1
|
Wu S, Zhao T, Jin L, Gong M. Exploring the synergistic effects of chuanxiong rhizoma and Cyperi rhizoma in eliciting a rapid anti-migraine action based on pharmacodynamics and pharmacokinetics. JOURNAL OF ETHNOPHARMACOLOGY 2024; 335:118608. [PMID: 39053709 DOI: 10.1016/j.jep.2024.118608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 07/09/2024] [Accepted: 07/21/2024] [Indexed: 07/27/2024]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Herb-herb combination has been used to maximize the therapeutic efficacy in the theory of traditional Chinese medicine. Chuanxiong rhizoma (called Chuanxiong in Chinese, CX) and Cyperi rhizoma (called Xiangfu in Chinese, XF) have been used alone or in combination (CRCR) to treat migraine dating back to Eastern Jin Dynasty (AD317) of China. But no data demonstrate the possible necessities or advantages of combining CX and XF for migraine. AIM OF THE STUDY This study explores the combination mechanism based on pharmacodynamics and pharmacokinetics. MATERIALS AND METHODS A nitroglycerin-induced acute migraine model in rats was used to evaluate the anti-migraine effects of CRCR and the individual herbs using behavior, real time polymerase chain reaction and Western blot experiments. The absorption characteristics of active components involved in the anti-migraine action were analyzed by UPLC-MS/MS. RESULTS CX and CRCR significantly reversed the abnormal levels of vasoactive substances (5-HT, CGRP, MMP-2 and MMP-9) to normal levels, but XF did not. XF and CRCR significantly decreased the pro-inflammatory cytokines (IL-1β, IL-6, and TNF-a), and increased the anti-inflammatory cytokines (IL-4 and IL-10). CRCR significantly decreased the mRNA expression levels of c-fos, iNos and nNos, and the corresponding protein expression levels of c-Fos, iNOS, and nNOS. CRCR inhibited NOS/NO pathway by downregulating the expression levels of NOS and NO. Furthermore, CRCR significantly increased the intestinal absorption rate and amount, and changed the pharmacokinetic parameters of active components in comparison with the individual herbs. CONCLUSIONS CX had an advantage in regulating vasoactive substances, and XF focused on regulating inflammatory cytokines. CRCR is more effective in treating migraine than the individual herbs by depending on the synergistic action of CX and XF. This research provided some critical evidences on synergistic action between herb-herb interactions, and revealed the potential advantages of herb-herb combination in traditional Chinese medicine.
Collapse
Affiliation(s)
- Sha Wu
- Beijing Key Lab of TCM Collateral Disease Theory Research, School of Traditional Chinese Medicine, Capital Medical University, Beijing, 100069, China.
| | - Ting Zhao
- Beijing Key Lab of TCM Collateral Disease Theory Research, School of Traditional Chinese Medicine, Capital Medical University, Beijing, 100069, China.
| | - Linli Jin
- Beijing Key Lab of TCM Collateral Disease Theory Research, School of Traditional Chinese Medicine, Capital Medical University, Beijing, 100069, China.
| | - Muxin Gong
- Beijing Key Lab of TCM Collateral Disease Theory Research, School of Traditional Chinese Medicine, Capital Medical University, Beijing, 100069, China.
| |
Collapse
|
2
|
Babek N, Fiechter C, Caretti R, Phinney T. Treatment of migraine with aura with osteopathic manipulative treatment: a case report with renewed perspectives. J Osteopath Med 2024:jom-2023-0228. [PMID: 39263717 DOI: 10.1515/jom-2023-0228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 06/28/2024] [Indexed: 09/13/2024]
Abstract
Migraines make up a significant number of office visits every year, yet their pathophysiology and etiology remain largely elusive. This case report presents a 33-year-old patient who originally presented to the emergency department (ED) as a stroke alert and was later determined to have migraine with aura. The patient experienced an acute onset of headache, dizziness, and new-onset expressive aphasia. Before administration of a migraine cocktail, osteopathic manipulative treatment (OMT) was performed and was able to fully resolve all of her symptoms. In an effort to explain the outcomes in this case, a review of the current literature was performed, which provides an interesting perspective on the interplay of the musculoskeletal system and neuroanatomy. The literature establishes that somatic dysfunctions in the cervical vertebrae and trapezius may play a role in migraines and provide rationale for the use of OMT.
Collapse
Affiliation(s)
- Natan Babek
- Lake Erie College of Osteopathic Medicine, Bradenton, FL, USA
| | | | - Rachael Caretti
- University of Pittsburgh Medical Center Harrisburg, Harrisburg, PA, USA
| | - Trevor Phinney
- University of Pittsburgh Medical Center Hamot, Erie, PA, USA
| |
Collapse
|
3
|
Cropper HC, Conway CM, Wyche W, Pradhan AA. Glial activation in pain and emotional processing regions in the nitroglycerin mouse model of chronic migraine. Headache 2024; 64:973-982. [PMID: 38899347 DOI: 10.1111/head.14740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 02/15/2024] [Accepted: 04/12/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE Our aim was to survey astrocyte and microglial activation across four brain regions in a mouse model of chronic migraine. BACKGROUND Chronic migraine is a leading cause of disability, with higher rates in females. The role of central nervous system neurons and glia in migraine pathophysiology is not fully elucidated. Preclinical studies have shown abnormal glial activation in the trigeminal nucleus caudalis of male rodents. No current reports have investigated glial activation in both sexes in other important brain regions involved with the nociceptive and emotional processing of pain. METHODS The mouse nitroglycerin model of migraine was used, and nitroglycerin (10 mg/kg) or vehicle was administered every other day for 9 days. Prior to injections on days 1, 5, and 9, cephalic allodynia was determined by periorbital von Frey hair testing. Immunofluorescent staining of astrocyte marker, glial fibrillary protein (GFAP), and microglial marker, ionized calcium binding adaptor molecule 1 (Iba1), in male and female trigeminal nucleus caudalis, periaqueductal gray, somatosensory cortex, and nucleus accumbens was completed. RESULTS Behavioral testing demonstrated increased cephalic allodynia in nitroglycerin- versus vehicle-treated mice. An increase in the percent area covered by GFAP+ cells in the trigeminal nucleus caudalis and nucleus accumbens, but not the periaqueductal gray or somatosensory cortex, was observed in response to nitroglycerin. No significant differences were observed for Iba1 staining across brain regions. We did not detect significant sex differences in GFAP or Iba1 quantification. CONCLUSIONS Immunohistochemical analysis suggests that, at the time point tested, immunoreactivity of GFAP+ astrocytes, but not Iba1+ microglia, changes in response to chronic migraine-associated pain. Additionally, there do not appear to be significant differences between males and females in GFAP+ or Iba1+ cells across the four brain regions analyzed.
Collapse
Affiliation(s)
- Haley C Cropper
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Catherine M Conway
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Whitney Wyche
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Amynah A Pradhan
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA
- Center for Clinical Pharmacology, Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri, USA
| |
Collapse
|
4
|
Kabaya K, Takahashi M, Esaki S, Minakata T, Iwasaki S. Impact of Migraine on the Tinnitus-Specific Health-Related Quality of Life and Psychiatric Comorbidities in Patients with Tinnitus. Otol Neurotol 2024; 45:e570-e575. [PMID: 39142307 DOI: 10.1097/mao.0000000000004278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/16/2024]
Abstract
OBJECTIVE To investigate the impact of migraine on the tinnitus-specific health-related quality of life (HRQOL) and psychiatric comorbidities in patients with tinnitus. METHODS This cross-sectional study included 227 consecutive patients with tinnitus as their primary complaint. Patients who were diagnosed as having comorbid migraine were asked whether their tinnitus exacerbated during attacks of migraine. All the patients completed three questionnaires: the Tinnitus Handicap Inventory (THI), the Hearing Handicap Inventory for Adults (HHIA) or its counterpart for the Elderly (HHIE), and the Hospital Anxiety and Depression Scale (HADS). RESULTS Among the 227 tinnitus patients, 60 (26.4%) had comorbid migraine. There were no significant differences in the THI or HHIA/HHIE scores between patients with migraine and those without migraine (both p > 0.05). The HADS score was significantly higher in patients with migraine than those without migraine (p < 0.05).Out of the 60 tinnitus patients with comorbid migraine, 27 (45.0%) experienced exacerbation of tinnitus during migraine attacks. Patients whose tinnitus exacerbated during migraine attacks had significantly higher scores in THI, HHIA/HHIE, and HADS compared to those whose tinnitus did not change during migraine attacks (p < 0.05 for THI and HADS, p < 0.01 for HHIA/HHIE). CONCLUSION The presence of migraine did not affect the tinnitus-specific HRQOL in tinnitus patients but had significant impacts on their psychiatric comorbidities. However, in patients who experienced exacerbation of tinnitus during migraine attacks, the presence of migraine had a significant impact on the tinnitus-specific HRQOL, hearing handicap, and psychiatric comorbidities.
Collapse
Affiliation(s)
- Kayoko Kabaya
- Department of Otolaryngology, Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | | | | | | | | |
Collapse
|
5
|
Chen ZF, Kong XM, Yang CH, Li XY, Guo H, Wang ZW. Global, regional, and national burden and trends of migraine among youths and young adults aged 15-39 years from 1990 to 2021: findings from the global burden of disease study 2021. J Headache Pain 2024; 25:131. [PMID: 39134934 PMCID: PMC11318134 DOI: 10.1186/s10194-024-01832-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2024] [Accepted: 07/18/2024] [Indexed: 08/15/2024] Open
Abstract
BACKGROUND Migraine, a widespread neurological condition, substantially affects the quality of life, particularly for adolescents and young adults. While its impact is significant, there remains a paucity of comprehensive global research on the burden of migraine in younger demographics. Our study sought to elucidate the global prevalence, incidence, and disability-adjusted life-years (DALYs) associated with migraine in the 15-39 age group from 1990 to 2021, utilizing data from the Global Burden of Disease (GBD) 2021 study. METHODS Our comprehensive study analyzed migraine data from the GBD 2021 report, examining the prevalence, incidence, and DALYs across 204 countries and territories over a 32-year span. We stratified the information by age, sex, year, geographical region, and Socio-demographic Index (SDI). To evaluate temporal trends in these metrics, we employed the estimated annual percentage change (EAPC) calculation. RESULTS Between 1990 and 2021, the worldwide prevalence of migraine among 15-39 year-olds increased substantially. By 2021, an estimated 593.8 million cases were reported, representing a 39.52% rise from 425.6 million cases in 1990. Global trends showed increases in age-standardized prevalence rate, incidence rate, and DALY rate for migraine during this period. The EAPC were positive for all three metrics: 0.09 for ASPR, 0.03 for ASIR, and 0.09 for DALY rate. Regions with medium SDI reported the highest absolute numbers of prevalent cases, incident cases, and DALYs in 2021. However, high SDI regions demonstrated the most elevated rates overall. Across the globe, migraine prevalence peaked in the 35-39 age group. Notably, female rates consistently exceeded male rates across all age categories. CONCLUSION The global impact of migraine on youths and young adults has grown considerably from 1990 to 2021, revealing notable variations across SDI regions, countries, age groups, and sexes. This escalating burden necessitates targeted interventions and public health initiatives, especially in areas and populations disproportionately affected by migraine.
Collapse
Affiliation(s)
- Zhi-Feng Chen
- Department of Anesthesiology, School of Medicine, Shanghai Putuo People's Hospital, Tongji University, Shanghai, China
| | - Xiang-Meng Kong
- Department of Cardiology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Huangpu District, No.639 Zhizaoju Road, Shanghai, 200011, China
| | - Cheng-Hao Yang
- Department of Vascular Surgery, School of Medicine, Shanghai Putuo People's Hospital, Tongji University, Shanghai, China
| | - Xin-Yu Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University, Shanghai, PR China.
- Department of Neurosurgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, No.639 Zhizaoju Road, Huangpu District, Shanghai, 200011, China.
| | - Hong Guo
- Department of Gynecology and Obstetrics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China.
| | - Zhao-Wei Wang
- Department of Neurology, Qianjiang Central Hospital of Hubei Province, Hubei, China.
| |
Collapse
|
6
|
Greene KA, Gelfand AA, Larry Charleston. Evidence-based review and frontiers of migraine therapy. Neurogastroenterol Motil 2024:e14899. [PMID: 39133210 DOI: 10.1111/nmo.14899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 07/25/2024] [Accepted: 07/31/2024] [Indexed: 08/13/2024]
Abstract
BACKGROUND Cyclic vomiting syndrome (CVS) is identified as one of the "episodic syndromes that may be associated with migraine," along with benign paroxysmal torticollis, benign paroxysmal vertigo, and abdominal migraine. It has been proposed that CVS and migraine may share pathophysiologic mechanisms of hypothalamic activation and altered dopaminergic signaling, and impaired sensorimotor intrinsic connectivity. The past decade has brought groundbreaking advances in the treatment of migraine and other headache disorders. While many of these therapies have yet to be studied in episodic syndromes associated with migraine including CVS and abdominal migraine, the potential shared pathophysiology among these conditions suggests that use of migraine-specific treatments may have a beneficial role even in those for whom headache is not the primary symptom. PURPOSE This manuscript highlights newer therapies in migraine. Calcitonin gene-related peptide (CGRP) and its relation to migraine pathophysiology and the therapies that target the CGRP pathway, as well as a 5HT1F receptor agonist and neuromodulation devices used to treat migraine are briefly discussed as they may potentially prove to be useful in the future treatment of CVS.
Collapse
Affiliation(s)
- Kaitlin A Greene
- Division of Pediatric Neurology, Oregon Health and Science University, Portland, Oregon, USA
| | - Amy A Gelfand
- Child and Adolescent Headache Program, University of California, San Francisco, California, USA
| | - Larry Charleston
- Department of Neurology and Ophthalmology, Michigan State University College of Human Medicine, Grand Rapids, Michigan, USA
| |
Collapse
|
7
|
Kang HS, Kim JH, Kim JH, Bang WJ, Yoo DM, Lee NE, Han KM, Kim NY, Choi HG, Min KW, Kwon MJ. The Association between Statin Use and Reduced Migraine Likelihood: A Comprehensive Analysis of Migraine Subtypes and Statin Types in a Nationwide Korean Cohort. Pharmaceuticals (Basel) 2024; 17:1056. [PMID: 39204161 PMCID: PMC11357270 DOI: 10.3390/ph17081056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Revised: 08/01/2024] [Accepted: 08/07/2024] [Indexed: 09/03/2024] Open
Abstract
Despite growing interest in the preventive effects of statins, as lipid-lowering agents, on migraine attacks, comprehensive nationwide studies comparing migraine likelihood between statin users and controls are lacking. Our nested case-control study within the Korean National Health Insurance Service-Health Screening Cohort (2002-2019) investigated this association using 38,957 migraine patients and 155,828 controls, considering migraine subtypes (with/without aura) and statin types (lipophilic vs. hydrophilic). Using propensity score matching and adjusting for confounders, statin use was linked to reduced migraine likelihood overall (odds ratio (OR) 0.93), particularly for migraines with aura (OR 0.75) and without aura (OR 0.94). Lipophilic statins were effective for both subtypes, while hydrophilic statins mainly reduced the likelihood of migraines without aura. Subgroup analyses showed consistent benefits across demographics, but varied effectiveness based on weight, smoking, alcohol use, hemoglobin levels, and dyslipidemia history. In summary, this nationwide cohort study suggests that statin use may reduce migraine likelihood among Korean adults across diverse demographics and clinical profiles, but varied effectiveness based on certain lifestyle and comorbidity factors underscores the importance of considering individual patient profiles when assessing the potential benefits of statin therapy for migraine prevention.
Collapse
Affiliation(s)
- Ho Suk Kang
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea;
| | - Joo-Hee Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea;
| | - Ji Hee Kim
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea;
| | - Woo Jin Bang
- Department of Urology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea;
| | - Dae Myoung Yoo
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang 14068, Republic of Korea; (D.M.Y.); (N.-E.L.); (K.M.H.)
- Laboratory of Brain and Cognitive Sciences for Convergence Medicine, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Na-Eun Lee
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang 14068, Republic of Korea; (D.M.Y.); (N.-E.L.); (K.M.H.)
- Laboratory of Brain and Cognitive Sciences for Convergence Medicine, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Kyeong Min Han
- Hallym Data Science Laboratory, Hallym University College of Medicine, Anyang 14068, Republic of Korea; (D.M.Y.); (N.-E.L.); (K.M.H.)
- Laboratory of Brain and Cognitive Sciences for Convergence Medicine, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| | - Nan Young Kim
- Hallym Institute of Translational Genomics and Bioinformatics, Hallym University Medical Center, Anyang 14068, Republic of Korea;
| | - Hyo Geun Choi
- Suseo Seoul E.N.T. Clinic, 10, Bamgogae-ro 1-gil, Gangnam-gu, Seoul 06349, Republic of Korea;
| | - Kyueng-Whan Min
- Department of Pathology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, 712, Dongil-ro, Uijeongbu-si 11496, Republic of Korea;
| | - Mi Jung Kwon
- Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| |
Collapse
|
8
|
Ristioja S, Leiviskä IL, Saarela VO, Liinamaa MJ. Retinal neural tissue and vascular calibres in migraine: the Northern Finland Birth Cohort Eye Study. Acta Ophthalmol 2024; 102:600-609. [PMID: 38146656 DOI: 10.1111/aos.16617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 11/26/2023] [Accepted: 12/08/2023] [Indexed: 12/27/2023]
Abstract
PURPOSE To evaluate the possible effects of migraine on retinal nerve fibre layer (RNFL), ganglion cell-inner plexiform layer (GC-IPL), macular thickness and retinal arteriolar and venular diameters (CRAE, CRVE) in a population-based birth cohort. METHODS 375 migraineurs and 1489 healthy controls were included in this cross-sectional cohort study. RNFL, GC-IPL and macular thickness parameters were measured by spectral domain optical coherence tomography (OCT), and vascular parameters were measured from fundus photographs. Migraine was determined by a questionnaire and specific features were selected as covariates (gender, smoking status, systolic blood pressure, refraction and diabetes). RESULTS There were no statistically significant differences between healthy controls and migraineurs in average RNFL (p = 0.123), macular (p = 0.488) or GC-IPL (p = 0.437) thickness. Migraine did not have a significant effect on any of the macular or GC-IPL subfields. For RNFL subfields, only temporal inferior was borderline significantly increased in migraineurs (p = 0.039) in adjusted results. No statistically significant differences were found between study groups on retinal vascular calibres CRAE (p = 0.879), CRVE (p = 0.145) or AVR (p = 0.259). GC-IPL thickness was found to be positively correlated with CRAE and CRVE in both study groups as GC-IPL thickness increased together with the increase in CRAE and CRVE (p-trend < 0.001 in both), and a similar trend was detected with central macular subfield thickness and systolic (p-trend < 0.001) and diastolic (p-trend = 0.010) blood pressure, but only in the control group. CONCLUSION There were no remarkable differences between migraineurs and healthy controls in retinal vascular or structural parameters in our study.
Collapse
Affiliation(s)
- Salla Ristioja
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland
- MRC Oulu, Oulu, Finland
- Research Unit of Clinical Medicine University of Oulu, Oulu, Finland
| | - Ilmari L Leiviskä
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland
- MRC Oulu, Oulu, Finland
- Research Unit of Clinical Medicine University of Oulu, Oulu, Finland
| | - Ville O Saarela
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland
- MRC Oulu, Oulu, Finland
- Research Unit of Clinical Medicine University of Oulu, Oulu, Finland
| | - M Johanna Liinamaa
- Department of Ophthalmology, Oulu University Hospital, Oulu, Finland
- MRC Oulu, Oulu, Finland
- Research Unit of Clinical Medicine University of Oulu, Oulu, Finland
| |
Collapse
|
9
|
Schramm S, Börner C, Reichert M, Hoffmann G, Kaczmarz S, Griessmair M, Jung K, Berndt MT, Zimmer C, Baum T, Heinen F, Bonfert MV, Sollmann N. Perfusion imaging by arterial spin labeling in migraine: A literature review. J Cereb Blood Flow Metab 2024; 44:1253-1270. [PMID: 38483125 PMCID: PMC11342727 DOI: 10.1177/0271678x241237733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 01/19/2024] [Accepted: 01/23/2024] [Indexed: 08/15/2024]
Abstract
Arterial spin labeling (ASL) is a non-invasive magnetic resonance imaging (MRI) method for the assessment of cerebral blood flow (CBF). This review summarizes recent ASL-based investigations in adult and pediatric patients with migraine with aura, migraine without aura, and chronic migraine. A systematic search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines was conducted within PubMed and reference sections of articles identified from April 2014 to November 2022. Out of 236 initial articles, 20 remained after filtering, encompassing data from 1155 subjects in total. Cross-sectional studies in adults showed inconsistent results, while longitudinal studies demonstrated that cerebral perfusion changes over the migraine cycle can be tracked using ASL. The most consistent findings were observed in ictal states among pediatric migraine patients, where studies showed hypoperfusion matching aura symptoms during early imaging followed by hyperperfusion. Overall, ASL is a useful but currently underutilized modality for evaluating cerebral perfusion in patients with migraine. The generalizability of results is currently limited by heterogeneities regarding study design and documentation of clinical variables (e.g., relation of attacks to scanning timepoint, migraine subtypes). Future MRI studies should consider augmenting imaging protocols with ASL to further elucidate perfusion dynamics in migraine.
Collapse
Affiliation(s)
- Severin Schramm
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Corinna Börner
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- LMU Hospital, Dr. von Hauner Children’s Hospital, Department of Pediatric Neurology and Developmental Medicine, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig Maximilian University, Munich, Germany
| | - Miriam Reichert
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Gabriel Hoffmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Stephan Kaczmarz
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Philips GmbH Market DACH, Hamburg, Germany
| | - Michael Griessmair
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Kirsten Jung
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Maria T Berndt
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Thomas Baum
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Florian Heinen
- LMU Hospital, Dr. von Hauner Children’s Hospital, Department of Pediatric Neurology and Developmental Medicine, Munich, Germany
| | - Michaela V Bonfert
- LMU Hospital, Dr. von Hauner Children’s Hospital, Department of Pediatric Neurology and Developmental Medicine, Munich, Germany
- LMU Center for Children with Medical Complexity – iSPZ Hauner, Ludwig Maximilian University, Munich, Germany
| | - Nico Sollmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| |
Collapse
|
10
|
Deodato M, Granato A, Martini M, Sabot R, Buoite Stella A, Manganotti P. Instrumental assessment of pressure pain threshold over trigeminal and extra-trigeminal area in people with episodic and chronic migraine: a cross-sectional observational study. Neurol Sci 2024; 45:3923-3929. [PMID: 38396170 PMCID: PMC11254968 DOI: 10.1007/s10072-024-07372-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 01/28/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Central and peripheral sensitization are characterized by widespread hyperalgesia that is manifested by larger pain extent area and reduction in pressure pain threshold (PPT). PPT decreases in patients with migraine not only over the trigeminal cervical complex but also throughout the body. METHODS A cross-sectional study was adopted to assess the local and widespread hyperalgesia in chronic and episodic migraine patients respect to healthy controls. The guidelines of Andersen's were used to evaluate the PPT bilaterally over 3 muscles in the trigemino-cervical complex (temporalis, sub-occipitalis, trapezius) and over 1 muscle far from this area (tensor fasciae latae). RESULTS Thirty subjects with episodic migraine (35.8 ± 2.82 years), 30 with chronic migraine (53.03 ± 19.79 years), and 30 healthy controls (29.06 ± 14.03 years) were enrolled. The interaction effect was present for the trapezius muscle with a significant difference between the right and the left side in episodic group (p = 0.003). A group effect was highlighted in all four muscles analyzed such as suboccipital (p < 0.001), temporalis (p > 0.001), trapezius (p < 0.001), and TFL (p < 0.001). PPT was usually higher in the control group than in the episodic group which in turn was characterized by higher PPT values than the chronic group. CONCLUSIONS People with chronic and episodic migraine presented lower PPT than healthy controls both in the trigeminal and in the extra-trigeminal area. People with chronic migraine presented lower PPT than episodic migraine only in the trigeminal area. Temporalis and sub-occipitalis are the most sensitive muscles in people with chronic and episodic migraine.
Collapse
Affiliation(s)
- Manuela Deodato
- Department of Medical, Surgical and Health Sciences, University of Trieste, Via Pascoli 31, 34100, Trieste, Italy.
- Azienda Sanitaria Universitaria Giuliano Isontina, Via Pascoli 31, 34100, Trieste, Italy.
| | - Antonio Granato
- Department of Medical, Surgical and Health Sciences, University of Trieste, Via Pascoli 31, 34100, Trieste, Italy
- Azienda Sanitaria Universitaria Giuliano Isontina, Via Pascoli 31, 34100, Trieste, Italy
| | - Miriam Martini
- Department of Medical, Surgical and Health Sciences, University of Trieste, Via Pascoli 31, 34100, Trieste, Italy
- Azienda Sanitaria Universitaria Giuliano Isontina, Via Pascoli 31, 34100, Trieste, Italy
| | - Raffaele Sabot
- Department of Medical, Surgical and Health Sciences, University of Trieste, Via Pascoli 31, 34100, Trieste, Italy
| | - Alex Buoite Stella
- Department of Medical, Surgical and Health Sciences, University of Trieste, Via Pascoli 31, 34100, Trieste, Italy
| | - Paolo Manganotti
- Department of Medical, Surgical and Health Sciences, University of Trieste, Via Pascoli 31, 34100, Trieste, Italy
- Azienda Sanitaria Universitaria Giuliano Isontina, Via Pascoli 31, 34100, Trieste, Italy
| |
Collapse
|
11
|
Deodato M, Granato A, Buoite Stella A, Martini M, Marchetti E, Lise I, Galmonte A, Murena L, Manganotti P. Efficacy of a dual task protocol on neurophysiological and clinical outcomes in migraine: a randomized control trial. Neurol Sci 2024; 45:4015-4026. [PMID: 38806882 PMCID: PMC11255006 DOI: 10.1007/s10072-024-07611-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 05/20/2024] [Indexed: 05/30/2024]
Abstract
The main aim of this study was to investigate the efficacy of a dual task protocol in people with episodic migraine with respect to both active exercises only and cognitive task only treatments, concerning some neurophysiological and clinical outcomes. A randomized control trial was adopted in people with episodic migraine without aura. Some neurophysiological and clinical outcomes were collected (t0): resting motor threshold (rMT), short intracortical inhibition (SICI) and facilitation (ICF), pressure pain threshold (PPT), trail making test (TMT), frontal assessment battery (FAB), headache-related disability (MIDAS) and headache parameters. Then, participants were randomized into three groups: active exercise only (n = 10), cognitive task only (n = 10) and dual task protocol (n = 10). After 3 months of each treatment and after 1-month follow-up the same neurophysiological and clinical outcomes were revaluated. A significant time x group effect was only found for the trapezius muscle (p = 0.012, pη2 = 0.210), suggesting that PPT increased significantly only in active exercise and dual task protocol groups. A significant time effect was found for rMT (p < 0.001, pη2 = 0.473), MIDAS (p < 0.001, pη2 = 0.426), TMT (p < 0.001, pη2 = 0.338) and FAB (p < 0.001, pη2 = 0.462). A repeated measures ANOVA for SICI at 3 ms highlighted a statistically significant time effect for the dual task group (p < 0.001, pη2 = 0.629), but not for the active exercises group (p = 0.565, pη2 = 0.061), and for the cognitive training (p = 0.357, pη2 = 0.108). The dual task protocol seems to have a more evident effect on both habituation and sensitization outcomes than the two monotherapies taken alone in people with migraine.
Collapse
Affiliation(s)
- Manuela Deodato
- Department of Life Sciences, University of Trieste, Trieste, Italy.
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
- Azienda Sanitaria Universitaria Giuliano Isontina, Via Pascoli 31, 34100, Trieste, Italy.
| | - Antonio Granato
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
- Azienda Sanitaria Universitaria Giuliano Isontina, Via Pascoli 31, 34100, Trieste, Italy
| | - Alex Buoite Stella
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
- Azienda Sanitaria Universitaria Giuliano Isontina, Strada Di Fiume 447, 34149, Trieste, Italy
| | - Miriam Martini
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
- Azienda Sanitaria Universitaria Giuliano Isontina, Via Pascoli 31, 34100, Trieste, Italy
| | - Enrico Marchetti
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Ilaria Lise
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Alessandra Galmonte
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Luigi Murena
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
- Azienda Sanitaria Universitaria Giuliano Isontina, Via Pascoli 31, 34100, Trieste, Italy
| | - Paolo Manganotti
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
- Azienda Sanitaria Universitaria Giuliano Isontina, Via Pascoli 31, 34100, Trieste, Italy
- Azienda Sanitaria Universitaria Giuliano Isontina, Strada Di Fiume 447, 34149, Trieste, Italy
| |
Collapse
|
12
|
Goel K, Chhetri A, Ludhiadch A, Munshi A. Current Update on Categorization of Migraine Subtypes on the Basis of Genetic Variation: a Systematic Review. Mol Neurobiol 2024; 61:4804-4833. [PMID: 38135854 DOI: 10.1007/s12035-023-03837-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/22/2023] [Indexed: 12/24/2023]
Abstract
Migraine is a complex neurovascular disorder that is characterized by severe behavioral, sensory, visual, and/or auditory symptoms. It has been labeled as one of the ten most disabling medical illnesses in the world by the World Health Organization (Aagaard et al Sci Transl Med 6(237):237ra65, 2014). According to a recent report by the American Migraine Foundation (Shoulson et al Ann Neurol 25(3):252-9, 1989), around 148 million people in the world currently suffer from migraine. On the basis of presence of aura, migraine is classified into two major subtypes: migraine with aura (Aagaard et al Sci Transl Med 6(237):237ra65, 2014) and migraine without aura. (Aagaard K et al Sci Transl Med 6(237):237ra65, 2014) Many complex genetic mechanisms have been proposed in the pathophysiology of migraine but specific pathways associated with the different subtypes of migraine have not yet been explored. Various approaches including candidate gene association studies (CGAS) and genome-wide association studies (Fan et al Headache: J Head Face Pain 54(4):709-715, 2014). have identified the genetic markers associated with migraine and its subtypes. Several single nucleotide polymorphisms (Kaur et al Egyp J Neurol, Psychiatry Neurosurg 55(1):1-7, 2019) within genes involved in ion homeostasis, solute transport, synaptic transmission, cortical excitability, and vascular function have been associated with the disorder. Currently, the diagnosis of migraine is majorly behavioral with no focus on the genetic markers and thereby the therapeutic intervention specific to subtypes. Therefore, there is a need to explore genetic variants significantly associated with MA and MO as susceptibility markers in the diagnosis and targets for therapeutic interventions in the specific subtypes of migraine. Although the proper characterization of pathways based on different subtypes is yet to be studied, this review aims to make a first attempt to compile the information available on various genetic variants and the molecular mechanisms involved with the development of MA and MO. An attempt has also been made to suggest novel candidate genes based on their function to be explored by future research.
Collapse
Affiliation(s)
- Kashish Goel
- Complex Disease Genomics and Precision Medicine Laboratory, Department of Human Genetics and Molecular Medicine, Central University of Punjab, Bathinda, Punjab, India, 151401
| | - Aakash Chhetri
- Complex Disease Genomics and Precision Medicine Laboratory, Department of Human Genetics and Molecular Medicine, Central University of Punjab, Bathinda, Punjab, India, 151401
| | - Abhilash Ludhiadch
- Complex Disease Genomics and Precision Medicine Laboratory, Department of Human Genetics and Molecular Medicine, Central University of Punjab, Bathinda, Punjab, India, 151401
| | - Anjana Munshi
- Complex Disease Genomics and Precision Medicine Laboratory, Department of Human Genetics and Molecular Medicine, Central University of Punjab, Bathinda, Punjab, India, 151401.
| |
Collapse
|
13
|
Balali A, Karimi E, Kazemi M, Hadi A, Askari G, Khorvash F, Arab A. Associations between diet quality and migraine headaches: a cross-sectional study. Nutr Neurosci 2024; 27:677-687. [PMID: 37542451 DOI: 10.1080/1028415x.2023.2244260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2023]
Abstract
AIMS We evaluated associations between diet quality and migraine outcomes. METHODS The current work represented a cross-sectional study on 262 patients with migraine (20-50 y). Diet quality was assessed using the standard healthy eating index 2015 (HEI-2015) and alternative healthy eating index 2010 (AHEI-2010). A validated 168-item food frequency questionnaire was used to assess dietary intake. Migraine outcomes included clinical factors (severity, duration, frequency, and disability related to migraine) and serum nitric oxide (NO). Associations between diet quality indices and migraine outcomes were evaluated using linear regressions, and β and 95% corresponding confidence interval (CI) were reported. RESULTS HEI-2015 was inversely associated with migraine frequency (β = -4.75, 95% CI: -6.73, -2.76) in patients with the highest HEI scores (third tertile) vs. those with the lowest scores (first tertile) after adjusting for relevant confounders. AHEI-2010 was inversely associated with migraine frequency (β = -3.67, 95% CI: -5.65, -1.69) and migraine-related disability (β = -2.74, 95% CI: -4.79, -0.68) in adjusted models. Also, AHEI-2010 was inversely associated with migraine severity in patients in the second vs. first tertile (β = -0.56; 95% CI: -1.08, -0.05). We detected no associations between diet quality and NO levels (All P > 0.14). CONCLUSIONS Improved diet quality may be associated with favorable migraine outcomes (lower headache frequency, severity, and migraine-related disability). Future studies are required to confirm and delineate the causal mechanisms of our observations.
Collapse
Affiliation(s)
- Arghavan Balali
- Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elham Karimi
- Department of Clinical Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
- Research Development Center, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Kazemi
- Department of Nutrition, Harvard TH Chan School of Public Health, Boston, USA
- Department of Epidemiology, Harvard TH Chan School of Public Health, Boston, USA
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, USA
| | - Amir Hadi
- Halal Research Center of IRI, Food and Drug Administration, Ministry of Health and Medical Education, Tehran, Iran
| | - Gholamreza Askari
- Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fariborz Khorvash
- Isfahan Neurosciences Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Arman Arab
- Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
14
|
Rohatgi S, Gundewar S, Nirhale S, Rao P, Naphade P, Oommen AB, Dubey P, Gitay AA, Khandait P. The Intersection of Migraine and Epistaxis: Clinical Observations and Analysis. Cureus 2024; 16:e65584. [PMID: 39192906 PMCID: PMC11349249 DOI: 10.7759/cureus.65584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 07/25/2024] [Indexed: 08/29/2024] Open
Abstract
Migraine prevalence has risen over the last few decades, which may be attributed to lifestyle changes. Epistaxis is unusual in migraine. Here we present a case series of four patients, who are presented with headaches associated with epistaxis. A detailed history revealed cardinal symptoms of migraine according to the International Headache Society, including hemicranial throbbing headache of moderate to severe intensity lasting for a duration of four to 72 hours, along with associated features of nausea, vomiting, photophobia, and phonophobia. Investigations, including ENT (ear, nose, and throat) examination, nasal endoscopy, gastroscopy, bronchoscopy, hematological, and coagulation parameters, were negative. All patients were started on prophylactic treatment for migraine, and they responded well. Epistaxis occurs at the peak of headache following which symptoms tend to resolve. The pathophysiology behind this is stimulation of the trigeminovascular system leading to dilatation of external and internal carotid arteries.
Collapse
Affiliation(s)
- Shalesh Rohatgi
- Department of Neurology, Dr. D Y Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Salil Gundewar
- Department of Neurology, Dr. D Y Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Satish Nirhale
- Department of Neurology, Dr. D Y Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Prajwal Rao
- Department of Neurology, Dr. D Y Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Pravin Naphade
- Department of Neurology, Dr. D Y Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Arun B Oommen
- Department of General Medicine, Dr. D Y Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Prashant Dubey
- Department of Neurology, Dr. D Y Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Advait A Gitay
- Department of Neurology, Dr. D Y Patil Medical College, Hospital and Research Centre, Pune, IND
| | - Pranit Khandait
- Department of Neurology, Dr. D Y Patil Medical College, Hospital and Research Centre, Pune, IND
| |
Collapse
|
15
|
Manganotti P, Deodato M, D’Acunto L, Biaduzzini F, Garascia G, Granato A. Effects of Anti-CGRP Monoclonal Antibodies on Neurophysiological and Clinical Outcomes: A Combined Transcranial Magnetic Stimulation and Algometer Study. Neurol Int 2024; 16:673-688. [PMID: 39051212 PMCID: PMC11270432 DOI: 10.3390/neurolint16040051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2024] [Revised: 06/16/2024] [Accepted: 06/19/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND the aim of this study was to investigate the neurophysiological effect of anti-CGRP monoclonal antibodies on central and peripheral levels in migraine patients. METHODS An observational cohort study in patients with migraine was performed. All subjects underwent Single-Pulse and Paired-Pulse Transcranial Magnetic Stimulation, as well as a Pressure Pain Threshold assessment. The same protocol was repeated three and four months after the first injection of anti-CGRP monoclonal antibodies. RESULTS A total of 11 patients with a diagnosis of migraine and 11 healthy controls were enrolled. The main findings of this study are the significant effects of anti-CGRP mAb treatment on the TMS parameters of intracortical inhibition and the rise in the resting motor threshold in our group of patients affected by resistant migraine. The clinical effect of therapy on migraine is associated with the increase in short-interval intracortical inhibition (SICI), resting motor threshold (RMT), and Pressure Pain Threshold (PPT). In all patients, all clinical headache parameters improved significantly 3 months after the first injection of mAbs and the improvement was maintained at the 1-month follow-up. At baseline, migraineurs and HCs had significant differences in all TMS parameters and in PPT, while at follow-up assessment, no differences were observed on RMT, SICI, and PPT between the two groups. After anti-CGRP monoclonal antibody injection, a significant increase in the intracortical inhibition, in the motor threshold, and in the Pressure Pain Threshold in critical head areas was observed in patients with migraine, which was related to significant clinical benefits. CONCLUSIONS Anti-CGRP monoclonal antibodies improved clinical and neurophysiological outcomes, reflecting a normalization of cortical excitability and peripheral and central sensitization. By directly acting on the thalamus or hypothalamus and indirectly on the trigeminocervical complex, treatment with anti-CGRP monoclonal antibodies may modulate central sensorimotor excitability and peripheral sensitization pain.
Collapse
Affiliation(s)
- Paolo Manganotti
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy; (P.M.); (L.D.); (F.B.); (G.G.); (A.G.)
- Azienda Sanitaria Universitaria Giuliano Isontina (ASU GI), 34128 Trieste, Italy
| | - Manuela Deodato
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy; (P.M.); (L.D.); (F.B.); (G.G.); (A.G.)
- Azienda Sanitaria Universitaria Giuliano Isontina (ASU GI), 34128 Trieste, Italy
| | - Laura D’Acunto
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy; (P.M.); (L.D.); (F.B.); (G.G.); (A.G.)
- Azienda Sanitaria Universitaria Giuliano Isontina (ASU GI), 34128 Trieste, Italy
| | - Francesco Biaduzzini
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy; (P.M.); (L.D.); (F.B.); (G.G.); (A.G.)
- Azienda Sanitaria Universitaria Giuliano Isontina (ASU GI), 34128 Trieste, Italy
| | - Gabriele Garascia
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy; (P.M.); (L.D.); (F.B.); (G.G.); (A.G.)
- Azienda Sanitaria Universitaria Giuliano Isontina (ASU GI), 34128 Trieste, Italy
| | - Antonio Granato
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34100 Trieste, Italy; (P.M.); (L.D.); (F.B.); (G.G.); (A.G.)
- Azienda Sanitaria Universitaria Giuliano Isontina (ASU GI), 34128 Trieste, Italy
| |
Collapse
|
16
|
Wei HL, Yu YS, Wang MY, Zhou GP, Li J, Zhang H, Zhou Z. Exploring potential neuroimaging biomarkers for the response to non-steroidal anti-inflammatory drugs in episodic migraine. J Headache Pain 2024; 25:104. [PMID: 38902598 PMCID: PMC11191194 DOI: 10.1186/s10194-024-01812-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Accepted: 06/13/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Non-steroidal anti-inflammatory drugs (NSAIDs) are considered first-line medications for acute migraine attacks. However, the response exhibits considerable variability among individuals. Thus, this study aimed to explore a machine learning model based on the percentage of amplitude oscillations (PerAF) and gray matter volume (GMV) to predict the response to NSAIDs in migraine treatment. METHODS Propensity score matching was adopted to match patients having migraine with response and nonresponse to NSAIDs, ensuring consistency in clinical characteristics and migraine-related features. Multimodal magnetic resonance imaging was employed to extract PerAF and GMV, followed by feature selection using the least absolute shrinkage and selection operator regression and recursive feature elimination algorithms. Multiple predictive models were constructed and the final model with the smallest predictive residuals was chosen. The model performance was evaluated using the area under the receiver operating characteristic (ROCAUC) curve, area under the precision-recall curve (PRAUC), balance accuracy (BACC), sensitivity, F1 score, positive predictive value (PPV), and negative predictive value (NPV). External validation was performed using a public database. Then, correlation analysis was performed between the neuroimaging predictors and clinical features in migraine. RESULTS One hundred eighteen patients with migraine (59 responders and 59 non-responders) were enrolled. Six features (PerAF of left insula and left transverse temporal gyrus; and GMV of right superior frontal gyrus, left postcentral gyrus, right postcentral gyrus, and left precuneus) were observed. The random forest model with the lowest predictive residuals was selected and model metrics (ROCAUC, PRAUC, BACC, sensitivity, F1 score, PPV, and NPV) in the training and testing groups were 0.982, 0.983, 0.927, 0.976, 0.930, 0.889, and 0.973; and 0.711, 0.648, 0.639, 0.667,0.649, 0.632, and 0.647, respectively. The model metrics of external validation were 0.631, 0.651, 0.611, 0.808, 0.656, 0.553, and 0.706. Additionally, a significant positive correlation was found between the GMV of the left precuneus and attack time in non-responders. CONCLUSIONS Our findings suggest the potential of multimodal neuroimaging features in predicting the efficacy of NSAIDs in migraine treatment and provide novel insights into the neural mechanisms underlying migraine and its optimized treatment strategy.
Collapse
Affiliation(s)
- Heng-Le Wei
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, No.169, Hushan Road, Nanjing, China
| | - Yu-Sheng Yu
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, No.169, Hushan Road, Nanjing, China
| | - Meng-Yao Wang
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, No.169, Hushan Road, Nanjing, China
| | - Gang-Ping Zhou
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, No.169, Hushan Road, Nanjing, China
| | - Junrong Li
- Department of Neurology, The Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, China.
| | - Hong Zhang
- Department of Radiology, The Affiliated Jiangning Hospital of Nanjing Medical University, No.169, Hushan Road, Nanjing, China.
| | - Zhengyang Zhou
- Department of Radiology, Nanjing Drum Tower Hospital Clinical College of Nanjing Medical University, Nanjing, China.
- Department of Radiology, Nanjing Drum Tower Hospital, Nanjing, China.
| |
Collapse
|
17
|
Özge A, Baykan B, Bıçakçı Ş, Ertaş M, Atalar AÇ, Gümrü S, Karlı N. Revolutionizing migraine management: advances and challenges in CGRP-targeted therapies and their clinical implications. Front Neurol 2024; 15:1402569. [PMID: 38938785 PMCID: PMC11210524 DOI: 10.3389/fneur.2024.1402569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 05/27/2024] [Indexed: 06/29/2024] Open
Abstract
Migraine, a prevalent neurological disorder, affects approximately 14.1% of the global population and disproportionately impacts females. This debilitating condition significantly compromises quality of life, productivity, and incurs high healthcare costs, presenting a challenge not only to individuals but to societal structures as a whole. Despite advances in our understanding of migraine pathophysiology, treatment options remain limited, necessitating ongoing research into effective therapies. This review delves into the complexity of migraine management, examining the roles of genetic predisposition, environmental influences, personalized treatment approaches, comorbidities, efficacy and safety of existing acute and preventive treatments. It further explores the continuum between migraine and tension-type headaches and discusses the intricacies of treating various migraine subtypes, including those with and without aura. We emphasize the recent paradigm shift toward trigeminovascular activation and the release of vasoactive substances, such as calcitonin gene-related peptide (CGRP), which offer novel therapeutic targets. We assess groundbreaking clinical trials, pharmacokinetic and pharmacodynamic perspectives, safety, tolerability, and the real-world application of CGRP monoclonal antibodies and gepants. In the face of persisting treatment barriers such as misdiagnosis, medication overuse headaches, and limited access to specialist care, we discuss innovative CGRP-targeted strategies, the high cost and scarcity of long-term efficacy data, and suggest comprehensive solutions tailored to Turkiye and developing countries. The review offers strategic recommendations including the formulation of primary care guidelines, establishment of specialized outpatient clinics, updating physicians on novel treatments, enhancing global accessibility to advanced therapies, and fostering patient education. Emphasizing the importance of lifestyle modifications and holistic approaches, the review underscores the potential of mass media and patient groups in disseminating critical health information and shaping the future of migraine management.
Collapse
Affiliation(s)
- A. Özge
- Department of Neurology, Algology and Clinical Neurophysiology, Mersin University School of Medicine, Mersin, Türkiye
| | - B. Baykan
- Department of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Ş. Bıçakçı
- Department of Neurology, Faculty of Medicine, Cukurova University, Adana, Türkiye
| | - M. Ertaş
- Department of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - A. Ç. Atalar
- Department of Neurology, University Health Sciences, Istanbul Physical Medicine and Rehabilitation Training and Research Hospital, Istanbul, Türkiye
| | - S. Gümrü
- Pfizer Pharmaceuticals, Istanbul, Türkiye
| | - N. Karlı
- Department of Neurology, Faculty of Medicine, Uludag University, Bursa, Türkiye
| |
Collapse
|
18
|
Charles A. The role of caffeine in headache disorders. Curr Opin Neurol 2024; 37:289-294. [PMID: 38327229 DOI: 10.1097/wco.0000000000001249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
PURPOSE OF REVIEW Caffeine is known to have both beneficial and adverse effects in individuals with headache disorders. This review describes recent findings regarding caffeine that are relevant to headache disorders and puts these findings into the context of clinical management. RECENT FINDINGS Preclinical studies show that caffeine has complex effects on sleep, brain blood flow, and intracranial pressure that may depend on the timing of caffeine intake relative to the sleep-wake cycle. Caffeine metabolism may have significant inter-individual variation that influences its therapeutic and/or adverse effects. Caffeine has acute therapeutic benefit for some primary headache disorders. For migraine, this benefit is predominantly in milder headache without cutaneous allodynia. High levels of caffeine intake may contribute to progression of headache disorders. Caffeine-containing combination analgesics commonly cause medication overuse headache. Abrupt reduction in caffeine consumption is a trigger for migraine that may be important in situations including the hospital setting, religious and cultural fasting, and pregnancy. SUMMARY There is not sufficient evidence to support universal guidelines for the use of dietary and medicinal caffeine in headache disorders. A sensible approach based upon available evidence is to limit dietary caffeine intake to moderate amounts with consistent timing before noon, and to use caffeine-containing combination analgesics infrequently for milder headache.
Collapse
Affiliation(s)
- Andrew Charles
- UCLA Goldberg Migraine Program Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| |
Collapse
|
19
|
Chaudhary S, Singh L, Kaur M, Kadyan P. Genistein mitigates nitroglycerine-induced migraine: modulation of nitric oxide-mediated vasodilation and oxidative stress. Metab Brain Dis 2024; 39:821-831. [PMID: 38795260 DOI: 10.1007/s11011-024-01360-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 05/06/2024] [Indexed: 05/27/2024]
Abstract
Migraine is a widespread brain condition described by frequent, recurrent episodes of incapacitating, moderate-to-severe headaches with throbbing pain that are usually one-sided. It is the 2nd most debilitating state lived with disability in terms of years, with a prevalence rate of 15-20%. Significant drops in estrogen levels have been associated with triggering acute migraine attacks in certain cases. Phytoestrogens are plant-derived compounds that resemble estrogen in structure, enabling them to imitate estrogen's functions in the body by attaching to estrogen receptors. Thus, the study was aimed to explore the protective effect of genistein against migraine. Moreover, the role of nitric oxide was also studied in the observed effect of genistein. Nitric oxide (NO) is implicated in migraine pathophysiology due to its role in promoting cerebral vasodilation and modulation of pain perception. Exploring L-NAME, a nitric oxide synthase inhibitor in migraine research helps scientists better understand the role of NO in migraine. Nitroglycerine treatment significantly increased the facial-unilateral head pain and spontaneous pain, as evidenced by the increased number of head scratching and groomings. Nitroglycerine treatment also induced anxiogenic behavior in mice. A significant reduction in the number of entries in the light phase and open arm, respectively. Biochemical analysis indicated a significant increase in inflammatory and oxidative stress in the nitroglycerin group. A significant increase and decrease in brain TBARS and GSH were observed with nitroglycerine treatment, respectively. Moreover, nitroglycerine treatment has uplifted the serum TNF-α level. Genistein (20 mg/kg) significantly mitigated the facial-unilateral head pain, spontaneous pain, photophobia, and anxiety-like behavior induced by nitroglycerine. Biochemical analysis showed that genistein (20 mg/kg) significantly abrogated the nitroglycerine-induced lipid peroxidation and increased serum TNF-α level. Genistein treatment also upregulated the brain GSH level and downregulated the serum TNF-α level. The L-NAME-mediated alleviation of the protective effect of genistein might be attributed to the vasodilatory effect of L-NAME. Conclusively, it can be suggested that genistein might provide relief from migraine pain by inhibiting nitric oxide-mediated vasodilation and oxidative stress.
Collapse
Affiliation(s)
- Sarika Chaudhary
- University Institute of Pharma Sciences, Chandigarh University, Mohali, Punjab, 140413, India
| | - Lovedeep Singh
- University Institute of Pharma Sciences, Chandigarh University, Mohali, Punjab, 140413, India.
| | - Manjot Kaur
- Department of Pharmaceutical Sciences, Guru Nanak Dev University, Amritsar, Punjab, 143005, India
| | - Pankaj Kadyan
- University Institute of Pharma Sciences, Chandigarh University, Mohali, Punjab, 140413, India
| |
Collapse
|
20
|
Ocal R, Buldukoglu OC, Hasoglan MG, Korucuk M, Cekin Y, Ocal S. Migraine and gasdermin D: a new perspective on the inflammatory basis of migraine. Acta Neurol Belg 2024; 124:981-986. [PMID: 38526645 DOI: 10.1007/s13760-024-02523-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 03/01/2024] [Indexed: 03/27/2024]
Abstract
Migraine is a common and disabling primary headache disorder and inflammation is a proposed factor in the complex ethiology of the disease. Gasdermin D (GSDMD) is a membrane pore-forming protein acting through the caspase system. End result is cell death caused by leakage of intracellular components to extracellular space which also results in inflammation. Stemming from this knowledge, the potential role of GSDMD in migraine was investigated in this prospective study. This prospective study was conducted between September 2022 to April 2023. 47 patients with migraine were designated as the patient group, whereas 47 healthy volunteers were designated as the control group. Serum GSDMD levels of both groups were compared, with an additional comparison between migraine patients during symptom-free and attack periods. Migraine related characteristics of the patients were also included in the study. Median GSDMD levels of the patient and control group did not reveal a significant difference. Nausea, vomiting and severity of headache were found to be correlated with GSDMD levels in migraine patients. Patients with nausea revealed a higher GSDMD level compared to patients without nausea during both symptom-free and attack periods (p = 0.021 and p = 0.01, respectively). Nausea was correlated to higher GSDMD levels in the patient population during symptom-free period (p = 0.030). The severity of pain was positively correlated with GSDMD levels during the attack period (p < 0.001). Gasdermin family and GSDMD in particular are promising prospects for therapy in a wide spectrum of disorders. Gasdermin proteins are candidates to be the focus for future studies both related to pathogenesis and drug therapy in migraine and varying inflammatory-driven clinical pictures.
Collapse
Affiliation(s)
- Ruhsen Ocal
- Department of Neurology, Antalya Training and Research Hospital, Antalya, Turkey.
| | | | | | - Meltem Korucuk
- Department of Neurology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Yesim Cekin
- Department of Medical Microbiology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Serkan Ocal
- Department of Gastroenterology, Antalya Training and Research Hospital, Antalya, Turkey
| |
Collapse
|
21
|
Wu SZ, Chen L. Efficacy and safety of ubrogepant for migraine: a meta-analysis of randomized controlled studies. Int J Neurosci 2024; 134:124-130. [PMID: 35999672 DOI: 10.1080/00207454.2022.2090351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 06/10/2022] [Indexed: 10/31/2022]
Abstract
Introduction: The efficacy of ubrogepant 50 mg versus 100 mg daily for migraine remained controversial. We conducted a systematic review and meta-analysis to compare the efficacy and safety of ubrogepant 50 mg versus 100 mg daily on treatment in migraine patients.Methods: We have searched PubMed, EMbase, Web of science, EBSCO, Cochrane library databases and SCOPUS through 21 March 2022 for randomized controlled trials (RCTs) assessing the effect of ubrogepant 50 mg versus 100 mg on treatment efficacy in migraine patients. This meta-analysis was performed using the random-effect model.Results: Three RCTs were included in the meta-analysis. Overall, compared with ubrogepant 100 mg in migraine patients, ubrogepant 50 mg obtained comparable pain freedom at 2 h (OR = 0.86; 95% CI = 0.64-1.15; p = 0.310), sustained pain freedom 2-24 h (OR = 0.76; 95% CI = 0.54-1.07; p = 0.110), photophobia absence at 2 h (OR = 0.80; 95% CI = 0.63-1.02; p = 0.070), phonophobia absence at 2 h (OR = 1.07; 95% CI = 0.82-1.40; p = 0.620) and nausea absence at 2 h (OR = 1.02; 95% CI = 0.79-1.32; p = 0.880). In terms of safety, adverse events were found to be increased in ubrogepant 100 mg as compared to ubrogepant 50 mg (OR = 0.81; 95% CI = 0.67-0.99; p = 0.040), and there was no statistical difference of serious adverse events between two groups (OR = 0.87; 95% CI = 0.40-1.91; p = 0.720).Conclusions: Ubrogepant 50 mg and 100 mg may be equally effective to alleviate migraine, but ubrogepant 100 mg led to increase incidence of adverse events.
Collapse
Affiliation(s)
- Shu-Zhi Wu
- Neurology Department, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Third Affiliated Hospital of Shanghai University, Wenzhou People's Hospital, Wenzhou, Zhejiang, China
| | - Linglong Chen
- Emergency Medicine Department, Wenzhou Third Clinical Institute Affiliated to Wenzhou Medical University, Third Affiliated Hospital of Shanghai University, Wenzhou People's Hospital, Wenzhou, Zhejiang, China
| |
Collapse
|
22
|
Biswas S, Singh R, Radhika AG. Association between migraine and pre-eclampsia among pregnant women: a single hospital-based case-control study in India. BMC Pregnancy Childbirth 2024; 24:373. [PMID: 38755536 PMCID: PMC11100195 DOI: 10.1186/s12884-024-06567-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 05/06/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Pre-eclampsia and migraine share some similar aspects of pathophysiology such as vascular function, platelet activation, and enhanced clotting. A few observational studies from different demographics showed that pregnant women with a history of migraine were at higher risk of developing pre-eclampsia. However, there is no such evidence available from the Indian context. Hence, a hospital-based case-control study was conducted among Indian women to determine the association between migraine and pre-eclampsia. METHOD It was a single-centre case-control study in a tertiary care hospital in India. Cases were pregnant women with clinically diagnosed pre-eclampsia, and controls were normotensive pregnant women. Migraine was diagnosed with a questionnaire adapted from the "International Classification of Headache Disorders (ICHD), 3rd Edition" by the International Headache Society, (IHS). We performed logistic regression to explore the association between migraine and pre-eclampsia. RESULT One hundred sixty-four women (82 women per group) were enrolled. The mean age among the cases (24.5 years, standard deviation of 2.4 years) was slightly higher than the mean age of the controls (23.5 years, standard deviation of 2.5 years) with a p-value of 0.006. We found that women with a history of migraine were more likely to develop pre-eclampsia (Adjusted Odds Ratio 6.17; p-value < 0.001, 95% Confidence Interval of 2.85 to 13.62). CONCLUSION The current findings suggest a significant association between migraine and pre-eclampsia aligning with previous study findings; nevertheless, larger follow-up studies including women from different states in India are needed.
Collapse
Affiliation(s)
| | | | - A G Radhika
- University College of Medical Science & GTB Hospital, Delhi, India
| |
Collapse
|
23
|
Saeedinia SA, Jahed-Motlagh MR, Tafakhori A, Kasabov NK. Diagnostic biomarker discovery from brain EEG data using LSTM, reservoir-SNN, and NeuCube methods in a pilot study comparing epilepsy and migraine. Sci Rep 2024; 14:10667. [PMID: 38724576 PMCID: PMC11082192 DOI: 10.1038/s41598-024-60996-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 04/30/2024] [Indexed: 05/12/2024] Open
Abstract
The study introduces a new online spike encoding algorithm for spiking neural networks (SNN) and suggests new methods for learning and identifying diagnostic biomarkers using three prominent deep learning neural network models: deep BiLSTM, reservoir SNN, and NeuCube. EEG data from datasets related to epilepsy, migraine, and healthy subjects are employed. Results reveal that BiLSTM hidden neurons capture biological significance, while reservoir SNN activities and NeuCube spiking dynamics identify EEG channels as diagnostic biomarkers. BiLSTM and reservoir SNN achieve 90 and 85% classification accuracy, while NeuCube achieves 97%, all methods pinpointing potential biomarkers like T6, F7, C4, and F8. The research bears implications for refining online EEG classification, analysis, and early brain state diagnosis, enhancing AI models with interpretability and discovery. The proposed techniques hold promise for streamlined brain-computer interfaces and clinical applications, representing a significant advancement in pattern discovery across the three most popular neural network methods for addressing a crucial problem. Further research is planned to study how early can these diagnostic biomarkers predict an onset of brain states.
Collapse
Affiliation(s)
| | | | - Abbas Tafakhori
- Department of Neurology, School of Medicine, Iranian Center of Neurological Research, Tehran University of Medical Sciences, Tehran, Iran
| | - Nikola Kirilov Kasabov
- School of Engineering, Computing and Mathematical Sciences, Auckland University of Technology, Auckland, New Zealand.
- Institute for Information and Communication Technology, Bulgarian Academy of Sciences, Sofia, Bulgaria.
- Computer Science and Engineering Department, Dalian University, Dalian, China.
| |
Collapse
|
24
|
Janković SM, Janković SV. Anti-calcitonin Gene-Related Peptide Monoclonal Antibodies in Migraine: Focus on Clinical Pharmacokinetics. Eur J Drug Metab Pharmacokinet 2024; 49:277-293. [PMID: 38461486 DOI: 10.1007/s13318-024-00885-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2024] [Indexed: 03/12/2024]
Abstract
The calcitonin gene-related peptide transmission was the target for recent development of drugs that effectively prevent attacks of both episodic and chronic migraine. The aim of this narrative review was to offer deeper insight into pharmacokinetics of monoclonal antibodies approved for prevention of migraine attacks. For this narrative review, relevant literature was searched for in MEDLINE and Google Scholar databases, covering periods 1966-2023 and 2006-2023, respectively. The ClinicalTrials.gov database was also searched for relevant clinical studies whose results had not been published previously in medical journals, covering the period 2000-2023. The monoclonal antibodies from this group are distributed mainly in the plasma and part of the extracellular space; they are neither metabolized in the liver nor excreted via the kidneys. The elimination of galcanezumab, eptinezumab and fremanezumab takes place only by a non-specific linear process via the reticuloendothelial system in the liver, while erenumab is eliminated by a non-specific process and by a specific, saturable process because of binding to receptors located on the cell membrane. Since the elimination processes do not have a large capacity, the half-life is about 2 weeks for erenumab and about 4 weeks for other monoclonal antibodies. Variability in the pharmacokinetics of these monoclonal antibodies is small in different subpopulations, and body weight is the only parameter to consider when choosing the dose of these drugs.
Collapse
Affiliation(s)
- Slobodan M Janković
- Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovića Street, 69, 34000, Kragujevac, Serbia.
| | - Snežana V Janković
- Faculty of Medical Sciences, University of Kragujevac, Svetozara Markovića Street, 69, 34000, Kragujevac, Serbia
| |
Collapse
|
25
|
Sun Y, Li X, Zhang G, Han L, Wu H, Peng W, Zhao L. Age and sex differences in the association between Dietary Inflammatory Index and severe headache or migraine: a nationwide cross-sectional study. Nutr Neurosci 2024; 27:477-486. [PMID: 37254530 DOI: 10.1080/1028415x.2023.2218563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND Migraine and severe headaches are extremely prevalent neurological disorders that plague humans and society. Prior research has revealed that DII may affect the occurrence of migraines, but there are too few relevant studies and more are required. This study aimed to determine the association between severe headache or migraine and the Dietary Inflammatory Index (DII), with particular attention to age and gender differences. METHODS Using data from the National Health and Nutrition Examination Survey (NHANES), we performed a cross-sectional study. In addition, we investigated the association between DII and severe headache or migraine using weighted multivariate logistic regression models, and restricted cubic splines models were plotted to explore their linear correlation. RESULTS There were a total of 13,439 people participating in the study, and of those, 2745 experienced a severe headache or migraine within the previous three months. The DII was linearly and positively correlated with severe headache or migraine (odds ratio [OR] = 1.05, 95% confidence interval [CI] = 1.01-1.08, p = 0.0051). Stratified analysis showed that this relationship persisted among women and those aged < 60 years, with ORs of 1.08 (95% CI = 1.04-1.13, p = 0.0004) and 1.05 (95% CI = 1.01-1.09, p = 0.0071), respectively. CONCLUSIONS We found that greater levels of DII were significantly related to an increased likelihood of migraine onset, especially among women and young and middle-aged populations. Further research is required to validate and expand upon our results.
Collapse
Affiliation(s)
- Yiyan Sun
- College of traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, People's Republic of China
| | - Xiaotong Li
- The First Clinical School of Shandong University of Traditional Chinese Medicine, Jinan, People's Republic of China
| | - Guangming Zhang
- College of traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, People's Republic of China
| | - Lin Han
- The First Clinical School of Shandong University of Traditional Chinese Medicine, Jinan, People's Republic of China
| | - Hongyun Wu
- Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, People's Republic of China
| | - Wei Peng
- Department of Neurology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, People's Republic of China
| | - Leiyong Zhao
- Department of Psychiatry, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, People's Republic of China
| |
Collapse
|
26
|
Deodato M, Granato A, Martini M, Buoite Stella A, Galmonte A, Murena L, Manganotti P. Neurophysiological and Clinical Outcomes in Episodic Migraine Without Aura: A Cross-Sectional Study. J Clin Neurophysiol 2024; 41:388-395. [PMID: 37934069 DOI: 10.1097/wnp.0000000000001055] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023] Open
Abstract
PURPOSE The aim of this study was to assess differences between people with episodic migraine and healthy controls in some neurophysiological and clinical outcomes, which, in turn, may highlight the differences in sensory processing, especially in cortical excitability, pain processing, and executive function. METHODS A cross-sectional study was performed, including the following outcomes: pressure pain thresholds with algometry; resting motor threshold, short-interval intracortical inhibition, and intracortical facilitation with transcranial magnetic stimulation; and executive functions with the trail making test and the frontal assessment battery. RESULTS Thirty adults with migraine (36 ± 10 years) and 30 healthy controls (29 ± 14 years) were included in this study. Compared with the healthy controls, participants with migraine presented lower pressure pain thresholds values in all the assessed muscles ( P < 0.001), lower resting motor threshold (-10.5% of the stimulator output, 95% CI: -16.8 to -4.2, P = 0.001, Cohen d = 0.869) and higher short-interval intracortical inhibition motor-evoked potential's amplitude at 3 ms (0.25, 95% CI: 0.05 to 0.46, P = 0.015, Cohen d = 0.662), and worse performances both in trail making test (7.1, 95% CI: 0.9 to 13.4, P = 0.027, Cohen d = 0.594) and frontal assessment battery (-1.1, 95% CI: -1.7 to -0.5, P = 0.001, Cohen d = 0.915). CONCLUSIONS Participants with migraine presented significant differences in cortical excitability, executive functions, and pressure pain thresholds, compared with healthy controls.
Collapse
Affiliation(s)
- Manuela Deodato
- PhD Program in Neural and Cognitive Sciences, Department of Life Sciences, University of Trieste, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy; and
- Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Antonio Granato
- Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Miriam Martini
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy; and
- Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Alex Buoite Stella
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy; and
| | - Alessandra Galmonte
- PhD Program in Neural and Cognitive Sciences, Department of Life Sciences, University of Trieste, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy; and
| | - Luigi Murena
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy; and
- Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Paolo Manganotti
- PhD Program in Neural and Cognitive Sciences, Department of Life Sciences, University of Trieste, Trieste, Italy
- Department of Medicine, Surgery and Health Sciences, University of Trieste, Trieste, Italy; and
- Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| |
Collapse
|
27
|
Shi Y, Zhang X, Feng Y. Association between the dietary inflammatory index and pain in US adults from NHANES. Nutr Neurosci 2024; 27:460-469. [PMID: 37254575 DOI: 10.1080/1028415x.2023.2218122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVES The growing global burden of pain is gradually expanding from the medical field to public health. Dietary inflammatory potential correlates with inflammatory markers, and inflammation is one of the main mechanisms of pain. METHODS This study explored the association between dietary inflammatory index (DII) and pain from the NHANES database on DII and pain (neck pain, low back pain, joint pain, and headache or migraine) using logistic regression and stratified analysis. RESULTS The results show a stronger association between DII and joint pain (Q4 of DII adjusted-OR = 1.23, 95% CI = 1.08-1.40, P = 0.003) and headache or migraine (Q4 of DII adjusted-OR = 1.31, 95% CI = 1.15-1.48, P < 0.001), but no association is found in neck pain (Q4 of DII adjusted-OR = 1.03, 95% CI = 0.89-1.20, P = 0.65) and low back pain (Q4 of DII adjusted-OR = 1.04, 95% CI = 0.92-1.17, P = 0.54). After stratifying the data according to demographics, differences in the relationship between DII and pain are found at different levels of the population. DISCUSSION This study identifies high DII as a risk factor for joint pain and headache or migraine.
Collapse
Affiliation(s)
- Yue Shi
- Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China
| | - Xueyi Zhang
- Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China
| | - Yue Feng
- Chengdu University of Traditional Chinese Medicine, Chengdu, People's Republic of China
| |
Collapse
|
28
|
Gago‐Veiga AB, Lopez‐Alcaide N, Quintas S, Fernández Lázaro I, Casas‐Limón J, Calle C, Latorre G, González‐García N, Porta‐Etessam J, Rodriguez‐Vico J, Jaimes A, Gómez García A, García‐Azorín D, Guerrero‐Peral ÁL, Sierra Á, Lozano Ros A, Sánchez‐Soblechero A, Díaz‐de‐Teran J, Membrilla JA, Treviño C, Gonzalez‐Martinez A. Evaluation of the concomitant use of prophylactic treatments in patients with migraine under anti-calcitonin gene-related peptide therapies: The PREVENAC study. Eur J Neurol 2024; 31:e16215. [PMID: 38323742 PMCID: PMC11235635 DOI: 10.1111/ene.16215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 12/23/2023] [Accepted: 01/04/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND AND PURPOSE Anti-calcitonin gene-related peptide (CGRP) therapies are recent preventive therapies approved for both episodic and chronic migraine. One of the measures of effectiveness is the withdrawal of other preventive treatments. The objective of this study is to quantify the impact of anti-CGRP drugs in concomitant preventive treatment in patients with migraine. METHODS This was an observational, retrospective, multicenter cohort study with patients from nine national headache units. Patients with migraine undergoing treatment for at least 6 months with anti-CGRP antibodies, who were initially associated with some preventive treatment (oral and/or onabotulinumtoxinA) were included. Demographic and clinical variables were collected, as well as variables related to headache. Differences according to withdrawal or nonwithdrawal were evaluated. RESULTS A total of 408 patients were included, 86.52% women, 48.79 (SD = 1.46) years old. Preventive treatment was withdrawn in 43.87% (179/408), 20.83% partially and 23.04% totally. In 27.45% (112/408), it was maintained exclusively due to comorbidity and in 28.6% (117/408) due to partial efficacy. The most frequent time of withdrawal was between 3 and 5 months after the start of treatment. The baseline characteristics associated with nonwithdrawal were comorbidities: insomnia, hypertension and obesity, chronic migraine, and medication overuse. In the multivariate analysis, the absence of high blood pressure, a greater number of preventive treatments at the start, and a lower number of migraine days/month after anti-CGRP treatment were independently associated with withdrawal of the treatment (p < 0.05). CONCLUSIONS Anti-CGRP antibodies allow the withdrawal of associated preventive treatment in a significant percentage of patients, which supports its effectiveness in real-life conditions.
Collapse
Affiliation(s)
- Ana Beatriz Gago‐Veiga
- Headache UnitHospital Universitario de la Princesa & Instituto de Investigación Sanitaria Princesa (IIS‐Princesa)MadridSpain
| | - Noelia Lopez‐Alcaide
- Headache UnitHospital Universitario de la Princesa & Instituto de Investigación Sanitaria Princesa (IIS‐Princesa)MadridSpain
| | - Sonia Quintas
- Headache UnitHospital Universitario de la Princesa & Instituto de Investigación Sanitaria Princesa (IIS‐Princesa)MadridSpain
| | - Iris Fernández Lázaro
- Headache UnitHospital Universitario de la Princesa & Instituto de Investigación Sanitaria Princesa (IIS‐Princesa)MadridSpain
| | | | | | | | | | | | | | - Alex Jaimes
- Headache UnitHospital Fundación Jiménez DíazMadridSpain
| | | | - David García‐Azorín
- Headache UnitHospital Clínico Universitario de ValladolidValladolidSpain
- Department of MedicineUniversidad de ValladolidValladolidSpain
| | - Ángel Luis Guerrero‐Peral
- Headache UnitHospital Clínico Universitario de ValladolidValladolidSpain
- Department of MedicineUniversidad de ValladolidValladolidSpain
| | - Álvaro Sierra
- Headache UnitHospital Clínico Universitario de ValladolidValladolidSpain
| | | | | | | | | | - Cristina Treviño
- Headache UnitHospital Clínico Universitario de la PazMadridSpain
| | - Alicia Gonzalez‐Martinez
- Headache UnitHospital Universitario de la Princesa & Instituto de Investigación Sanitaria Princesa (IIS‐Princesa)MadridSpain
| |
Collapse
|
29
|
Leighton T, VanHorne E, Parsons D. Oxygen Straight to the Brain: An Overview of Hyperbaric Oxygen Therapy for a Variety of Brain Morbidities. Curr Sports Med Rep 2024; 23:130-136. [PMID: 38578490 DOI: 10.1249/jsr.0000000000001158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
ABSTRACT Hyperbaric oxygen therapy as a treatment for conditions like traumatic brain injury, posttraumatic stress disorder, and migraines would seem intuitive, given its effect on condition-related ischemia and inflammation. However, hyperbaric therapeutic impacts for these in acute and chronic, or prolonged symptoms are elusive. This narrative review of hyperbaric's utility provided in sections per disease renders first a review of conventional pathological mechanisms and then articulates hyperbaric treatment targets versus their respective impacts. Multiple challenges exist using hyperbaric oxygen therapy for each morbidity, even in tertiary and adjunctive treatments. An almost universal shortfall across studies includes a lack of consistent, appropriate patient selection criteria intersected with delivery timing of therapy to symptomatic target, necessary to provide a higher fidelity in treatment metrics. Further research into these respective conditions is needed along with a revisitation of hyperbaric oxygen therapy's application to their conventional pathological mechanisms, lending new perspective to their employment and efficacy.
Collapse
Affiliation(s)
- Terrance Leighton
- Basic Underwater Demolition/SEAL Training Command, Naval Special Warfare Center, San Diego, CA
| | - Edgar VanHorne
- Naval Hospital Camp Pendleton Sports Medicine Fellowship, Camp Pendleton North, CA
| | - Dale Parsons
- United States Marine Corps School of Infantry West, Camp Pendleton North, CA
| |
Collapse
|
30
|
Sutherland HG, Jenkins B, Griffiths LR. Genetics of migraine: complexity, implications, and potential clinical applications. Lancet Neurol 2024; 23:429-446. [PMID: 38508838 DOI: 10.1016/s1474-4422(24)00026-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 01/09/2024] [Accepted: 01/11/2024] [Indexed: 03/22/2024]
Abstract
Migraine is a common neurological disorder with large burden in terms of disability for individuals and costs for society. Accurate diagnosis and effective treatments remain priorities. Understanding the genetic factors that contribute to migraine risk and symptom manifestation could improve individual management. Migraine has a strong genetic basis that includes both monogenic and polygenic forms. Some distinct, rare, familial migraine subtypes are caused by pathogenic variants in genes involved in ion transport and neurotransmitter release, suggesting an underlying vulnerability of the excitatory-inhibitory balance in the brain, which might be exacerbated by disruption of homoeostasis and lead to migraine. For more prevalent migraine subtypes, genetic studies have identified many susceptibility loci, implicating genes involved in both neuronal and vascular pathways. Genetic factors can also reveal the nature of relationships between migraine and its associated biomarkers and comorbidities and could potentially be used to identify new therapeutic targets and predict treatment response.
Collapse
Affiliation(s)
- Heidi G Sutherland
- Centre for Genomics and Personalised Health, Genomics Research Centre, School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Bronwyn Jenkins
- Department of Neurology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Lyn R Griffiths
- Centre for Genomics and Personalised Health, Genomics Research Centre, School of Biomedical Sciences, Queensland University of Technology, Brisbane, QLD, Australia.
| |
Collapse
|
31
|
Braca S, Miele A, Stornaiuolo A, Cretella G, De Simone R, Russo CV. Are anti-calcitonin gene-related peptide monoclonal antibodies effective in treating migraine aura? A pilot prospective observational cohort study. Neurol Sci 2024; 45:1655-1660. [PMID: 38091211 DOI: 10.1007/s10072-023-07241-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 11/28/2023] [Indexed: 03/16/2024]
Abstract
BACKGROUND About 15% to one third of migraineurs experience aura symptoms. Aura is a reversible focal neurological phenomenon involving visual, sensory, speech, and motor symptoms that usually precede migraine pain. Monoclonal antibodies against calcitonin-related peptide (anti- CGRP mAbs) are effective in preventing chronic and episodic migraine, but little is known about their effectiveness on specifically preventing migraine with aura. METHODS This is a pilot prospective observational cohort study, aiming at evaluating the effectiveness and safety of Erenumab, Fremanezumab or Galcanezumab for the treatment of migraine aura. We enrolled 14 patients at the Headache Centre of University Federico II of Naples. Duration of follow-up was 12 months. We assessed mean monthly days with aura symptoms, with or without subsequent headache, as well as mean monthly days with headache and mean monthly MIDAS score, by reviewing standardized paper patient headache diaries every three months. RESULTS A significant decrease in mean monthly aura days was observed throughout the observation period (median baseline: 13, interquartile range: 4-16; after 12 months: 1, interquartile range: 0-3, p < 0.001). We observed a statistically significant decrease in mean monthly headache days as well (median baseline 21, interquartile range: 16-30; after 12 months: 5, interquartile range: 4-7, p < 0.001). During the 12-month treatment period, none of the 14 patients reported mild or serious adverse events. CONCLUSION Our findings suggest that anti-CGRP mAbs are highly effective in migraine with aura, both in reducing mean monthly aura days and mean monthly days with headache.
Collapse
Affiliation(s)
- Simone Braca
- Department of Neurological Sciences, Reproductive and Odontostomatological Sciences, University Federico II, Naples, Italy
| | - Angelo Miele
- Department of Neurological Sciences, Reproductive and Odontostomatological Sciences, University Federico II, Naples, Italy
| | - Antonio Stornaiuolo
- Department of Neurological Sciences, Reproductive and Odontostomatological Sciences, University Federico II, Naples, Italy
| | - Gennaro Cretella
- Department of Neurological Sciences, Reproductive and Odontostomatological Sciences, University Federico II, Naples, Italy
| | - Roberto De Simone
- Department of Neurological Sciences, Reproductive and Odontostomatological Sciences, University Federico II, Naples, Italy
| | - Cinzia Valeria Russo
- Department of Neurological Sciences, Reproductive and Odontostomatological Sciences, University Federico II, Naples, Italy.
| |
Collapse
|
32
|
Rikos D, Vikelis M, Dermitzakis EV, Soldatos P, Rallis D, Rudolf J, Andreou AP, Argyriou AA. Reporting Quality and Risk of Bias Analysis of Published RCTs Assessing Anti-CGRP Monoclonal Antibodies in Migraine Prophylaxis: A Systematic Review. J Clin Med 2024; 13:1964. [PMID: 38610729 PMCID: PMC11012539 DOI: 10.3390/jcm13071964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 03/19/2024] [Accepted: 03/25/2024] [Indexed: 04/14/2024] Open
Abstract
Objective: Phase II/III randomized clinical trials (RCTs) are vulnerable to many types of bias beyond randomization. Insights into the reporting quality of RCTs involving migraine patients treated with monoclonal antibodies targeting the calcitonin gene-related peptide system (anti-CGRP MAbs) are currently lacking. Our aim was to analyze the reporting quality of phase II/III RCTs involving migraine patients treated with anti-CGRP MAbs. Methods: A systematic search was performed on the PubMed and EMBASE databases, according to PRISMA guidelines, for relevant RCTs in either episodic or chronic migraine prevention. Additionally, an adapted version of the 2010 CONSORT statement checklist was utilized. The ROBvis online tool was used to document the risk of bias. Results: From the initially identified 179 articles, we finally found 31 RCTs that were eligible for evaluation. The average CONSORT compliance was 88.7% (69.7-100%), while 93.5% (N = 29) of the articles had a compliance greater than 75%. Twenty-eight CONSORT items were reported in more than 75% of the articles. The average compliance of the analyzed RCTs was 93.9% for Galcanezumab, 91.3% for Fremanezumab, followed by 85.4% for Erenumab and Eptinezumab studies. Implementation of the ROB2 tool showed some concerning "missing information" arising from the inadequate reporting. Specifically, 50% of the studies (N = 16) were categorized as having inadequate information regarding the randomization process. Conclusions: Adequate reporting quality was disclosed in the evaluated RCTs with anti-CGRP MAbs in migraine prevention. However, some methodological issues need to be highlighted to be addressed in future studies assessing the efficacy of new molecules targeting CGRP or other candidate pathways implicated in migraine pathophysiology.
Collapse
Affiliation(s)
| | - Michail Vikelis
- Headache Clinic, Mediterraneo Hospital, 16675 Athens, Greece;
| | | | | | - Dimitrios Rallis
- Department of Neurology, Tzaneio General Hospital of Piraeus, 18536 Athens, Greece;
| | - Jobst Rudolf
- Department of Neurology, Papageorgiou General Hospital of Thessaloniki, 54645 Thessaloniki, Greece;
| | - Anna P. Andreou
- Headache Centre, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 9RT, UK;
- Headache Research-Wolfson Sensory, Pain and Regeneration Centre, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE1 1LU, UK
| | - Andreas A. Argyriou
- Headache Outpatient Clinic, Department of Neurology, Agios Andreas General Hospital of Patras, 26335 Patras, Greece;
| |
Collapse
|
33
|
Cacabelos R. Genomics of Brain Disorders 4.0. Int J Mol Sci 2024; 25:3667. [PMID: 38612479 PMCID: PMC11011366 DOI: 10.3390/ijms25073667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 03/14/2024] [Indexed: 04/14/2024] Open
Abstract
Several historic, scientific events have occurred in the decade 2013-2023, in particular the COVID-19 pandemic. This massive pathogenic threat, which has affected the world's population, has had a devastating effect on scientific production worldwide. [...].
Collapse
Affiliation(s)
- Ramón Cacabelos
- International Center of Neuroscience and Genomic Medicine, EuroEspes Biomedical Research Center, 15165 Bergondo, Spain
| |
Collapse
|
34
|
Zeng W, Han C, Mohammed S, Li S, Song Y, Sun F, Du Y. Indole-containing pharmaceuticals: targets, pharmacological activities, and SAR studies. RSC Med Chem 2024; 15:788-808. [PMID: 38516587 PMCID: PMC10953485 DOI: 10.1039/d3md00677h] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 01/29/2024] [Indexed: 03/23/2024] Open
Abstract
Indole is a prestigious heterocyclic skeleton widely found in both naturally-occurring and biologically-active compounds. Pharmaceutical agents containing an indole skeleton in their framework possess a wide range of pharmacological properties, including antiviral, antitumor, analgesic, and other therapeutic activities, and many indole-containing drugs have been proven to have excellent pharmacokinetic and pharmacological effects. Over the past few decades, the FDA has approved over 40 indole-containing drugs for the treatment of various clinical conditions, and the development of indole-related drugs has attracted significant attention from medicinal chemists. This review aims to provide an overview of all the approved drugs that contain an indole nucleus, focusing on their targets, pharmacological activities, and SAR studies.
Collapse
Affiliation(s)
- Wei Zeng
- School of Pharmaceutical Science and Technology, Tianjin University Tianjin 300072 China
| | - Chi Han
- School of Pharmaceutical Science and Technology, Tianjin University Tianjin 300072 China
| | - Sarah Mohammed
- School of Pharmaceutical Science and Technology, Tianjin University Tianjin 300072 China
| | - Shanshan Li
- School of Pharmaceutical Science and Technology, Tianjin University Tianjin 300072 China
| | - Yixuan Song
- Department of Chemical Engineering & Biotechnology, University of Cambridge CB2 3RA Cambridge UK
| | - Fengxia Sun
- Research Center for Chemical Safety & Security and Verification Technology & College of Chemical and Pharmaceutical Engineering, Hebei University of Science and Technology Shijiazhuang 050018 China
| | - Yunfei Du
- School of Pharmaceutical Science and Technology, Tianjin University Tianjin 300072 China
| |
Collapse
|
35
|
del Blanco Muñiz JÁ, Sánchez Sierra A, Ladriñán Maestro A, Ucero Lozano R, Sosa-Reina MD, Martín Vera D. Cervical impairments in subjects with migraine or tension type headache: an observational study. Front Neurol 2024; 15:1373912. [PMID: 38529031 PMCID: PMC10962388 DOI: 10.3389/fneur.2024.1373912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 02/21/2024] [Indexed: 03/27/2024] Open
Abstract
Objective The aim of this investigation was to compare the thickness of the deep local muscles in the neck region, as well as local and widespread sensitivity and functionality, between individuals with migraine, Tension-Type Headache (TTH), and healthy controls. To date, we know that the onset of migraine and TTH share similar pathophysiological pathways. Nevertheless, there may be some anatomical and functional differences which would explain why clinicians may obtain variable results when treating both pathological entities with similar or equal approaches. Methods An observational study was conducted in accordance with STROBE guidelines. The flexor longus colli and multifidus, two neck-stabilizing muscles, were measured using B-mode ultrasound imaging. The upper trapezius, masseter, temporalis, tibialis anterior, and median nerve all underwent bilateral pressure-pain threshold (PPT) assessments. Results Ninety participants were enrolled in the study. All subjects were equally divided into TTH, migraine and control groups. The PPT values exhibited lower thresholds in patients with TTH than both migraine and healthy participants. Specifically, in the temporal muscle on both sides, patients with TTH exhibited a significantly lower threshold (p < 0.001)than both migraine and healthy participants. Patients with TTH displayed significantly lower thresholds in both upper trapezius muscles (right: p < 0.001; left: p = 0.001). Similar results were obtained for the tibialis anterior PPTs from both sides (p = 0.001 in both). However, both clinical groups exhibited lower thresholds than the healthy subjects (p < 0.001). In multifidus muscle cross-sectional area (CSA), no statistically significant differences were found between migraine patients and healthy subjects, both in relaxation and contraction (right; p > 0.05 and p > 0.05; left: p > 0.05 and p > 0.05). However, patients with TTH exhibited a smaller CSA than both migraine patients and healthy controls in multifidus relaxed and contracted state (right: p < 0.001 in both relaxed and contracted multifidus; left: p = 0.001 and p < 0.001, respectively). Similar results were obtained for the left longus colli muscle in both relaxation and contraction for patients with TTH and migraine compared with healthy subjects (p = 0.001 and p < 0.001, respectively, for muscle relaxation and p < 0.001 for muscle contraction). However, no significant differences were observed between patients with TTH and migraine (p < 0.05 in both relaxation and contraction). In the right longus colli, TTH and migraine patients had a significantly smaller CSA during contraction than healthy subjects (p < 0.001 in both comparisons). In the craniocervical flexion test, both groups of patients with TTH and migraine showed significantly lower values than healthy subjects (p < 0.001 in both comparisons). However, no significant differences were found between patients with TTH and migraineurs (p > 0.05). Conclusion The findings provide a significant message for clinicians since anatomical and functional impairments were shown in patients with TTH and migraine. This study corroborates a lack of strength and smaller CSA in both clinical groups compared to controls. Therefore, strengthening programs may be addressed successfully for people with these pathological entities. To be more accurate, according to PPTs and CSA lower values in patients with TTH compared to migraine and controls, manual therapy approaches to desensitize craniocervical soft tissues and exercise therapy to increase endurance of deep cervical muscles may become meaningful especially in subjects with TTH. Nevertheless, in order to distinguish precisely between patients with TTH and migraine, different diagnostic strategies may be used in the future to describe these populations in further detail, which will assist health professionals in a more accurate treatment selection.
Collapse
Affiliation(s)
- Jose Ángel del Blanco Muñiz
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
- Research Group on Exercise Therapy and Functional Rehabilitation, Faculty of Health Sciences, Universidad Europea de Madrid, Madrid, Spain
| | - Alberto Sánchez Sierra
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
- Research Group on Exercise Therapy and Functional Rehabilitation, Faculty of Health Sciences, Universidad Europea de Madrid, Madrid, Spain
- Faculty of Physiotherapy and Nursing, University of Castilla La Mancha, Toledo, Spain
- Physiotherapy Research Group of Toledo (GIFTO), Faculty of Physiotherapy and Nursing, Universidad de Castilla-La Mancha, Toledo, Spain
| | - Arturo Ladriñán Maestro
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
- Research Group on Exercise Therapy and Functional Rehabilitation, Faculty of Health Sciences, Universidad Europea de Madrid, Madrid, Spain
- Faculty of Physiotherapy and Nursing, University of Castilla La Mancha, Toledo, Spain
| | - Roberto Ucero Lozano
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - María Dolores Sosa-Reina
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
| | - Daniel Martín Vera
- Department of Physiotherapy, Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Madrid, Spain
- Research Group on Exercise Therapy and Functional Rehabilitation, Faculty of Health Sciences, Universidad Europea de Madrid, Madrid, Spain
| |
Collapse
|
36
|
Ulgen Temel E, Ozbudak P, Serdaroglu A, Arhan E. Sleep Spindle Alterations in Children With Migraine. Pediatr Neurol 2024; 152:184-188. [PMID: 38301321 DOI: 10.1016/j.pediatrneurol.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Accepted: 12/16/2023] [Indexed: 02/03/2024]
Abstract
BACKGROUND The modulation of thalamocortical activity is the most important site of several levels of interference between sleep spindles and migraine. Thalamocortical circuits are responsible for the electrophysiological phenomenon of sleep spindles. Spindle alterations may be used as a beneficial marker in the diagnosis and follow-up of children with migraine. We aimed to formulate the hypothesis that there is a shared mechanism that underlies migraine and sleep spindle activity. METHODS We analyzed the amplitude, frequency, duration, density, and activity of sleep spindles in non-rapid eye movement stage 2 sleep in patients with migraine without aura when compared with healthy control subjects. RESULTS The amplitudes of average, slow, and fast sleep spindles were higher in children with migraine without aura (P = 0.020, 0.013, and 0.033, respectively). The frequency of fast spindles was lower in children with migraines without aura when compared with the control group (P = 0.03). Although not statistically significant, the fast sleep spindle duration in the migraine group was shorter (P = 0.055). Multivariate analysis revealed an increased risk of migraine associated with increased mean spindle amplitude and decreased fast spindle frequency and duration. CONCLUSIONS Our data suggest that spindle alterations may correlate with the vulnerability to develop migraine and may be used as a model for future research about the association between the thalamocortical networks and migraine.
Collapse
Affiliation(s)
- Esra Ulgen Temel
- Division of Child Neurology, Cengiz Gökçek Maternity and Children's Hospital, Gaziantep, Turkey
| | - Pinar Ozbudak
- Division of Child Neurology, Etlik City Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Ayse Serdaroglu
- Department of Child Neurology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Ebru Arhan
- Department of Child Neurology, Gazi University Faculty of Medicine, Ankara, Turkey.
| |
Collapse
|
37
|
Joshi S, Williamson J, Moosa S, Kapur J. Progesterone Receptor Activation Regulates Sensory Sensitivity and Migraine Susceptibility. THE JOURNAL OF PAIN 2024; 25:642-658. [PMID: 37777034 DOI: 10.1016/j.jpain.2023.09.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 08/20/2023] [Accepted: 09/25/2023] [Indexed: 10/02/2023]
Abstract
Women develop chronic pain during their reproductive years more often than men, and estrogen and progesterone regulate this susceptibility. We tested whether brain progesterone receptor (PR) signaling regulates pain susceptibility. During the estrous cycle, animals were more sensitive to mechanical stimulus during the estrus stage than in the diestrus stage, suggesting a role for reproductive hormones, estrogen, and progesterone. Progesterone treatment of ovariectomized and estrogen-primed mice caused a delayed reduction in the mechanical threshold. Segesterone, a specific agonist of PRs replicated this effect, whereas, the segesterone-induced reduction in mechanical threshold was blocked in the mice lacking PRs in the nervous system. Segesterone treatment also did not alter mechanical threshold in adult male and juvenile female mice. PR activation increased the cold sensitivity but did not affect the heat and light sensitivity. We evaluated whether PR activation altered experimental migraine. Segesterone and nitroglycerin when administered sequentially, reduced the pain threshold but not when given separately. PRs were expressed in several components of the migraine ascending pain pathway, and their deletion blocked the painful effects of nitroglycerin. PR activation also increased the number of active neurons in the components of the migraine ascending pain pathway. These studies have uncovered a pain-regulating function of PRs. Targeting PRs may provide a novel therapeutic avenue to treat chronic pain and migraine in women. PERSPECTIVE: This article provides evidence for the role of progesterone receptors in regulating pain sensitivity and migraine susceptibility in females. Progesterone receptors may be a therapeutic target to treat chronic pain conditions more prevalent in women than men.
Collapse
Affiliation(s)
- Suchitra Joshi
- Department of Neurology, University of Virginia, Charlottesville, Virginia
| | - John Williamson
- Department of Neurology, University of Virginia, Charlottesville, Virginia
| | - Shayan Moosa
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Jaideep Kapur
- Department of Neurology, University of Virginia, Charlottesville, Virginia; Department of Neuroscience, University of Virginia, Charlottesville, Virginia; UVA Brain Institute, University of Virginia, Charlottesville, Virginia
| |
Collapse
|
38
|
Hashemi S, Saadat P, Gorgani-Firouzjaee T, Ferdosi-Shahandashti E, Jafarzadeh J. Potential genetic polymorphism of matrix metalloproteinase (MMP)-9 in Iranian migraine patients with Toxoplasma gondii infection. Parasitol Res 2024; 123:140. [PMID: 38386175 DOI: 10.1007/s00436-024-08156-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 02/06/2024] [Indexed: 02/23/2024]
Abstract
Toxoplasma gondii is an intracellular protozoan parasite that causes neuroinflammation in the brain and a constant need for peripheral leukocyte migration. Matrix metalloproteinase 9 (MMP-9) can play a major role in this neuroinflammation and be implicated in some neurological disorders, such as migraines. Therefore, the genetic polymorphism evaluation of MMP-9 in migraine patients with T. gondii infection was performed. One hundred fourteen migraine patients and 114 healthy controls were evaluated for the presence of anti-Toxoplasma IgG antibodies. Seventy-two migraine patients and 40 healthy controls were randomly selected for assessment of the MMP 9-1562C/T genetic polymorphism. In the preliminary examination, 61 (53.5%) migraine patients and 43 (37.3%) healthy controls were positive for IgG antibodies, with a significant association between T. gondii seropositivity and migraine (OR = 1.90; 95% CI = 1.21-3.223; P = 0.012). Genetic distribution for the polymorphism was not in Hardy-Weinberg equilibrium in cases but showed no significant variation in control groups (P = 0.03 and P = 0.180, respectively). A significant preponderance of the CT + TT genotype was found in migraine subjects compared to controls (P = 0.042) (OR, 1.77, CI, 1.013-2.229). The homozygote muted allele TT had a higher rate in migraine patients (6.9%). There were significant differences in CT + TT genotype between T. gondii positive and negative migraine patients (P = 0.024), but T allele frequencies had no significant variation (OR 1.7 CI, 1.084-2.44 and 0.42 CI, 0.044-3.97, respectively). In conclusion, the results may provide the first evidence for the involvement of the MMP-9 gene polymorphism in the mechanism of migraine pathology following Toxoplasma infection.
Collapse
Affiliation(s)
- Sepideh Hashemi
- Student Research Committee, Babol University of Medical Sciences, Babol, Iran
| | - Payam Saadat
- Mobility Impairment Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Tahmineh Gorgani-Firouzjaee
- Infectious Diseases and Tropical Medicine Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran.
| | | | - Jalal Jafarzadeh
- Department of Mycology and Parasitology, School of Medicine, Babol University of Medical Sciences, Babol, Iran
| |
Collapse
|
39
|
Ouyang D, Huang C, Liu H, Xie W, Chen C, Su B, Guo L. Comprehensive analysis of genetic associations and single-cell expression profiles reveals potential links between migraine and multiple diseases: a phenome-wide association study. Front Neurol 2024; 15:1301208. [PMID: 38385040 PMCID: PMC10879407 DOI: 10.3389/fneur.2024.1301208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 01/19/2024] [Indexed: 02/23/2024] Open
Abstract
Migraine is a common neurological disorder that affects more than one billion people worldwide. Recent genome-wide association studies have identified 123 genetic loci associated with migraine risk. However, the biological mechanisms underlying migraine and its relationships with other complex diseases remain unclear. We performed a phenome-wide association study (PheWAS) using UK Biobank data to investigate associations between migraine and 416 phenotypes. Mendelian randomization was employed using the IVW method. For loci associated with multiple diseases, pleiotropy was tested using MR-Egger. Single-cell RNA sequencing data was analyzed to profile the expression of 73 migraine susceptibility genes across brain cell types. qPCR was used to validate the expression of selected genes in microglia. PheWAS identified 15 disorders significantly associated with migraine, with one association detecting potential pleiotropy. Single-cell analysis revealed elevated expression of seven susceptibility genes (including ZEB2, RUNX1, SLC24A3, ANKDD1B, etc.) in brain glial cells. And qPCR confirmed the upregulation of these genes in LPS-treated microglia. This multimodal analysis provides novel insights into the link between migraine and other diseases. The single-cell profiling suggests the involvement of specific brain cells and molecular pathways. Validation of gene expression in microglia supports their potential role in migraine pathology. Overall, this study uncovers pleiotropic relationships and the biological underpinnings of migraine susceptibility.
Collapse
Affiliation(s)
- Di Ouyang
- Nanjing University of Chinese Medicine, Nanjing, China
- Traditional Chinese Medicine Hospital of Yulin, Yulin, China
| | - Chunying Huang
- Traditional Chinese Medicine Hospital of Yulin, Yulin, China
| | - Huihua Liu
- Traditional Chinese Medicine Hospital of Yulin, Yulin, China
| | | | | | - Ben Su
- Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lizhong Guo
- Nanjing University of Chinese Medicine, Nanjing, China
| |
Collapse
|
40
|
Briskey D, Skinner R, Smith C, Rao A. Effectiveness of Palmitoylethanolamide (Levagen+) Compared to a Placebo for Reducing Pain, Duration, and Medication Use during Migraines in Otherwise Healthy Participants-A Double-Blind Randomised Controlled Study. Pharmaceuticals (Basel) 2024; 17:145. [PMID: 38399360 PMCID: PMC10892859 DOI: 10.3390/ph17020145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/25/2024] Open
Abstract
Migraines are a common neurological disorder that generally affects young to middle-aged adults and females more than males. Various treatment options are available; however, these can cause undesirable side effects. Therefore, alternative treatments with minimal side effects are still being investigated. Palmitoylethanolamide (PEA) is a signalling lipid known to have anti-inflammatory and analgesic properties. Previous prophylactic research has reported PEA supplementation to decrease pain associated with migraines. Upon commencement of migraine symptoms, participants were supplemented with either 600 mg of PEA (Levagen+) or a placebo (maltodextrin). Once a dose was taken, participants recorded a visual analogue scale (VAS) for pain every 30 min for 4 h or until the migraine resolved. If the migraine had not resolved 2 h post-dose, participants were instructed to take a second dose. Levagen+ supplementation resolved more headaches after 2- and 8 h, had a lower VAS for pain score at 1.5 and 4 h, and reduced rescue medication use significantly more than a placebo. No adverse events were reported in either group. Overall, PEA was safe and effective in reducing migraine pain, duration, and medication use in an otherwise healthy adult population.
Collapse
Affiliation(s)
- David Briskey
- RDC Clinical, Level 3, 252 St Pauls Terrace, Brisbane, QLD 4006, Australia
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD 4072, Australia
| | - Rachael Skinner
- RDC Clinical, Level 3, 252 St Pauls Terrace, Brisbane, QLD 4006, Australia
| | - Chelsie Smith
- RDC Clinical, Level 3, 252 St Pauls Terrace, Brisbane, QLD 4006, Australia
| | - Amanda Rao
- RDC Clinical, Level 3, 252 St Pauls Terrace, Brisbane, QLD 4006, Australia
- School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, QLD 4072, Australia
| |
Collapse
|
41
|
Podraza K, Bangera N, Feliz A, Charles A. Reduction in retinal microvascular perfusion during migraine attacks. Headache 2024; 64:16-36. [PMID: 38031892 DOI: 10.1111/head.14654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/19/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE To determine if there are changes in structure and function of the retinal vasculature during and between migraine attacks using optical coherence tomography angiography (OCTA). BACKGROUND Migraine attacks commonly include visual symptoms, but the potential role of the retina in these symptoms is not well understood. OCTA is a rapid, non-invasive imaging technique that is used to visualize the retinal microvasculature with high spatial resolution in a clinical setting. In this study we used OCTA to quantify different features of the retinal vasculature in patients with migraine during and between attacks, as well as in healthy controls (HCs). METHODS We performed a prospective cohort study of 37 patients with migraine with aura (MA) (median [interquartile range, IQR] age of 37 [14] years, 86% female) and 30 with migraine without aura (MO) (median [IQR] age of 37 [17] years, 77% female) and 20 HCs (median [IQR] age of 35 [7] years, 50% female). Macular OCTA scans were obtained for all participants for the interictal analysis. In 12 MA and eight MO, scans were captured both during and outside of migraine attacks and five HCs had initial and repeat scans. In addition to analyzing the morphology of the foveal avascular zone, we calculated the vessel flux index (VFI), which is an indicator of retinal perfusion and conventional metrics (such as vessel area density) in the foveal and parafoveal regions. RESULTS There was a significant difference in the parafoveal VFI in the ictal state between the groups (p = 0.009). During migraine attacks there was a significant reduction in the parafoveal region VFI in MA (-7%, 95% confidence interval [CI] -10% to -4%; p = 0.006) and MO (-7%, 95% CI -10% to -3%; p = 0.016) from their interictal baseline as compared to the change between repeat scans in HCs (2%, 95% CI -3% to 7%). Interictally, there was a mean (standard deviation [SD]) 13% (10%) (p = 0.003) lower blood perfusion in the MA group as compared to the MO group in the foveal region (mean [SD] 0.093 [0.023] vs. 0.107 [0.021], p = 0.003). Interictal analysis also revealed higher circularity in the superficial foveal avascular zone in the MA group compared with the MO group (mean [SD] 0.686 [0.088] vs. 0.629 [0.120], p = 0.004). In addition, interictal analysis of the patients with MA or MO and unilateral headache showed increased retinal vascular parameters consistent with greater perfusion in the eye ipsilateral to the side of the pain as compared with the contralateral eye. CONCLUSIONS These results indicate that perfusion is reduced in MA and MO in the parafoveal retina during the ictal period. Interictally, the foveal retina in MA has reduced perfusion when compared to the foveal retina in MO. Patients with unilateral headache showed interictal asymmetry of retinal perfusion between eyes. These results indicate that changes in retinal perfusion could be a part of migraine pathophysiology, and that distinct retinal vascular signatures identified with OCTA could represent biomarkers for migraine.
Collapse
Affiliation(s)
- Katherine Podraza
- Department of Neurology, University of California, Los Angeles, California, USA
- Hartford Healthcare Headache Center, Mystic, Connecticut, USA
| | - Nitin Bangera
- Department of Neurology, University of California, Los Angeles, California, USA
- Center for Advanced Diagnostics, Evaluation and Therapeutics (CADET NM Inc.), Albuquerque, New Mexico, USA
| | - Akira Feliz
- Department of Neurology, University of California, Los Angeles, California, USA
| | - Andrew Charles
- Department of Neurology, University of California, Los Angeles, California, USA
| |
Collapse
|
42
|
Liaquat A, Sheikh WA, Yousaf I, Mumtaz H, Zafar M, Khan Sherwani AH. Frequency of migraine and its associated triggers and relievers among medical students of Lahore: a cross-sectional study. Ann Med Surg (Lond) 2024; 86:103-108. [PMID: 38222774 PMCID: PMC10783279 DOI: 10.1097/ms9.0000000000001377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 09/25/2023] [Indexed: 01/16/2024] Open
Abstract
Introduction Headache is a widely prevalent illness that negatively impacts people's lives, leaving them functionally incapable of performing regular everyday tasks. The global burden of headache is 40%, of which migraine accounts for 47%. Objective This study aims to determine the frequency of migraine among medical students of Lahore and its characteristics, associated triggers, and relievers among medical students. Methodology A cross-sectional study was conducted in medical colleges after obtaining ethical approval. Migraine was diagnosed using the criteria provided in the International Classification of Headache Disorders, Third Edition (ICHD-3), and data on triggers, relief, and demographics were collected. The information is analyzed using SPSS 22. Result The data were collected from 522 medical students. The average age of the students was 21.3 ± 2.0 SD (in years). About 146 (28.0%) of the medical students have migraine according to ICHD-3 criteria and were diagnosed initially. Gender was insignificantly associated with migraine (P-value=0.32). Students with psoriasis, hypertension, and polycystic ovarian syndrome were statistically significantly related to migraines with a P-value=0.002. Dehydration is the most frequent aggravator, and adequate sleep is the most frequent reliever of migraine. Conclusion The findings show a high frequency of migraine. They are similar in both genders, depicting that stressful lifestyles, inadequate sleep patterns, and bizarre dietary habits make them more prone to migraine episodes. So, further, detailed studies should be done on evaluating triggers and relievers of migraine and their interrelations with migraine so we can focus on preventive strategies, diagnosis, and treatment of migraine.
Collapse
Affiliation(s)
| | | | | | - Hassan Mumtaz
- Maroof International Hospital, Islamabad
- Health Services Academy, Chak Shahzad, Islamabad, Pakistan
| | | | | |
Collapse
|
43
|
Zhou M, Pang F, Liao D, Yang Y, Wang Y, Yang Z, He X, Tang C. Electroacupuncture improves allodynia and central sensitization via modulation of microglial activation associated P2X4R and inflammation in a rat model of migraine. Mol Pain 2024; 20:17448069241258113. [PMID: 38744426 PMCID: PMC11143845 DOI: 10.1177/17448069241258113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 05/08/2024] [Accepted: 05/10/2024] [Indexed: 05/16/2024] Open
Abstract
Background: Recent studies have demonstrated that activated microglia were involved in the pathogenesis of central sensitization characterized by cutaneous allodynia in migraine. Activation of microglia is accompanied by increased expression of its receptors and release of inflammatory mediators. Acupuncture and its developed electroacupuncture (EA) have been recommended as an alternative therapy for migraine and are widely used for relieving migraine-associated pain. However, it remains rare studies that show whether EA exerts anti-migraine effects via inhibiting microglial activation related to a release of microglial receptors and the inflammatory pathway. Therefore, this study aimed to investigate EA' ability to ameliorate central sensitization via modulation of microglial activation, microglial receptor, and inflammatory response using a rat model of migraine induced by repeated epidural chemical stimulation. Methods: In the present study, a rat model of migraine was established by epidural repeated inflammatory soup (IS) stimulation and treated with EA at Fengchi (GB20) and Yanglingquan (GB34) and acupuncture at sham-acupoints. Pain hypersensitivity was further determined by measuring the mechanical withdrawal threshold using the von-Frey filament. The changes in c-Fos and ionized calcium binding adaptor molecule 1 (Ibal-1) labeled microglia in the trigeminal nucleus caudalis (TNC) were examined by immunflurescence to assess the central sensitization and whether accompanied with microglia activation. In addition, the expression of Ibal-1, microglial purinoceptor P2X4, and its associated inflammatory signaling pathway mediators, including interleukin (IL)-1β, NOD-like receptor protein 3 (NLRP3), and Caspase-1 in the TNC were investigated by western blot and real-time polymerase chain reaction analysis. Results: Allodynia increased of c-Fos, and activated microglia were observed after repeated IS stimulation. EA alleviated the decrease in mechanical withdrawal thresholds, reduced the activation of c-Fos and microglia labeled with Ibal-1, downregulated the level of microglial purinoceptor P2X4, and limited the inflammatory response (NLRP3/Caspase-1/IL-1β signaling pathway) in the TNC of migraine rat model. Conclusions: Our results indicate that the anti-hyperalgesia effects of EA ameliorate central sensitization in IS-induced migraine by regulating microglial activation related to P2X4R and NLRP3/IL-1β inflammatory pathway.
Collapse
Affiliation(s)
- Min Zhou
- Chongqing Traditional Chinese Medicine Hospital, The First Affiliated Hospital of Chongqing College of Traditional Chinese Medicine, Chongqing, China
- College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China
| | - Fang Pang
- College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China
| | - Dongmei Liao
- College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China
| | - Yunhao Yang
- College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China
| | - Ying Wang
- Chongqing College of Traditional Chinese Medicine, Chongqing, China
| | - Zhuxin Yang
- College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China
| | - Xinlu He
- College of Traditional Chinese Medicine, Chongqing Medical University, Chongqing, China
| | - Chenglin Tang
- Chongqing College of Traditional Chinese Medicine, Chongqing, China
| |
Collapse
|
44
|
Sollmann N, Hoffmann G, Schramm S, Reichert M, Hernandez Petzsche M, Strobel J, Nigris L, Kloth C, Rosskopf J, Börner C, Bonfert M, Berndt M, Grön G, Müller HP, Kassubek J, Kreiser K, Koerte IK, Liebl H, Beer A, Zimmer C, Beer M, Kaczmarz S. Arterial Spin Labeling (ASL) in Neuroradiological Diagnostics - Methodological Overview and Use Cases. ROFO-FORTSCHR RONTG 2024; 196:36-51. [PMID: 37467779 DOI: 10.1055/a-2119-5574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
BACKGROUND Arterial spin labeling (ASL) is a magnetic resonance imaging (MRI)-based technique using labeled blood-water of the brain-feeding arteries as an endogenous tracer to derive information about brain perfusion. It enables the assessment of cerebral blood flow (CBF). METHOD This review aims to provide a methodological and technical overview of ASL techniques, and to give examples of clinical use cases for various diseases affecting the central nervous system (CNS). There is a special focus on recent developments including super-selective ASL (ssASL) and time-resolved ASL-based magnetic resonance angiography (MRA) and on diseases commonly not leading to characteristic alterations on conventional structural MRI (e. g., concussion or migraine). RESULTS ASL-derived CBF may represent a clinically relevant parameter in various pathologies such as cerebrovascular diseases, neoplasms, or neurodegenerative diseases. Furthermore, ASL has also been used to investigate CBF in mild traumatic brain injury or migraine, potentially leading to the establishment of imaging-based biomarkers. Recent advances made possible the acquisition of ssASL by selective labeling of single brain-feeding arteries, enabling spatial perfusion territory mapping dependent on blood flow of a specific preselected artery. Furthermore, ASL-based MRA has been introduced, providing time-resolved delineation of single intracranial vessels. CONCLUSION Perfusion imaging by ASL has shown promise in various diseases of the CNS. Given that ASL does not require intravenous administration of a gadolinium-based contrast agent, it may be of particular interest for investigations in pediatric cohorts, patients with impaired kidney function, patients with relevant allergies, or patients that undergo serial MRI for clinical indications such as disease monitoring. KEY POINTS · ASL is an MRI technique that uses labeled blood-water as an endogenous tracer for brain perfusion imaging.. · It allows the assessment of CBF without the need for administration of a gadolinium-based contrast agent.. · CBF quantification by ASL has been used in several pathologies including brain tumors or neurodegenerative diseases.. · Vessel-selective ASL methods can provide brain perfusion territory mapping in cerebrovascular diseases.. · ASL may be of particular interest in patient cohorts with caveats concerning gadolinium administration..
Collapse
Affiliation(s)
- Nico Sollmann
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- cBrain, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Gabriel Hoffmann
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Severin Schramm
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Miriam Reichert
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Moritz Hernandez Petzsche
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Joachim Strobel
- Department of Nuclear Medicine, University Hospital Ulm, Ulm, Germany
| | - Lorenzo Nigris
- cBrain, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Christopher Kloth
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Johannes Rosskopf
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
- Section of Neuroradiology, Bezirkskrankenhaus Günzburg, Günzburg, Germany
| | - Corinna Börner
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- LMU Hospital, Department of Pediatrics - Dr. von Hauner Children's Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity - iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Michaela Bonfert
- LMU Hospital, Department of Pediatrics - Dr. von Hauner Children's Hospital, Division of Pediatric Neurology and Developmental Medicine, Ludwig-Maximilians-Universität München, Munich, Germany
- LMU Center for Children with Medical Complexity - iSPZ Hauner, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Maria Berndt
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Georg Grön
- Department of Psychiatry and Psychotherapy III, University Hospital Ulm, Ulm, Germany
| | | | - Jan Kassubek
- Department of Neurology, University Hospital Ulm, Ulm, Germany
- German Center for Neurodegenerative Diseases (DZNE), Ulm University, Ulm, Germany
| | - Kornelia Kreiser
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
- Department of Radiology and Neuroradiology, Universitäts- und Rehabilitationskliniken Ulm, Ulm, Germany
| | - Inga K Koerte
- cBrain, Department of Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy, Ludwig-Maximilians-Universität München, Munich, Germany
- Psychiatry Neuroimaging Laboratory, Department of Psychiatry, Brigham and Women's Hospital, Boston, United States
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, United States
| | - Hans Liebl
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Department of Radiology, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany
| | - Ambros Beer
- Department of Nuclear Medicine, University Hospital Ulm, Ulm, Germany
- MoMan - Center for Translational Imaging, University Hospital Ulm, Ulm, Germany
- i2SouI - Innovative Imaging in Surgical Oncology, University Hospital Ulm, Ulm, Germany
| | - Claus Zimmer
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Meinrad Beer
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
- MoMan - Center for Translational Imaging, University Hospital Ulm, Ulm, Germany
- i2SouI - Innovative Imaging in Surgical Oncology, University Hospital Ulm, Ulm, Germany
| | - Stephan Kaczmarz
- Department of Diagnostic and Interventional Neuroradiology, School of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- TUM-Neuroimaging Center, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- Market DACH, Philips GmbH, Hamburg, Germany
| |
Collapse
|
45
|
Ozudogru Celik T, Gorgulu U, Kenar SG, Koca N, Yalcin E, Koymen I, Yasar E. Evaluation of forward head posture and thoracic kyphosis in migraine. J Clin Neurosci 2024; 119:17-21. [PMID: 37976910 DOI: 10.1016/j.jocn.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 10/12/2023] [Accepted: 11/10/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND The purpose of the current study was to investigate the forward head posture (FHP), thoracic kyphosis and their relationships between individuals with migraine and healthy controls using the DIERS Formetric 4D motion imaging system. METHODS In this observational case-control study, a total of 39 migraine patients and 44 healthy subjects were enrolled. FHP and thoracic kyphosis were assessed by using the 4D Formetric DIERS system. The visual analogue scale (VAS) and Neck Disability Index (NDI) was used to evaluate neck pain and neck disability. Headache status were evaluated through Migraine Disability Assessment (MIDAS) and Numeric Pain Rating Scale (NPRS) questionnaires. RESULTS The fleche cervicale (57.72 ± 13.72 mm vs. 40.00 ± 4.75 mm; p < 0.001) and kyphotic angle (57.39 ± 8.76° vs. 38.21 ± 5.67°; p < 0.001) were significantly higher in patients with migraine compared to control group. When NDI categories were compared, the migraine group showed significantly increase in the number of patients with moderate or severe disability (p < 0.001). A positive correlation was found between fleche cervicale and thoracic kyphosis (r = 0.71, p < 0.001). CONCLUSIONS This study revealed that patients with migraine exhibited a greater FHP and thoracic kyphosis compared to the control group. A 3-dimensional objective measurement may be a reliable diagnostic tool to evaluate posture analysis in clinical practice in the future.
Collapse
Affiliation(s)
- Tugba Ozudogru Celik
- Department of Physical Medicine and Rehabilitation, Ankara City Hospital, University of Health Sciences Turkey, Ankara, Turkey.
| | - Umit Gorgulu
- Department of Neurology, Ankara City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Safiye Gul Kenar
- Department of Neurology, Ankara City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Nadide Koca
- Department of Physical Medicine and Rehabilitation, Ankara Education and Research Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Elif Yalcin
- Department of Physical Medicine and Rehabilitation, Ankara City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Ipek Koymen
- Department of Physical Medicine and Rehabilitation, Ankara City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| | - Evren Yasar
- Department of Physical Medicine and Rehabilitation, Ankara City Hospital, University of Health Sciences Turkey, Ankara, Turkey
| |
Collapse
|
46
|
Lackovic M, Jankovic M, Mihajlovic S, Milovanovic Z, Nikolic D. Exploring the Connection between Migraines and Pregnancy: The Impact of Physical Activity on Symptom Management. MEDICINA (KAUNAS, LITHUANIA) 2023; 60:49. [PMID: 38256310 PMCID: PMC10820455 DOI: 10.3390/medicina60010049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 12/20/2023] [Accepted: 12/25/2023] [Indexed: 01/24/2024]
Abstract
Migraine is a prevalent neurological disorder that significantly impacts the quality of life for affected individuals. The pathogenesis behind migraines is not yet fully understood, but hormonal changes, especially fluctuations in, estrogen and progesterone levels, have a significant role in the susceptibility of women to migraines. Pregnancy introduces a unique set of challenges for women who experience migraines, as they must navigate the complexities of managing their condition while safeguarding the health of both them and their unborn child. Pharmacological options for treating migraines during pregnancy are limited, and, therefore, there is a growing interest in exploring alternative approaches to migraine symptom relief and management. Physical activity during pregnancy provides a range of benefits, and it has gained attention as a potentially valuable tool for alleviating migraine symptoms in pregnant patients. This review explores the intricate relationship between migraines and pregnancy, emphasizing how physical activity and other alternative approaches may influence the frequency, severity, and overall experience of migraines during pregnancy. Through collaboration with healthcare providers and the adoption of personalized management strategies, women can strike a balance that supports both their own well-being and the healthy development of their unborn child. By examining existing research and emerging insights, we aim to provide a comprehensive understanding of the potential benefits and considerations of incorporating physical activity and other treatment options into migraine management strategies for pregnant women. Further research is needed to elucidate the specific mechanisms linking migraines, pregnancy, and physical activity, enabling the development of more targeted interventions and guidelines.
Collapse
Affiliation(s)
- Milan Lackovic
- Department of Obstetrics and Gynecology, University Hospital “Dragisa Misovic”, Milana Tepica 1, 11000 Belgrade, Serbia; (M.L.); (S.M.)
| | - Milena Jankovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.J.); (Z.M.)
- Neurology Clinic, University Clinical Center of Serbia, 11000 Belgrade, Serbia
| | - Sladjana Mihajlovic
- Department of Obstetrics and Gynecology, University Hospital “Dragisa Misovic”, Milana Tepica 1, 11000 Belgrade, Serbia; (M.L.); (S.M.)
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.J.); (Z.M.)
| | - Zagorka Milovanovic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.J.); (Z.M.)
- Clinic for Gynecology and Obstetrics “Narodni Front”, 11000 Belgrade, Serbia
| | - Dejan Nikolic
- Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia; (M.J.); (Z.M.)
- Department of Physical Medicine and Rehabilitation, University Children’s Hospital, 11000 Belgrade, Serbia
| |
Collapse
|
47
|
Kang HS, Kim JH, Kim JH, Bang WJ, Choi HG, Kim NY, Park HY, Choi KC, Choi Y, Kwon MJ. Gout and Migraines: Exploring the Complex Link in a 16-Year Longitudinal Study of the Korean Population. J Clin Med 2023; 13:138. [PMID: 38202145 PMCID: PMC10780186 DOI: 10.3390/jcm13010138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 12/19/2023] [Accepted: 12/25/2023] [Indexed: 01/12/2024] Open
Abstract
Despite the growing prevalence of gout and its associated health concerns as a chronic disorder, population-based studies on its link to migraines are scarce. We conducted a 16-year longitudinal study in a Korean population to investigate the relationship between gout and migraines, including different subtypes. We enrolled 23,137 patients with gout and matched them with 92,548 controls based on age, sex, income, and residence. Using Cox proportional hazards models, we calculated hazard ratios to assess the likelihood of migraines while considering relevant factors. During the follow-up, 1000 gout patients and 3214 controls experienced migraines. After adjusting for various factors, including demographics, health-related variables, and weight categories, the gout group had a 1.26-fold higher likelihood of developing migraines compared to the group without gout. This association was particularly strong for migraines without aura, while it was not significant for migraines with aura. In summary, our study reveals a significant link between gout and migraines in the Korean population, emphasizing the complex relationship among chronic disorders, with a specific focus on migraine subtypes.
Collapse
Affiliation(s)
- Ho Suk Kang
- Division of Gastroenterology, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea;
| | - Ji Hee Kim
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea;
| | - Joo-Hee Kim
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea;
| | - Woo Jin Bang
- Department of Urology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea;
| | - Hyo Geun Choi
- Suseo Seoul E.N.T. Clinic and MD Analytics, 10, Bamgogae-ro 1-gil, Gangnam-gu, Seoul 06349, Republic of Korea;
| | - Nan Young Kim
- Hallym Institute of Translational Genomics and Bioinformatics, Hallym University Medical Center, Anyang 14068, Republic of Korea;
| | - Ha Young Park
- Department of Pathology, Busan Paik Hospital, Inje University College of Medicine, Busan 47392, Republic of Korea;
| | - Kyung Chan Choi
- Department of Pathology, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Republic of Korea;
| | - Younghee Choi
- Department of Pathology, Hallym University Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong 18450, Republic of Korea;
- Research Insititute for Complementary & Alternative Medicine, Hallym University, Chuncheon 24252, Republic of Korea
| | - Mi Jung Kwon
- Research Insititute for Complementary & Alternative Medicine, Hallym University, Chuncheon 24252, Republic of Korea
- Department of Pathology, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang 14068, Republic of Korea
| |
Collapse
|
48
|
Ravi D, Parikh RV, Aboulhosn J, Tobis JM. A New Syndrome of Patent Foramen Ovale Inducing Vasospastic Angina and Migraine. JACC Case Rep 2023; 28:102132. [PMID: 38204551 PMCID: PMC10774900 DOI: 10.1016/j.jaccas.2023.102132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 09/18/2023] [Indexed: 01/12/2024]
Abstract
Patent foramen ovale (PFO) is the most common congenital cardiac abnormality and is usually considered a benign finding. This case series suggests a potential link between PFO and vasospastic angina. It also demonstrates PFO closure as a potential therapeutic intervention for individuals with PFO who suffer from refractory vasospastic angina.
Collapse
Affiliation(s)
- Deepak Ravi
- Division of Cardiology, University of California-Los Angeles, Los Angeles, California, USA
| | - Rushi V. Parikh
- Division of Cardiology, University of California-Los Angeles, Los Angeles, California, USA
| | - Jamil Aboulhosn
- Division of Cardiology, University of California-Los Angeles, Los Angeles, California, USA
| | - Jonathan M. Tobis
- Division of Cardiology, University of California-Los Angeles, Los Angeles, California, USA
| |
Collapse
|
49
|
Alsaadi T, Kayed DM, Al-Madani A, Hassan AM, Terruzzi A, Krieger D, Riachi N, Sarathchandran P, Al-Rukn S. Consensus-Based Recommendations on the Use of CGRP-Based Therapies for Migraine Prevention in the UAE. Neurol Ther 2023; 12:1845-1865. [PMID: 37792218 PMCID: PMC10630270 DOI: 10.1007/s40120-023-00550-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/19/2023] [Indexed: 10/05/2023] Open
Abstract
INTRODUCTION Migraine is a common debilitating neurological disorder affecting a large proportion of the general population. Calcitonin gene-related peptide (CGRP), a 37-amino acid neuropeptide, plays a key role in the pathophysiology of migraine, and the development of therapies targeting the anti-CGRP pathway has revolutionized the field of migraine treatment. METHODS An expert task force of neurologists in the United Arab Emirates (UAE) developed and critically assessed recommendations on the use of CGRP-based therapies in migraine treatment and management in the UAE, based on available published literature. A consensus was reached for each statement by means of an open-voting process, based on a predefined agreement level of at least 60%. RESULTS The consensus recommendations advocate the need for guidelines for the appropriate use of CGRP-based therapies by defining patient cohorts and appropriate monitoring of therapeutic response as well as standardizing the initiation, assessment, and cessation of treatment. The consensus recommendations were primarily formulated on the basis of international studies, because of the limited availability of regional and local data. As such, they may also act as guidelines for global healthcare providers. CONCLUSIONS These are the first consensus recommendations for the UAE that address the use of CGRP-based therapies in the treatment and management of migraine, integrating both clinical evidence and medical expertise to enhance clinical judgment and decision-making.
Collapse
Affiliation(s)
- Taoufik Alsaadi
- Department of Neurology, American Center for Psychiatry and Neurology, Abu Dhabi, UAE.
| | - Deeb M Kayed
- Neurology Department, Mediclinic City Hospital, Dubai, UAE
| | | | | | | | - Derk Krieger
- Neurology Department, Mediclinic Parkview Hospital, Dubai, UAE
| | - Naji Riachi
- Sheikh Shakhbout Medical City, Khalifa University College of Medicine and Health Sciences, Abu Dhabi, UAE
| | | | | |
Collapse
|
50
|
Zhang L, Zhang H, Zhou X, Zhao J, Wang X. Bibliometric Analysis of Research on Migraine-Stroke Association from 2013 to 2023. J Pain Res 2023; 16:4089-4112. [PMID: 38058980 PMCID: PMC10697147 DOI: 10.2147/jpr.s438745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 11/22/2023] [Indexed: 12/08/2023] Open
Abstract
Background Both migraine and stroke heavily burden individuals, health systems, and society. The migraine-stroke association is of concern and has been studied widely. Our objective is to explore and overview the current research status and emerging trends. Materials and Methods Studies on migraine-stroke association from January 2013 to May 2023 were retrieved and screened from the Web of Science Core Collection (WOSCC) database. Records fulfilling the selection criteria were downloaded and imported into CiteSpace for data mining and visualization. Results A total of 862 papers on migraine-stroke association were included. Annual publications grew slowly. The United States and European countries dominated research in this area. Harvard University published the largest number of articles, while the University of London was most active with other institutions. Ayata Cenk contributed the most articles, while KURTH T and NEUROLOGY were co-cited most. Research hotspots included migraine with aura, ischemic stroke, patent foramen ovale, cortical spreading depolarization, meta-analysis, cross-sectional study, and risk factors. Pathophysiology and small vessel disease represented research frontiers and emerging trends. Conclusion Our study scientifically outlines the migraine-stroke association over the past decade, presenting useful information.
Collapse
Affiliation(s)
- Long Zhang
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, People’s Republic of China
- Department of Traditional Chinese Medicine, Zibo TCM-Integrated Hospital, Zibo, Shandong, People’s Republic of China
| | - Hongyan Zhang
- Department of Traditional Chinese Medicine, Shanghai Sixth People’s Hospital, Shanghai, People’s Republic of China
- Shaanxi Key Laboratory of Research on TCM Physical Constitution and Diseases Prevention and Treatment, Shaanxi University of Chinese Medicine, Xianyang, Shaanxi, People’s Republic of China
| | - Xue Zhou
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, People’s Republic of China
| | - Jing Zhao
- Experimental Center, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, People’s Republic of China
| | - Xingchen Wang
- Division of Neurology, the Second Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, People’s Republic of China
| |
Collapse
|