Positive Family History Of Migraine Research Articles

Trigger Factors of Migraine in Patients Attending Headache and Neurology Outpatient Clinics at Ain Shams University Hospitals

Abstract Background Migraine is the second most common cause of headache, affecting approximately 15% of women and 6% of men. Also, it is one of the most ten disabling diseases in the world. Objectives To determine the triggers of migraine headache in migraine patients attending Headache clinic at Ain Shams university hospitals. Methods A descriptive study was carried out among 292 migraine subjects from different parts of Cairo governorate from December 2019 to March 2020. Case definition of migraine was based on the International Headache Society (IHS) criteria. Results Females constituted 85.6% of the study sample. The majority of the sample (71.3%) aged 18-39 years. Psychological problems as: stress and family problems were the commonest triggers (89%), followed by fatigue (86.3%), too little sleep (staying up late) (82.2%), loud noises (77.7%), hunger, fasting and missing meals (75.3%), bright lights or and sun exposure (75%), and in relation to females menstruation (61.9%), hot weather (61.3%), too much sleep (46.9%), odors (46.2%). The least triggers were physical exercise, caffeinated drinks, smoking, chocolate and dairy products, and ice-cream were 28.8%, 26%, 24.7%, 23.3%, 16.1% respectively. Forty percent of the study population had positive family history of migraine, 30.1% of them reported major stresses (moving of residence, marriage, or death of a close relative) in the last year. Conclusion Stress, anxiety, family problems, fatigue, too little sleep, and loud noises were the commonest triggers of migraine headache. Family history was present in 41.1% of migraine patients.

New-onset headache after percutaneous atrial septal defect closure.

Percutaneous closure of atrial septal defect (ASD) is a well-established procedure both in children and adults with very good long-term outcomes. Migraine headache (MHA) can be precipitated after ASD device closure and the mechanism is not fully understood. We reviewed medical records of all patients undergoing ASD device closure from January 2015 to January 2021 for new onset headache after the procedure. Diagnosis of migraine was established by guidelines of the International Headache Society. Out of 325 patients undergoing ASD device closure, five patients (1.5%) of various age groups (range 3.5-35 years) complained of severe migraine-like headaches within 2 weeks of the procedure. MHA was reported exclusively by females. All the patients were treated with oral paracetamol for the management of headaches. Three of 5 (60%) patients had a positive family history of migraine. Three patients reported complete disappearance of symptoms within 4-6 months. While two others (40%) had ongoing symptoms at 6 months follow-up. MHA can be precipitated after ASD device closure. The risk is specifically high in females with a family history of migraine. Dual antiplatelet drugs for the first 3 months after device closure may prevent such episodes. Prospective studies are needed to establish the universal role of dual antiplatelet drugs after ASD device closure.

A Chinese CADASIL family with p.R578C mutation at exon 11 of the NOTCH3 gene

ObjectiveTo analyze one clinical case of cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy(CADASIL), and to perform analysis of the related gene mutation for the proband and her family. MethodsAnalysis of clinical data from the patient diagnosed with CADASIL, including clinical manifestations, blood test results and brain imaging results, followed by high-throughput sequencing of blood samples. Pathogenicity assessment of the gene mutation, and first generation verification were performed on some family members according to genetic variation interpretation standards and guidelines of the American College of Medical Genetics and Genomics (ACMG). ResultsOnset of the proband occurred younger than 50-years-old with recurrent migraine attacks and positive family history of migraine and stroke, but without risk factors for cerebrovascular diseases. The craniocerebral magnetic resonance imaging (MRI) results showed diffusive white matter lesions and thus clinically met criteria for CADASIL diagnosis. NOTCH3 gene analysis showed a p.R578C mutation (1732 C > T) at the11th exon on chromosome 19 of the proband and some family members. ConclusionsNOTCH3 mutation is related to CADASIL. In this study, we observed a rather rare familial NOTCH3 mutation in China. This report further support the mutation site is pathogenic.

Associations between migraine occurrence and the effect of aura, age at onset, family history, and sex: A cross-sectional study.

IntroductionThe relationships between family history, sex, age at onset, and migraine occurrence have been documented. However, the associations between these factors across different sexes and subgroups of patients have yet to be elucidated. This study evaluated the association between family history and migraine in male and female patients experiencing episodic and chronic migraine with and without aura.MethodsThis cross-sectional, case–control study included 299 headache-free controls and 885 patients receiving outpatient treatment for migraine. Participants were classified into episodic (1–14 days/month) and chronic (≥15 days/month) migraine groups.ResultsPositive family history was significantly more frequently observed in the episodic group than in the chronic group (49.5% vs. 26%; P < 0.001) in male patients, particularly in male patients without aura (50.3% vs. 21.9%; P = 0.003); it was less frequently observed (58.7% vs. 73.7%; P = 0.048) in female patients with aura. Family history was correlated with an earlier age at onset (20.7 years vs. 22.8 years; P = 0.002), particularly in patients without aura (21 years vs. 23.7 years; P = 0.002), who were women (20.9 years vs. 23.9 years; P = 0.002).ConclusionsDifferent patterns of association between family history and migraine can be observed between men and women. A positive family history of migraine is correlated with an earlier age at onset, particularly among female patients without aura.

Gamma-aminobutyric acid (GABA) receptors GABRA4, GABRE, and GABRQ gene polymorphisms and risk for migraine

Several biochemical, pharmacological, neurophysiological and experimental data suggest a possible role of gamma-aminobutyric acid (GABA) in the pathogenesis of migraine. We investigated the possible association of the most common single nucleotide polymorphisms (SNPs) in the GABA receptor alpha4 (GABRA4), epsilon (GABRE), and theta (GABRQ) genes with the risk for migraine. A TaqMan-based qPCR assay designed to detect the most common SNPs in the GABRA4 (rs2229940), GABRE (rs1139916), and GABRQ (rs3810651) was performed in 197 migraine patients and 394 age- and gender-matched controls. The possible influence of gender, age at onset of migraine, positive family history of migraine, presence or absence of aura, and triggering of migraine by ethanol on the frequency of the genotypes was also studied. The frequency of GABRE rs1139916AA genotype was significantly lower in the migraine group only in the female gender, but the differences did not reach statistical significance after correction for multiple comparisons. The mean±SD age at onset of migraine was significantly lower in patients with GABRQ rs3810651AA as compared with the other two genotypes. Positive family history of migraine and presence or absence of aura did not influence the frequencies of the genotypes of the three SNPs studied. Triggering of migraine by ethanol was significantly less frequent in patients with GABRA4 rs2229940GG and more frequent in patients with GABRQ 3810651TT genotype, but the differences lost statistical significance after correction for multiple comparisons. GABRQ rs3810651 could play a role in the modification of age at onset of migraine.

Clinical Features, Familial History, and Migraine Precursors in Patients With Definite Vestibular Migraine: The VM-Phenotypes Projects.

The aim of this work was to assess through a questionnaire the features of vertiginous episodes, accompanying symptoms, familial history, and migraine precursors in a sample of 252 subjects with a diagnosis of definite vestibular migraine. Migraine is a common neurological disorder characterized by episodic headaches with specific features. About two-thirds of cases run in families, and patients may refer symptoms occurring in infancy and childhood, defined as episodic syndromes that may be associated with migraine. Migraine is associated with episodic vertigo, called vestibular migraine, whose diagnosis mainly relies on clinical history showing a temporary association of symptoms. In this cross-sectional multicentric study, 252 subjects were recruited in different centers; a senior specialist through a structured questionnaire assessed features of vestibular symptoms and accompanying symptoms. The age of onset of migraine was 23 years, while onset of vertigo was at 38 years. One hundred and eighty-four subjects reported internal vertigo (73%), while 63 subjects (25%) reported external vertigo. The duration of vertigo attacks was less than 5 minutes in 58 subjects (23%), between 6 and 60 minutes in 55 (21.8%), between 1 and 4 hours in 29 (11.5%), 5 and 24 hours in 44 (17.5%), up to 3 days in 14 (5.5%), and more than 3 days in seven (2.8%); 14 subjects (5.5%) referred attacks lasting from less than 5 minutes and up to 1 hour, nine (3.6%) referred attacks lasting from less than 5 minutes and up to 1 to 4 hours, six (2.4%) referred attacks lasting from less than 5 minutes and up to 5 to 24 hours, and five (2%) cases referred attacks lasting from less than 5 minutes and up to days. Among accompanying symptoms, patients referred the following usually occurring, in order of frequency: nausea (59.9%), photophobia (44.4%), phonophobia (38.9%), vomiting (17.8%), palpitations (11.5%), tinnitus (10.7%), fullness of the ear (8.7%), and hearing loss (4%). In total, 177 subjects referred a positive family history of migraine (70.2%), while 167 (66.3%) reported a positive family history of vertigo. In the sample, 69% of patients referred at least one of the pediatric precursors, in particular, 42.8% of subjects referred motion sickness. The age of onset of the first headache was lower in the subsample with a familial history of migraine than in the total sample. Among the pediatric precursors, benign paroxysmal vertigo - BPV, benign paroxysmal torticollis, and motion sickness were predictive of a lower age of onset of vertigo in adulthood; cyclic vomiting was predictive for vomiting during vertigo attacks in adults. Our results may indicate that vestibular symptoms in pediatric patients may act as a predisposing factor to develop vestibular migraine at an earlier age in adulthood.

Is Infantile Colic an Early Life Expression of Childhood Migraine?

Migraine is the mosyndrome and infantile colic is a common cause of infantile cry. The pathogenesis of migraine and colic has not been well established and different factors may cause them. There is an association between infantile colic and the occurrence of childhood migraine. We aimed to assess whether infantile colic could be noted as an early life expression of childhood migraine or not. This retrospective case-control study was conducted on 5-15-year-old childrenin Rasht, Iran during 2015-2016. Forty-one cases were children with migraine with or without aura. Overall, 123 Control participants were children with the same age referred to the pediatric clinic for routine care. Data were gathered by a checklist including age, sex, birth weight, family history of migraine, the occurrence of colic and type of feeding during infancy. Data were reported by descriptive statistics and analyzed by Fisher exact test using SPSS ver. 19. Overall, 164 children with the mean age of 8.36± 2.53 yr were enrolled. Seventeen (41.46%) children with migraine vs. 44 (35.7%) children in control group had the positive history of infantile colic and Fisher exact test noted significant relation between migraine and colic. Thirty-three children with infantile colic (46.57%) had the positive family history of migraine, which was significantly higher than 27 children without colic (29.7%). There was a significant relation between infantile feeding and migraine. There is a probable relation between colic and migraine, therefore, migraine and colic as 2 pain syndromes may have a common pathophysiology and further investigations on this common pathophysiology is justified.

Gamma-Aminobutyric Acid (Gaba) Receptors Rho (Gabrr) Gene Polymorphisms and Risk for Migraine.

The possible role of gammaaminobutyric acid (GABA) in the pathogenesis of migraine has been suggested by a number of biochemical, pharmacological, neurophysiological and experimental data. We investigated the possible association between the most common single nucleotide polymorphisms (SNPs) in the GABA receptor rho1, 2, and 3 genes (GABRR1, GABRR2, and GABRR3) and the risk of developing migraine. The frequency of GABRR1 rs12200969, GABRR1 rs1186902, GABRR2 rs282129, and GABRR3 rs832032 genotypes and allelic variants were studied in a case-control association study involving 197 patients with migraine and 278 healthy controls by means of a TaqMan-based qPCR Assay. We also studied the possible influence of gender, age at onset of migraine, positive family history of migraine, presence or absence of aura, and triggering of migraine by ethanol on the frequency of the genotypes. The frequencies of the genotypes and allelic variants of the 4 SNPs were similar in migraine patients and controls. Gender, positive family history of migraine, presence or absence of aura, and triggering of migraine attacks by ethanol did not influence the frequency of these genotypes. Carriers of the minor allele of the rs1186902 SNP showed a trend towards later onset of migraine. The most common polymorphisms in the GABRR genes seemed to be not associated with the risk for migraine in Caucasian Spanish people, although one of them (GABRR1 rs1186902) shows a statistically significant association with the age of onset of migraine.

Neuronal Nitric Oxide Synthase (nNOS, NOS1) rs693534 and rs7977109 Variants and Risk for Migraine.

Many biochemical, pharmacological, neuropathological, and experimental data suggest a possible role of nitric oxide in the pathogenesis of migraine. We investigated the possible association between functional single nucleotide polymorphisms (SNPs) in the neuronal nitric oxide synthase gene (NOS1 or nNOS; chromosome 12q24.22) and the risk for migraine. We studied the frequency of the of rs7977109 and rs693534 genotypes and allelic variants in 197 patients with migraine and 308 healthy controls using a TaqMan-based qPCR assay. As a secondary analysis, we studied the possible influence of gender, age at onset of migraine, positive family history of migraine, and presence or absence of aura on the genotypes frequency. The frequencies of rs7977109 and rs693534 genotypes and allelic variants were not associated with the risk for migraine with OR for minor alleles = 0.94 (95% CI 0.72-1.23) and = 0.88 (0.68-1.15), respectively, and the lack of association was not influenced by gender, age at onset of migraine, positive family history of migraine, and presence or absence of aura. NOS1 rs7977109 and rs693534 genotypes and allelic variants are not associated with the risk for migraine in Caucasian Spanish people.

69. Reduced visual cortical reactivity in migraineurs with a positive family history of migraine

In migraine, the genetic load can be seen as determining, on the one hand, a critical threshold for the disease development, and on the other hand, it may be responsible for interictal nervous system dysfunction. We were aimed at verifying whether a family history of migraine might influence migraineurs’ cortical abnormal information processing. We retrospectively collected 109 migraine patients from those reviewed who had visual evoked potentials (VEPs) recordings (6 blocks of 100 sweeps, 15 min of arc cheques, 3.1 repetition rate) and information about parental history of migraine. Neurophysiological data were compared with those of 42 healthy volunteers (HV) without family history of migraine. We recruited 109 migraineurs, 85 with and 24 without a positive family history of migraine. Patients who had one parent affected (mother or father) had significantly lower N75-P100 VEP amplitude blocks overall than those had no parents affected, the latter resulting not different from HV. Lack of VEP N75-P100 amplitude habituation was found in overall migraineurs compared with HV, irrespectively of whether they had a parent affected or not. These findings suggest that familial occurrence of migraine may predispose to a general reduced cortical reactivity to visual stimulation.

EHMTI-0182. Positive family history of migraine predisposes to a reduced migraineurs visual cortical reactivity

Results We recruited 85 patients with and 24 without a positive family history of migraine. Patients who had one parent affected (mother or father) had significantly lower N75-P100 VEP amplitude blocks overall than those had no parents affected, the latter resulting not different from HV. Lack of VEP N75-P100 amplitude habituation was found in overall migraineurs compared with HV, irrespectively of whether they had a parent affected or not. Conclusion These findings suggest that familial occurrence of migraine may predispose to a general reduced cortical reactivity to visual stimulation. No conflict of interest.

Chronic Headache Diagnosed as Brucellosis: A Case Report

Introduction: Headache is a common complaint in children, and it has a significant effect on their daily living activities. Having a definite diagnosis for the cause of the headache is very important for its appropriate management. Case Presentation: We report a 12-year-old boy complaining of chronic headache, with a positive family history of migraine. The only abnormal finding in his general and neurological examinations, and CT scan evaluation of his brain and paranasal sinuses, was a retention cyst in his sphenoid sinus. The child’s symptoms did not improve after receiving migraine medications or treatment for sinusitis. Further investigations revealed positive serological results for brucellosis infection. His symptoms were relieved, and imaging evidence of sinus involvement disappeared after brucellosis treatment. The child remained headache free in later follow-ups. Discussion: In evaluating the cause of children’s headaches, brucellosis must be considered in differential diagnosis.

A survey of female students with migraine: what is the influence of family history and lifestyle?

Objectives: To compare characteristics of migraine and some lifestyle habits in migraineurs with and without a positive family history for migraine. Method: The prevalence study was combined with a case-control study and comprised 245 female students with migraine. Results: Out of 245 female students with migraine, 132 (53.9%) had a positive family history for migraine. In comparison with migraineurs who had not, those with a positive family history were younger at the onset of migraine and significantly more frequently reported menstrual migraine (p < 0.001), unilateral pain ( p < 0.05) and pulsate pain ( p < 0.05) as well as severe headache ( p < 0.01). In comparison to migraineurs with a positive family history for migraine, those who did not report a significantly higher frequency of average number of meals per day of <3 ( p < 0.001), missed meals ( p < 0.05) and an average sleep duration of ≤6 h ( p < 0.05). Conclusions: The results of the present study are in line with literature showing a high frequency of positive family history for migraine among migraineurs. They also suggest that subjects with a positive family history have a lower “migrainous threshold” for the development of migraine and that environmental factors are more important for the occurrence of migraine in subjects without a positive family history. Accordingly, the conclusions of this study are limited to reproductive aged women.

Migraine-Related Symptoms in Childhood

Periodic disorders of childhood often represent precursors of migraine. As we advance our knowledge of migraine and its complicated phenotypic presentation in childhood, we have noted the similarities in overlapping symptoms of children presenting with childhood periodic syndromes. There is often a positive family history of migraine in children that present with periodic syndromes. There is a known transformation of periodic syndromes from childhood into adult migraine with and without aura phenotype. There has been an evolution of our understanding of what was initially referred to as periodic symptoms of childhood and more recently been called childhood periodic syndromes and is now evolving into the terminology of episodic symptoms that are associated with migraine. International classification of headache disorders has been instrumental in the evolution of the classification of headache and children adults. The most recent classification utilizes and replaces the periodic symptom terminology with episodic symptoms that will no longer be limited to just childhood. This article will address the evolution of our understanding of the diagnostic criteria, pathophysiology and management of the episodic syndromes that may be associated with migraine.

Transient Horner’s syndrome as sign of intrapetrous carotid dissection in a migrainous patient

We report the case of a patient that, during a migraine attack presented a transient Horner’s syndrome (HS), secondary to a spontaneous intrapetrous carotid artery dissection (IPCAD). Migraine is a common disorder with a pathophysiology that is incompletely understood. Migraine is considered a functional disorder of the brain, however, there are evidences linking migraine to the vascular system [1]. Endothelial dysfunction, altered vascular reactivity and hypercoagulability are reported in patients with migraine [2]. Migraine with aura seems to increase the risk of ischemic stroke [3] with unclear mechanisms. One link may be cervical artery dissection (CAD), since the association between M and CAD has been suggested [4]. Among CAD, spontaneous IPCAD is a rare occurrence, by far rarer than extracranial dissection, probably related to the anatomic localization that determinate the immobility of the petrous carotid portion fixed in the carotid canal [4]. A 36-year-old female presented with a moderate headache associated with 2-mm left ptosis and 2-mm anisocoria (left pupil smaller) without other neurological signs. The degree of anisocoria was enhanced in dim light, while visual fields and tonometry were normal. She had a positive family history for migraine without aura (MO). Past medical history was unremarkable. The patient did not present any cerebrovascular risk factor. When she was 17 years old, she started suffering from MO (ICHD-II criteria, [5]). The attacks were characterized by moderate, rarely severe, pulsating pain, aggravated by efforts. The pain was usually localized unilaterally in the periorbital right or left region and lasted 6–8 h. She reported nausea, rarely vomiting, phono and photophobia during the attacks. NSAIDs showed a good response. The attack associated with HS did not differ from the usual ones; pain was moderate, pulsating, localized in left fronto-temporal region and associated with phono and photophobia. Brain MRI with gadolinium and neck MRI with fat suppression were reported as negative; intracranial angio-MRI evidenced IPCAD on the left side (Fig. 1a, c). No etiological or predisposing factors to the dissection were disclosed, in particular, no clinical signs of Marfan’s syndrome were present. An occasional precipitating factor could have been the cough, secondary to a pharyngitis presented by the patient few days before hospital admittance. Routine blood counts, blood chemistry, coagulation studies, chest X-ray, electrocardiogram, transthoracic echocardiography and ophthalmology assessment were negative. A patent foramen ovale was excluded by a negative transcranial Doppler sonography with bubble test. Therapy with ASA was started; the subjective and neurological symptoms including HS disappeared in 48 h. A follow-up a month later evidenced a recanalization of the left carotid artery (Fig. 1b, d) and the patient was asymptomatic. The mechanisms by which migraine increase the risk of ischemic stroke could be resumed in the following points: (1) migraine may directly cause an ischemic stroke F. Maggioni (&) C. Disco G. Zanchin Department of Neurosciences, Headache Center, University of Padua, Via Giustiniani 5, 35128 Padua, Italy e-mail: ferdinando.maggioni@unipd.it

Primary Stabbing “Ice-Pick” Headache

Primary stabbing "ice-pick" headache is rarely reported in children. It is characterized by transient, sharp stabbing pain that occurs within a localized area of the scalp for seconds. Five children were diagnosed according to the International Classification of Headache Disorders Diagnostic Criteria, Second Edition. Ages at diagnosis ranged from 6-16 years (mean age, 9.8 years), with signs lasting for 3-12 months (mean, 6.5 months) before assessment. All children presented with recurrent daily to monthly headaches that were very brief, lasting for seconds. The headache was orbital in one child, temporal in one child, and occipital in three children. Three children manifested other associated migraine headache types, and two had a positive family history of migraine. Amitriptyline was prescribed to two patients because of headache frequency and severity. The signs gradually subsided in all patients during follow-up of 3 months to 5 years (mean, 27 months). Primary stabbing headache may occasionally occur in children with features different from those encountered in adults. The headache is less frequent and often occipital in location. Its signs respond well to amitriptyline. However, larger prospective pediatric studies are needed to describe this syndrome further.

A Child with Abdominal Pain, Headache, and Dizziness

Abdominal migraine is a syndrome characterized by recurrent episodes of paroxysmal abdominal pain and nausea or vomiting with wellness between episodes. It is often associated with a positive family history of migraine and no other apparent underlying disease. Abdominal epilepsy is an infrequent syndrome which occurs with gastrointestinal complaints caused by a seizure activity. It is characterized by paroxysmal onset of abdominal pain without visceral disorders, but comes along with the alteration of awareness during the attack and abnormal electroencephalogram findings. Like other epilepsies, this abdominal epilepsy is improved with anticonvulsant medication. (Korean J Pediatr Gastroenterol Nutr 2011; 14(Suppl 1): S19∼S24)

Long-term outcome of Alice-in-Wonderland-Syndrome: Results from a case series of 12 patients

Purpose: There are several reports of so called Alice-in-Wonderland-syndrome mostly concerning differenzial diagnosis and aetiology. So far there are no reports on the long-term outcome of these patients. From a parental point of view this however is a very important information. Methods: Between January 2003 and December 2008 all patients presenting to our hospital with Alice-in-Wonderland-syndrome were included in our data base and contacted for follow-up in regular intervals. Results: During the 6 year period 12 patients with Alice-in-Wonderland-syndrome presented at our hospital. The mean age was 9.3 years (SD±1.8) ranging from 6 to 11 years. All patients included were male. Five patients (41.7%) had a family history of migraine or epilepsy and in one case the father was reported to have had similar symptoms during childhood. Serology for Epstein-Barr virus infection was available in four cases but was not indicative for acute infection in either of these. Three patients (20%) were lost to follow-up. In all remaining cases symptoms of Alice-in-Wonderland-syndrome had ceased within one week to four months. Only two patients (22.2%) experienced additional episodes of metamorphic hallucinations after a symptom-free interval of three years and one year, respectively. Conclusion: According to our observations Alice-in-Wonderland-syndrome seems to be a benign and self-terminating childhood condition, although occasional recurrence of symptoms is possible. The increased prevalence of a positive family history for migraine and epilepsy is suggestive for a hereditary predisposition.

Precipitating and Relieving Factors of Migraine Headache in 200 Iraqi Kurdish Patients

To study the precipitating and relieving factors of migraine headache in a group of Iraqi Kurdish patients including the effect of fasting in Ramadan, and to estimate the percentage of family history of migraine. A series of 200 migraine cases from different parts of the Kurdistan region in the North of Iraq attending the out-patient Neurology clinic at Rizgary Teaching Hospital and a private Neurology clinic at Erbil City was carried out between October 2007 and May 2008 were reviewed. The precipitating factors and relieving factors for migraine headache were registered and tabulated to be compared with others. Case definition of migraine was based on the International Headache Society (IHS) criteria. 33% of the patients were aged between 30-39 years, while 40.5% of patients experienced their first attack aged between 20-29 years. Stress or psychological upset was the commonest triggering factor (80%), followed by increasing physical activity (68%), change in weather (65.5%), and in relation to fasting (65%). Fasting in Ramadan was a triggering factor for headaches in 65% of patients. However, there was no significant association between the triggering factors with regards to sex difference. Relief of migraine in the studied sample was achieved using NSAIDs in 50% of patients, and sleep (45.5%). Hence, 61% of the study population had positive family history of migraine, 32.5% of them reported maternal history of migraine. Psychological upset, stress and excessive physical activity were the commonest triggering factors of migraine headache, while NSAID was the commonest relieving factor of migraine in this population. Family history was present in 61% of migraine patients based mainly from maternal root.

Abdominal Migraine Associated with Ecchymosis of the Legs and Buttocks: Does the Symptom Imply an Unknown Mechanism of Migraine?

Abdominal migraine is one subcategory of migraine-related syndromes. Migraine is sometimes associated with facial ecchymosis, which may be accounted for by trigeminovascular activation. However, the precise mechanism of this concurrence remains unknown. Here, we describe a 9-year-old girl, who presented ecchymosis of the legs and buttock associated with recurrent, severe, non-localized midline abdominal pain. The patient has positive family history of migraine. Investigations during an attack revealed no obvious abnormalities. According to the International Classification of Headache Disorders (Second Edition), she was diagnosed with abdominal migraine. Her abdominal pain was relieved with sumatriptan, a migraine-specific serotonin(1B/1D) agonist. The ecchymosis always occurred in conjunction with abdominal pain and tended to regress after pain relief. In contrast to the local trigeminovascular activation theory that explains the ecchymosis in a migraine-related condition, the findings gained from the presented patient suggest a mechanism that involves the initial activation of the visceral nerves responsible for abdominal nociception under the predisposition of visceral hypersensitivity associated with abdominal migraine. Subsequently, ecchymosis developed in the skin region innerved by the activated nerves, possibly involving dichotomizing afferent fibers and afferent-afferent interactions via sacral spinal cord pathway or a sympathetic reflex. Taken together with the probable common mechanism of migraine and abdominal migraine, we suggest that the skin changes in migraine are associated with somatic referral of migraine headache via the trigeminal nerve pathway.