Symptoms In Migraine Patients Research Articles

Efficacy of Nano-curcumin Supplementation on Depression, Anxiety, Stress and Clinical Symptoms in Migraine Patients: A Randomized Double-blind Clinical Trial

Background:: Migraine is a debilitating neuroinflammatory disorder. Patients with migraine often experience elevated levels of depression, anxiety, and stress, which are associated with the frequency and severity of migraine attacks. Curcumin has been shown to have regulatory effects on depression, anxiety, and stress, as well as analgesic properties through various mechanisms. The objective of this study was to assess the impact of nanocurcumin supplementation on depression, anxiety, stress, and clinical manifestations in patients with migraine. Methodology:: This study was conducted as a randomized, double-blind clinical trial. A total of forty-four patients with episodic migraines were recruited for the trial. Stratified randomization was employed to ensure a balanced distribution of participants based on BMI and sex. The patients were equally assigned to two groups using permuted block randomization: 1) the intervention group, which received 80 mg of nano-curcumin, and 2) the placebo (control) group, which received a paraffin-based placebo. The intervention and control periods lasted for 2 months. Anthropometric and demographic data, clinical signs and symptoms (including headache frequency, duration, and severity as reported by the patients), as well as stress, anxiety, and depression scores (using the Dass-21 questionnaire), were recorded before and after the study. The collected data were analyzed using SPSS 22. For normally distributed data, paired t-tests and independent t-tests were utilized. Non-normal data were analyzed using the Wilcoxon test and Mann-Whitney U test. The chi-squared test was employed for categorical variables. To account for confounding factors, the ANCOVA test was conducted. A p-value of ≤ 0.05 was considered statistically significant. The intention-to-treat method was applied to address outliers and missing data. Results:: Based on the findings, the current study demonstrates that supplementation with nano-curcumin can effectively mitigate symptoms of depression and anxiety (p < 0.05). Regarding stress, a noticeable reduction within the nano-curcumin group was observed, although it did not reach statistical significance when compared between groups (p > 0.05). Moreover, nano-curcumin exhibited a significant decrease in the frequency, duration, and severity of headaches (p < 0.05). Conclusion:: Our research findings have shown that supplementation with nano-curcumin can effectively decrease the frequency, severity, and duration of headaches while also alleviating symptoms of depression and anxiety in comparison to the placebo group. Hence, curcumin exhibits significant potential as an adjuvant therapy to enhance the treatment of migraines.

Evaluation of Cochlear Symptoms in Migraine Patients without Vestibular Migraine and/or Ménière's Disease.

Migraine pathogenic pathways may selectively target the cochlea. A qualitative and quantitative analysis of cochlear symptoms in migraine patients without vestibular migraine and/or Méniere's disease was conducted. We examined 60 consecutive patients with history of cochlear symptoms, including fullness, tinnitus, and hearing loss. Patients were divided into two groups based on migraine history: M (migraine) and nM (no migraine). The incidence of migraine was compared to a homogeneous control group with dysfunctional and inflammatory dysphonia without cochlear symptoms. The type, time of onset, recurrence, bilaterality of symptoms, and hearing threshold were analyzed. The incidence of migraine was significantly higher (p = 0.04) in patients with cochlear symptoms than in the control group. The onset of symptoms is significantly earlier (p < 0.05) in the presence of migraine. The fullness, recurrence, and bilaterality of symptoms are associated with migraine in a statistically significant way (p < 0.05). Pure tone audiometry shows a statistically significant increase in the hearing threshold (500-1000 Hz) in group M. Based on developing findings, cochlear migraine may be considered as a novel clinical entity, like vestibular migraine. It would be the expression, in the absence of vertiginous symptoms, of a selective suffering of the anterior labyrinth by known operating mechanisms of migraine.

Coping with stress, psychological resilience and psychiatric symptoms in migraine patients

Coping with stress, psychological resilience and psychiatric symptoms in migraine patients

Altered functional brain network patterns in patients with migraine without aura after transcutaneous auricular vagus nerve stimulation

Transcutaneous auricular vagus nerve stimulation (taVNS) shows excellent effects on relieving clinical symptoms in migraine patients. Nevertheless, the neurological mechanisms of taVNS for migraineurs remain unclear. In recent years, voxel-wise degree centrality (DC) and functional connectivity (FC) methods were extensively utilized for exploring alterations in patterns of FC in the resting-state brain. In the present study, thirty-five migraine patients without aura and thirty-eight healthy controls (HCs) were recruited for magnetic resonance imaging scans. Firstly, this study used voxel-wise DC analysis to explore brain regions where abnormalities were present in migraine patients. Secondly, for elucidating neurological mechanisms underlying taVNS in migraine, seed-based resting-state functional connectivity analysis was employed to the taVNS treatment group. Finally, correlation analysis was performed to explore the relationship between alterations in neurological mechanisms and clinical symptoms. Our findings indicated that migraineurs have lower DC values in the inferior temporal gyrus (ITG) and paracentral lobule than in healthy controls (HCs). In addition, migraineurs have higher DC values in the cerebellar lobule VIII and the fusiform gyrus than HCs. Moreover, after taVNS treatment (post-taVNS), patients displayed increased FC between the ITG with the inferior parietal lobule (IPL), orbitofrontal gyrus, angular gyrus, and posterior cingulate gyrus than before taVNS treatment (pre-taVNS). Besides, the post-taVNS patients showed decreased FC between the cerebellar lobule VIII with the supplementary motor area and postcentral gyrus compared with the pre-taVNS patients. The changed FC of ITG-IPL was significantly related to changes in headache intensity. Our study suggested that migraine patients without aura have altered brain connectivity patterns in several hub regions involving multisensory integration, pain perception, and cognitive function. More importantly, taVNS modulated the default mode network and the vestibular cortical network related to the dysfunctions in migraineurs. This paper provides a new perspective on the potential neurological mechanisms and therapeutic targets of taVNS for treating migraine.

Cluster and network analysis of non-headache symptoms in migraine patients reveals distinct subgroups based on onset age and vestibular-cochlear symptom interconnection.

The present study endeavors to identify natural subgroups of migraine patients based on the patterns of non-headache symptoms, utilizing cluster analysis. Subsequently, network analysis was performed to estimate the structure of symptoms and explore the potential pathophysiology of these findings. A total of 475 patients who met the diagnostic criteria for migraine were surveyed face-to-face during the period of 2019 to 2022. The survey included collecting demographic and symptom data. Four different solutions were generated by the K-means for mixed large data (KAMILA) clustering algorithm, from which the final cluster solutions were selected based on a series of cluster metrics. Subsequently, we performed network analysis using Bayesian Gaussian graphical models (BGGM) to estimate the symptom structure across subgroups and conducted global and pairwise comparisons between structures. Cluster analysis identified two distinct patient groups, and the onset age of migraine proved to be an effective characteristic differentiating the two patient groups. Participants assigned to late-onset group showed a longer course of migraine, higher frequency of monthly headache attacks, and greater tendency toward medication overuse. In contrast, patients in early-onset group exhibited a higher frequency of nausea, vomiting, and phonophobia compared to their counterparts in the other group. The network analysis revealed a different symptom structure between the two groups globally, while the pairwise differences indicated an increasing connection between tinnitus and dizziness, and a decreasing connection between tinnitus and hearing loss in the early-onset group. Utilizing clustering and network analysis, we have identified two distinct non-headache symptom structures of migraine patients with early-onset age and late-onset age. Our findings suggest that the vestibular-cochlear symptoms may differ in the context of different onset ages of migraine patients, which may contribute to a better understanding of the pathology of vestibular-cochlear symptoms in migraine.

The role of migraine-associated symptoms in the clinical picture of migraine pain

Migraine is a disorder of multisensory integration of somatosensory, visual, auditory, olfactory stimuli, which subsequently can lead to various combinations of symptoms: headache, photophobia, phonophobia, nausea/vomiting, osmophobia.The purpose of the study: To isolate the characteristics of pain phenomenon (frequency, duration, and severity of migraine symptoms) in relation to associated symptoms in migraine patients. Materials and Methods: 94 patients with frequent episodic and chronic migraine were included in a cross-sectional study. Research methods used: clinical, descriptive, statistical. Migraine patient questionnaires were used as a research instrument. Primary data were entered into Excel programs and processed in MedCalc. Results and discussion: A statistically significant positive correlation between phonophobia and throbbing headache was observed in the conducted study. Statistically significant positive correlations were found between the duration of a migraine attack (in hours) and some migraine-related symptoms, such as: anxiety, shortness of breath. Conclusions: Thus, intensity rather than duration of headache may be the trigger for most, but not all, of the associated symptoms. This study demonstrated the clinical significance of the pain phenomenon and symptoms associated with migraine. In order to isolate the specificity of migraine attacks and elucidate their features, the study of autonomic symptoms accompanying the pain phenomenon is a particularly important part of establishing a correct diagnosis.

Evaluation of the effectiveness of migraine therapy using functional resting MRI with course rhythmic transcranial magnetic stimulation

Introduction. In the context of the search for new migraine therapy options, strict control of their eff ectiveness by means of objective examination methods is required.Objective. Objective assessment of the eff ectiveness of TMS in patients with migraine on the basis of functional magnetic resonance imaging (fMRI) data.Material and methods. Resting-state fMRI before and after a fi ve-day course of TMS of the junction of the inferior frontal and temporal lobes bilaterally was performed in 19 patients with migraine. Changes in functional connectivity (FC) of the main neuronal networks of the brain, as well as clinical parameters of pain and quality of life of the patients were assessed before and after the course of TMS.Results. A decrease in pain intensity and anxiety scores, as well as a decrease in the number of acute pain medications taken, was observed against the background of the therapy. Changes in FC aff ected three main networks: the default mode network, the salience and visual networks. At the same time, decreased effi cacy of therapy was noted in patients with higher severity of depressive symptoms and presence of neuroimaging criteria of depression.Conclusion. The study suggests the effi cacy of TMS in patients with migraine based on neuroimaging criteria. It is worth paying special attention to the presence of depressive symptoms in migraine patients.

Depressive symptoms are correlated with periaqueductal gray matter functional connectivity in migraine

IntroductionDepression is the most common comorbidity of migraine. The brain of migraineurs with depression shows differences compared to migraine only or depression only patients. The comorbidity may affect specific regions such as the periaqueductal gray matter (PAG) which is important in negative emotion regulation and pain modulatory system.ObjectivesWe hypothesized that the alterations in PAG functional connectivity (FC) may play a role in migraineurs vulnerability for depression.MethodsA resting-state fMRI was conducted with 34 episodic migraine without aura patients and 41 control subjects. All participants were medication free and they did not have any psychiatric or chronic disorders. Depressive symptoms were measured with Zung Self-Rating Depression Scale. To investigate the relationship between depressive symptoms and PAG functional connectivity, Zung scores were used as covariates in each groups’ PAG-FC analysis using the Statistical Parametric Mapping (SPM12) toolbox in MATLAB environment.Results There were no significant difference between migraine and control group in Zung scores (p=0.394). Negative correlation was found between Zung scores and PAG-FC with thalamus, fusiform gyrus, middle occipital gyrus and calcarine (pFWE&lt;0.05) in migraine group. However, there was no significant correlation between Zung scores and PAG-FC in healthy control group.ConclusionsOur results suggest that PAG-FC with emotion and pain processing areas is affected by depressive symptoms in migraine patients, but not in healthy controls. Migraine patients without comorbid depression might have vulnerable neuronal pathways for depressive symptoms. A follow-up of these patients could be interesting to determine whether these connectivity alterations predict the possible comorbid depression.DisclosureHungarian Brain Research Program (2017-1.2.1-NKP-2017-00002, KTIA_13_NAPA-II/14, KTIA_NAP_13-1-2013- 0001, KTIA_NAP_13-2- 2015-0001); 2020-4.1.1.-TKP2020; ERA PerMed (2019-2.1.7-ERA-NET-2020-00005); ÚNKP-21-4-I-SE-15 (DB).

Effect of yoga nidra on the brain activity in individuals with migraine

Background: Migraine is a frequent neurological problem that carries the largest burden in terms of years spent disabled among neurological conditions. The conventional management has not been able to successfully treat migraine and hence, there was a need for combating these disorders through conventional therapies like yoga with an evidence-based approach. As there are only few evidence in this aspect, this research aims at finding evidence for yoga and naturopathy on migraine. Materials and Methods: Participants (n = 60) were randomly allocated into two groups, control group (n = 30) and intervention group (n = 30). The intervention group received Yoga Nidra and the control group was given supine rest (Rest without conscious awareness). The electroencephalogram data were recorded both at baseline and postintervention for both groups. The data were analyzed using SPSS version 20.0 (IBM Corp. Released 2011. IBM SPSS Statistics for Windows, Armonk, NY: IBM Corp), and the results were tabulated. Results: The results of the current study showed increased frequency in alpha waves in the interventional group compared to the control group. The control group showed no significant changes in the brain activity. Conclusion: The results indicate that Yoga Nidra induces relaxation through enhanced alpha waves. This shows that Yoga Nidra helps in parasympathetic dominance and hence decreases sympathetic activation. Hence, this study suggests that Yoga Nidra could be used as an effective tool in combating stress and neuropsychiatric symptoms in migraine patients.

Cranial autonomic symptoms in episodic migraine: An observational study from headache clinic of a tertiary care center of North India

Introduction: The presence of cranial autonomic symptoms (CAS) is a hallmark of trigeminal autonomic cephalalgia like cluster headache but their presence in migraine is also not uncommon. Like in trigeminal autonomic cephalalgias, the activation of the trigeminal autonomic reflex pathway is thought to be the possible explanation of the presence of cranial autonomic symptoms in migraine also. Previous studies suggested that around half of the patients of migraine suffer from these symptoms. The aim of our study was to observe the frequency of cranial autonomic symptoms in episodic migraine patients along with their clinical and autonomic characteristics. Methods and Materials: Fifty patients of episodic migraine attending the headache clinic of Dr. RMLIMS, Lucknow and fulfilling the diagnostic criteria of International classification of headache disorder third edition beta were randomly selected and enrolled in the study. The detailed interview regarding presence of cranial autonomic symptoms was recorded along with the clinical characteristics, demographic features and autonomic profile of the migraine patients. Results: About three-fourth (72%) of the patients were females. The mean age of study participants was 27.7±8.3 years. A considerable number of patients (54%) had a long duration (5-10 years) of illness and 70% of patients had severe headaches. Photophobia was the most common (88%) associated clinical symptoms while lacrimation was the most common (56%) cranial autonomic symptom in migraine patients. Among 50 patients of migraine 74% of patients were having at least one cranial autonomic symptoms. Conclusion: Cranial autonomic symptoms are common in patients of episodic migraine. More severe headache is more likely to be associated with the development of cranial autonomic symptoms.

Frequency of cranio-autonomic symptoms in the patients of migraine presenting in an outpatient department of Dow University Hospital: A cross-sectional study

Objectives. Migraine is a prevalent debilitating neurological disorder manifested by frequent episodes of pounding headache. Cranial autonomic symptoms are frequently reported in patients of trigeminal autonomic cephalgias, but various studies also documented these cranio-autonomic symptoms in migraine patients as well. The primary objective of our study is to evaluate the prevalence of cranio-autonomic symptoms (CAS) amongst the patients suffering from migraines. Material and methods. This study was conducted as a descriptive, cross-sectional survey involving patients attending the neurology clinic at Dow University Hospital. 132 patients met the inclusion criteria (according to ICHDIII) and were assessed for the frequency of cranio-autonomic symptoms. Outcomes. The mean age recorded was 26.37 ± 6.31 years, while the mean duration of diagnosis was 23.54 ± 16.52 months. The frequency of cranio-autonomic symptoms was observed among 55% of the patients suffering from migraines in our study. The prominent symptom observed was lacrimation (56%), followed by nasal congestion (31%) and rhinorrhea (28%). The least prevalent symptom was ptosis (4%). Lacrimation was found more likely to be associated with the male gender (p = 0.096), while forehead/ facial sweating was found more prevalent in females (p = 0.162). The ciliary injection was frequent in conjunction with unilateral rather than a bilateral headache in the migraine patients (p= 0.055), while lacrimation was the most common symptom in the 21-30 years of age group followed by ciliary injection which was exclusively conspicuous in the same age category (p = 0.020). Conclusions. Cranio-autonomic symptoms were detected prevailing in our study population, and may present as a confounding factor in physician’s daily practice to diagnose migraine.

Premonitory symptoms in glyceryl trinitrate triggered migraine attacks: a case-control study.

Spontaneous and pharmacologically provoked migraine attacks are frequently preceded by nonheadache symptoms called premonitory symptoms. Here, we systematically evaluated premonitory symptoms in migraine patients and healthy controls after glyceryl trinitrate (GTN) infusion. In women with migraine without aura (n = 34) and age-matched female controls (n = 24), we conducted systematically a semistructured interview assessing 21 possible premonitory symptoms every 15 minutes in the 5 hours after GTN infusion (0.5 µg/kg/min over 20 minutes). Migraine-like headaches occurred in 28/34 (82.4%) migraineurs (GTN responders). After GTN, 26/28 (92.9%) responders, 6/6 (100%) nonresponders, and 13/24 (54.2%) controls reported at least one possible premonitory symptom. Concentration difficulties (P = 0.011), yawning (P = 0.009), nausea (P = 0.028), and photophobia (P = 0.001) were more frequently reported by those migraineurs who developed a migraine-like attack vs healthy controls. Importantly, concentration difficulties were exclusively reported by those who developed a migraine-like attack. Thus, our findings support the view that GTN is able to provoke the naturally occurring premonitory symptoms and show that yawning, nausea, photophobia, and concentration difficulties are most specific for an impending GTN-induced migraine-like headache. We suggest that these symptoms may also be helpful as early warning signals in clinical practice with concentration difficulties exclusively reported by those who develop a migraine-like attack.

Low frequency activation of the sphenopalatine ganglion does not induce migraine-like attacks in migraine patients.

Cephalic autonomic symptoms occur in 27‒73% of migraine patients during attacks. The role of parasympathetic activation in migraine attack initiation remains elusive. Low frequency stimulation of the sphenopalatine ganglion increases parasympathetic outflow. In this study, we hypothesized that low frequency stimulation of the sphenopalatine ganglion would provoke migraine-like attacks in migraine patients. In a double-blind randomized sham-controlled crossover study, 12 migraine patients with a sphenopalatine ganglion neurostimulator received low frequency or sham stimulation for 30 min on two separate days. We recorded headache characteristics, cephalic autonomic symptoms, ipsilateral mechanical perception and pain thresholds, mean blood flow velocity in the middle cerebral artery (VMCA) and diameter of the superficial temporal artery during and after stimulation. Five patients (42%) reported a migraine-like attack after low frequency stimulation compared to six patients (50%) after sham (p = 1.000). We found a significant increase in mechanical detection thresholds during low frequency stimulation compared to baseline (p = 0.007). Occurrence of cephalic autonomic symptoms and changes in mechanical perception thresholds, VMCA and diameter of the superficial temporal artery showed no difference between low frequency stimulation compared to sham (p = 0.533). Low frequency stimulation of the sphenopalatine ganglion did not induce migraine-like attacks or autonomic symptoms in migraine patients. These data suggest that increased parasympathetic outflow by the sphenopalatine ganglion neurostimulator does not initiate migraine-like attacks.Study protocol: ClinicalTrials.gov registration number NCT02510742.

Investigating the mediating role of dysfunctional attitudes on the relationship between early maladaptive schemas and clinical symptoms in migraine patients

Investigating the mediating role of dysfunctional attitudes on the relationship between early maladaptive schemas and clinical symptoms in migraine patients

The effect of Neurofeedback Intervention on Quality of Life, Anxiety and Stress Symptoms in Migraine Patients

The effect of Neurofeedback Intervention on Quality of Life, Anxiety and Stress Symptoms in Migraine Patients

Impact of right-to-left shunt and transcatheter closure on the clinical features of migraine

Objectives: In this study, we aimed to explore the influence of right-to-left shunt (RLS) presence on the clinical features of migraine and to follow-up on the post-operative curative effect of transcatheter patent foramen ovale (PFO) closure on migraine features.Methods: A total of 103 migraine patients were divided into a mild volume RLS group, moderate volume RLS group, large volume RLS group and non-RLS group in accordance with contrast enhancement transcranial Doppler (c-TCD) findings. The Visual Analogue Scale (VAS) score, migraine frequency, migraine duration, migraine disability assessment (MIDAS) and headache impact test-6 (HIT-6) scores were compared amongst the different groups. A total of 39 patients with moderate or large RLS received transcatheter PFO closure and those patients were followed up by the same criteria.Results: The attack frequency, HIT-6 and MIDAS scores amongst the migraine patients with moderate or large RLS were significantly higher than those in patients from the mild RLS group and non-RLS group (p < .05). The transcatheter closure was successful in all patients (n = 39), and no post-operative complications were observed during the hospitalisation and follow-up period. The differences in VAS, HIT-6 and MIDAS scores as well as the headache duration were statistically significant amongst patients before and after PFO closure (p < .05).Conclusions: Moderate to large RLS significantly influenced the clinical features of migraine, and transcatheter PFO closure could significantly relieve headache symptoms in migraine patients with PFO.

Psychiatric symptoms in migraine patients and their attitudes towards psychological support on stigmatization

ObjectiveAlthough migraine patients experience more psychological problems when compared to the general population, they are usually not treated. The reasons for non-treatment of these problems are not clear. The anxiety and concern of migraine patients about stigmatization may also prevent them to express psychological symptoms. The present study aimed to investigate the attitudes and behavior of migraine patients about receiving psychological help and their concerns about stigmatization. Material and methodThe study group included 50 18–49 years old patients diagnosed with migraine in the neurology clinic and the control group included 50 healthy individuals with similar age, gender socio demographic characteristics with the study group. Attitude Scale Towards Seeking Professional Help (ASPH-SF), Self-Stigma in Seeking Professional Help Scale (SSPHS), Intentions to Seek Psychological Help Scale (ISHP), Stigma Scale for Receiving Psychological Help (SSRPH) and Symptom Checklist (SCL-90-R) were applied to all participants. FindingsThe comparison of the patient and control groups based on SCL-90-R findings demonstrated that the patient group scores in somatization, anxiety (p = 0.000), depression (p = 0.003), anger (p = 0.02), interpersonal sensitivity (p = 0.006), phobia (p = 0.001), paranoid thoughts (p = 0.012), psychosis (p = 0.031) subscales and additional subscale (p = 0.014) and general symptom index (p = 0.001) scores were higher. Based on SCL 90, it was found that patients with higher levels of symptoms had higher social stigma scores when compared to patients with lower symptom levels (p = 0.007). Migraine patients with high symptom levels were found to have significantly lower rates of seeking psychiatric help (14% vs 33%) when compared to the control group. There was no difference between the patient and control groups based on ASPH-SF, SSPHS, ISPH and SSRPH scale scores. ConclusionAlthough migraine patients exhibit higher levels of psychiatric symptoms when compared to healthy individuals, it was determined that only a minority of these patients receive psychiatric treatment. Especially patients with high level of psychiatric symptoms could have sought less psychiatric help due to the concerns of stigmatization.

Effects of topical vs injection treatment of cervical myofascial trigger points on headache symptoms in migraine patients: a retrospective analysis

BackgroundIn migraine patients with cervical myofascial trigger points whose target areas coincide with migraine sites (M + cTrPs), TrP anesthetic injection reduces migraine symptoms, but the procedure often causes discomfort. This study evaluated if a topical TrP treatment with 3% nimesulide gel has similar efficacy as the injection but produces lesser discomfort with higher acceptability by the patients.MethodsRetrospective analysis of medical charts of M + cTrPs patients in the period January 2012–December 2016 at a single Headache Center. Three groups of 25 patients each were included, all receiving migraine prophylaxis (flunarizine 5 mg/day) for 3 months and symptomatic treatment on demand. Group 1 received no TrP treatment, group 2 received TrP injections (bupivacaine 5 mg/ml at basis, 3rd, 10th, 30th and 60th day), group 3 received daily TrP topical treatment with 1.5 g of 3% nimesulide gel for 15 consecutive days, 15 days interruption and again 15 consecutive days. The following were evaluated: monthly number of migraine attacks and rescue medications, migraine intensity; pain thresholds to skin electrical stimulation (EPTs) and muscle pressure stimulation (PPTs) in TrP and target (basis, 30th, 60th and 180th days); discomfort from, acceptability of and willingness to repeat treatment (end of study). ANOVA for repeated measures and 1-way ANOVA were used to assess temporal trends in each group and comparisons among groups, respectively. Significance level was set at p < 0.05.ResultsMigraine improved over time in all groups, but significantly more and earlier in those receiving TrP treatment vs no TrP treatment (0.02 < p < 0.0001, 30–180 days for intensity and rescue medication, 60–180 days for number). All thresholds in the non-TrP-treated group did not change over time, while significantly improving in both the injection and nimesulide gel groups (0.01 < p < 0.0001, 30–180 days). Improvement of migraine and thresholds did not differ in the two TrP-treated groups. Discomfort was significantly lower, acceptability and willingness to repeat treatment significantly higher (0.05 < p < 0.0001) with gel than injection.ConclusionIn migraine patients, topical treatment of cervical TrPs with 5% nimesulide gel proves equally effective as TrP injection with local anesthetics but more acceptable by the patients. This treatment could be effectively associated to standard migraine prophylaxis to improve therapeutic outcomes.

Thyrotropin levels and severity of symptoms in migraine patients of tertiary headache center.

The role of thyroid regulation in migraine is poorly understood, and data is contradictory. To study the possible association of clinical features of migraine with patients' thyroid function. One hundred and thirty migraine patients of a tertiary headache center took part in an open-label, cross-sectional comparative study. The Migraine Disability Assessment questionnaire, Spielberger State-Trait Anxiety Inventory, Beck Depression Inventory, Vanderbilt's Questionnaire of Pain Management, Gothenburg Quality of Life Questionnaire and Migraine-Specific Quality of Life questionnaire were used. The effectiveness of the attacks' therapy was assessed according to the Migraine Assessment of Current Therapy questionnaire. Levels of thyrotropine (thyroid stimulating hormone), thyroxine, and triiodothyronine were studied by standard immune chemiluminescent method using the Immulite-2000 set. An inverse correlation between levels of thyroid stimulating hormone in serum and duration of headache attacks was revealed. The effectiveness of abortive therapy for attacks showed a statistically significant positive correlation with thyroid stimulating hormone level. Quality of life measured by a general quality of life questionnaire, as well as the functional and social indices of a migraine-specific questionnaire, showed direct correlation with serum thyroid stimulating hormone. These results show an association of a more severe clinical course of migraine with lower thyroid stimulating hormone levels.

Cyclic changes in sensations to painful stimuli in migraine patients.

Migraine is characterized by cycling phases (interictal, preictal, ictal and postictal) with differing symptoms, while in chronic tension type headache pain phases are fluctuating. The question we asked is whether these phases are associated with changes in parameters of somatosensation and axon-reflex erythema. Patients with episodic migraine and chronic tension type headache were examined psychophysically in the interictal, preictal and ictal phase and healthy subjects on five different test days. Thresholds and suprathreshold ratings of pressure and electrical pain were assessed on three different regions of the head. In migraine patients and in healthy controls, electrically induced axon-reflex erythema was measured in the area of the first trigeminal branch. All migraine patients filled out questionnaires about prodromal symptoms at every visit. The axon-reflex erythema was always larger in patients with migraine in contrast to healthy subjects. The pressure pain threshold was lower in migraine patients and chronic tension type headache in comparison to healthy subjects. Electrical pain thresholds did not differ between headache patients and healthy subjects and showed no changes between the phases. However, suprathreshold pain ratings showed less habituation solely in the preictal phase of migraine. The number of prodromal symptoms in migraine patients was increased in the preictal and ictal phase. Reduced habituation was the unique sign of the preictal phase in migraine patients, independently of prodromal symptoms, whereas a larger axon-reflex erythema and higher pressure pain sensitivity are constitutional and non-phase dependent properties of migraine. Reduced inhibitory mechanisms in the preictal phase may contribute to trigger headache attacks in migraine.