Migraine Type Research Articles

Cerebral Venous Sinus Pressure and Head Pain: A Case of Cough Headache Secondary to Superior Sagittal Sinus Stenosis (P3-12.009)

<h3>Objective:</h3> Headache triggered by cough is an uncommon disorder that can be primary or secondary in etiology. While the pathophysiology of cough headache is poorly described, there are several theories that suggest that an interplay of elevated intracranial pressure (ICP) and increased central venous pressure results in nociceptor activation with cough. We present a case of secondary cough headache resulting from sagittal sinus stenosis. <h3>Background:</h3> A 31-year old female with a history of migraine presented with a new headache described as 2–5 minute spikes of severe head pain triggered by cough or Valsalva. MRI brain imaging showed a 1.5 cm left para-falcine extra-axial mass involving the lateral wall of the sagittal sinus, most consistent with a meningioma. This finding was initially thought to be unrelated to her head pain. The patient’s head pain remained refractory to typical migraine treatments; however, it responded well to indomethacin and acetazolamide. Due to intolerable side effects, acetazolamide was tapered off and cough-induced head pain recurred. Venous manometry revealed a significant pressure gradient across the sagittal sinus stenosis. Her symptoms significantly improved with meningioma resection and superior sagittal venous stenting. <h3>Design/Methods:</h3> NA <h3>Results:</h3> NA <h3>Conclusions:</h3> This a rare presentation of cough headache secondary to superior sinus stenosis, which significantly improved on correction of increased venous pressure. This case highlights the role of pressure dynamics within the cerebral venous sinus system not only in the etiology of primary and secondary cough and other Valsalva-induced headaches, but also as a potential etiology in patients with idiopathic interracial hypertension with venous sinus stenosis. This case also suggests that venous stenting can be an alternative to acetazolamide. Prompt recognition of secondary causes of cough headache is essential for early intervention. <b>Disclosure:</b> Ms. Haddad has nothing to disclose. Dr. Wang has nothing to disclose. Dr. Parikh has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biohaven. Dr. Parikh has received personal compensation in the range of $500-$4,999 for serving as a Author with Medlink.

Clinical features and genetic analysis of two Chinese ATP1A2 gene variants pedigrees of familial hemiplegic migraine

ObjectiveTo analyze the clinical manifestations and genetic examination results of affected members of two Chinese ATP1A2 gene variants pedigrees, and to summarize their phenotypic and genotypic features. MethodsThe clinical features were recorded in detailed. The cranial magnetic resonance imaging for patients and gene sequencing of two Chinese ATP1A2 gene variant pedigrees were perform. The correlation between the types of variants and the clinical phenotypes of ATP1A2 gene were analyzed. ResultsThese two pedigrees are diagnosed as familial hemiplegic migraine type 2 (FHM2) with ATP1A2 heterozygous missense variants, c.1091C > T (p.T364M) found in pedigree 1 and c.899T > C (p.L300P) in pedigree 2. Multiple phenotypes coexist in both families, and the two probands have severe cranial magnetic resonance imaging manifesting hemiplegic contralateral cortical swelling and diffusion weighted imaging hyperintense signal, which can be fully recovered. ATP1A2 gene variants were seen in FHM2, sporadic hemiplegic migraine and atypical alternating hemiplegia of childhood (AHC) families or sporadic cases, etc. The clinical features of ATP1A2 variant c.1091C > T (p.T364M) are basically similar in Chinese patients and European patients. ConclusionThese two Chinese pedigrees had FHM2 due to ATP1A2 heterozygous missense variation. It would expand the understanding of ATP1A2.

Hypercontractile Cardiac Phenotype in Mice with Migraine-Associated Mutation in the Na+,K+-ATPase α2-Isoform.

Two α-isoforms of the Na+,K+-ATPase (α1 and α2) are expressed in the cardiovascular system, and it is unclear which isoform is the preferential regulator of contractility. Mice heterozygous for the familial hemiplegic migraine type 2 (FHM2) associated mutation in the α2-isoform (G301R; α2+/G301R mice) have decreased expression of cardiac α2-isoform but elevated expression of the α1-isoform. We aimed to investigate the contribution of the α2-isoform function to the cardiac phenotype of α2+/G301R hearts. We hypothesized that α2+/G301R hearts exhibit greater contractility due to reduced expression of cardiac α2-isoform. Variables for contractility and relaxation of isolated hearts were assessed in the Langendorff system without and in the presence of ouabain (1 µM). Atrial pacing was performed to investigate rate-dependent changes. The α2+/G301R hearts displayed greater contractility than WT hearts during sinus rhythm, which was rate-dependent. The inotropic effect of ouabain was more augmented in α2+/G301R hearts than in WT hearts during sinus rhythm and atrial pacing. In conclusion, cardiac contractility was greater in α2+/G301R hearts than in WT hearts under resting conditions. The inotropic effect of ouabain was rate-independent and enhanced in α2+/G301R hearts, which was associated with increased systolic work.

Abstract Number ‐ 89: Left M1 occlusion rescued by the Recurrent artery of Huebner: a spectrum of MCA collaterals

Introduction Proximal MCA occlusion has variable presentation and clinical course, ranging from MCA syndrome with completed infarct at presentation to asymptomatic, discovered incidentally on imaging. This variability is likely dictated by variable collateral circulation that ultimately fails on variable time courses. For discussion we can divide these into (1) rapid progressors, (2) standard, (3) slow progressors, (4) situationally symptomatic, and (5) asymptomatic. There is clear evidence for the role of endovascular therapy for those who are significantly symptomatic and progress along an acute timeline when combined with imaging criteria (1 and 2), but there is no clear guidance for those patients who progress slowly or are minimally symptomatic (3‐5). Methods We present selected cases of patients with left MCA occlusion from groups 3–5 along with their presentation and collateral flow as assessed by non‐invasive imaging and DSA. Results Case 1. Slow Progressor. A 63‐year‐old woman with past occipital lobe strokes presented with progressive aphasia of insidious onset that began at some point the previous day. NIHSS 4 for aphasia and LOC questions. Initial CTA revealed a left M1 occlusion with ASPECTS 9. Despite low NIHSS and extended time to LKW, she was brought to the angiography suite. Initial angiogram confirmed M1 occlusion with extensive collateralization via the left ACA and anterior temporal artery, but no reconstitution of the MCA proper. Thrombectomy was completed with TICI2B recanalization. Followup MRI revealed minimal infarct in the left insula. The patient was discharged with an NIHSS of 1 for a baseline hemianopia not appreciated on initial exam. Case 2. Situationally Symptomatic. A 55‐year‐old man with symptomatic epilepsy from bilateral subdural hygromas was admitted for video EEG monitoring of episodic dizziness and word‐finding difficulty. Initial exam revealed only orthostatic light‐headedness. Further history revealed these events often happed at night upon standing. No epileptiform events were captured. MRA revealed a complete occlusion of the proximal M1 with reconstitution at the M2 bifurcation in the sylvian fissure. Given lack of persistent clinical deficit and absence of infarct on MRI, DSA was deferred. The patient is followed outpatient without further symptom progression. Case 3. Asymptomatic. A 38 year‐old‐man with TBI presented to the emergency department with thunderclap headache. Initial exam was without deficits. CTA and MRA revealed complete occlusion of the left MCA. We proceeded to the angiography suite where DSA revealed complete left M1 occlusion with distal reconstitution at the M2 bifurcation primarily via the Recurrent Artery of Huebner in addition to ACA collaterals. Lumbar puncture was benign and his headache responded completely to typical migraine treatment. The patient was discharged to outpatient follow up without further sequalae. Conclusions We present a series of illustrative cases of patients with MCA occlusion of variable collateral supply and clinical course, none of whom met conventional criteria for endovascular intervention. More research is needed to establish clinical and imaging criteria to separate patients who would benefit from endovascular intervention from those who are best managed medically in these scenarios.

Clinical evaluation of super-responders vs. non-responders to CGRP(-receptor) monoclonal antibodies: a real-world experience

BackgroundClinical trials and real-world studies revealed a spectrum of response to CGRP(-receptor) monoclonal antibodies (mAbs) in migraine prophylaxis, ranging from no effect at all to total migraine freedom. In this study, we aimed to compare clinical characteristics between super-responders (SR) and non-responders (NR) to CGRP(-receptor) mAbs.MethodsWe performed a retrospective cohort study at the Headache Center, Charité – Universitätsmedizin Berlin. The definition of super-response was a ≥ 75% reduction in monthly headache days (MHD) in the third month after treatment initiation compared to the month prior to treatment begin (baseline). Non-response was defined as ≤ 25% reduction in MHD after three months of treatment with a CGRP-receptor mAb and subsequent three months of treatment with CGRP mAb, or vice versa. We collected demographic data, migraine disease characteristics, migraine symptoms during the attacks in both study groups (SR/NR) as well as the general medical history. SR and NR were compared using Chi-square test for categorical variables, and t-test for continuous variables.ResultsBetween November 2018 and June 2022, n = 260 patients with migraine received preventive treatment with CGRP(-receptor) mAbs and provided complete headache documentation for the baseline phase and the third treatment month. Among those, we identified n = 29 SR (11%) and n = 26 NR (10%). SR reported more often especially vomiting (SR n = 12/25, 48% vs. NR n = 4/22, 18%; p = 0.031) and typical migraine characteristics such as unilateral localization, pulsating character, photophobia and nausea. A subjective good response to triptans was significantly higher in SR (n = 26/29, 90%) than in NR (n = 15/25, 60%, p = 0.010). NR suffered more frequently from chronic migraine (NR n = 24/26, 92% vs. SR n = 15/29, 52%; p = 0.001), medication overuse headache (NR n = 14/24, 58% versus SR n = 8/29, 28%; p = 0.024), and concomitant depression (NR n = 17/26, 65% vs. SR n = 8/29, 28%; p = 0.005).ConclusionSeveral clinical parameters differ between SR and NR to prophylactic CGRP(-R) mAbs. A thorough clinical evaluation prior to treatment initiation might help to achieve a more personalized management in patients with migraine.

Clinical characteristics, medication use, and impact of primary headache on daily activities: an observational study using linked online survey and medical claims data in Japan

BackgroundLimited epidemiological data are available for headache disorders in Japan, and no recent studies have reported the impact of several primary headache disorders in Japan. This study aimed to report the up-to-date epidemiological data and impact of primary headaches on daily activities as well as the use of medical care, clinical features, and pain severity/activity impairment using nationwide data in Japan.MethodsWe used anonymized online survey data coupled with medical claims data, from individuals aged 19–74 years old, that were provided by DeSC Healthcare Inc. The outcomes included the prevalence of migraine, tension-type headache, cluster headache, and other headache types stratified by age and sex, use of medical care, clinical features, medication use, and severity of pain/activity impairment. All outcomes were examined separately for each headache type. This is the second paper reported concurrently with this research.ResultsThe study population comprised 691/1,441/21/5,208 individuals with migraine/tension-type headache/cluster headache/other headache types, respectively. The prevalence of migraine and tension-type headache was higher in women than in men but was similar for cluster headache (male vs. female, 1.7% vs. 7.4%, 5.3% vs. 10.8%, and 0.1% vs. 0.1%, respectively). The percentage of individuals with migraine, tension-type headache, cluster headache who had not seen a doctor was 81.0%, 92.0%, 57.1%, respectively. The common headache triggers were fatigue in migraine and tension-type headache, and weather-related phenomena and turning of the seasons in migraine. Common activities refrained from or reduced by headaches were “operating a computer or smartphone”, “drinking alcohol”, and “going to crowded places” in all three headache types and housework-related activities in women. Among individuals taking medicines, 16.8%, 15.8%, 47.6% with migraine, tension-type headache, and cluster headache reported moderate to severe pain, respectively, and 12.6%, 7.7%, 19.0% reported moderate to severe disability, respectively.ConclusionsThis study found various triggers of headache attacks, and daily activities refrained from or reduced by headaches. Additionally, this study suggested that the disease burden in people possibly experiencing tension-type headaches, many of whom had not seen a doctor. The study findings are of clinical value for the diagnosis and treatment of primary headaches.

White Matter Lesions Identified by Magnetic Resonance in Women with Migraine: A Volumetric Analysis and Clinical Correlations.

Repeated migraine attacks and aura could independently cause structural changes in the central nervous system. Our research aims to study the correlation of migraine type, attack frequency, and other clinical variables with the presence, volume and localization of white matter lesions (WML), in a controlled study. Sixty volunteers from a tertiary headache center were selected and divided equally into four groups: episodic migraine without aura (MoA), episodic migraine with aura (MA), chronic migraine (CM) and controls (CG). Voxel-based morphometry techniques were used to analyze WML. There were no differences in WML variables between groups. There was a positive correlation between age and the number and total volume of WMLs, which persisted in the comparison categorized by size and brain lobe. Disease duration was positively correlated with the number and total volume of WML, and when controlled by age, the correlation maintained significance only for the insular lobe. Aura frequency was associated with frontal and temporal lobe WMLs. There was no statistically significant correlation between WML and other clinical variables. Migraine overall is not a risk factor for WML. Aura frequency is, however, associated with temporal WML. Disease duration, in adjusted analyses that account for age, is associated with insular WML.

Use of combined hormonal contraception and stroke: A case-control study of the impact of migraine type and estrogen dose on ischemic stroke risk.

To clarify how factors such as estrogen dose and migraine history (including migraine subtype) impact ischemic stroke risks associated with combined hormonal contraceptive (CHC) use. CHC use in those with migraine with aura has been restricted due to concerns about stroke risk. We conducted a case-control analysis of stroke risk associated with estrogen dose and migraine history among CHC users in a large tertiary care center. All women aged 18-55 who used a CHC between January 1, 2010, and December 31, 2019, were identified. Those with a stroke diagnosis were identified using ICD codes and confirmed via chart and imaging review. Details of personal and family medical history, stroke evaluation, ethinyl estradiol dosing (EE; ≥30 vs. <30 μg), and demographics were collected. From a random sample of 20,000 CHC users without stroke, a control cohort (n=635) was identified and matched based on patient characteristics, medical and family histories, as well as stroke risk factors, to assess association between migraine diagnosis, migraine subtype, estrogen dose, and stroke. Of the 203,853 CHC users in our cohort, 127 had confirmed stroke (0.06%; CI 0.05%, 0.07%). In unadjusted analyses, a higher number of patients in the case cohort had a diagnosis of migraine (34/127, 26.8%) compared to controls (109/635, 17.2%; p=0.011). Stroke risk was higher with ≥30-μg EE doses compared to those using a <30-μg dose (OR, 1.52; CI 1.02, 2.26; p=0.040). Compared to no migraine, personal history of migraine increased the odds of stroke (OR, 2.00; CI 1.27, 3.17; p=0.003). Compared to no migraine, stroke risk was not significantly increased in those with migraine with aura, but migraine without aura increased the risk (OR, 2.35; CI 1.32, 4.2; p=0.004). Overall stroke risk in our cohort of CHC users was low. When CHCs are used in those with migraine, formulations containing ≤30 μg EE are preferred. Shared decision-making should include discussions about ischemic stroke risks in patients with migraine, even those without aura.

Human Brain Organoids in Migraine Research: Pathogenesis and Drug Development.

Human organoids are small, self-organized, three-dimensional (3D) tissue cultures that have started to revolutionize medical science in terms of understanding disease, testing pharmacologically active compounds, and offering novel ways to treat disease. Organoids of the liver, kidney, intestine, lung, and brain have been developed in recent years. Human brain organoids are used for understanding pathogenesis and investigating therapeutic options for neurodevelopmental, neuropsychiatric, neurodegenerative, and neurological disorders. Theoretically, several brain disorders can be modeled with the aid of human brain organoids, and hence the potential exists for understanding migraine pathogenesis and its treatment with the aid of brain organoids. Migraine is considered a brain disorder with neurological and non-neurological abnormalities and symptoms. Both genetic and environmental factors play essential roles in migraine pathogenesis and its clinical manifestations. Several types of migraines are classified, for example, migraines with and without aura, and human brain organoids can be developed from patients with these types of migraines to study genetic factors (e.g., channelopathy in calcium channels) and environmental stressors (e.g., chemical and mechanical). In these models, drug candidates for therapeutic purposes can also be tested. Here, the potential and limitations of human brain organoids for studying migraine pathogenesis and its treatment are communicated to generate motivation and stimulate curiosity for further research. This must, however, be considered alongside the complexity of the concept of brain organoids and the neuroethical aspects of the topic. Interested researchers are invited to join the network for protocol development and testing the hypothesis presented here.

Description of recurrent headaches in 7–14-year-old children: Baseline data from a randomized clinical trial on effectiveness of chiropractic spinal manipulation in children with recurrent headaches

BackgroundHeadaches in children are poorly described and diagnosing can be challenging. Objectives are: (1) to describe headache characteristics and child characteristics, (2) to explore whether data can suggest a more diverse way to categorize headaches than traditionally.MethodsBaseline data for a clinical trial included a questionnaire and a physical screening. Children's characteristics and detailed description of headache symptoms were provided. Children were classified for migraine or tension-type-headache based on questionnaire data reported by children and parents. This required to apply slightly modified classification criteria and a “non-classifiable” group was added. Severity and symptoms, related to the migraine versus tension type distinction, were investigated to define a migraine-tension-type-index.Results253 children were included. Mean pain intensity was 5.9/10. Over 2/3 of the children had headache for > 1 year, and > 50% for several days/week. Half of the children were non-classifiable, 22% were classified as migraine and 23% as tension-type headache. A migraine-tension-type-index was constructed and describes a continuous spectrum rather than two distinct groups.ConclusionsChildren with recurrent headaches are often severely affected. A questionnaire-based classification appeared feasible to distinguish between migraine and tension-type headaches in children but leaving many children unclassified. A migraine-tension-type-index can be generated allowing to regard the traditional distinction as a continuum (including mixed headache), and potentially serving as an instrument to improve headache management.Trial registration ClinicalTrials.gov, identifier NCT02684916.

Cerebrospinal Fluid and Plasma Amine Profiles in Interictal Migraine.

Impaired amine metabolism has been associated with the etiology of migraine, that is, why patients continue to get migraine attacks. However, evidence from cerebrospinal fluid (CSF) is lacking. Here, we evaluated individual amine levels, global amine profiles, and amine pathways in CSF and plasma of interictal migraine patients and healthy controls. CSF and plasma were sampled between 8:30 am and 1:00 pm, randomly and interchangeably over the time span to avoid any diurnal and seasonal influences, from healthy volunteers and interictal migraine patients, matched for age, sex, and sampling time. The study was approved by the local medical ethics committee. Individual amines (n=31), global amine profiles, and specific amine pathways were analyzed using a validated ultraperformance liquid chromatography mass spectrometry platform. We analyzed n=99 participants with migraine with aura, n=98 with migraine without aura, and n=96 healthy volunteers. Univariate analysis with Bonferroni correction indicated that CSF L-arginine was reduced in migraine with aura (10.4%, p< 0.001) and without aura (5.0%, p= 0.03). False discovery rate-corrected CSF L-phenylalanine was also lower in migraine with aura (6.9%, p= 0.011) and without aura (8.1%, p= 0.001), p= 0.088 after Bonferroni correction. Multivariate analysis revealed that CSF global amine profiles were similar for both types of migraine (p= 0.64), but distinct from controls (p= 0.009). Global profile analyses were similar in plasma. The strongest associated pathways with migraine were related to L-arginine metabolism. L-Arginine was decreased in the CSF (but not in plasma) of interictal patients with migraine with or without aura, and associated pathways were altered. This suggests that dysfunction of nitric oxide signaling is involved in susceptibility to getting migraine attacks. ANN NEUROL 2023;93:715-728.

Infantile Colic and Long-Term Outcomes in Childhood: A Narrative Synthesis of the Evidence.

About 1 in 4 infants comes forward with prolonged crying, agitation, or infant colic (IC) during the first three months of life and is referred for medical evaluation. The pathogenesis remains poorly understood, as do its implications for future health. The aim of this narrative review was to critically examine and discuss the available literature on long-term consequences of excessive crying and/or colic. Most studies display an association between IC and the onset of functional gastrointestinal disorders (FGIDs) years later, probably related to the presence of common etiopathogenetic factors (environmental, dietary, intestinal dysmotility, visceral hypersensitivity). Although allergic disease in first-degree relatives may be a risk factor for IC, the latter does not appear to be a risk factor for subsequent atopic disease in the individual. Overall, there seems to be a relationship between IC and subsequent headaches, of the migraine type. Similarly, behavioral problems in children with a history of IC appear to be associated with higher parental stress scores. However, the current evidence is based on associations, and currently, a causal relationship between excessive crying and IC and long-term consequences remains not documented.

Role of Migraine as a Risk Factor of Ischemic Stroke in Young Women

Background: Migraine is a chronic primary headache disorder with episodic attacks which affects the people in the most productive periods of their working lives; women are affected up to four times more often than men. Objective: The purpose of the present study was to identify the association of migraine and risk of ischemic stroke in young women.&#x0D; Methodology: It’s a hospital based case-control study carried out in the Department of Neurology, Bangabandhu Sheikh Mujib Medical University from January 2010 to December, 2012.&#x0D; Results: The result obtained from our study shows that migraine and ischemic stroke were strongly associated; 60% (95% confidence interval 48% to 71%) of cases had migraine compared with 30%(23% to 37%) of controls (P &lt; 000 1). This association persisted after we controlled for age, history of hypertension, use of oral contraceptives, and smoking.Women with migraine had a more than threefold increased risk of ischemic stroke compared with women without migraine. This increase occurred with both types of migraine, although the risk was higher with migraine with aura (odds ratio 6-2) than with migraine without aura.&#x0D; Conclusion: In conclusion, the risk of ischemic stroke was higher among young women with migraine who smoked or who took oral contraceptives.&#x0D; Journal of National Institute of Neurosciences Bangladesh, July 2022;8(2):193-197

The Effects of Vitamin B-Complex Supplementation on Serum Homocysteine Levels and Migraine Severity in Children A Randomized Controlled Trial.

Given that deficiency in B vitamins can lead to the accumulation of homocysteine (Hcy), and hyperhomocysteinemia may have a role in migraine pathogenesis, the present prospective randomized double-blinded placebo-controlled trial aimed to evaluate the effect of vitamin B-complex supplementation on the alleviation of migraine in children through a possible reduction in Hcy levels. Ninety children under 15 years of age suffering from typical migraine were included in the present trial. They were randomly assigned into two groups (forty-five patients in each group) to receive either vitamin B-complex or a matching placebo for six months. Serum Hcy levels and headache characteristics were evaluated and compared before and after administering vitamin B-complex or placebo. Unlike the placebo group, the monthly headache frequency, severity of headache, headache disability, and serum Hcy levels were significantly decreased after the vitamin administration. The headache duration was not significantly different before and after the treatment. In the vitamin group, there were significant positive correlations between the frequency and severity, frequency and disability, and severity and disability of headaches. Hcy also had significant positive correlations with the frequency and disability of headaches. In the placebo group, the only found significant correlation was between headache frequency and disability. The administration of vitamin B-complex might effectively relieve migraine severity in children by reducing serum Hcy. However, further studies are needed to confirm the results.

Quality of sleep and disability associated with headache: migraine versus tension-type headache: A comparative study.

One of the commonest and most frequently said, quoted and understood by even the least educated elements of our society is the neurological symptom of headache. The commonly diagnosed and studied headaches are Migraine and Tension type headache [TTH]. Headache has the power to reduce the very essence of a peaceful life and produce a disability in a person. The aim of our study is to approach the subject with view of correlation of quality of sleep with the disability associated with migraine and compare it to TTH. For the same a cross-sectional study design was adopted and a consecutive sampling procedure was adopted. The sample was subjected to basic socio-demography, VAS, PSQI and HDI. Statistical analysis was done on the collected data. Based on scales the results were evaluated using appropriate statistical methods. It was observed that there was a higher female preponderance in both migraine and TTH, there was severe disability associated and both headaches cause poor sleep quality. The current study concludes that headache is a debilitating illness which causes significant disability to a person.

Astrocytic Glutamate Transporters and Migraine.

Glutamate levels and lifetime in the brain extracellular space are dinamically regulated by a family of Na+- and K+-dependent glutamate transporters, which thereby control numerous brain functions and play a role in numerous neurological and psychiatric diseases. Migraine is a neurological disorder characterized by recurrent attacks of typically throbbing and unilateral headache and by a global dysfunction in multisensory processing. Familial hemiplegic migraine type 2 (FHM2) is a rare monogenic form of migraine with aura caused by loss-of-function mutations in the α2 Na/K ATPase (α2NKA). In the adult brain, this pump is expressed almost exclusively in astrocytes where it is colocalized with glutamate transporters. Knockin mouse models of FHM2 (FHM2 mice) show a reduced density of glutamate transporters in perisynaptic astrocytic processes (mirroring the reduced expression of α2NKA) and a reduced rate of glutamate clearance at cortical synapses during neuronal activity and sensory stimulation. Here we review the migraine-relevant alterations produced by the astrocytic glutamate transport dysfunction in FHM2 mice and their underlying mechanisms, in particular regarding the enhanced brain susceptibility to cortical spreading depression (the phenomenon that underlies migraine aura and can also initiate the headache mechanisms) and the enhanced algesic response to a migraine trigger.

Cervical cord infarction mimicking migraine in a patient with vertebral artery dissection.

Cervical cord infarction mimicking migraine in a patient with vertebral artery dissection.

A Case-Control Study to Analyze the Association Between the Frequency of Headaches and Depression or Anxiety in Patients Suffering from Migraine

Objective: The present study aims at investigating the presence of depression or anxiety in patients suffering from migraine. Study design: A case-control study Place and Duration: This study was conducted at Neurological Institute, Cleveland Clinic Abu Dhabi, UAE from April 2021 to April 2022 Methodology: A total of 400 participants were included in this study. The stratification of migraine was done based on the frequency of the attacks, the presence or absence of the aura, and some other significant variables. Clinical data, such as sleep characteristics, and demographic data were collected. The multivariable linear regression method was employed for the examination of the frequency of headache attacks and their association with the symptoms of anxiety and depression, as per the indication given by Hospital Anxiety and Depression Subscales (HADS) and Beck's Depression Inventory (BDI). Results: The score of BDI was highest in the patients with chronic migraine and it was 12.9±7.8. It was 11.8±8.1 in the patients with high-frequency migraine, 10.5±7.5 in the medium frequency, 9.2±7.2 in low frequency, and 6.4±5.5 in the non-migraine participants in the control group. The trend was significant (p&lt;0.001). The results were similar for the HADS scores. HADS and BDI scores were related independently to chronic migraine frequency, high-frequency episodic, and poor quality of sleep. A relationship between the frequency of migraine and BDI was found in both aura-absent (p=0.029) and the aura-present group (p=0.001). Conclusion: There is a significant association between a higher frequency of headaches and depression/anxiety. This relationship is important in both types of migraine; ie with aura and without aura. Keywords: depression, anxiety, migraine, headache, frequency

Migraine in university students: A systematic review and meta-analysis.

Migraine is a complex, neurobiological disorder usually presenting as a unilateral, moderate to severe headache accompanied by sensory disturbances. Migraine prevalence has risen globally, affecting 14% of individuals and 16% of students and carries many negative impacts in both cohorts. With no recent meta-analysis of global migraine prevalence or associated factors in students, this systematic review and meta-analysis were conducted. The review was registered with PROSPERO (CRD42020167927). Electronic databases (n=12) were searched for cross-sectional studies (1988 to August 2021, IHS criteria). Ninety-two articles were meta-analysed and 103 were narratively reviewed. The risk of bias was assessed using an established tool. The risk of bias ranged from low to moderate. Migraine pooled prevalence (R-Studio) was demonstrated at 19% (95% CI, 16%-22%, p < 0.001, I^2 98%): females 23% (95% CI, 19%-27%, p < 0.001), males 12% (95% CI, 9%-15%, p < 0.001). Gender (p < 0.0001), geographical region (p= 0.01), migraine types (p= 0.0002) and prevalence timeframes (p= 0.02) may be influencing the substantial heterogeneity. Migraine triggers were primarily behavioural and environmental and treatments were predominantly pharmaceutical. Impacts ranged from academic performance impairment to psychological co-morbidities. This study offers the most comprehensive overview of migraine prevalence and associated factors in university students. Migraine prevalence in university students has increased and has many negative effects. Enhancing migraine recognition and management at university may have positive implications for an improved educational experience, as well as for the burden migraine currently incurs, both in university and beyond. This global systematic review and meta-analysis of 92 studies and narrative review of 103 studies provide the most comprehensive synthesis to date of migraine prevalence and associated factors in university students. Pooled prevalence has increased to 19%. The significant heterogeneity demonstrated is influenced by gender, geographical region, migraine type and prevalence timeframes. Students manage migraines primarily with pharmaceuticals. Further studies conducted in low and middle-income countries, following headache protocols and reporting frequency of treatment-seeking and medication usage are warranted.

The ATP1A2 Mutation Associated with Hemiplegic Migraines: Case Report and Literature Review

Familial hemiplegic migraine type 2 is a premonitory subtype of migraine caused by an ATP1A2 gene mutation. It is an autosomal dominant genetic disease. Here, we report a 51-year-old woman who had a migraine attack due to a pathogenic ATP1A2 gene mutation. With frequent attacks, the patient developed complete left hemiplegia, a confusion of consciousness and partial seizures. Magnetic resonance imaging showed extensive angiogenic edema in the right cerebral hemisphere. In this article, we review the latest literature and try to explain the above symptoms in our patient with cortical spreading depression (CSD) and ATP1A2 gene mutations.