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Druschky K, Lorenz J, Druschky A. Effects of Respiratory Rate on Heart Rate Variability in Neurologic Outpatients with Epilepsies or Migraine: A Preliminary Study. Med Princ Pract 2020; 29:318-325. [PMID: 31698355 PMCID: PMC7445653 DOI: 10.1159/000503710] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Accepted: 10/31/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Variation of spontaneous respiratory rates and influences of spontaneous and paced breathing rates on heart rate variability (HRV) were assessed in patients with epilepsy or migraine, and HRV parameters were compared between the groups. MATERIALS AND METHODS Thirty neurologic outpatients, 16 diagnosed with epilepsies and 14 with migraine, were included. Autonomic testing consisted of short-term HRV, the deep breathing test (DBT), and measurement of HRV at systematically changed breathing rates (paced breathing, 5-18 breaths per minute, bpm). RESULTS Spontaneous respiratory rate during short-term HRV varied from 9 to 23 bpm in the epileptic group and from 5 to 21 bpm in migraine patients and was significantly and negatively correlated with SD of all normal RR intervals (SDNN) and total power (TP) in epileptic patients but not in migraine patients. Paced breathing rate had a significant effect on all HRV parameters assessed in both groups. HRV (SD1, SDNN, TP) and DBT (E-I, SD1, SDNN) parameters were significantly lower in the epileptic group. Group differences were significantly greater during slow compared to fast breathing. CONCLUSIONS An important and new finding is the wide variation of spontaneous respiratory rate in both groups, along with the significant negative correlation with the assessed HRV parameters. The reduction of HRV during slow breathing in epileptic patients may indicate a diminished cardiorespiratory coupling caused by a probable loss of sensitivity within the cardiovagal brainstem circuitry.
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Affiliation(s)
- Katrin Druschky
- Neurologische Gemeinschaftspraxis, PDDr. Katrin Druschky, PDDr. Achim Druschky, Nürnberg, Germany
- Department of Neurology, University of Erlangen-Nuernberg, Erlangen, Germany
- *Katrin Druschky, Neurologische Gemeinschaftspraxis, PDDr. Katrin Druschky, PDDr. Achim Druschky, Am Stadtpark 2, DE–90409 Nürnberg (Germany), E-Mail ;
| | - Jürgen Lorenz
- Faculty of Life Science, Laboratory of Human Biology and Physiology, Applied Science University, Hamburg, Germany
| | - Achim Druschky
- Neurologische Gemeinschaftspraxis, PDDr. Katrin Druschky, PDDr. Achim Druschky, Nürnberg, Germany
- Department of Neurology, University of Erlangen-Nuernberg, Erlangen, Germany
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Sen S. Author response: Migraine with visual aura is a risk factor for incident atrial fibrillation: A cohort study. Neurology 2019; 93:646-647. [DOI: 10.1212/wnl.0000000000008211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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53
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Wig R, Oakley CB. Dysautonomia and Headache in the Pediatric Population. Headache 2019; 59:1582-1588. [DOI: 10.1111/head.13659] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Rebecca Wig
- DY Patil School of Medicine Navi Mumbai India
| | - Christopher B. Oakley
- Departments of Neurology and Nursing Johns Hopkins University School of Medicine Baltimore MD USA
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Lee S, Gong M, Lai RWC, Liu FZ, Lam MHS, Chang D, Xia Y, Liu T, Tse G, Li KHC. Electrographic indices in migraine patients: A systematic review and meta-analysis. J Electrocardiol 2019; 57:63-68. [PMID: 31514014 DOI: 10.1016/j.jelectrocard.2019.05.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/18/2019] [Accepted: 05/31/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIM Migraine patients can exhibit autonomic dysregulation, in turn leading to cardiac conduction and repolarization abnormalities. This systematic review and meta-analysis evaluated the electrocardiographic changes in migraineurs. METHOD PubMed and Embase databases were searched for human studies using the search terms 'migraine' and 'electrocardiogram' until 15th December 2018, identifying 108 and 131 studies. RESULTS Thirteen studies involving 667 migraineurs and 208 normal subjects included (mean age=30.7, total male percentage=19.8%) were included. A longer mean QTc interval (standard mean difference=7.89, 95% confidence interval=[3.29, 12.49], p=0.0008) and higher frequency of QTc prolongation (risk ratio [RR]=6.23, [2.86-13.58], p<0.00001), but no difference in PR-interval (SMD=4.33, [-3.90-12.56], p=0.30) were observed during migraine attacks compared to pain-free periods. P-wave dispersion was higher in migraine patients compared to controls (mean difference=3.62, [1.03-6.21], p=0.006). RR-interval were statistically indistinguishable between migraine patients and controls (SMD=0.08, [-0.65-0.81], p=0.83), or between migraineurs with and without aura (SMD=-0.03, [-0.44-0.38], p=0.89). Deep breathing ratio was significantly lower in migraineurs compared to controls (SMD=-0.27, 95% CI=[-0.46, -0.08], p=0.006) but similar between migraineurs with and without aura (SMD=-0.04, [-0.27-0.19], p=0.74). No significant difference in Valsalva ratio is found between migraineurs and controls (SMD=0.10, [-0.32-0.53], p=0.63) or between migraineurs with and without aura (SMD=-0.17, [-0.40-0.06], p=0.14). Root mean square of successive differences (RMSSD) (SMD=-0.07, [-1.10-0.95], p=0.89) and standard deviation of NN intervals (SDNN) (SMD=-0.10, [-0.61-0.41], p=0.71) did not significantly differ between migraine patients and controls. CONCLUSION Electrocardiographic alterations are observed in migraine patients compared to controls, especially during migraine attacks.
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Affiliation(s)
- Sharen Lee
- Laboratory of Cardiovascular Physiology, Li Ka Shing Institute of Health Sciences, Hong Kong S.A.R., P.R. China
| | - Mengqi Gong
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Rachel W C Lai
- Laboratory of Cardiovascular Physiology, Li Ka Shing Institute of Health Sciences, Hong Kong S.A.R., P.R. China
| | - Fang Zhou Liu
- Department of Cardiovascular, Guangdong Cardiovascular Institute, Guangdong General Hospital Affiliated to South China University of Technology, Guangzhou, China
| | | | - Dong Chang
- Xiamen Cardiovascular Hospital Affiliated to Xiamen University, Xiamen, China
| | - Yunlong Xia
- Department of Cardiovascular Medicine, First Affiliated Hospital of Dalian Medical University, Dalian, China
| | - Tong Liu
- Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
| | - Gary Tse
- Laboratory of Cardiovascular Physiology, Li Ka Shing Institute of Health Sciences, Hong Kong S.A.R., P.R. China; Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular Disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China.
| | - Ka Hou Christien Li
- Laboratory of Cardiovascular Physiology, Li Ka Shing Institute of Health Sciences, Hong Kong S.A.R., P.R. China; Faculty of Medicine, Newcastle University, United Kingdom.
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Maleki N, Cheng YC, Tu Y, Locascio JJ. Longitudinal course of vasomotor symptoms in perimenopausal migraineurs. Ann Neurol 2019; 85:865-874. [PMID: 30937949 DOI: 10.1002/ana.25476] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 02/27/2019] [Accepted: 03/31/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To examine the longitudinal course of vasomotor symptoms (VMS) in women with a history of migraine in comparison to women without a history of migraine disease. METHODS The study sample consisted of 467 women with a self-reported prior migraine diagnosis and 2,466 women without prior migraine diagnosis who were assessed longitudinally during menopausal transition as part of the Study of Women's Health Across the Nation. Linear mixed regression models with backward elimination were used to evaluate longitudinal associations between VMS and migraine while adjusting for baseline and time-varying demographic, socioeconomic, psychological, and reproductive factors. Additional analyses were performed to further assess the specificity of the association between migraine and VMS that included evaluating the association between migraine and vaginal dryness and between back pain and VMS. RESULTS A history of migraine predicted an increased frequency of VMS but not vaginal dryness during menopausal transition. Significant interaction between history of migraine and menopausal status for the prediction of VMS was also identified. Burden of VMS was found to be higher during late-stage perimenopause in women with migraine. In contrast, the history of back pain did not predict the frequency of VMS. INTERPRETATION This is the first study to delineate that a history of migraine predicts an increased frequency of VMS in women during menopausal transition. Hypothalamic abnormalities and thermoregulatory dysfunction against a milieu of decreasing estradiol concentrations during menopausal transition may explain the increased frequency of VMS in migraineurs during menopausal transition. ANN NEUROL 2019;85:865-874.
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Affiliation(s)
- Nasim Maleki
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Yu-Chen Cheng
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
- Department of Neurology, Fu Jen University Hospital, Taipei, Taiwan
| | - Yiheng Tu
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Joseph J Locascio
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Pyykkö I, Manchaiah V, Zou J, Levo H, Kentala E. Association between Syncope and Tumarkin Attacks in Ménière's Disease. J Int Adv Otol 2019; 15:135-140. [PMID: 31058603 PMCID: PMC6483450 DOI: 10.5152/iao.2019.6094] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 01/15/2019] [Accepted: 03/19/2019] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES The aim of the current study was to further collect evidence that would confirm the hypothesis that vestibular drop attacks (VDAs) could cause syncope in patients with Ménière's disease (MD). MATERIALS AND METHODS A cross-sectional survey design was employed in the present study. An Internet-based survey was administered on 602 individuals with MD. The mean age of the participants was 56.7 (25-75) years, and the mean duration of the disease was 12.4 (0.5-35) years. RESULTS VDAs with varying severity were present among 307 (50.7%) patients and led to fall in 92 patients, and syncope occurred in 45 patients with VDA. The overall percentage of syncope due to MD was 4.7%. Factors, such as duration of disease, age, and gender of the patient, did not explain attacks of syncope. Migraine and headache were not associated with syncope. Syncope was witnessed in 23 and self-reported by 22 patients. Syncope was associated with frequent VDA, duration of VDA, and falls that occurred during VDA. Patients with syncope reported the experience as frightening, had reduced general health-related quality of life, had higher anxiousness scores, and suffered more from fatigue. They also experienced problems with work, employment, and social restrictions. CONCLUSION Approximately 5% of patients with MD suffer from syncope, and syncope occurs among patients with VDA. In vestibular syncope, the sympathetic tone is lost, and baroreflex feedback is inhibited leading to fall and syncope. The consequences of vestibular syncope are severe, and patients face injuries and a significantly reduced quality of life.
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Affiliation(s)
- Ilmari Pyykkö
- Department of Otolaryngology, University of Tampere, School of Medicine, Tampere, Finland
| | - Vinaya Manchaiah
- Department of Speech and Hearing Sciences, Lamar University, School of Medicine, Beaumont, USA
| | - Jing Zou
- Department of Otolaryngology, University of Tampere, School of Medicine, Tampere, Finland
| | - Hilla Levo
- Department of Otolaryngology, University of Helsinki, School of Medicine, Helsinki, Finland
| | - Erna Kentala
- Department of Otolaryngology, University of Helsinki, School of Medicine, Helsinki, Finland
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Abstract
PURPOSE OF REVIEW The purpose of this review is to provide an overview and update on the common causes of headache attributed to arterial hypertension with a focus on secondary headache disorders. We will also highlight uncommon and recent findings in this area of research. RECENT FINDINGS There is some controversy in the relationship between chronic hypertension and headache, particularly migraine; recent research suggests that there may be a link, but it is likely complex and multifactorial. Many recent studies and case reports demonstrate that the pathophysiology underlying the onset of headache as it relates to abrupt rises in blood pressure seems to lie at the cellular level and mechanically becomes an issue with disruption of the blood-brain barrier. Although not a formally defined headache entity, carotid revascularization syndrome demonstrates this phenomenon and also has a recent set of proposed criteria that include headache and elevated blood pressure. This paper reviews the various etiologies of hypertensive headaches, mostly in regard to headache as a secondary symptom of elevated blood pressure. We will also discuss trends of hypertensive headache in pregnancy. Finally, we will touch on controversy that exists in relation to chronic hypertension and its causal relationship to headache as well as the relationship between hypertension and migraine.
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Yu ES, Priyadharsini S S Y, Venkatesan T. Migraine, Cyclic Vomiting Syndrome, and Other Gastrointestinal Disorders. ACTA ACUST UNITED AC 2018; 16:511-527. [PMID: 30361855 DOI: 10.1007/s11938-018-0202-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW Cyclic vomiting syndrome (CVS) is a chronic functional gastrointestinal disorder characterized by episodic nausea and vomiting and is diagnosed using Rome IV criteria. CVS is being recognized more frequently in adults with a prevalence of 2%. It is associated with several functional disorders like autonomic dysfunction, anxiety, and depression, but the strongest association is with migraine. We will elucidate the close relationship between migraine and CVS and briefly discuss its association with other gastrointestinal disorders. RECENT FINDINGS We highlight similarities in pathophysiology, clinical presentation, and response to medications between CVS and migraine (tricyclic antidepressants, triptans, antiepileptics). We also discuss novel therapies like CGRP inhibitors which are effective in migraine and have potential for adaptation in patients with CVS. Using migraine as a template should enable investigators to elucidate the mechanisms underlying this disorder, develop novel therapies, and direct future research in CVS.
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Affiliation(s)
- Elliot S Yu
- Department of Internal Medicine, The Hub for Collaborative Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Yasodara Priyadharsini S S
- Division of Gastroenterology and Hepatology, The Hub for Collaborative Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA
| | - Thangam Venkatesan
- Division of Gastroenterology and Hepatology, The Hub for Collaborative Medicine, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI, 53226, USA.
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Wienholtz N, Christensen CE, Egeberg A, Thyssen JP, Ashina M. Vasomotor reactions in the face and head of patients with migraine. CEPHALALGIA REPORTS 2018. [DOI: 10.1177/2515816318790543] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective: To systematically review extracranial vasomotor reactions in patients with migraine, and to discuss potential overlaps with rosacea. Background: Autonomic manifestations are common in migraine and may reflect trigeminovascular system activation. Flushing during migraine attacks may indicate altered extracranial vasomotor reactivity which resembles that of the facial skin disorder rosacea. Methods: PubMed and EMBASE were searched for studies investigating extracranial vascular reactions in migraine and rosacea published until January 2018. Results: We uncovered 41 studies investigating extracranial circulation in migraine and 12 studies in rosacea. Skin temperature was generally lower on the forehead, nose and hands of migraine patients compared to controls. The superficial temporal artery (STA) showed greater amplitude variations in migraine patients compared to controls, and compression of either the STA or the common carotid artery during attacks led to transient pain relief in about one-third of the investigated patients. Facial skin blood flow was asymmetrical in migraine patients compared to healthy volunteers. Conclusion: Findings on extracranial microcirculation suggest an altered function of the autonomic nervous system in migraine patients. Similar signs of autonomic nervous system dysfunction are reported in rosacea. We suggest an overlap in autonomic and neurovascular pathophysiology in migraine and rosacea.
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Affiliation(s)
- Nita Wienholtz
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Casper Emil Christensen
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
| | - Alexander Egeberg
- Department of Dermatology and Allergy, Herlev and Gentofte Hospitals, University of Copenhagen, Denmark
| | - Jacob P Thyssen
- Department of Dermatology and Allergy, Herlev and Gentofte Hospitals, University of Copenhagen, Denmark
| | - Messoud Ashina
- Danish Headache Center and Department of Neurology, Rigshospitalet Glostrup, Faculty of Health and Medical Sciences, University of Copenhagen, Glostrup, Denmark
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Howard L, Dumkrieger G, Chong CD, Ross K, Berisha V, Schwedt TJ. Symptoms of Autonomic Dysfunction Among Those With Persistent Posttraumatic Headache Attributed to Mild Traumatic Brain Injury: A Comparison to Migraine and Healthy Controls. Headache 2018; 58:1397-1407. [DOI: 10.1111/head.13396] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/06/2018] [Accepted: 07/08/2018] [Indexed: 12/23/2022]
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