin B12 level was 386 ng/L in patients with attack duration of 2-6 hours versus 343.5 ng/L in those with an attack duration of 12-24 hours (P = .048). The median ferritin level was 34 μg/L among patients not receiving prophylactic treatment and 24 μg/L among those receiving prophylactic treatment (P = .019). This study suggests that assessing micronutrient levels may be beneficial in children with migraine.

Cyproheptadine Treatment in Children and Adolescents with Migraine: A Retrospective Study in Japan.

Evidence on prophylactic drugs for pediatric migraine is limited, especially when comorbid conditions contribute to treatment resistance. This study evaluated the efficacy of cyproheptadine in children with migraine and explored the impact of comorbid neurodevelopmental disorders and orthostatic intolerance (OI). We retrospectively analyzed pediatric migraine patients treated with cyproheptadine. Efficacy was assessed based on the reduction in headache frequency, with responders defined as patients experiencing at least a 50% reduction in headache episodes. Fisher's exact test analyzed the relationship between efficacy and comorbid conditions or treatment sequence. Multiple logistic regression was performed to identify factors associated with adverse events. In total, 155 children (71 males, 84 females) aged 3-15 years were included. Comorbid neurodevelopmental disorders and OI were present in 27 (17.4%) and 22 (14.2%) patients, respectively. Efficacy was evaluated in 148 patients, with 68.9% classified as responders. Patients with comorbid conditions showed lower efficacy. Responders required a lower dose of cyproheptadine (p = 0.039). Multiple logistic regression identified headache frequency, cyproheptadine dose, and comorbid OI and neurodevelopmental disorders as factors influencing treatment efficacy. Cyproheptadine is effective in treating pediatric migraine, though patients with neurodevelopmental disorders and OI demonstrated reduced efficacy.

Internalizing disorders rather than ADHD are risk factors for chronicity in pediatric migraine patients.

Migraine is a prevalent neurological disorder that can lead to disability in children and adolescents. It is frequently accompanied by psychiatric comorbidities, both internalizing and externalizing disorders. While the relationship between migraine and internalizing disorders has been studied, there is limited research on the link between migraine and attention deficit hyperactivity disorder (ADHD). A total of 280 pediatric headache patients, 107 with externalizing (ADHD) and 173 with internalizing disorders (depression and/or anxiety), were included. The dataset was composed using the Turkish headache database, Mersin Branch. Pain characteristics, associated symptoms, and accompanying comorbidities were evaluated retrospectively. Two hundred four patients were followed up with episodic migraine (EM) and 76 patients with chronic migraine (CM). One hundred forty-six boys and 134 girls were evaluated, and internalizing disorders were more common in the girls (p < 0.001). It was a much more prominent accompaniment in chronic migraine internalizing disorders (p = 0.038). EM, on the other hand, was more frequent in ADHD. Pain intensity and frequency were greater in those with internalizing disorders (p = 0.007), while photophobia was more prevalent in those with ADHD (OR; 0.555, p = 0.044). Moreover, we observed that individuals with internalizing disorders were predominantly female (p = 0.003) and had a higher mean age (p < 0.001) than those with externalizing disorders. Internalizing disorders seem to be a risk factor for migraine chronification in pediatric migraine. ADHD is a prototypic externalizing disorder more associated with EM. This outcome provides an opportunity to follow our patients in terms of prognosis and offers us the chance for a better evaluation. Identifying factors that contribute to the chronicity of migraine may lead to better management and reduced disability for migraine sufferers.

The effect of physical therapy integrated with pharmacotherapy on tension-type headache and migraine in children and adolescents

BackgroundTension-type headache (TTH) and migraine are prevalent neurological conditions in children and adolescents that significantly impact activity of daily living (ADL) and quality of life (QOL). Although physical therapy targeting cervical myofascial trigger points (MTrPs) on TTH and migraine has been extensively studied in adults, the efficacy in pediatric patients remains unexplored. The aim of this study is to reveal the effect of physical therapy integrated with pharmacotherapy on TTH and migraine in children and adolescents.MethodsWe conducted a prospective, observational cohort study recruiting consecutive patients aged 6 to 18 years with TTH and migraine with cervical MTrPs. They were classified into 4 types of headaches: frequent episodic TTH (FRTTH), chronic TTH (CTTH), episodic migraine (EM) and chronic migraine (CM). The once-weekly 40-minutes physical therapy session integrated with pharmacotherapy (integrated physical therapy) was continued until the treatment goals (headache days per week less than 2 days, headache impact test-6 (HIT-6) score to below of 50, and the ability to attend school daily) was achieved. Multifaceted assessments including headache frequency (headache days per week), headache intensity using the Visual Analogue Scale (VAS), pain catastrophizing score (PCS), hospital anxiety and depression scale (HADS) score, HIT-6 scores, and EuroQol 5 dimensions 5-level questionnaire (EQ-5D-5 L) scores, were conducted to evaluate the treatment effects.Results161 patients were enrolled in this study. 106 patients (65.8%) were diagnosed with TTH: 70 (66.8%) with FETHH, 36 (34.0%) with CTTH, and 55 patients (34.2%) were diagnosed with migraine: 43 patients (78.2%) with EM, 12 patients (21.8%) with CM. We observed significant improvements in headache frequency, headache intensity, PCS, HADS score, HIT-6 scores, and EQ-5D-5 L scores before and after the treatment in all 4 types of headaches. The average number of sessions required to achieve the treatment goals was 4 times (weeks) for patients with FETTH and EM, 5.5 for those with CTTH, and 7.5 for those with chronic migraine.ConclusionThe integrated physical therapy on pediatric TTH and migraine patients with the cervical MTrPs was significantly effective in reducing headache symptoms and improving ADL and QOL.

Alterations in the tear film and ocular surface in pediatric migraine patients.

To evaluate the ocular surface (OS) parameters in the pediatric migraine patients (PMPs). This prospective case-control study consisted of 51 PMPs (PMP group) and 55 healthy pediatric patients (HPP group). In all participants, tear function was evaluated subjectively using the Ocular Surface Disease Index (OSDI) questionnaire, objectively using Schirmer tear test (STT) and tear film disintegration time (TBUT), and with clinical and laboratory examinations (conjunctival impression cytology). The PMP group was subdivided into two groups according to their aura. The mean age and gender distribution of the study groups were almost the same ( P > 0.05 for both of them). In the PMP group, both the STT value and the TBUT value were significantly lower than those determined in the HPP group ( P = 0.021 and P = 0.018, respectively). In the PMP group, the OSDI scores were higher than those in the HPP group ( P = 0.032). In the PMP group, the goblet cell density values were lower than those in the HPP group ( P = 0.01). With regard to the aura, the TBUT and STT values were nonsignificantly lower in the PMP aura-positive group than in the PMP aura-negative group ( P > 0.05 for both of them). The OSDI assessment was similar in both the groups. With regard to the goblet cell count, it was observed to be less in the PMP aura-positive group than in the PMP aura-negative group ( P = 0.01). Influence of OS in children with migraine was also demonstrated using the samples taken from the conjunctiva. These changes were also demonstrated by objective tests such as STT and TBUT. Both clinical objective evaluations and pathologic changes were more prominent in the migraine with aura group.

Application and Effectiveness of Dietary Therapies for Pediatric Migraine

Migraine is a representative type of primary headache and a common chronic neurological disease that accounts for a large proportion of headaches in children, adolescents, and adults. Unlike migraine in adulthood, pediatric migraine occurs when brain development is not yet complete. This characteristic may require a new perspective for the treatment and management of pediatric migraine. Dietary therapies, mainly the ketogenic diet and its variants, can have positive effects on pediatric migraine. Several recent studies have revealed that dietary therapies, such as the classic ketogenic diet, modified Atkins diet, and low glycemic index diet, improve various neurological diseases by improving dysbiosis of microbiota, reducing proinflammatory cytokines, and increasing mitochondrial function. Nonetheless, the mechanism through which active dietary therapy affects pediatric migraine requires further research. To achieve this, an important role is played by the neuro-nutritional team, which can develop and manage tolerable diets for pediatric migraine patients through mutual collaboration among pediatric neurologists, nurses, and nutritionists.

Suboptimal multisensory processing in pediatric migraine without aura: a comparative, cross-sectional study

Alterations of sensory processing in migraine are well known. There is some evidence to suggest that multisensory processing is altered in migraine as well, but the area is underexplored, especially regarding pediatric migraine. A visual and an audiovisual version of the Rutgers Acquired Equivalence Test paradigm was administered to pediatric patients with migraine without aura (aged 7–17.5 years) and to age- and sex-matched controls. The application of audiovisual stimuli significantly facilitated associative pair learning in migraine-free children and adolescents, but not in pediatric migraine patients. The results of this study corroborate the hypothesis that multisensory processing is altered in pediatric migraine without aura.

Analysis of Retinal Nerve Fiber Layer Thickness in Pediatric Migraine Using Optical Coherence Tomography

Purpose: We investigated disparities in retinal nerve fiber layer (RNFL) thickness surrounding the optic disc among pediatric migraine patients based on the presence of a concomitant visual aura.Methods: We used optical coherence tomography to measure RNFL thickness around the optic disc in children with migraines and no organic diseases, along with a control group of healthy children. Differences in RNFL thickness were analyzed based on the pattern of prognostic symptoms. Additionally, we investigated the effects of migraine duration and frequency on RNFL thickness.Results: In total, 45 children with migraine and 30 healthy controls were enrolled in this study. Among the children with migraine, 15 experienced visual aura, whereas 30 did not exhibit visual aura. Visual prognostic symptoms included blurred vision, scotoma, and scintillating scotoma. Seven children presented with blurred vision and scotoma, whereas eight reported scintillating scotomas. The mean RNFL thickness around the optic disc was significantly lower in patients with blurred vision and scotomas (89.19 ± 7.99 μm) compared with the control group (98.79 ± 8.49 μm), patients without visual aura (100.55 ± 6.43 μm), and patients with scintillating scotoma (102.21 ± 10.13 μm, p &lt; 0.05).Conclusions: RNFL thickness around the optic disc was significantly reduced in children with migraine who reported symptoms of blurred vision and scotoma.

Mitochondrial metabolism related markers GDF-15, FGF-21, and HIF-1α are elevated in pediatric migraine attacks.

The purpose of this study was to investigate the serum levels of mitochondrial metabolism/reactive oxygen species (ROS)-related peptides (hypoxia inducible factor-1α [HIF-1α], fibroblast growth factor-21 [FGF-21], growth differentiation factor-15 [GDF-15]) and key migraine-related neuropeptides (calcitonin gene-related peptide [CGRP], pituitary adenylate cyclase-activating peptide-38 [PACAP-38], substance P [SP], and vasoactive intestinal peptide [VIP]) during migraine attacks and to evaluate their diagnostic value in pediatric migraine. There is increasing evidence for the important role of impairment in oxidative mitochondrial metabolism in the pathophysiology of migraine. Potential biomarkers that may reflect the relationship between migraine and mitochondrial dysfunction are unclear. A total of 68 female pediatric migraine patients without aura and 20 female healthy controls aged 8-18 years, admitted to the hospital, were enrolled in this cross-sectional study. Serum concentrations of these molecules were determined by enzyme-linked immunosorbent assays, and clinical features and their possible diagnostic value were analyzed. Serum levels of HIF-1α (252.4 ± 51.9 [mean ± standard deviation]) pg/mL), GDF-15 (233.7 ± 24.7 pg/mL), FGF-21 (96.1 ± 13.1 pg/mL), CGRP (44.5 ± 11.3), and PACAP-38 (504.7 ± 128.9) were significantly higher in migraine patients compared to healthy controls (199.8 ± 26.8, 192.8 ± 20.7, 79.3 ± 4.1, 34.1 ± 3.5 and 361.2 ± 86.3 pg/mL, respectively). The serum levels of these peptides were also higher in patients with chronic migraine than in patients with episodic migraine, and higher in the ictal period than in the interictal period. A positive correlation was found between attack frequency and both HIF-1α and FGF-21 levels in migraine patients. Serum levels of VIP and SP were not different between the migraine patients and healthy controls. Migraine attacks are accompanied by elevated HIF-1α, FGF-21, GDF-15, CGRP, and PACAP-38 in medication-naive pediatric patients with migraine. Elevated circulating mitochondrial metabolism/ROS-related peptides suggest a mitochondrial stress in pediatric migraine attacks and may have potential diagnostic value in monitoring disease progression and treatment response in children. Novel approaches intervening with mitochondrial metabolism need to be investigated.

Evolution of Pediatric Migraine Patients Admitted at an Emergency Department after a 10-Year Follow-Up.

Despite its high prevalence, the clinical course of pediatric migraine has not been fully understood, and previous studies present conflicting results. We present here the findings of a 10-year follow-up study involving children with severe migraine pain admitted to our emergency department. Furthermore, all studies were carried out on selected outpatient clinical case studies. Our aim was to evaluate a population of migraine children admitted to an emergency department because of increased severity or frequency of pain or even because of very anxious parents concerning their child's headache in order to describe their long-term outcomes, whether it differed from that of outpatient populations and to identify possible predictors of prognosis. We recruited 80 subjects with migraine headaches (mean age 8 years with a range of 4-14 years, 50% females), attending the baseline examination of a population admitted for a headache to the Emergency Department in the first half year of 2012. Of the 80 subjects, 48 (60%) were eligible for follow-up in 2022. We included in our study only patients diagnosed with migraine, according to the diagnostic criteria of the International Classification of Headache Disorders. All were contacted by telephone, and a semi-structured questionnaire was provided to them by email. The association between several possible prognostic factors (gender, familiar neurologic disorders, prenatal and perinatal disorders, social activities, sleep disorders, etc.) and the long-term persistence of migraine headaches were explored using logistic regression analysis. Of 48 subjects with migraine headaches at baseline, 31 (65%) had persistent migraine, and 17 (35%) experienced remission. The preliminary results showed that the presence of neurologic disorders in parents (p < 0.01-odds ratio 9.34 (2.53-41.64) and sleep disorders (p < 0.01-odds ratio 13.18 (2.25-252.74) significantly predicted the 10-year persistence of migraine headaches, while the other considered predictors were found not to influence prognosis. To our knowledge, this was the first study conducted on a selected pediatric population upon admission to the emergency room. Our study suggests that a population of pediatric migraine selected for admission to the emergency department also shows a favorable long-term prognosis, like the studies conducted in the outpatient sample. Familial neurological comorbidity and sleep disorders were unfavorable factors for predicting good outcomes.

Assessment of the Optic Disc and Retinal Microvasculature by Optical Coherence Tomography Angiography in Patients With Pediatric Migraine.

Migraine, as a chronic neurovascular disease, is known to be a risk factor for retinal and optic nerve head damage. Herein, we aimed to evaluate the optic disc and retinal microvasculature in pediatric migraine (PM) patients using optical coherence tomography angiography (OCTA). Forty-six eyes of 23 patients with PM without aura (PM group) and 46 eyes of 23 age- and sex-matched healthy subjects (control group) were included in this cross-sectional prospective study. Demographic features and ophthalmological examination including OCTA measurements were evaluated. OCTA was performed with 6- × 6-mm sections for macula and 4.5- × 4.5-mm sections for optic nerve head in all eyes. Foveal retinal thickness (FRT), peripapillary retinal nerve fiber layer (RNFL) thickness, vessel density in different sections of the retina, and optic disc were analyzed and compared between the groups. All measurements of the PM patients were taken in the attack-free period. The mean ages of the PM group and control group were 11.17 ± 3.3 and 11.83 ± 2.8 years, respectively ( P = 0.479). Gender and mean intraocular pressures were similar between the groups. The mean central corneal thickness levels in the PM group were significantly lower than control group, 548.28 ± 26.3 µm and 562.04 ± 24.5 µm, respectively ( P = 0.011). There was no significant difference regarding average and all quadrant RNFL thicknesses, foveal avascular zone and flow areas, deep vessel densities, and optic disc capillary densities between the groups. However, compared with the control group, the PM group showed significant higher values of FRT, and lower values of superficial whole and parafoveal vessel densities (247.28 ± 15.8 µm vs 285.93 ± 11.1, P < 0.001, 51.85 ± 2.4% vs 50.31 ± 4.0%, P = 0.02, 55.09 ± 2.3% vs 53.5 ± 3.5%, P = 0.01, respectively). Disease duration and attacks/year did not show any significant correlations with OCTA values. PM seems to be associated with lower superficial whole and parafoveal vessel densities because of hypoperfusion and ischemia. OCTA may be suggested for use in follow-up and management of PM patients.

CGRP and PACAP-38 play an important role in diagnosing pediatric migraine

BackgroundAn increasing number of studies have suggested that the important role of vasoactive peptides, such as pituitary adenylate cyclase-activating polypeptide-38 (PACAP-38) and calcitonin gene-related peptide (CGRP), in the pathophysiology of migraine seems undeniable in adults, but studies in pediatric migraine patients remain scarce. We prospectively investigated CGRP and PACAP-38 plasma levels in children with migraine during ictal and interictal periods and compared the results between migraine patients with aura and without aura. We were the first to explore the diagnostic value of a combination of CGRP and PACAP-38.MethodsSeventy-six migraine patients aged 4–18 years and seventy-seven age-matched healthy children were included in the study. Plasma vasoactive peptides were measured using the enzyme-linked immunosorbent assay (ELISA). Differences and correlations of groups were analyzed using the independent samples t-test, analysis of variance (ANOVA), Mann-Whitney U test, and multiple linear regression. We also performed logistic regression and receiver operating characteristic curve (ROC) analyses to evaluate the diagnostic value of CGRP and PACAP-38 in pediatric migraine.ResultsPACAP-38 and CGRP levels in migraine patients during the ictal and interictal periods were higher than those in controls (p < 0.001). PACAP-38 and CGRP levels in migraine patients with aura and without aura were higher than those in controls (p < 0.001). PACAP-38 and CGRP were independent risk factors in diagnosing pediatric migraine (adjusted OR (PACAP-38) =1.331, 95% CI: 1.177–1.506, p < 0.001; adjusted OR (CGRP) = 1.113, 95% CI: 1.064–1.165, p < 0.001). Area Under Curve (AUC) comparison: Combination (0.926) > CGRP (0.869) > PACAP-38 (0.867).ConclusionsOur study found almost the same changes in CGRP and PACAP levels in pediatric migraine, suggesting that CGRP and PACAP-38 may work together to play an integral role in pediatric migraine. Higher CGRP levels were found in the ictal phase than in the interictal phase and with aura group than without aura group, indicating that CGRP may take part in the formation of pain and aura. Moreover, ROC and logistic regression analyses suggested that CGRP and PACAP-38 are good indicators to diagnose pediatric migraine, and the combination of CGRP and PACAP-38 was valuable in diagnosing pediatric migraine and differentiating pediatric migraine from non-migraine headaches.Trial registrationThe study has been registered at the Chinese Clinical Trial Registry (ChiCTR2100043157).

Effect of the COVID-19 Pandemic on Headache in Pediatric Migraine Patients at a Single Tertiary Center

Purpose: The aim of this study was to evaluate the impact of the coronavirus disease 2019 (COVID-19) pandemic on children and adolescents with migraine. Methods: This longitudinal cohort study enrolled children and adolescents with migraine from the Department of Pediatric Neurology at our hospital from January 2017 to June 2021. Self-reported data from individual headache diaries were used. The patients were questioned about their headache frequency and intensity, stress, physical activity, changes in mood and sleep, and their school and home lives during the COVID-19 pandemic. The Pediatric Migraine Disability Assessment (Ped-MIDAS) scoring system was applied to assess headache-related disability. Results: In total, 325 pediatric migraine patients (mean age 12.8±5.6 years, 62.5% female) were included in this study. The average monthly frequency of migraine headaches was 2.17±1.32 and 4.62±3.29 before and during the COVID-19 pandemic (P&lt;0.001), respectively. The Ped-MIDAS score was obtained for 207 patients both before and during the pandemic, and the total score slightly increased from 13.8 to 14.7 points (P=0.295). Sixty patients (18.5%) showed significantly worsening migraine headaches. Younger age (P=0.017), mood deterioration (P&lt;0.001), sleep problems (P&lt;0.001), increased acute medication use (P=0.010), and larger changes in the Ped-MIDAS score (P=0.002) were significantly associated with worsening headache in the logistic regression analysis. Conclusion: Headache attacks in children and adolescents with migraine were more frequent during the COVID-19 pandemic than before it. Worsening headaches could be independently attributed to younger age, mood deterioration, and poor sleep during the COVID-19 pandemic.

Inflammation and endothelial dysfunction in pediatric migraine patients.

Inflammation and endothelial dysfunction are the suggested underlying mechanisms in migraine. Pentraxins, C-reactive protein, erythrocyte sedimentation rate, neutrophil to lymphocyte ratio, platelet to lymphocyte ratio are good indicators of inflammation. Alterations in insulin levels and insulin sensitivity may trigger endothelial dysfunction. This study evaluates the association between migraine and serum biomarkers of inflammation and endothelial dysfunction in children. Children with migraine and healthy subjects were recruited. Serum samples were obtained in an attack-free period. We collected data on serum levels of complete blood cell count, C-reactive protein, erythrocyte sedimentation rate, pentraxin-3, and data from biochemical investigations. We compared these with clinical data such as age, sex, disease duration, attack frequency, attack duration, analgesic use, family history, and Pediatric Migraine Disability Assessment Questionnaire scores. We assessed samples from 32 children (11 boys, 21 girls) with migraine and 19 healthy controls (8 boys, 11 girls). We found significantly higher pentraxin-3, insulin, and insulin resistance in patients with migraine (P = 0.001, P = 0.032, and P = 0.008, respectively). A positive directional correlation is found between pentraxin-3 and Pediatric Migraine Disability Assessment Questionnaire scores. The best cut-off values for pentraxin-3 is determined between 12.75 pg/mL to 15 pg/mL in migraineurs. In conclusion increased pentraxin-3 levels support the suggestions that inflammation plays a role in pediatric migraine. The vascular endothelial dysfunction is observed by a rise in insulin and insulin resistance levels. Our findings support the idea that ongoing inflammation and vascular endothelial dysfunction between attacks may play a role in migraine pathogenesis in children.

Analysis of Plasma Orexin Levels in Pedıatrıc Migraine Patients: A Prospectıve Controlled Clinical Study

Objective: Migraine is the most common primary headache disorder in children. However, its pathogenetic mechanisms are not fully understood. Researchers focused on Orexin A (a neuropeptide with anti-nociceptive effects) and Orexin B (a neuropeptide with pro-nociceptive effects), but the literature is scarce in terms of studies investigating the plasma levels of these neuropeptides in pediatric migraine patients. We aimed to compare the plasma levels of orexins between pediatric migraine patients and healthy controlsMethods: Children aged between 5 and 18 who were under diagnostic evaluation for and diagnosed with migraine in Ondokuz Mayıs University, Department of Pediatric Neurology between December 2018 and December 2019, constituted the target population. All study group patients (Group 1) were diagnosed with migraine according to IHS 2004 criteria. The control group (Group 2) consisted of healthy children. Data including age, gender, and presence or absence of aura were recorded. Two blood samples were taken from the patients in Group 1. The first sample was withdrawn during a non-attack period, and the second sample was withdrawn during the initial migraine attack. Only one blood sampling was done in the control group. Plasma Orexin A and Orexin B levels were analyzed by radioimmunoassay and compared between Group 1 and Group 2 during non-attack and attack periods. Also, intra-group comparative analyses were performed. Non-parametric tests were used for statistical analysis.Results: This study included 98 patients, 52 children with migraine (Group 1), and 46 healthy children (Group 2). Mean patient age was 12,5±3,1 year in Group 1 and 12,3±3,4 years in Group 2. There was no difference between patient groups in terms of gender (p=0,103) and age (p=0,734). Plasma Orexin A levels of the migraine patients were higher than control group participants during the non-attack period, while Orexin B levels of the migraine patients were higher than migraine patients during the attack period. The mean plasma Orexin A level was significantly higher during the non-attack period than the attack period (p=0,002). The mean plasma Orexin B level was significantly higher during the attack than in the non-attack period (p=0,002). The presence of aura did not impact plasma orexin levels during both attack and non-attack periods.Conclusions: The plasma level of Orexin A is elevated in migraine patients, probably as a response to nociceptive signals, and migraine attack is associated with elevated plasma Orexin B levels. Targeting the orexinergic system seems like a reasonable approach to improving the treatment of migraine disease.

Vitamin B12 and folic acid levels in pediatric migraine patients.

Migraine is a recurrent, primary cause of headache. Although prophylactic vitamin B12 therapy is used on migraine patients, there is a limited number of studies examining the levels of B12 vitamin and folic acid in pediatric patients diagnosed with migraine. The study group (Group 1) included 65 pediatric patients diagnosed with migraine in the Pediatric neurology outpatient clinic, and 87 healthy cases admitted to the general pediatric clinic were included in the control group (Group 2). Complete blood count parameters, vitamin B12, folic acid, ferritin, and 25 OH D vitamin levels of the study and control groups were compared. The mean vitamin B12 level was 196.42 ± 95.54pg/mL (59-499) in Group 1 and 240 ± 105.24pg/mL (74-619) in Group 2. The mean folic acid level was 8.85 ± 3.49pg/mL (3.68-23.70) in Group 1 and 7.24 ± 7.17pg/mL (1.11-35.50) in Group 2. There was a statistically significant difference between Group 1 and 2 in terms of vitamin B12 and folic acid levels (p = 0.008, p = 0.00). The results of this study indicate the requirement for routine evaluation of vitamin B12 and folic acid levels in pediatric patients diagnosed with migraine.

Plasma levels of vasoactive neuropeptides in pediatric patients with migraine during attack and attack-free periods

Increasing evidence suggests that vasoactive neuropeptides such as pituitary adenylate cyclase-activating polypeptide-38 (PACAP-38), substance P, calcitonin gene-related peptide, and vasoactive intestinal peptide are involved in the pathophysiology of migraine in adults, but their role in pediatric migraineurs remains unclear. We prospectively investigated plasma levels of these vasoactive neuropeptides in pediatric migraine patients without aura and compared the results with those of age-matched healthy controls. Thirty-eight children aged 6-18 years with migraine without aura and 20 age-matched control subjects were included in the study. Neuropeptides in plasma samples from the controls, and in either the ictal or interictal periods in pediatric migraine without aura, were measured using ELISA. PACAP-38 and vasoactive intestinal peptide levels in both ictal and interictal plasma were higher in the patients with pediatric migraine without aura than in the controls (p < 0.001), although calcitonin gene-related peptide and substance P levels remained unchanged. Otherwise, no significant difference was determined between ictal and interictal periods in terms of all neuropeptide levels. This study demonstrates increased plasma PACAP-38 and vasoactive intestinal peptide levels, but not calcitonin gene-related peptide and substance P levels, in pediatric patients with migraine during both attack and attack-free periods. The study findings suggest that PACAP-38 and vasoactive intestinal peptide may be implicated in the pathophysiology of migraine, particularly in pediatric migraineurs.

Insomnia and psychological reactions during the COVID-19 outbreak in China.

Citation:Li Y, Qin Q, Sun Q, Sanford LD, Vgontzas AN, Tang X. Insomnia and psychological reactions during the COVID-19 outbreak in China. J Clin Sleep Med. 2020;16(8):1417–1418.

The Role of Polysomnography in Identifying Sleep Disorders in Children with Migraine.

Migraine pathophysiology and sleep share common neural pathways, and there are clinical as well as paraclinical observations, which lead to the hypothesis of an association between migraine and sleep disorders.The objective of this study consisted of the evaluation of a possible correlation between migraine and sleep disorders in children, as reflected by sleep architecture and electroencephalographic patterns.Eighteen patients aged five to seventeen were recruited for the migraine group, and sixteen age-matched patients with no criteria for migraine or any underlying organic disorder, diagnosed with emotional disorders, were enrolled in the control group. All patients underwent inpatient full night polysomnographic recordings, the results of which were analyzed using appropriate statistical methods.Patients in the migraine group had decreased REM sleep (p = 0.049) and increased N1 sleep (p = 0.018) percentages, compared to the control group. Also, more arousals (p = 0.011) and lower sleep latency (p = 0.029) were noted in the migraine group. A statistically significant association was observed between migraine and sleep disorders when the latter was defined with respect to normal values of polysomnographic parameters published in studies conducted on healthy children.Polysomnography can be a useful tool for studying sleep in pediatric migraine patients. The results of this study can be regarded as a starting point for a better understanding of the complex role of sleep in the developing brain and of eventual intricacies with migraine pathophysiological mechanisms.