51
|
Christensen J, Yamakawa GR, Shultz SR, Mychasiuk R. Is the glymphatic system the missing link between sleep impairments and neurological disorders? Examining the implications and uncertainties. Prog Neurobiol 2020; 198:101917. [PMID: 32991958 DOI: 10.1016/j.pneurobio.2020.101917] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/09/2020] [Accepted: 09/21/2020] [Indexed: 12/11/2022]
Abstract
Until recently, both the purpose of the biological need for sleep and the mechanism by which the central nervous system eliminated metabolic waste products were unknown. The glymphatic system is the recently discovered macroscopic waste clearance system for the CNS, which predominantly functions during sleep states. Important implications for the glymphatic system exist for a significant proportion of neurological disorders, including traumatic brain injury, epilepsy, stroke, migraine, and Alzheimer's disease. Within the limited amount of research pertaining to this novel system there exists controversy regarding several of the key structural and functional aspects of the glymphatic system. In this review we address evidence from both standpoints regarding the prominent debates surrounding the glymphatic system, including the functional differences in wakefulness vs. sleep, the role of glial aquaporin-4 water channels, and whether it reflects a convective flow or a passive diffusion process. The answers that underlie these questions will have crucial and distinct outcomes for the future of the glymphatic system and the disorders it has been implicated in. However, this review also summarizes the potential role of the glymphatic system in the development and progression of the aforementioned neurological disorders. Furthermore, the possible contribution of the orexinergic system to this relationship between the glymphatic system, sleep, and these neurological disorders is also explored. Overall, in order to develop and utilize therapeutic interventions centred around the glymphatic system we must first dedicate further investigation to elucidating these discrepancies and unanswered questions.
Collapse
Affiliation(s)
- Jennaya Christensen
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Glenn R Yamakawa
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Sandy R Shultz
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Richelle Mychasiuk
- Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Victoria, Australia.
| |
Collapse
|
52
|
Vives-Mestres M, Casanova A, Buse DC, Donoghue S, Houle TT, Lipton RB, Mian A, Shulman KJ, Orr SL. Patterns of Perceived Stress Throughout the Migraine Cycle: A Longitudinal Cohort Study Using Daily Prospective Diary Data. Headache 2020; 61:90-102. [PMID: 32918830 DOI: 10.1111/head.13943] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 07/31/2020] [Accepted: 08/01/2020] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To describe patterns of perceived stress across stages of the migraine cycle, within and between individuals and migraine episodes as defined for this study. METHODS Individuals with migraine aged ≥18 years, who were registered to use the digital health platform N1-HeadacheTM , and completed 90 days of daily data entry regarding migraine, headache symptoms, and lifestyle factors were eligible for inclusion. Perceived stress was rated once a day at the participant's chosen time with a single question, "How stressed have you felt today?" with response options graded on a 0-10 scale. Days were categorized into phases of the migraine cycle: Ppre = pre-migraine headache (the 2 days prior to the first day with migraine headache), P0 = migraine headache days, Ppost = post-migraine headache (the 2 days following the last migraine day with migraine headache), and Pi = interictal days (all other days). Episodes, defined as discrete occurrences of migraine with days in all 4 phases, were eligible if there was at least 1 reported daily perceived stress value in each phase. Individuals with ≥5 valid episodes, and ≥75% compliance (tracking 90 days in 120 calendar days or less) were eligible for inclusion in the analysis. RESULTS Data from 351 participants and 2115 episodes were included in this analysis. Eighty-six percent of the sample (302/351) were female. The mean number of migraine days per month was 6.1 (range 2-13, standard deviation = 2.3) and the mean number of episodes was 6.0 (range 5-10, standard deviation = 1.0) over the 90-day period. Only 8 (8/351, 2.3%) participants had chronic migraine (defined as 15 or more headache days per month with at least 8 days meeting criteria for migraine). Cluster analysis revealed 3 common patterns of perceived stress variation across the migraine cycle. For cluster 1, the "let down" pattern, perceived stress in the interictal phase (Pi ) falls in the pre-headache phase (Ppre ) and then decreases more in the migraine phase (P0 ) relative to Pi . For cluster 2, the "flat" pattern, perceived stress is relatively unchanging throughout the migraine cycle. For cluster 3, the "stress as a trigger/symptom" pattern, perceived stress in Ppre increases relative to Pi , and increases further in P0 relative to Pi . Episodes were distributed across clusters as follows: cluster 1: 354/2115, 16.7%; cluster 2: 1253/2115, 59.2%, and cluster 3: 508/2115, 24.0%. Twelve participants (12/351, 3.4%) had more than 50% of their episodes fall into cluster 1, 216 participants (216/351, 61.5%) had more than 50% of their episodes fall into cluster 2, and 25 participants (25/351, 7.1%) had more than 50% of their episodes fall into cluster 3. There were 40 participants with ≥90% of their episodes in cluster 2, with no participants having ≥90% of their episodes in cluster 1 or 3. CONCLUSIONS On an aggregate level, perceived stress peaks during the pain phase of the migraine cycle. However, on an individual and episode basis, there are 3 dominant patterns of perceived stress variation across the migraine cycle. Elucidating how patterns of perceived stress vary across the migraine cycle may contribute insights into disease biology, triggers and protective factors, and provide a framework for targeting individualized treatment plans.
Collapse
Affiliation(s)
- Marina Vives-Mestres
- Curelator Inc., Cambridge, MA, USA.,Department of Computer Science and Applied Mathematics, Universitat de Girona, Girona, Spain
| | | | - Dawn C Buse
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Timothy T Houle
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, MA, USA.,Department of Anesthesia, Harvard Medical School, Boston, MA, USA
| | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA.,Departments of Neurology, Psychiatry and Behavioral Sciences and Epidemiology and Population Health, Montefiore Medical Center, Bronx, NY, USA
| | | | | | - Serena L Orr
- Department of Pediatrics, Alberta Children's Hospital, Calgary, Canada.,Departments of Pediatrics, Clinical Neurosciences and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| |
Collapse
|
53
|
Abstract
Arrhythmic fluctuations in neural activity occur at many levels of the nervous system. Such activity does not have a characteristic temporal periodicity but can exhibit statistical similarities, most commonly power-law scaling behavior, which is indicative of scale-free dynamics. The recurrence of scaling laws across many different systems and its manifestation in behavior has prompted a search for unifying principles in human brain function. With this in mind, a focused search for abnormities in scale-free dynamics is of considerable clinical relevance to migraine and other clinical pain disorders. Here, we examined the scale-free properties of the resting-state functional magnetic resonance imaging (fMRI) signal in the broadband frequency range known to be related to spontaneous neural activity (0.01-0.1 Hz). In a large cohort of episodic migraine patients (N = 40), we observed that the strength of long-range temporal correlations in the fMRI signal (captured by the scaling exponent α) was significantly higher in the sensorimotor network compared with healthy controls. Increases in the scaling exponent were positively correlated with fMRI signal variance and negatively correlated with the patient's self-reported headache intensity. These changes in the fMRI signal suggest that the temporal structure of amplitude fluctuations carries valuable information about the dynamic state of the underlying neuronal networks and ensuing sensory impairments in migraine. The demonstrated scaling laws pose a novel quantitative approach for examining clinically relevant interindividual variability in migraine and other pain disorders.
Collapse
|
54
|
Powell G, Derry-Sumner H, Shelton K, Rushton S, Hedge C, Rajenderkumar D, Sumner P. Visually-induced dizziness is associated with sensitivity and avoidance across all senses. J Neurol 2020; 267:2260-2271. [PMID: 32306170 PMCID: PMC7359147 DOI: 10.1007/s00415-020-09817-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/30/2020] [Accepted: 04/01/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Persistent postural perceptual dizziness (PPPD) is a common chronic condition presenting in neurology and neuro-otology clinics. Symptoms lie on a spectrum in the general population. The cause is unknown and thought to involve interactions between visual and vestibular systems, but symptoms also correlate with anxiety and migraine. OBJECTIVE To test whether PDDD symptoms are associated with reported differences in other senses (touch, hearing, smell and taste); to investigate possible mediation via anxiety or migraine; to discover the proportion of variance accountable to these non-vestibular factors. METHODS We measured self-report multisensory sensitivity, anxiety, visual difficulties, visual discomfort and migraine in patients with PPPD (N = 29) and a large general population cohort (N > 1100). We used structural equation modelling to examine relationships between the factors using a step-wise approach. RESULTS We found increased self-reported over-sensitivity in sensory domains beyond vision and balance in both patients with PPPD and non-clinical participants with more PPPD symptoms. SEM analysis revealed that anxiety partly, but not wholly, mediated this relationship. Adding visual difficulties and visual discomfort to the model allowed it to explain 50% of PPPD symptom variance. Most of the path coefficients and mediation effects in our model were unchanged between participants with and without migraine. CONCLUSIONS Our findings support the idea that PPPD is a complex neurological condition that includes broad perceptual factors, and may suggest that some brains are predisposed to generalised cross-modal sensory-overload. This may give rise to vulnerability to severe PPPD should a vestibular insult occur.
Collapse
Affiliation(s)
- Georgina Powell
- School of Psychology, Cardiff University, Tower building, Park Place, Cardiff, UK.
| | - Hannah Derry-Sumner
- Department of Audiovestibular Medicine, University Hospital of Wales, Cardiff, UK
| | - Katherine Shelton
- School of Psychology, Cardiff University, Tower building, Park Place, Cardiff, UK
| | - Simon Rushton
- School of Psychology, Cardiff University, Tower building, Park Place, Cardiff, UK
| | - Craig Hedge
- School of Psychology, Cardiff University, Tower building, Park Place, Cardiff, UK
| | - Deepak Rajenderkumar
- Department of Audiovestibular Medicine, University Hospital of Wales, Cardiff, UK
| | - Petroc Sumner
- School of Psychology, Cardiff University, Tower building, Park Place, Cardiff, UK
| |
Collapse
|
55
|
The visual system as target of non-invasive brain stimulation for migraine treatment: Current insights and future challenges. PROGRESS IN BRAIN RESEARCH 2020. [PMID: 33008507 DOI: 10.1016/bs.pbr.2020.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
Abstract
The visual network is crucially implicated in the pathophysiology of migraine. Several lines of evidence indicate that migraine is characterized by an altered visual cortex excitability both during and between attacks. Visual symptoms, the most common clinical manifestation of migraine aura, are likely the result of cortical spreading depression originating from the extrastriate area V3A. Photophobia, a clinical hallmark of migraine, is linked to an abnormal sensory processing of the thalamus which is converged with the non-image forming visual pathway. Finally, visual snow is an increasingly recognized persistent visual phenomenon in migraine, possibly caused by increased perception of subthreshold visual stimuli. Emerging research in non-invasive brain stimulation (NIBS) has vastly developed into a diversity of areas with promising potential. One of its clinical applications is the single-pulse transcranial magnetic stimulation (sTMS) applied over the occipital cortex which has been approved for treating migraine with aura, albeit limited evidence. Studies have also investigated other NIBS techniques, such as repetitive TMS (rTMS) and transcranial direct current stimulation (tDCS), for migraine prophylaxis but with conflicting results. As a dynamic brain disorder with widespread pathophysiology, targeting migraine with NIBS is challenging. Furthermore, unlike the motor cortex, evidence suggests that the visual cortex may be less plastic. Controversy exists as to whether the same fundamental principles of NIBS, based mainly on findings in the motor cortex, can be applied to the visual cortex. This review aims to explore existing literature surrounding NIBS studies on the visual system of migraine. We will first provide an overview highlighting the direct implication of the visual network in migraine. Next, we will focus on the rationale behind using NIBS for migraine treatment, including its effects on the visual cortex, and the shortcomings of currently available evidence. Finally, we propose a broader perspective of how novel approaches, the concept of brain networks and the integration of multimodal imaging with computational modeling, can help refine current NIBS methods, with the ultimate goal of optimizing a more individualized treatment for migraine.
Collapse
|
56
|
Abstract
Migraine encompasses a broader spectrum of sensory symptoms than just headache. These "other" symptoms, eg, sensory phobias, cognitive and mood changes, allodynia, and many others indicate an altered sensitivity to sensory input which can be measured, in principle, by quantifying sensory threshold changes longitudinally over time. Photophobia, for example, can be quantified by investigating the discomfort thresholds towards the luminance of light. The aim of this review is to look into how thresholds change in patients with migraine. We performed a PubMed search up to June 2018 targeting all peer-reviewed articles evaluating the changes in threshold, sensory phobia, or sensitivity in patients with migraine. Migraineurs, in general, exhibit lower sensory thresholds compared with healthy controls. These threshold changes seem to follow the different phases during a migraine cycle. In general, thresholds reach a nadir when the headache starts (the ictal phase), rise after the headache ends, and then gradually descend towards the next attack. The sensory modality of measurement-mechanical, thermal, or nociceptive-and the location of measurement-trigeminal vs somatic dermatome-also influence the sensory threshold. Functional imaging studies provide evidence that the hypothalamo-thalamo-brainstem network may be the driving force behind the periodic threshold changes. In summary, there is evidence in the literature that migraine could be understood as a periodic sensory dysregulation originating from the brain. Nevertheless, the interstudy discrepancy is still high due to different study designs and a lack of focus on distinct migraine phases. Further well-designed and harmonized studies with an emphasis on the cyclic changes still need to be conducted.
Collapse
|
57
|
Shepherd AJ, Patterson AJK. Exploration of anomalous perceptual experiences in migraine between attacks using the Cardiff Anomalous Perceptions Scale. Conscious Cogn 2020; 82:102945. [PMID: 32422548 DOI: 10.1016/j.concog.2020.102945] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 04/28/2020] [Accepted: 04/30/2020] [Indexed: 02/04/2023]
Abstract
Distortions in sensory experiences that precede a migraine attack have been extensively documented, the most well-known being the visual aura. Distortions in the experience of other senses are also reported as part of an aura, albeit less frequently, together with changes in the perception or ownership of the body or body parts. There are many examples of differences in aspects of visual perception between migraine and control groups, between attacks, but not as much on unusual experiences involving other senses, the sense of the body or the experience of the environment. Seventy-seven migraine (33 with aura) and 74 control participants took part. Anomalous perceptions were experienced by both migraine and control groups, but more with migraine experienced them and rated them as more distressing, intrusive and frequent. Associations with reports of visual triggers of migraine and visual discomfort are presented. This study is the first to show relationships between these factors.
Collapse
Affiliation(s)
- Alex J Shepherd
- Department of Psychological Sciences, Birkbeck College, University of London, UK.
| | - Adam J K Patterson
- Department of Psychological Sciences, Birkbeck College, University of London, UK
| |
Collapse
|
58
|
Gomez-Pilar J, García-Azorín D, Gomez-Lopez-de-San-Roman C, Guerrero ÁL, Hornero R. Exploring EEG Spectral Patterns in Episodic and Chronic Migraine During the Interictal State: Determining Frequencies of Interest in the Resting State. PAIN MEDICINE 2020; 21:3530-3538. [DOI: 10.1093/pm/pnaa117] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Abstract
Objective
The analysis of particular (electroencephalographic) EEG frequency bands has revealed new insights relative to the neural dynamics that, when studying the EEG spectrum as a whole, would have remained hidden. This study is aimed at characterizing spectral resting state EEG patterns for assessing possible differences of episodic and chronic migraine during the interictal period. For that purpose, a novel methodology for analyzing specific frequencies of interest was performed.
Methods
Eighty-seven patients with migraine (45 with episodic and 42 with chronic migraine) and 39 age- and sex-matched controls performed a resting-state EEG recording. Spectral measures were computed using conventional frequency bands. Additionally, particular frequency bands were determined to distinguish between controls and migraine patients, as well as between migraine subgroups.
Results
Frequencies ranging from 11.6 Hz to 12.8 Hz characterized migraine as a whole, with differences evident in the central and left parietal regions (controlling for false discovery rate). An additional band between 24.1 Hz and 29.8 Hz was used to discriminate between migraine subgroups. Interestingly, the power in this band was positively correlated with time from onset in episodic migraine, but no correlation was found for chronic migraine.
Conclusions
Specific frequency bands were proposed to identify the spectral characteristics of the electrical brain activity in migraine during the interictal stage. Our findings support the importance of discriminating between migraine subgroups to avoid hiding relevant features in migraine.
Collapse
Affiliation(s)
- Javier Gomez-Pilar
- Biomedical Engineering Group, E.T.S. Ingenieros de Telecomunicación, University of Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Valladolid, Spain
| | - David García-Azorín
- Headache Unit, Neurology Department, University Hospital of Valladolid, Valladolid, Spain
| | | | - Ángel L Guerrero
- Headache Unit, Neurology Department, University Hospital of Valladolid, Valladolid, Spain
- Institute for Biomedical Research of Salamanca (IBSAL), Salamanca, Spain
- Department of Medicine, University of Valladolid, Valladolid, Spain
| | - Roberto Hornero
- Biomedical Engineering Group, E.T.S. Ingenieros de Telecomunicación, University of Valladolid, Valladolid, Spain
- Centro de Investigación Biomédica en Red en Bioingeniería, Biomateriales y Nanomedicina (CIBER-BBN), Valladolid, Spain
| |
Collapse
|
59
|
Transcranial Direct Current Stimulation of the Occipital Cortex in Medication Overuse Headache: A Pilot Randomized Controlled Cross-Over Study. J Clin Med 2020; 9:jcm9041075. [PMID: 32290078 PMCID: PMC7230777 DOI: 10.3390/jcm9041075] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 12/19/2022] Open
Abstract
Background: Medication overuse headache (MOH) is a chronic pain syndrome that arises from the frequent use of acute antimigraine drugs. Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique with a possible therapeutic effect in this particular context. Methods: This was a randomized, sham-controlled, cross-over study. Eighteen patients with MOH (17 women, age range: 20–38 years) received three sets of three consecutive daily sessions of tDCS: anodal tDCS over the prefrontal cortex, cathodal tDCS over the occipital cortex ipsilateral to the dominant side of migraine pain, and sham. The order in which the tDCS blocks were delivered was randomly defined based on a 1:1:1 ratio. Patients filled in a migraine diary that allowed recording of the pain intensity (visual analogue scale) and the daily consumption of analgesic pills from one week before to two weeks after each condition. Results: Both prefrontal and occipital tDCS lowered the total number of migraine days and the number of severe migraine days per week at week 1, but only the effects of occipital tDCS on these two outcomes lasted until week 2. Only occipital tDCS decreased the daily analgesic pills consumption, at weeks 1 and 2. Conclusion: Three consecutive days of cathodal occipital tDCS appear to improve the clinical outcomes in patients with MOH.
Collapse
|
60
|
Perenboom MJ, van de Ruit M, Zielman R, van den Maagdenberg AM, Ferrari MD, Carpay JA, Tolner EA. Enhanced pre-ictal cortical responsivity in migraine patients assessed by visual chirp stimulation. Cephalalgia 2020; 40:913-923. [PMID: 32188264 PMCID: PMC7412874 DOI: 10.1177/0333102420912725] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background Migraine is associated with altered sensory processing and cortical responsivity that may contribute to susceptibility to attacks by changing brain network excitability dynamics. To gain better insight into cortical responsivity changes in migraine we subjected patients to a short series of light inputs over a broad frequency range (“chirp” stimulation), designed to uncover dynamic features of visual cortex responsivity. Methods EEG responses to visual chirp stimulation (10–40 Hz) were measured in controls (n = 24) and patients with migraine with aura (n = 19) or migraine without aura (n = 20). Average EEG responses were assessed at (i) all EEG frequencies between 5 and 125 Hz, (ii) stimulation frequencies, and (iii) harmonic frequencies. We compared average responses in a low (10–18 Hz), medium (19–26 Hz) and high (27–40 Hz) frequency band. Results Responses to chirp stimulation were similar in controls and migraine subtypes. Eight measurements (n = 3 migraine with aura; n = 5 without aura) were assigned as “pre-ictal”, based on reported headache within 48 hours after investigation. Pre-ictally, an increased harmonic response to 22–32 Hz stimulation (beta band) was observed (p = 0.001), compared to interictal state measurements. Conclusions We found chirp responses to be enhanced in the 48 hours prior to migraine headache onset. Visual chirp stimulation proved a simple and reliable technique with potential to detect changes in cortical responsivity associated with the onset of migraine attacks.
Collapse
Affiliation(s)
| | - Mark van de Ruit
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ronald Zielman
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Arn Mjm van den Maagdenberg
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Michel D Ferrari
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Johannes A Carpay
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Neurology, the Tergooi Hospital, Hilversum, the Netherlands
| | - Else A Tolner
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
61
|
Susvirkar AA, Velusami D, Srinivasan N. Evaluation of habituation to visual evoked potentials using pattern reversal among migraine individuals - a cross-sectional study. J Basic Clin Physiol Pharmacol 2020; 31:/j/jbcpp.ahead-of-print/jbcpp-2019-0217/jbcpp-2019-0217.xml. [PMID: 31940287 DOI: 10.1515/jbcpp-2019-0217] [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: 08/14/2019] [Accepted: 11/08/2019] [Indexed: 06/10/2023]
Abstract
Background Migraine is a multifaceted chronic disease with common ocular symptoms. Habituation is the decremental response on repeated stimulations. The literature review indicates controversial results regarding habituation in migraine individuals. The present study aimed to compare the habituation response using visual evoked potential (VEP) measures among migraine and control subjects. Methods This was a cross-sectional study performed among migraine individuals attending the Department of Medicine and Neurology, of the age group of 18-30 years at Sri Manakula Vinayagar Medical College and Hospital, Puducherry. Habituation was evaluated in the two groups, control (n = 40) and migraine (n = 40), using pattern reversal VEP. The recording was done for 15-min duration and divided into four blocks of 3.8 min each. The results were compared employing Student t-test, and p < 0.05 was considered to be statistically significant. Results Our study indicates that latency N75, N145, and P100 amplitude showed significant differences between the two groups. In the right eye, on comparing the first and fourth block P100 amplitude in the migraine group, a significant increase (p < 0.001) was observed in the fourth block. Similarly, in the left eye, the control group showed a significant decrease in the fourth block (p = 0.002), whereas the migraine group showed a significant increase (p < 0.001). Conclusions The present study concludes that migraine individuals report deficient habituation, evaluated using pattern reversal VEP.
Collapse
Affiliation(s)
- Ashish Anand Susvirkar
- Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala 695011, India
| | - Deepika Velusami
- Department of Physiology, Sri Manakula Vinayagar Medical College and Hospital, Madagadipet, Puducherry 605107, India
| | - Nithiyasree Srinivasan
- Sri Manakula Vinayagar Medical College and Hospital, Madagadipet, Puducherry 605107, India
| |
Collapse
|
62
|
Puledda F, Schankin C, Goadsby PJ. Visual snow syndrome: A clinical and phenotypical description of 1,100 cases. Neurology 2020; 94:e564-e574. [PMID: 31941797 PMCID: PMC7136068 DOI: 10.1212/wnl.0000000000008909] [Citation(s) in RCA: 68] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 08/28/2019] [Indexed: 12/23/2022] Open
Abstract
Objective To validate the current criteria of visual snow and to describe its common phenotype using a substantial clinical database. Methods We performed a web-based survey of patients with self-assessed visual snow (n = 1,104), with either the complete visual snow syndrome (n = 1,061) or visual snow without the syndrome (n = 43). We also describe a population of patients (n = 70) with possible hallucinogen persisting perception disorder who presented clinically with visual snow syndrome. Results The visual snow population had an average age of 29 years and had no sex prevalence. The disorder usually started in early life, and ≈40% of patients had symptoms for as long as they could remember. The most commonly experienced static was black and white. Floaters, afterimages, and photophobia were the most reported additional visual symptoms. A latent class analysis showed that visual snow does not present with specific clinical endophenotypes. Severity can be classified by the amount of visual symptoms experienced. Migraine and tinnitus had a very high prevalence and were independently associated with a more severe presentation of the syndrome. Conclusions Clinical characteristics of visual snow did not differ from the previous cohort in the literature, supporting validity of the current criteria. Visual snow likely represents a clinical continuum, with different degrees of severity. On the severe end of the spectrum, it is more likely to present with its common comorbid conditions, migraine and tinnitus. Visual snow does not depend on the effect of psychotropic substances on the brain.
Collapse
Affiliation(s)
- Francesca Puledda
- From the Headache Group (F.P., P.J.G.), Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London; NIHR-Wellcome Trust King's Clinical Research Facility (F.P., P.J.G.), SLaM Biomedical Research Centre, King's College Hospital, London, UK; and Department of Neurology (C.S.), Inselspital, Bern University Hospital, University of Bern, Switzerland.
| | - Christoph Schankin
- From the Headache Group (F.P., P.J.G.), Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London; NIHR-Wellcome Trust King's Clinical Research Facility (F.P., P.J.G.), SLaM Biomedical Research Centre, King's College Hospital, London, UK; and Department of Neurology (C.S.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Peter J Goadsby
- From the Headache Group (F.P., P.J.G.), Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, King's College London; NIHR-Wellcome Trust King's Clinical Research Facility (F.P., P.J.G.), SLaM Biomedical Research Centre, King's College Hospital, London, UK; and Department of Neurology (C.S.), Inselspital, Bern University Hospital, University of Bern, Switzerland
| |
Collapse
|
63
|
Maccora S, Bolognini N, Cosentino G, Baschi R, Vallar G, Fierro B, Brighina F. Multisensorial Perception in Chronic Migraine and the Role of Medication Overuse. THE JOURNAL OF PAIN 2020; 21:919-929. [PMID: 31904501 DOI: 10.1016/j.jpain.2019.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 11/12/2019] [Accepted: 12/04/2019] [Indexed: 01/03/2023]
Abstract
Multisensory processing can be assessed by measuring susceptibility to crossmodal illusions such as the Sound-Induced Flash Illusion (SIFI). When a single flash is accompanied by 2 or more beeps, it is perceived as multiple flashes (fission illusion); conversely, a fusion illusion is experienced when more flashes are matched with a single beep, leading to the perception of a single flash. Such illusory perceptions are associated to crossmodal changes in visual cortical excitability. Indeed, increasing occipital cortical excitability, by means of transcranial electrical currents, disrupts the SIFI (ie, fission illusion). Similarly, a reduced fission illusion was shown in patients with episodic migraine, especially during the attack, in agreement with the pathophysiological model of cortical hyperexcitability of this disease. If episodic migraine patients present with reduced SIFI especially during the attack, we hypothesize that chronic migraine (CM) patients should consistently report less illusory effects than healthy controls; drugs intake could also affect SIFI. On such a basis, we studied the proneness to SIFI in CM patients (n = 63), including 52 patients with Medication Overuse Headache (MOH), compared to 24 healthy controls. All migraine patients showed reduced fission phenomena than controls (P < .0001). Triptan MOH patients (n = 23) presented significantly less fission effects than other CM groups (P = .008). This exploratory study suggests that CM - both with and without medication overuse - is associated to a higher visual cortical responsiveness which causes deficit of multisensorial processing, as assessed by the SIFI. PERSPECTIVE: This observational study shows reduced susceptibility to the SIFI in CM, confirming and extending previous results in episodic migraine. MOH contributes to this phenomenon, especially in case of triptans.
Collapse
Affiliation(s)
- Simona Maccora
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University of Palermo, Palermo, Italy
| | - Nadia Bolognini
- Department of Psychology, Milan Center for Neuroscience - NeuroMi, University of Milano-Bicocca, Milano, Italy; Laboratory of Neuropsychology, IRCSS Istituto Auxologico, Milano, Italy
| | - Giuseppe Cosentino
- Department of Brain and Behavioural Sciences, University of Pavia, Italy; IRCCS Mondino Foundation, Pavia, Italy
| | - Roberta Baschi
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University of Palermo, Palermo, Italy
| | - Giuseppe Vallar
- Department of Psychology, Milan Center for Neuroscience - NeuroMi, University of Milano-Bicocca, Milano, Italy; Laboratory of Neuropsychology, IRCSS Istituto Auxologico, Milano, Italy
| | - Brigida Fierro
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University of Palermo, Palermo, Italy
| | - Filippo Brighina
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BIND), University of Palermo, Palermo, Italy.
| |
Collapse
|
64
|
Ahdab R, Mansour AG, Khazen G, El-Khoury C, Sabbouh TM, Salem M, Yamak W, Ayache SS, Riachi N. Cathodal Transcranial Direct Current Stimulation of the Occipital cortex in Episodic Migraine: A Randomized Sham-Controlled Crossover Study. J Clin Med 2019; 9:jcm9010060. [PMID: 31888011 PMCID: PMC7019486 DOI: 10.3390/jcm9010060] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 12/19/2019] [Accepted: 12/20/2019] [Indexed: 01/25/2023] Open
Abstract
Three consecutive daily sessions of cathodal transcranial direct current stimulation (tDCS) was sufficient to show a significant decrease in headache duration and intensity as well as tablets consumption, in patients suffering from episodic migraine. BACKGROUND Migraine prophylaxis is recommended in patients with frequent and/or intense headaches, but poor tolerability and lack of efficacy of preventive drugs are common in clinical practice. Hence, new prophylactic strategies are needed. OBJECTIVE The aim of this study was to evaluate the efficacy of tDCS in terms of migraine prophylaxis. METHODS This was a double blind and sham-controlled trial. Forty-two migraine patients were randomly assigned in a crossover design to receive three consecutive daily sessions of both sham and cathodal tDCS stimulation (2.0 mA, 20 min) over the occipital cortex of the dominant side of the migraine pain (O1/O2). Migraine duration and intensity, number of analgesic tablets, and number of headache-free days (where no headache abortive medications are taken) were recorded one week before and two weeks after treatment. A washout period of one week was allowed before crossing to the other treatment arm. RESULTS Relative to sham, cathodal stimulation was associated with a significant reduction in the number of headache days, tablets consumption, and pain intensity; and a significant increase in the number of headache-free days. These beneficial effects were sustained over two weeks. No serious side effects were observed, and the procedure was well tolerated. CONCLUSION Based on these findings, cathodal tDCS applied to the occipital cortex seems to be an effective and well tolerated alternative to pharmacotherapy in patients with episodic migraine.
Collapse
Affiliation(s)
- Rechdi Ahdab
- Division of Neurology, Lebanese American University Medical Center Rizk Hospital, Beirut 113288, Lebanon; (R.A.); (W.Y.)
- Division of Neurology, Gilbert and Rose Mary Chagoury School of Medicine, Lebanese American University, Byblos 4504, Lebanon; (A.G.M.); (G.K.); (C.E.-K.); (M.S.)
- Division of Neurology, Hamidy Medical center, Tripoli 1300, Lebanon
| | - Anthony G. Mansour
- Division of Neurology, Gilbert and Rose Mary Chagoury School of Medicine, Lebanese American University, Byblos 4504, Lebanon; (A.G.M.); (G.K.); (C.E.-K.); (M.S.)
- Division of Neurology, Hamidy Medical center, Tripoli 1300, Lebanon
- Department of Internal Medicine, Ohio State University, Columbus, OH 43210, USA
| | - Georges Khazen
- Division of Neurology, Gilbert and Rose Mary Chagoury School of Medicine, Lebanese American University, Byblos 4504, Lebanon; (A.G.M.); (G.K.); (C.E.-K.); (M.S.)
- Computer Science and Mathematics Department, Lebanese American University, Byblos 4504, Lebanon
| | - Christelle El-Khoury
- Division of Neurology, Gilbert and Rose Mary Chagoury School of Medicine, Lebanese American University, Byblos 4504, Lebanon; (A.G.M.); (G.K.); (C.E.-K.); (M.S.)
- Division of Family Medicine, Lebanese American University Medical Center Rizk Hospital, Beirut 113288, Lebanon
| | - Toni M. Sabbouh
- Department of Internal Medicine, Morristown Medical Center, Morristown, NJ 07960, USA;
| | - Maher Salem
- Division of Neurology, Gilbert and Rose Mary Chagoury School of Medicine, Lebanese American University, Byblos 4504, Lebanon; (A.G.M.); (G.K.); (C.E.-K.); (M.S.)
| | - Wissam Yamak
- Division of Neurology, Lebanese American University Medical Center Rizk Hospital, Beirut 113288, Lebanon; (R.A.); (W.Y.)
- Division of Neurology, Gilbert and Rose Mary Chagoury School of Medicine, Lebanese American University, Byblos 4504, Lebanon; (A.G.M.); (G.K.); (C.E.-K.); (M.S.)
- Division of Neurology, Hamidy Medical center, Tripoli 1300, Lebanon
| | - Samar S. Ayache
- Service de Physiologie-Explorations Fonctionnelles, Hôpital Henri Mondor, Assistance Publique- Hôpitaux de Paris, 94010 Créteil, France;
- EA 4391, Excitabilité Nerveuse et Thérapeutique, Université Paris-Est-Créteil, 94000 Créteil, France
| | - Naji Riachi
- Division of Neurology, Lebanese American University Medical Center Rizk Hospital, Beirut 113288, Lebanon; (R.A.); (W.Y.)
- Division of Neurology, Gilbert and Rose Mary Chagoury School of Medicine, Lebanese American University, Byblos 4504, Lebanon; (A.G.M.); (G.K.); (C.E.-K.); (M.S.)
- Corresponding: ; Tel.: +96-112-00-061
| |
Collapse
|
65
|
Andreou AP, Edvinsson L. Mechanisms of migraine as a chronic evolutive condition. J Headache Pain 2019; 20:117. [PMID: 31870279 PMCID: PMC6929435 DOI: 10.1186/s10194-019-1066-0] [Citation(s) in RCA: 125] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 12/03/2019] [Indexed: 12/17/2022] Open
Abstract
Understanding the mechanisms of migraine remains challenging as migraine is not a static disorder, and even in its episodic form migraine remains an "evolutive" chronic condition. Considerable progress has been made in elucidating the pathophysiological mechanisms of migraine, associated genetic factors that may influence susceptibility to the disease, and functional and anatomical changes during the progression of a migraine attack or the transformation of episodic to chronic migraine. Migraine is a life span neurological disorder that follows an evolutive age-dependent change in its prevalence and even clinical presentations. As a disorder, migraine involves recurrent intense head pain and associated unpleasant symptoms. Migraine attacks evolve over different phases with specific neural mechanisms and symptoms being involved during each phase. In some patients, migraine can be transformed into a chronic form with daily or almost daily headaches. The mechanisms behind this evolutive process remain unknown, but genetic and epigenetic factors, inflammatory processes and central sensitization may play an important role.
Collapse
Affiliation(s)
- Anna P Andreou
- Headache Research, Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- The Headache Centre, Guy's and St Thomas', NHS Foundation Trust, London, UK.
| | - Lars Edvinsson
- Department of Medicine, Lund University, 22185, Lund, Sweden
| |
Collapse
|
66
|
Puledda F, Ffytche D, O'Daly O, Goadsby PJ. Imaging the Visual Network in the Migraine Spectrum. Front Neurol 2019; 10:1325. [PMID: 31920945 PMCID: PMC6923266 DOI: 10.3389/fneur.2019.01325] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/29/2019] [Indexed: 01/13/2023] Open
Abstract
The involvement of the visual network in migraine pathophysiology has been well-known for more than a century. Not only is the aura phenomenon linked to cortical alterations primarily localized in the visual cortex; but also migraine without aura has shown distinct dysfunction of visual processing in several studies in the past. Further, the study of photophobia, a hallmark migraine symptom, has allowed unraveling of distinct connections that link retinal pathways to the trigeminovascular system. Finally, visual snow, a recently recognized neurological disorder characterized by a continuous visual disturbance, is highly comorbid with migraine and possibly shares with it some common pathophysiological mechanisms. Here, we review the most relevant neuroimaging literature to date, considering studies that have either attempted to investigate the visual network or have indirectly shown visual processing dysfunctions in migraine. We do this by taking into account the broader spectrum of migrainous biology, thus analyzing migraine both with and without aura, focusing on light sensitivity as the most relevant visual symptom in migraine, and finally analyzing the visual snow syndrome. We also present possible hypotheses on the underlying pathophysiology of visual snow, for which very little is currently known.
Collapse
Affiliation(s)
- Francesca Puledda
- Headache Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- NIHR-Wellcome Trust King's Clinical Research Facility, SLaM NIHR Biomedical Research Centre, King's College Hospital, London, United Kingdom
| | - Dominic Ffytche
- Department of Old Age Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Owen O'Daly
- Department of Neuroimaging, Centre for Neuroimaging Sciences, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Peter J. Goadsby
- Headache Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- NIHR-Wellcome Trust King's Clinical Research Facility, SLaM NIHR Biomedical Research Centre, King's College Hospital, London, United Kingdom
| |
Collapse
|
67
|
Vinciguerra L, Cantone M, Lanza G, Bramanti A, Santalucia P, Puglisi V, Pennisi G, Bella R. Migrainous Infarction And Cerebral Vasospasm: Case Report And Literature Review. J Pain Res 2019. [PMID: 31695483 DOI: 10.2147/jpr.s209485.] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Migrainous infarction (MI) is a rare complication of migraines that accounts for 0.5-1.5% of all ischemic strokes. Although the pathogenesis of MI is still debated, cortical spreading depression and the consequent biochemical cascade and hemodynamic changes are presumed to play an important role. Here we describe a case of MI and systematically review the literature on the complex and possibly bidirectional relationship between migraine and stroke. A 44-year-old female with history of migraine with visual aura presented at the Emergency Department due to a sudden onset of left limb paresis and hypoesthesia. Brain magnetic resonance imaging revealed right fronto-parietal ischemic stroke. Two days after hospitalization, the patient experienced a prolonged visual aura and showed ultrasound evidence of intracranial artery vasospasm. To date, there have been 33 published articles on a total 119 patients with MI, although intracranial vasospasm has rarely been reported. Sustained hyperexcitability of cortical neurons, impairment of γ-aminobutyric acid inhibitory circuitry, altered serotonergic transmission, release of vasoconstrictive molecules, and cerebral blood flow changes have been proposed as pathogenic mechanisms of MI. The present case provides insight into the pathophysiological link between stroke and migraine, thus aiding clinicians in therapeutic decision-making although additional studies are needed to clarify the clinical, neuroradiological, and ultrasound findings that link MI and stroke-related migraine.
Collapse
Affiliation(s)
- Luisa Vinciguerra
- Neurology Department and Stroke Unit, IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | | | - Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy.,Department of Neurology IC, Oasi Research Institute - IRCCS, Troina, Italy
| | - Alessia Bramanti
- Institute of Applied Sciences and Intelligent Systems (ISASI), IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | - Paola Santalucia
- Neurology Department and Stroke Unit, IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | - Valentina Puglisi
- Neurology Department and Stroke Unit, IRCCS Centro Neurolesi "Bonino Pulejo", Messina, Italy
| | - Giovanni Pennisi
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technology, Section of Neurosciences, University of Catania, Catania, Italy
| |
Collapse
|
68
|
Tolner EA, Chen SP, Eikermann-Haerter K. Current understanding of cortical structure and function in migraine. Cephalalgia 2019; 39:1683-1699. [PMID: 30922081 PMCID: PMC6859601 DOI: 10.1177/0333102419840643] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 02/28/2019] [Accepted: 03/04/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To review and discuss the literature on the role of cortical structure and function in migraine. DISCUSSION Structural and functional findings suggest that changes in cortical morphology and function contribute to migraine susceptibility by modulating dynamic interactions across cortical and subcortical networks. The involvement of the cortex in migraine is well established for the aura phase with the underlying phenomenon of cortical spreading depolarization, while increasing evidence suggests an important role for the cortex in perception of head pain and associated sensations. As part of trigeminovascular pain and sensory processing networks, cortical dysfunction is likely to also affect initiation of attacks. CONCLUSION Morphological and functional changes identified across cortical regions are likely to contribute to initiation, cyclic recurrence and chronification of migraine. Future studies are needed to address underlying mechanisms, including interactions between cortical and subcortical regions and effects of internal (e.g. genetics, gender) and external (e.g. sensory inputs, stress) modifying factors, as well as possible clinical and therapeutic implications.
Collapse
Affiliation(s)
- Else A Tolner
- Departments of Neurology and Human Genetics, Leiden University Medical Centre, Leiden, The Netherlands
| | - Shih-Pin Chen
- Insitute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei
- Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei
| | | |
Collapse
|
69
|
Simshäuser K, Lüking M, Kaube H, Schultz C, Schmidt S. Is Mindfulness-Based Stress Reduction a Promising and Feasible Intervention for Patients Suffering from Migraine? A Randomized Controlled Pilot Trial. Complement Med Res 2019; 27:19-30. [PMID: 31390617 DOI: 10.1159/000501425] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 06/07/2019] [Indexed: 11/19/2022]
Abstract
AIM We performed a pilot study in order to evaluate the feasibility and to estimate effect sizes of mindfulness-based stress reduction (MBSR) in a sample of patients suffering from migraine. METHOD Migraine patients (n = 62, mean age 44 years, 92% female) were randomly allocated to either MBSR or an active control intervention based on progressive muscle relaxation and psychoeducation. The primary outcome was the number of migraine days per month assessed by headache diaries covering one month before and one month after the intervention. Secondary outcomes included functional impairment, use of medication, psychological symptoms, quality of life, pain acceptance, pain self-efficacy, pain perception and self-attributed mindfulness. To measure feasibility, questionnaires assessing study compliance and contentment were administered. RESULTS The primary outcome migraine frequency showed no significant group difference. Compared to the control group, the MBSR group showed greater improvements in variables of psychological symptoms, pain self-efficacy and sensory pain perception. Within the MBSR condition, all variables showed significant improvements over the course span with effect sizes ranging from d = 0.37 to 0.81, apart from the primary outcome (27% reduction in migraine days, p = 0.07). Compliance and contentment rates were good, supporting the feasibility of the MBSR intervention. CONCLUSION Overall, participants in the MBSR group showed more adaptive coping strategies and decreased levels of psychological impairment compared to the control group, indicating a reduced impact of migraine on their everyday lives. It is concluded that this feasibility study demonstrates the ability of mindfulness-based interventions to reduce suffering in patients with migraine.
Collapse
Affiliation(s)
- Kathrin Simshäuser
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Medical Center, University of Freiburg, Freiburg, Germany.,Interdisciplinary Pain Center, Medical Faculty, Medical Center, University of Freiburg, Freiburg, Germany
| | - Marianne Lüking
- Interdisciplinary Pain Center, Medical Faculty, Medical Center, University of Freiburg, Freiburg, Germany.,Psychotherapy Practice, Freiburg, Germany
| | - Holger Kaube
- Interdisciplinary Pain Center, Medical Faculty, Medical Center, University of Freiburg, Freiburg, Germany.,Headache and Neurology Center, Munich, Germany
| | - Claudia Schultz
- University Center for Complementary Medicine, Medical Faculty, Medical Center, University of Freiburg, Freiburg, Germany.,General Practice B80, Gundelfingen, Germany
| | - Stefan Schmidt
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Medical Center, University of Freiburg, Freiburg, Germany,
| |
Collapse
|
70
|
Mykland MS, Bjørk MH, Stjern M, Omland PM, Uglem M, Sand T. Fluctuations of sensorimotor processing in migraine: a controlled longitudinal study of beta event related desynchronization. J Headache Pain 2019; 20:77. [PMID: 31288756 PMCID: PMC6734210 DOI: 10.1186/s10194-019-1026-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 06/17/2019] [Indexed: 11/16/2022] Open
Abstract
Background The migraine brain seems to undergo cyclic fluctuations of sensory processing. For instance, during the preictal phase, migraineurs experience symptoms and signs of altered pain perception as well as other well-known premonitory CNS-symptoms. In the present study we measured EEG-activation to non-painful motor and sensorimotor tasks in the different phases of the migraine cycle by longitudinal measurements of beta event related desynchronization (beta-ERD). Methods We recorded electroencephalography (EEG) of 41 migraine patients and 31 healthy controls. Each subject underwent three EEG recordings on three different days with classification of each EEG recording according to the actual migraine phase. During each recording, subjects performed one motor and one sensorimotor task with the flexion-extension movement of the right wrist. Results Migraine patients had significantly increased beta-ERD and higher baseline beta power at the contralateral C3 electrode overlying the primary sensorimotor cortex in the preictal phase compared to the interictal phase. We found no significant differences in beta-ERD or baseline beta power between interictal migraineurs and controls. Conclusion Increased preictal baseline beta activity may reflect a decrease in pre-activation in the sensorimotor cortex. Altered pre-activation may lead to changes in thresholds for inhibitory responses and increased beta-ERD response, possibly reflecting a generally increased preictal cortical responsivity in migraine. Cyclic fluctuations in the activity of second- and third-order afferent somatosensory neurons, and their associated cortical and/or thalamic interneurons, may accordingly also be a central part of the migraine pathophysiology.
Collapse
Affiliation(s)
- Martin Syvertsen Mykland
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.
| | - Marte Helene Bjørk
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.,Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Marit Stjern
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway
| | - Petter Moe Omland
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway
| | - Martin Uglem
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway
| | - Trond Sand
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway.,Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway
| |
Collapse
|
71
|
Bourgeais-Rambur L, Beynac L, Villanueva L. [Brain network dysfunctions as substrates of primary headaches]. Biol Aujourdhui 2019; 213:43-49. [PMID: 31274102 DOI: 10.1051/jbio/2019022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Indexed: 01/16/2023]
Abstract
A large body of clinical and pre-clinical evidence has shown complex interactions between bottom-up and top-down mechanisms that are essential for the discrimination of noxious information and pain perception. These endogenous systems, mainly originating from the brainstem, hypothalamus and cerebral cortex, are strongly influenced by behavioral, cognitive and emotional factors that are relevant for the survival of the individual. Under pathological conditions, however, dysfunctional engagement of these descending pathways certainly contributes to the transformation from acute into chronic pain states. In disorders such as primary headaches, dysfunctions affecting brain regulation mechanisms contribute to the generation of episodic painful states in susceptible individuals, and to the evolution from acute to chronic migraine or cluster headache. Taken together, these studies support the concept that CNS mechanisms that process trigemino-vascular pain do not consist only of a bottom-up process, whereby a painful focus modifies the inputs to the next higher level. Indeed, several CNS regions mediate subtle forms of plasticity by adjusting neural maps downstream and, consequently, altering all the modulatory mechanisms as a result of sensory, autonomic, endocrine, cognitive and emotional influences. Disturbances in normal sensory processing within these loops could lead to maladaptive changes and impaired craniofacial functions at the origin of primary headaches.
Collapse
Affiliation(s)
- Laurence Bourgeais-Rambur
- Université Paris Descartes, Paris, France - Institut de Psychiatrie et Neurosciences de Paris (IPNP), Inserm U1261, 102-108, rue de la Santé, 75014 Paris, France
| | - Laurianne Beynac
- Université Paris Descartes, Paris, France - Institut de Psychiatrie et Neurosciences de Paris (IPNP), Inserm U1261, 102-108, rue de la Santé, 75014 Paris, France
| | - Luis Villanueva
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), Inserm U1261, 102-108, rue de la Santé, 75014 Paris, France
| |
Collapse
|
72
|
Russo A, Silvestro M, Tessitore A, Tedeschi G. Shedding light on migraine with aura: the clarifying role of advanced neuroimaging investigations. Expert Rev Neurother 2019; 19:739-750. [PMID: 31267785 DOI: 10.1080/14737175.2019.1638252] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Introduction: While migraine with aura is a complex neurological syndrome with a well-characterized clinical phenotype, its pathophysiology still has grey areas which could be partially clarified by microstructural and functional neuroimaging investigations. Areas covered: This article, summarizing the most significant findings from advanced neuroimaging studies, aims to achieve a unifying pathophysiological model of the migraine aura. A comprehensive review has been conducted of PubMed citations by entering the key word 'neuroimaging' combined with 'migraine with aura' AND/OR 'MRI.' Other keywords included 'grey matter' OR 'white matter', 'structural' OR 'functional'. Expert opinion: Converging evidence from advanced neuroimaging investigations underlined the critical role of the extrastriate visual cortex, and in particular the lingual gyrus, in the genesis of the aura phenomenon. However, the relationship between the aura and the headache phase of migraine attacks has not been completely clarified, to date, and underlying pathophysiological mechanisms need to be further elucidated.
Collapse
Affiliation(s)
- Antonio Russo
- a Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences , University of Campania "Luigi Vanvitelli" , Naples , Italy.,b MRI Research Center SUN-FISM , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Marcello Silvestro
- a Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences , University of Campania "Luigi Vanvitelli" , Naples , Italy.,b MRI Research Center SUN-FISM , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Alessandro Tessitore
- a Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences , University of Campania "Luigi Vanvitelli" , Naples , Italy.,b MRI Research Center SUN-FISM , University of Campania "Luigi Vanvitelli" , Naples , Italy
| | - Gioacchino Tedeschi
- a Headache Center, Department of Medical, Surgical, Neurological, Metabolic and Aging Sciences , University of Campania "Luigi Vanvitelli" , Naples , Italy.,c Institute for Diagnosis and Care ''Hermitage Capodimonte'' , Naples , Italy
| |
Collapse
|
73
|
Kim YS, Kim M, Choi SH, You SH, Yoo RE, Kang KM, Yun TJ, Lee ST, Moon J, Shin YW. Altered Vascular Permeability in Migraine-associated Brain Regions: Evaluation with Dynamic Contrast-enhanced MRI. Radiology 2019; 292:713-720. [PMID: 31264949 DOI: 10.1148/radiol.2019182566] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Background Recent studies showed the possible association between inflammation-induced blood-brain barrier (BBB) structural changes followed by greater permeability of the BBB and chronic pain. Thus, measurement of BBB breakdown would be a valuable aid in the diagnosis in migraine. Dynamic contrast material-enhanced (DCE) MRI can determine perfusion and permeability properties related to the BBB. Purpose To evaluate the relationship between permeability of the BBB in migraine-associated brain regions by using DCE MRI. Materials and Methods In this prospective study, from September 2016 to December 2017, 56 study participants underwent DCE MRI after gadobutrol administration and were classified into migraine (n = 35) and healthy control (n = 21) groups. Automatic volumetric segmentation was performed on the pre-contrast-enhanced T1-weighted images by using FreeSurfer, and migraine-associated brain region masks were extracted by using the software NordicICE. The corresponding maps for pharmacokinetic parameters Ktrans (the volume transfer constant) and Vp (the fractional plasma volume) were coregistered with the region-of-interest masks, and their mean values of corresponding total volume of interest were calculated. For comparison analyses, the Mann-Whitney tests were used. Receiver operating characteristic curve analysis and Spearman rank correlation tests were used to identify correlations between clinical characteristics and the aforementioned perfusion parameters. Results Mean age was younger in the migraine group (mean ± standard deviation, 57 years ± 12) than in the healthy control group (mean, 71 years ± 8) (P < .001). In the migraine group, the mean value of Vp in the left amygdala (median, 0.27 mL/100 g) was lower than that in the healthy control group (median, 0.39 mL/100 g) (P = .04). The mean value of Vp in the left amygdala was correlated with the intensity of headache attack in participants with migraine (correlation coefficient, -0.34; P = .04). Conclusion Lower fractional plasma volume in the left amygdala was observed in participants with migraine than in healthy participants. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Carroll and Ginat in this issue.
Collapse
Affiliation(s)
- Yeon Soo Kim
- From the Departments of Radiology (Y.S.K., S.H.C., R.E.Y., K.M.K., T.J.Y.), Neurology (M.K., S.T.L., J.M., Y.W.S.), and Neurosurgery (J.M.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Radiology (Y.S.K., S.H.C., R.E.Y., K.M.K., T.J.Y.), Neuroscience Research Institute (M.K.), and Protein Metabolism Research Center (M.K.), Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.H.C.); and Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea (S.H.Y.)
| | - Manho Kim
- From the Departments of Radiology (Y.S.K., S.H.C., R.E.Y., K.M.K., T.J.Y.), Neurology (M.K., S.T.L., J.M., Y.W.S.), and Neurosurgery (J.M.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Radiology (Y.S.K., S.H.C., R.E.Y., K.M.K., T.J.Y.), Neuroscience Research Institute (M.K.), and Protein Metabolism Research Center (M.K.), Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.H.C.); and Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea (S.H.Y.)
| | - Seung Hong Choi
- From the Departments of Radiology (Y.S.K., S.H.C., R.E.Y., K.M.K., T.J.Y.), Neurology (M.K., S.T.L., J.M., Y.W.S.), and Neurosurgery (J.M.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Radiology (Y.S.K., S.H.C., R.E.Y., K.M.K., T.J.Y.), Neuroscience Research Institute (M.K.), and Protein Metabolism Research Center (M.K.), Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.H.C.); and Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea (S.H.Y.)
| | - Sung-Hye You
- From the Departments of Radiology (Y.S.K., S.H.C., R.E.Y., K.M.K., T.J.Y.), Neurology (M.K., S.T.L., J.M., Y.W.S.), and Neurosurgery (J.M.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Radiology (Y.S.K., S.H.C., R.E.Y., K.M.K., T.J.Y.), Neuroscience Research Institute (M.K.), and Protein Metabolism Research Center (M.K.), Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.H.C.); and Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea (S.H.Y.)
| | - Roh-Eul Yoo
- From the Departments of Radiology (Y.S.K., S.H.C., R.E.Y., K.M.K., T.J.Y.), Neurology (M.K., S.T.L., J.M., Y.W.S.), and Neurosurgery (J.M.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Radiology (Y.S.K., S.H.C., R.E.Y., K.M.K., T.J.Y.), Neuroscience Research Institute (M.K.), and Protein Metabolism Research Center (M.K.), Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.H.C.); and Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea (S.H.Y.)
| | - Koung Mi Kang
- From the Departments of Radiology (Y.S.K., S.H.C., R.E.Y., K.M.K., T.J.Y.), Neurology (M.K., S.T.L., J.M., Y.W.S.), and Neurosurgery (J.M.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Radiology (Y.S.K., S.H.C., R.E.Y., K.M.K., T.J.Y.), Neuroscience Research Institute (M.K.), and Protein Metabolism Research Center (M.K.), Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.H.C.); and Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea (S.H.Y.)
| | - Tae Jin Yun
- From the Departments of Radiology (Y.S.K., S.H.C., R.E.Y., K.M.K., T.J.Y.), Neurology (M.K., S.T.L., J.M., Y.W.S.), and Neurosurgery (J.M.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Radiology (Y.S.K., S.H.C., R.E.Y., K.M.K., T.J.Y.), Neuroscience Research Institute (M.K.), and Protein Metabolism Research Center (M.K.), Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.H.C.); and Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea (S.H.Y.)
| | - Soon-Tae Lee
- From the Departments of Radiology (Y.S.K., S.H.C., R.E.Y., K.M.K., T.J.Y.), Neurology (M.K., S.T.L., J.M., Y.W.S.), and Neurosurgery (J.M.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Radiology (Y.S.K., S.H.C., R.E.Y., K.M.K., T.J.Y.), Neuroscience Research Institute (M.K.), and Protein Metabolism Research Center (M.K.), Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.H.C.); and Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea (S.H.Y.)
| | - Jangsup Moon
- From the Departments of Radiology (Y.S.K., S.H.C., R.E.Y., K.M.K., T.J.Y.), Neurology (M.K., S.T.L., J.M., Y.W.S.), and Neurosurgery (J.M.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Radiology (Y.S.K., S.H.C., R.E.Y., K.M.K., T.J.Y.), Neuroscience Research Institute (M.K.), and Protein Metabolism Research Center (M.K.), Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.H.C.); and Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea (S.H.Y.)
| | - Yong-Won Shin
- From the Departments of Radiology (Y.S.K., S.H.C., R.E.Y., K.M.K., T.J.Y.), Neurology (M.K., S.T.L., J.M., Y.W.S.), and Neurosurgery (J.M.), Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea; Department of Radiology (Y.S.K., S.H.C., R.E.Y., K.M.K., T.J.Y.), Neuroscience Research Institute (M.K.), and Protein Metabolism Research Center (M.K.), Seoul National University College of Medicine, Seoul, Republic of Korea; Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea (S.H.C.); and Department of Radiology, Korea University Anam Hospital, Seoul, Republic of Korea (S.H.Y.)
| |
Collapse
|
74
|
The migraine eye: distinct rod-driven retinal pathways' response to dim light challenges the visual cortex hyperexcitability theory. Pain 2019; 160:569-578. [PMID: 30376534 DOI: 10.1097/j.pain.0000000000001434] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Migraine-type photophobia, most commonly described as exacerbation of headache by light, affects nearly 90% of the patients. It is the most bothersome symptom accompanying an attack. Using subjective psychophysical assessments, we showed that migraine patients are more sensitive to all colors of light during ictal than during interictal phase and that control subjects do not experience pain when exposed to different colors of light. Based on these findings, we suggested that color preference is unique to migraineurs (as it was not found in control subjects) rather than migraine phase (as it was found in both phases). To identify the origin of this photophobia in migraineurs, we compared the electrical waveforms that were generated in the retina and visual cortex of 46 interictal migraineurs to those generated in 42 healthy controls using color-based electroretinography and visual-evoked potential paradigms. Unexpectedly, it was the amplitude of the retinal rod-driven b wave, which was consistently larger (by 14%-19% in the light-adapted and 18%-34% in the dark-adapted flash ERG) in the migraineurs than in the controls, rather than the retinal cone-driven a wave or the visual-evoked potentials that differs most strikingly between the 2 groups. Mechanistically, these findings suggest that the inherent hypersensitivity to light among migraine patients may originate in the retinal rods rather than retinal cones or the visual cortex. Clinically, the findings may explain why migraineurs complain that the light is too bright even when it is dim to the extent that nonmigraineurs feel as if they are in a cave.
Collapse
|
75
|
Whitsel BL, Vierck CJ, Waters RS, Tommerdahl M, Favorov OV. Contributions of Nociresponsive Area 3a to Normal and Abnormal Somatosensory Perception. THE JOURNAL OF PAIN 2019; 20:405-419. [PMID: 30227224 PMCID: PMC6420406 DOI: 10.1016/j.jpain.2018.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 07/12/2018] [Accepted: 08/11/2018] [Indexed: 12/29/2022]
Abstract
Traditionally, cytoarchitectonic area 3a of primary somatosensory cortex (SI) has been regarded as a proprioceptive relay to motor cortex. However, neuronal spike-train recordings and optical intrinsic signal imaging, obtained from nonhuman sensorimotor cortex, show that neuronal activity in some of the cortical columns in area 3a can be readily triggered by a C-nociceptor afferent drive. These findings indicate that area 3a is a critical link in cerebral cortical encoding of secondary/slow pain. Also, area 3a contributes to abnormal pain processing in the presence of activity-dependent reversal of gamma-aminobutyric acid A receptor-mediated inhibition. Accordingly, abnormal processing within area 3a may contribute mechanistically to generation of clinical pain conditions. PERSPECTIVE: Optical imaging and neurophysiological mapping of area 3a of SI has revealed substantial driving from unmyelinated cutaneous nociceptors, complementing input to areas 3b and 1 of SI from myelinated nociceptors and non-nociceptors. These and related findings force a reconsideration of mechanisms for SI processing of pain.
Collapse
Affiliation(s)
- Barry L Whitsel
- Department of Cell Biology and Physiology, University of North Carolina, Chapel Hill, North Carolina
| | - Charles J Vierck
- Department of Neuroscience, University of Florida College of Medicine, Gainesville, Florida
| | - Robert S Waters
- Department of Anatomy and Neurobiology, University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee
| | - Mark Tommerdahl
- Department of Biomedical Engineering, University of North Carolina, Chapel Hill, North Carolina
| | - Oleg V Favorov
- Department of Biomedical Engineering, University of North Carolina, Chapel Hill, North Carolina.
| |
Collapse
|
76
|
Does the migraine attack start in the cortex and is the cortex critical in the migraine process? Neurol Sci 2019; 40:31-37. [DOI: 10.1007/s10072-019-03838-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
|
77
|
Abstract
Aversion to light is common among migraineurs undergoing acute attacks. Using psychophysical assessments in patients with episodic migraine, we reported that white, blue, amber, and red lights exacerbate migraine headache in a significantly larger percentage of patients and to a greater extent compared with green light. This study aimed at determining whether these findings are phase-dependent-namely, manifested exclusively during migraine (ictally) but not in its absence (interictally), or condition-dependent-ie, expressed uniquely in migraineurs but not in healthy controls. To determine whether the color preference of migraine-type photophobia is phase- or condition-dependent, we compared the effects of each color of light in each intensity between migraineurs during and in-between attacks and healthy controls. During the ictal and interictal phases, the proportion of migraineurs reporting changes in headache severity when exposed to the different colors of light increased in accordance with elevated light intensities. During the ictal phase, white, blue, amber, and red lights exacerbated headaches in ∼80% of the patients; however, during the interictal phase, light initiated headache in only 16% to 19%. Notably, green light exacerbated headaches in 40% and triggered headaches in 3% of the patients studied during the ictal and interictal phases, respectively. With one exception (highest red light intensity), no control subject reported headache in response to the light stimuli. These findings suggest that color preference is unique to migraineurs-as it was not found in control subjects-and that it is independent of whether or not the patients are in their ictal or interictal phase.
Collapse
|
78
|
Viganò A, Toscano M, Puledda F, Di Piero V. Treating Chronic Migraine With Neuromodulation: The Role of Neurophysiological Abnormalities and Maladaptive Plasticity. Front Pharmacol 2019; 10:32. [PMID: 30804782 PMCID: PMC6370938 DOI: 10.3389/fphar.2019.00032] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 01/14/2019] [Indexed: 12/20/2022] Open
Abstract
Chronic migraine (CM) is the most disabling form of migraine, because pharmacological treatments have low efficacy and cumbersome side effects. New evidence has shown that migraine is primarily a disorder of brain plasticity and migraine chronification depends on a maladaptive process favoring the development of a brain state of hyperexcitability. Due to the ability to induce plastic changes in the brain, researchers started to look at Non-Invasive Brain Stimulation (NIBS) as a possible therapeutic option in migraine field. On one side, NIBS techniques induce changes of neural plasticity that outlast the period of the stimulation (a fundamental prerequisite of a prophylactic migraine treatment, concurrently they allow targeting neurophysiological abnormalities that contribute to the transition from episodic to CM. The action may thus influence not only the cortex but also brainstem and diencephalic structures. Plus, NIBS is not burdened by serious medication side effects and drug–drug interactions. Although the majority of the studies reported somewhat beneficial effects in migraine patients, no standard intervention has been defined. This may be due to methodological differences regarding the used techniques (e.g., transcranial magnetic stimulation, transcranial direct current stimulation), the brain regions chosen as targets, and the stimulation types (e.g., the use of inhibitory and excitatory stimulations on the basis of opposite rationales), and an intrinsic variability of stimulation effect. Hence, it is difficult to draw a conclusion on the real effect of neuromodulation in migraine. In this article, we first will review the definition and mechanisms of brain plasticity, some neurophysiological hallmarks of migraine, and migraine chronification-related (dys)plasticity. Secondly, we will review available results from therapeutic and physiological studies using neuromodulation in CM. Lastly we will discuss the results obtained in these preventive trials in the light of a possible effect on brain plasticity.
Collapse
Affiliation(s)
- Alessandro Viganò
- Headache Research Centre and Neurocritical Care Unit, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy.,Molecular and Cellular Networks Lab, Department of Anatomy, Histology, Forensic Medicine and Orthopaedics, Sapienza University of Rome, Rome, Italy
| | - Massimiliano Toscano
- Headache Research Centre and Neurocritical Care Unit, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy.,Department of Neurology, Fatebenefratelli Hospital, Rome, Italy
| | - Francesca Puledda
- Headache Group, Department of Basic and Clinical Neuroscience, King's College Hospital, King's College London, London, United Kingdom
| | - Vittorio Di Piero
- Headache Research Centre and Neurocritical Care Unit, Department of Human Neuroscience, Sapienza University of Rome, Rome, Italy.,University Consortium for Adaptive Disorders and Head Pain - UCADH, Pavia, Italy
| |
Collapse
|
79
|
Zhou ZY, Yu YW, Wu D, Liu HX, Xiang J, Wu T, Chen QQ, Wang XS. Abnormality of visual neuromagnetic activation in female migraineurs without aura between attacks. J Headache Pain 2019; 20:7. [PMID: 30651072 PMCID: PMC6734467 DOI: 10.1186/s10194-018-0957-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 12/27/2018] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The present study aimed to preliminary explore the abnormal neuromagnetic activation in female migraine patients between attacks using magnetoencephalography (MEG) and pattern reversed visual evoked magnetic fields (PR-VEFs). METHODS A total of 17 female migraine subjects during the headache-free phase and 17 healthy controls (HC) were studied using a 275-channel magnetoencephalography (MEG) system. In this study, visual evoked magnetic fields (VEFs) were generated by a pattern-reversal check as the visual stimulus. The average of 100 VEFs was evolved by different half patterns were averaged and used to analyze waveform, spectrum, and source location within two frequency ranges (5-100 and 100-1000 Hz), respectively. RESULTS In migraine subjects, the latency of second peak of VEFs (VIIs) showed significant prolongations when compared with HC. On the sensor level, the cortical spectral power in migraine subjects was similar to that of HC in the 5-100 Hz range and was lower in the 1000-1000 Hz range. There was a decrement of source strength in the visual cortex in migraine patients when compared to HC in both the 5-100 and 100-1000 Hz frequency range. Moreover, there was a similar odds of activation in 5-100 and 100-1000 Hz frequency ranges in the area beyond the primary visual cortex between the two groups. In addition, no correlation was observed between clinical data (intensity of headache, headache-history duration, the frequency of headaches) and MEG results. CONCLUSIONS The findings presented in the current study, suggested that interictal cortical activation following a visual stimulus was low in female migraine patients. The low pre-activation was detected in the visual cortex using VEF and MEG in both low and high-frequency band. Our results add to the existing evidence that cortical interictal excitability change may be relative to the pain-module mechanism in migraine brains. Thus, our data improved the apprehension of the cortical disorder of migraine in the high-frequency domain.
Collapse
Affiliation(s)
- Zhi Y. Zhou
- The Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Guang Zhou Road 264, Nanjing, Jiangsu 210029 People’s Republic of China
| | - Yan W. Yu
- The Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Guang Zhou Road 264, Nanjing, Jiangsu 210029 People’s Republic of China
| | - Di Wu
- The Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Guang Zhou Road 264, Nanjing, Jiangsu 210029 People’s Republic of China
| | - Hong X. Liu
- The Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Guang Zhou Road 264, Nanjing, Jiangsu 210029 People’s Republic of China
| | - Jing Xiang
- The MEG Center, Division of Neurology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45220 USA
| | - Ting Wu
- The MEG Center, Nanjing Brain Hospital, Nanjing, Jiangsu People’s Republic of China
| | - Qi Q. Chen
- The MEG Center, Nanjing Brain Hospital, Nanjing, Jiangsu People’s Republic of China
| | - Xiao S. Wang
- The Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, Guang Zhou Road 264, Nanjing, Jiangsu 210029 People’s Republic of China
| |
Collapse
|
80
|
Vinciguerra L, Cantone M, Lanza G, Bramanti A, Santalucia P, Puglisi V, Pennisi G, Bella R. Migrainous Infarction And Cerebral Vasospasm: Case Report And Literature Review. J Pain Res 2019; 12:2941-2950. [PMID: 31695483 PMCID: PMC6814312 DOI: 10.2147/jpr.s209485] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 07/19/2019] [Indexed: 02/05/2023] Open
Abstract
Migrainous infarction (MI) is a rare complication of migraines that accounts for 0.5-1.5% of all ischemic strokes. Although the pathogenesis of MI is still debated, cortical spreading depression and the consequent biochemical cascade and hemodynamic changes are presumed to play an important role. Here we describe a case of MI and systematically review the literature on the complex and possibly bidirectional relationship between migraine and stroke. A 44-year-old female with history of migraine with visual aura presented at the Emergency Department due to a sudden onset of left limb paresis and hypoesthesia. Brain magnetic resonance imaging revealed right fronto-parietal ischemic stroke. Two days after hospitalization, the patient experienced a prolonged visual aura and showed ultrasound evidence of intracranial artery vasospasm. To date, there have been 33 published articles on a total 119 patients with MI, although intracranial vasospasm has rarely been reported. Sustained hyperexcitability of cortical neurons, impairment of γ-aminobutyric acid inhibitory circuitry, altered serotonergic transmission, release of vasoconstrictive molecules, and cerebral blood flow changes have been proposed as pathogenic mechanisms of MI. The present case provides insight into the pathophysiological link between stroke and migraine, thus aiding clinicians in therapeutic decision-making although additional studies are needed to clarify the clinical, neuroradiological, and ultrasound findings that link MI and stroke-related migraine.
Collapse
Affiliation(s)
- Luisa Vinciguerra
- Neurology Department and Stroke Unit, IRCCS Centro Neurolesi “Bonino Pulejo”, Messina, Italy
- Correspondence: Luisa Vinciguerra Neurology Department and Stroke Unit, IRCCS Centro Neurolesi “Bonino Pulejo”, Via Provinciale Palermo, Contrada Casazza, 98124Messina, ItalyTel +39 090 6012 8395Fax +39 090 6012 8850 Email
| | | | - Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
- Department of Neurology IC, Oasi Research Institute – IRCCS, Troina, Italy
| | - Alessia Bramanti
- Institute of Applied Sciences and Intelligent Systems (ISASI), IRCCS Centro Neurolesi “Bonino Pulejo”, Messina, Italy
| | - Paola Santalucia
- Neurology Department and Stroke Unit, IRCCS Centro Neurolesi “Bonino Pulejo”, Messina, Italy
| | - Valentina Puglisi
- Neurology Department and Stroke Unit, IRCCS Centro Neurolesi “Bonino Pulejo”, Messina, Italy
| | - Giovanni Pennisi
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | - Rita Bella
- Department of Medical and Surgical Sciences and Advanced Technology, Section of Neurosciences, University of Catania, Catania, Italy
| |
Collapse
|
81
|
Anagnostou E, Gerakoulis S, Voskou P, Kararizou E. Postural instability during attacks of migraine without aura. Eur J Neurol 2018; 26:319-e21. [PMID: 30295375 DOI: 10.1111/ene.13815] [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] [Received: 04/01/2018] [Accepted: 10/03/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND PURPOSE Migraine has long been associated with unsteadiness and dizziness but postural control has not been studied in the ictal state. Here, the stability of upright stance during migraine attacks was measured. METHODS Static balance was assessed prospectively in migraine patients (n = 30) during quiet stance for 40 s on a posturographic force platform. Recordings were performed both ictally and in the pain-free interval. Subjects were assessed under four different conditions yielding different visual and proprioceptive feedback environments. Both ictal and interictal data were compared with age-matched healthy controls (n = 30). RESULTS Postural instability increased significantly under all experimental conditions during migraine attacks. Whilst standing on a foam pad with eyes closed, median sway area was 353 mm2 in control subjects, 318 mm2 in migraineurs in the pain-free period and 618 mm2 in the ictal state. However, Romberg and vestibular Romberg quotients were not altered during migraine attacks. Spectral analyses of postural sway also showed similar profiles in migraineurs and controls. The severity of headache was inversely correlated to Romberg quotients. CONCLUSIONS The demonstrated pattern of balance disorder during migraine attacks suggests a transient cerebellar dysfunction. Our findings also indicate that intense headache induces a re-weighting of sensory processing toward less dependence on visual and proprioceptive information.
Collapse
Affiliation(s)
- E Anagnostou
- Department of Neurology, Eginition Hospital, University of Athens, Athens, Greece
| | - S Gerakoulis
- Department of Neurology, Eginition Hospital, University of Athens, Athens, Greece
| | - P Voskou
- Department of Neurology, Eginition Hospital, University of Athens, Athens, Greece
| | - E Kararizou
- Department of Neurology, Eginition Hospital, University of Athens, Athens, Greece
| |
Collapse
|
82
|
Naegel S, Biermann J, Theysohn N, Kleinschnitz C, Diener HC, Katsarava Z, Obermann M, Holle D. Polarity-specific modulation of pain processing by transcranial direct current stimulation - a blinded longitudinal fMRI study. J Headache Pain 2018; 19:99. [PMID: 30355321 PMCID: PMC6755563 DOI: 10.1186/s10194-018-0924-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 09/24/2018] [Indexed: 12/21/2022] Open
Abstract
Background To enrich the hitherto insufficient understanding regarding the mechanisms of action of transcranial direct current stimulation (tDCS) in pain disorders, we investigated its modulating effects on cerebral pain processing using functional magnetic resonance imaging (fMRI). Methods Thirteen right-handed healthy participants received 20 min of 1.5 mA tDCS applied over the primary motor cortex thrice and under three different stimulation pattern (1.anodal-tDCS, 2.cathodal-tDCS, and 3.sham-tDCS) in a blinded cross-over design. After tDCS neural response to electric trigeminal-nociceptive stimulation was investigated using a block designed fMRI. Results Pain stimulation showed a distinct activation pattern within well-established brain regions associated with pain processing. Following anodal tDCS increased activation was detected in the thalamus, basal ganglia, amygdala, cingulate, precentral, postcentral, and dorsolateral prefrontal cortex, while cathodal t-DCS showed decreased response in these areas (pFWE < 0.05). Interestingly the observed effect was reversed in both control conditions (visual- and motor-stimulation). Behavioral data remained unchanged irrespective of the tDCS stimulation mode. Conclusions This study demonstrates polarity-specific modulation of cerebral pain processing, in reconfirmation of previous electrophysiological data. Anodal tDCS leads to an activation of the central pain-network while cathodal tDCS does not. Results contribute to a network-based understanding of tDCS’s impact on cerebral pain-processing.
Collapse
Affiliation(s)
- Steffen Naegel
- Department of Neurology, University of Duisburg-Essen, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany.
| | - Josephine Biermann
- Department of Neurology, University of Duisburg-Essen, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - Nina Theysohn
- Institute of Diagnostic and Interventional Radiology and Neuroradiology, University of Duisburg-Essen, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - Christoph Kleinschnitz
- Department of Neurology, University of Duisburg-Essen, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - Hans-Christoph Diener
- Department of Neurology, University of Duisburg-Essen, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany
| | - Zaza Katsarava
- Department of Neurology, University of Duisburg-Essen, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany.,Department of Neurology, Evangelical Hospital Unna, Holbeinstr. 10, 59423, Unna, Germany.,EVEX Medical Corporation, 40 Vazha-Pshavela Avenue, Tbilisi, 0177, Georgia.,Sechenov University Moscow, 8-2 Trubetskaya str., Moscow, 119991, Russian Federation
| | - Mark Obermann
- Department of Neurology, University of Duisburg-Essen, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany.,Center for Neurology, Asklepios Hospitals Schildautal, Karl-Herold-Straße 1, 38723, Seesen, Germany
| | - Dagny Holle
- Department of Neurology, University of Duisburg-Essen, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany
| |
Collapse
|
83
|
Kalashnikova LA, Dobrynina LA, Korepina OS, Gubanova MV, Timiraysova AA. [Anamnestic headache in patients with cervical artery dissection: clinical characteristics and pathogenetic mechanisms]. Zh Nevrol Psikhiatr Im S S Korsakova 2018; 118:4-11. [PMID: 30132449 DOI: 10.17116/jnevro2018118714] [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] [Indexed: 01/03/2023]
Abstract
AIM To study the frequency and characteristics of headache which is in the past history (HPH) of patients with cervical artery dissection (CeAD) and evaluate with the help of EEG and visual evoked potentials (VEP) the role of central mechanisms in its development. MATERIAL AND METHODS Two hundred and twenty-seven patients with CeAD verified by neuroimaging were studied. All patients were interviewed about the presence of a headache in the past history and its features. The comparison group comprised 35 patients (mean age - 32,3±8,9 years, 77% female) with migraine. Thirty-five patients with HPH and 35 patients of the comparison group underwent EEG and VEP. RESULTS HPH was found in 101 patients (average age of 38.5±8.5 years, 70% female) (44.5%) out of 227 patients. In 35 patients (15.4%), HPH met the International Criteria for migraine (with aura - 3.1%, without aura - 12.3%) and in 66 patients (29.1%) did not (non-migraine headache). The latter started at the age of 24.5±10.2 years, had mild/ moderate intensity (95%), diffuse localization (68%), dull/pressing/squeezing character (53%), never accompanied by vomiting and rarely by nausea (8%), photo- phonophobia (11%). HPH, which met the migraine criteria unlike migraine in the comparison group began at a later age (19.9±9.6 vs 16.2±4.4 years, p<0.03), more frequently did not have aura (80% vs 48%, p<0.003), less often was unilateral (31% vs 71%, p<0,004) and had less intensity. The visual EEG analysis less often found rhythmic disorganization in CeAD patients with HPH than in comparison group with migraine. The hyperventilation caused a slight increase in the spectral power of Teta, Delta waves in HPH patients and significant enhancement in comparison group with migraine (p<0.05). Pattern reversal VEP in patients with HPH had a greater latency and smaller amplitude of cortical responses than in comparison group with migraine (p=0.028 and =0.037, respectively). The flash VEP amplitude was lower in HPH patients than in migraine (p=0.01). CONCLUSION HPH in patients with CeAD meets criteria of migraine in 15.4% (with aura - 3.1%, without aura - 12.3%), 29.1% patients have nonmigraine HPH. Central mechanisms, namely, the hypersensitivity of the cerebral cortex playing the main role in migraine pathogenesis, are not significant in HPH genesis. The main role appears to have peripheral mechanisms - dysplastic changes in the wall of extra- and intracranial arteries that predispose both to headache and dissection.
Collapse
|
84
|
Bathel A, Schweizer L, Stude P, Glaubitz B, Wulms N, Delice S, Schmidt-Wilcke T. Increased thalamic glutamate/glutamine levels in migraineurs. J Headache Pain 2018; 19:55. [PMID: 30019230 PMCID: PMC6049847 DOI: 10.1186/s10194-018-0885-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 07/04/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Increased cortical excitability has been hypothesized to play a critical role in various neurological disorders, such as restless legs syndrome, epilepsy and migraine. Particularly for migraine, local hyperexcitability has been reported. Levels of regional excitatory and inhibitory neurotransmitters are related to cortical excitability and hence may play a role in the origin of the disease. Consequently, a mismatch of the excitatory-inhibitory neurotransmitter network might contribute to local hyperexcitability and the onset of migraine attacks. In this study we sought to assess local levels of glutamate / glutamine (GLX) and gamma-aminobutyric acid (GABA) in the occipital cortex and right thalamus of migraineurs and healthy subjects. METHODS We measured interictally local biochemical concentrations in the occipital lobe and the right thalamus in patients with migraine (without aura) and healthy controls (HCs) using proton magnetic resonance spectroscopy at 3 T. GLX levels were acquired using PRESS and GABA levels using the GABA-sensitive editing sequence MEGA-PRESS. Regional GLX and GABA levels were compared between groups. RESULTS Statistical analyses revealed significantly increased GLX levels in both the primary occipital cortex and thalamus. However, we found no group differences in GABA levels for these two regions. Correlation analyses within the migraine group revealed no significant correlations between pain intensity and levels of GLX or GABA in either of the two brain regions. CONCLUSIONS Further research is needed to investigate the role of GABA/GLX ratios in greater depth and to measure changes in neurotransmitter levels over time, i.e. during migraine attacks and interictally.
Collapse
Affiliation(s)
- Adina Bathel
- Department of Neurology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Ruhr-University-Bochum, Bochum, Germany
- Department of Anesthesiology, Unfallkrankenhaus Berlin, Berlin, Germany
| | - Lauren Schweizer
- Department of Neurology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Ruhr-University-Bochum, Bochum, Germany
| | - Philipp Stude
- Department of Neurology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Ruhr-University-Bochum, Bochum, Germany
| | - Benjamin Glaubitz
- Department of Neurology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Ruhr-University-Bochum, Bochum, Germany
| | - Niklas Wulms
- Department of Neurology, St. Mauritius Therapieklinik, Meerbusch, Germany
| | - Sibel Delice
- Department of Neurology, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Ruhr-University-Bochum, Bochum, Germany
| | - Tobias Schmidt-Wilcke
- Department of Neurology, St. Mauritius Therapieklinik, Meerbusch, Germany
- Institute of Clinical Neuroscience and Medical Psychology, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| |
Collapse
|
85
|
Metzler AI, Robertson CE. Visual Snow Syndrome: Proposed Criteria, Clinical Implications, and Pathophysiology. Curr Neurol Neurosci Rep 2018; 18:52. [DOI: 10.1007/s11910-018-0854-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
86
|
Lisicki M, D'Ostilio K, Coppola G, Maertens de Noordhout A, Parisi V, Schoenen J, Magis D. Brain Correlates of Single Trial Visual Evoked Potentials in Migraine: More Than Meets the Eye. Front Neurol 2018; 9:393. [PMID: 29899730 PMCID: PMC5989125 DOI: 10.3389/fneur.2018.00393] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 05/14/2018] [Indexed: 01/03/2023] Open
Abstract
Background: Using conventional visual evoked potentials (VEPs), migraine patients were found to be hyperresponsive to visual stimulus. Considering that a significant portion of neuronal activity is lost for analysis in the averaging process of conventional VEPs, in this study we investigated visual evoked responses of migraine patients and healthy volunteers using a different approach: single trial analysis. This method permits to preserve all stimulus-induced neuronal activations, whether they are synchronized or not. In addition, we used MRI voxel-based morphometry to search for cortical regions where gray matter volume correlated with single trial (st) VEP amplitude. Finally, using resting-state functional MRI, we explored the connectivity between these regions. Results: stVEP amplitude was greater in episodic migraine patients than in healthy volunteers. Moreover, in migraine patients it correlated positively with gray matter volume of several brain areas likely involved in visual processing, mostly belonging to the ventral attention network. Finally, resting state functional connectivity corroborated the existence of functional interactions between these areas and helped delineating their directions. Conclusions: st-VEPs appear to be a reliable measure of cerebral responsiveness to visual stimuli. Mean st-VEP amplitude is higher in episodic migraine patients compared to controls. Visual hyper-responsiveness in migraine involves several functionally-interconnected brain regions, suggesting that it is the result of a complex multi-regional process coupled to stimulus driven attention systems rather than a localized alteration.
Collapse
Affiliation(s)
- Marco Lisicki
- Headache Research Unit, University of Liège, University Department of Neurology CHR Citadelle Hospital, Liège, Belgium
| | - Kevin D'Ostilio
- Headache Research Unit, University of Liège, University Department of Neurology CHR Citadelle Hospital, Liège, Belgium
| | - Gianluca Coppola
- Research Unit of Neurophysiology of Vision and Neuro-Ophthalmology, G. B. Bietti Foundation IRCCS, Rome, Italy
| | - Alain Maertens de Noordhout
- Headache Research Unit, University of Liège, University Department of Neurology CHR Citadelle Hospital, Liège, Belgium
| | - Vincenzo Parisi
- Research Unit of Neurophysiology of Vision and Neuro-Ophthalmology, G. B. Bietti Foundation IRCCS, Rome, Italy
| | - Jean Schoenen
- Headache Research Unit, University of Liège, University Department of Neurology CHR Citadelle Hospital, Liège, Belgium
| | - Delphine Magis
- Headache Research Unit, University of Liège, University Department of Neurology CHR Citadelle Hospital, Liège, Belgium
| |
Collapse
|
87
|
Asher JM, O’Hare L, Romei V, Hibbard PB. Typical Lateral Interactions, but Increased Contrast Sensitivity, in Migraine-With-Aura. Vision (Basel) 2018; 2:E7. [PMID: 31735871 PMCID: PMC6836116 DOI: 10.3390/vision2010007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 01/31/2018] [Accepted: 02/07/2018] [Indexed: 02/07/2023] Open
Abstract
Individuals with migraine show differences in visual perception compared to control groups. It has been suggested that differences in lateral interactions between neurons might account for some of these differences. This study seeks to further establish the strength and spatial extent of excitatory and inhibitory interactions in migraine-with-aura using a classic lateral masking task. Observers indicated which of two intervals contained a centrally presented, vertical Gabor target of varying contrast. In separate blocks of trials, the target was presented alone or was flanked by two additional collinear, high contrast Gabors. Flanker distances varied between 1 and 12 wavelengths of the Gabor stimuli. Overall, contrast thresholds for the migraine group were lower than those in the control group. There was no difference in the degree of lateral interaction in the migraine group. These results are consistent with the previous work showing enhanced contrast sensitivity in migraine-with-aura for small, rapidly presented targets, and they suggest that impaired performance in global perceptual tasks in migraine may be attributed to difficulties in segmenting relevant from irrelevant features, rather than altered local mechanisms.
Collapse
Affiliation(s)
- Jordi M. Asher
- Department of Psychology, University of Essex, Wivenhoe Park, Colchester CO4 3SQ, UK
| | - Louise O’Hare
- Faculty of Health and Social Sciences, Lincoln University, Brayford Way, Brayford Pool, Lincoln LN6 7TS, UK
| | - Vincenzo Romei
- Department of Psychology, University of Essex, Wivenhoe Park, Colchester CO4 3SQ, UK
- Dipartimento di Psicologia and Centro studi e Ricerche in Neuroscienze Cognitive, Università di Bologna, Campus di Cesena, 47521 Cesena, Italy
| | - Paul B. Hibbard
- Department of Psychology, University of Essex, Wivenhoe Park, Colchester CO4 3SQ, UK
| |
Collapse
|
88
|
Comparison of somatosensory cortex excitability between migraine and “strict-criteria” tension-type headache: a magnetoencephalographic study. Pain 2018; 159:793-803. [DOI: 10.1097/j.pain.0000000000001151] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
|
89
|
Abstract
The success of naturalistic or therapeutic neuroregeneration likely depends on an internal milieu that facilitates the survival, proliferation, migration, and differentiation of stem cells and their assimilation into neural networks. Migraine attacks are an integrated sequence of physiological processes that may protect the brain from oxidative stress by releasing growth factors, suppressing apoptosis, stimulating neurogenesis, encouraging mitochondrial biogenesis, reducing the production of oxidants, and upregulating antioxidant defenses. Thus, the migraine attack may constitute a physiologic environment conducive to stem cells. In this paper, key components of migraine are reviewed – neurogenic inflammation with release of calcitonin gene-related peptide (CGRP) and substance P, plasma protein extravasation, platelet activation, release of serotonin by platelets and likely by the dorsal raphe nucleus, activation of endothelial nitric oxide synthase (eNOS), production of brain-derived neurotrophic factor (BDNF) and, in migraine aura, cortical spreading depression – along with their potential neurorestorative aspects. The possibility is considered of using these components to facilitate successful stem cell transplantation. Potential methods for doing so are discussed, including chemical stimulation of the TRPA1 ion channel, conjoint activation of a subset of migraine components, invasive and noninvasive deep brain stimulation of the dorsal raphe nucleus, transcranial focused ultrasound, and stimulation of the Zusanli (ST36) acupuncture point.
Collapse
Affiliation(s)
- Jonathan M Borkum
- Department of Psychology, University of Maine, Orono; Health Psych Maine, Waterville, ME, USA
| |
Collapse
|
90
|
The treatment of migraine patients within chiropractic: analysis of a nationally representative survey of 1869 chiropractors. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 17:519. [PMID: 29202816 PMCID: PMC5715542 DOI: 10.1186/s12906-017-2026-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 11/22/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND While the clinical role of manual therapies in migraine management is unclear, the use of chiropractors for this condition is considerable. The aim of this study is to evaluate the prevalence and characteristics of chiropractors who frequently manage patients with migraine. METHODS A national cross-sectional survey of chiropractors collected information on practitioner characteristics, clinical management characteristics and practice settings. A secondary analysis was conducted on 1869 respondents who reported on their migraine caseload to determine the predictors associated with the frequent management of patients with migraine. RESULTS A large proportion of chiropractors report having a high migraine caseload (HMC) (n = 990; 53.0%). The strongest factors predicting a chiropractor having a HMC include the frequent treatment of patients with axial neck pain (OR = 2.89; 95%CI: 1.18, 7.07), thoracic pain (referred/radicular) (OR = 2.52; 95%CI: 1.58, 3.21) and non-musculoskeletal disorders (OR = 3.06; 95%CI: 2.13, 4.39). CONCLUSIONS Several practice-setting and clinical management characteristics are associated with chiropractors managing a HMC. These findings raise key questions about the therapeutic approach to chiropractic migraine management that deserves further examination. There is a need for more primary research to assess the approach to headache and migraine management provided by chiropractors and to understand the prevalence, burden and comorbidities associated with migraine found within chiropractic patient populations. This information is vital in helping to inform safe, effective and coordinated care for migraine sufferers within the wider health system.
Collapse
|
91
|
Neverdahl J, Omland P, Uglem M, Engstrøm M, Sand T. Reduced motor cortical inhibition in migraine: A blinded transcranial magnetic stimulation study. Clin Neurophysiol 2017; 128:2411-2418. [DOI: 10.1016/j.clinph.2017.08.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 08/20/2017] [Accepted: 08/25/2017] [Indexed: 01/03/2023]
|
92
|
Jay GW, Barkin RL. Primary Headache Disorders Part I- Migraine and the Trigeminal Autonomic Cephalalgias. Dis Mon 2017; 63:308-338. [DOI: 10.1016/j.disamonth.2017.04.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
93
|
Borkum JM. The Migraine Attack as a Homeostatic, Neuroprotective Response to Brain Oxidative Stress: Preliminary Evidence for a Theory. Headache 2017; 58:118-135. [DOI: 10.1111/head.13214] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Jonathan M. Borkum
- Department of Psychology; University of Maine; Orono ME USA
- Health Psych Maine; Waterville ME USA
| |
Collapse
|
94
|
Auditory Event-Related Potentials in the Interictal Phase of Migraine Indicate Alterations in Automatic Attention. Appl Psychophysiol Biofeedback 2017; 42:323-333. [DOI: 10.1007/s10484-017-9378-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
95
|
Vinogradova LV. Initiation of spreading depression by synaptic and network hyperactivity: Insights into trigger mechanisms of migraine aura. Cephalalgia 2017; 38:1177-1187. [DOI: 10.1177/0333102417724151] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background Cortical spreading depression (SD) is thought to underlie migraine aura but mechanisms of triggering SD in the structurally normal, well-nourished cortex of migraine patients remain unknown. Synaptic and network dysfunctions appear to underlie episodic neurological disorders, including migraine. The narrative review summarizes old and recent experimental evidence for triggering SD by synaptic/network mechanisms and discusses the relevance of the data to migraine pathogenesis. Our hypothesis is that under some conditions synaptic/network hyperactivity may reliably ignite SD, and this mechanism may underlie triggering migraine aura in patients. Findings High-frequency tetanic stimulation of the cortex reliably triggers SD in synaptically connected regions; SD is a reliable cortical response to acute hyperexcitability (epileptic seizures), though chronic epilepsy prevents triggering SD; in the hyperexcitable cortex, SD may be triggered by sensory stimulation; compromised glutamatergic transmission plays the critical role in triggering SD. Conclusion SD may be triggered by dynamic network instability produced by dysfunction of calcium-dependent glutamate release. Synaptic drive from subcortical sensory processing structures (brainstem and/or thalamocortical networks) is able to evoke depolarization of hyperexcitable cortical neurons sufficient to initiate the regenerative SD process. Studying SD initiation by synaptic/network hyperexcitability may provide insights into basic mechanisms underlying SD generation in migraine brain.
Collapse
Affiliation(s)
- Lyudmila V Vinogradova
- Institute of Higher Nervous Activity and Neurophysiology, Russian Academy of Sciences, Moscow, Russia
| |
Collapse
|
96
|
Lisicki M, Ruiz-Romagnoli E, Piedrabuena R, Giobellina R, Schoenen J, Magis D. Migraine triggers and habituation of visual evoked potentials. Cephalalgia 2017; 38:988-992. [PMID: 28691517 DOI: 10.1177/0333102417720217] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Identifying specific subsets of patients within the clinical spectrum of migraine could help in personalizing migraine treatment. Profiling patients by combining clinical characteristics and neurophysiological biomarkers is largely unexplored. We studied the association between migraine attack triggers and habituation of visual evoked potentials. Methods We personally interviewed 25 patients about their migraine triggers following a structured list, and measured the N1-P1 habituation slope over six blocks of 100 averaged pattern-reversal VEP afterwards. Results The mean number of triggers per patient was 4.52 ± 1.42. Habituation slopes differed significantly between subjects who reported stress as a migraine trigger (deficient VEP habituation) and subjects who did not (preserved VEP habituation). For the remaining categories, the mean amplitude slope was always positive, indicating deficient habituation, and was not significantly different between subgroups. Conclusions Migraine patients not reporting perceived stress as a trigger for their attacks might constitute a distinct clinic-physiological subset within the migraine spectrum.
Collapse
Affiliation(s)
- Marco Lisicki
- 1 Headache Research Unit, University Department of Neurology CHR, Liège, Belgium
| | - Emiliano Ruiz-Romagnoli
- 2 Department of Neurology, Reina Fabiola University Clinic, Catholic University of Córdoba, Córdoba, Argentina
| | - Raúl Piedrabuena
- 2 Department of Neurology, Reina Fabiola University Clinic, Catholic University of Córdoba, Córdoba, Argentina
| | - Roberto Giobellina
- 2 Department of Neurology, Reina Fabiola University Clinic, Catholic University of Córdoba, Córdoba, Argentina
| | - Jean Schoenen
- 1 Headache Research Unit, University Department of Neurology CHR, Liège, Belgium
| | - Delphine Magis
- 1 Headache Research Unit, University Department of Neurology CHR, Liège, Belgium
| |
Collapse
|
97
|
Increased Amplitude of Thalamocortical Low-Frequency Oscillations in Patients with Migraine. J Neurosci 2017; 36:8026-36. [PMID: 27466345 DOI: 10.1523/jneurosci.1038-16.2016] [Citation(s) in RCA: 72] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 06/16/2016] [Indexed: 01/11/2023] Open
Abstract
UNLABELLED For many years, neurobiological theories have emphasized the importance of neuronal oscillations in the emergence of brain function. At the same time, clinical studies have shown that disturbances or irregularities in brain rhythms may relate to various common neurological conditions, including migraine. Increasing evidence suggests that the CNS plays a fundamental role in the predisposition to develop different forms of headache. Here, we present human imaging data that strongly support the presence of abnormal low-frequency oscillations (LFOs) in thalamocortical networks of patients in the interictal phase of migraine. Our results show that the main source of arrhythmic activity was localized to the higher-order thalamic relays of the medial dorsal nucleus. In addition, spontaneous LFOs in the thalamus were selectively associated with the headache attack frequency, meaning that the varying amplitude of dysrhythmia could predispose patients to recurrent attacks. Rhythmic cortical feedback to the thalamus is a major factor in the amplification of thalamocortical oscillations, making it a strong candidate for influencing neuronal excitability. We further speculate that the intrinsic dynamics of thalamocortical network oscillations are crucial for early sensory processing and therefore could underlie important pathophysiological processes involved in multisensory integration. SIGNIFICANCE STATEMENT In many cases, migraine attacks are thought to begin centrally. A major obstacle to studying intrinsic brain activity has been the identification of the precise anatomical structures and functional networks that are involved in migraine. Here, we present imaging data that strongly support the presence of abnormal low-frequency oscillations in thalamocortical networks of patients in the interictal phase of migraine. This arrhythmic activity was localized to the higher-order thalamic relays of the medial dorsal nucleus and was selectively associated with headache attack frequency. Rhythmic cortical feedback to the thalamus is a major factor in the amplification of thalamocortical oscillations, making it a strong candidate for influencing neuronal excitability and higher-level processes involved in multisensory integration.
Collapse
|
98
|
Ince F, Erdogan-Bakar E, Unal-Cevik I. Preventive drugs restore visual evoked habituation and attention in migraineurs. Acta Neurol Belg 2017; 117:523-530. [PMID: 28150096 DOI: 10.1007/s13760-017-0749-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/17/2017] [Indexed: 01/03/2023]
Abstract
Visual system pathway dysfunction has been postulated in migraineurs. We wanted to investigate if any difference exists interictally in visual attention and visual evoked habituation of frequently attacked migraineurs compared to the healthy control group. The effects of 3-month prophylactic migraine treatment on these parameters were also assessed. The migraineurs at headache-free interval (n = 52) and age, sex-matched healthy controls (n = 35) were compared by habituation response to 10 blocks of repetitive pattern-reversal visual stimuli (each block consisted 100 responses). The amplitude changes of 5th and 10th blocks were further compared with that of block 1 to assess the response of habituation (i.e., decrease) or potentiation (i.e., increase). The level of sustained visual attention was assessed by Cancellation test. Migraineurs were randomized to three different preventive treatments: propranolol 40 mg tid, flunarizine 5 mg bid, or topiramate 50 mg bid. After 3 months of preventive treatment, migraineurs data were compared with their baseline values. The groups did not differ by sex and age. In electrophysiological studies, the habituation ability observed in the healthy group was not observed in migraineurs. However, it was restored 3 months after preventive treatment. In migraineurs, compared to their baseline values, the distorted visual attention parameters also improved after treatment. All drugs were effective. The loss of habituation ability and low visual attention performance in migraineurs can be restored by migraine preventive treatment. This electrophysiological study accompanied by neuropsychological test may aid an objective and quantitative assessment tool for understanding migraine pathophysiology.
Collapse
Affiliation(s)
- Ferda Ince
- Department of Neurology, Ozel Ilke Yasam Medical Center, Dortyol, Turkey
| | - Emel Erdogan-Bakar
- Department of Psychology, Faculty of Science and Letter, Ufuk University, Ankara, Turkey
| | - Isin Unal-Cevik
- Department of Neurology, Faculty of Medicine, Pain Unit, Hacettepe University, Sıhhiye, 06100, Ankara, Turkey.
| |
Collapse
|
99
|
Mykland MS, Bjørk MH, Stjern M, Sand T. Alterations in post-movement beta event related synchronization throughout the migraine cycle: A controlled, longitudinal study. Cephalalgia 2017; 38:718-729. [PMID: 28478712 DOI: 10.1177/0333102417709011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The migraine brain is believed to have altered cortical excitability compared to controls and between migraine cycle phases. Our aim was to evaluate post-activation excitability through post-movement beta event related synchronization (PMBS) in sensorimotor cortices with and without sensory discrimination. Subjects and methods We recorded EEG of 41 migraine patients and 31 healthy controls on three different days with classification of days in relation to migraine phases. During each recording, subjects performed one motor and one sensorimotor task with the right wrist. Controls and migraine patients in the interictal phase were compared with repeated measures (R-) ANOVA and two sample Student's t-test. Migraine phases were compared to the interictal phase with R-ANOVA and paired Student's t-test. Results The difference between PMBS at the contralateral and ipsilateral sensorimotor cortex was altered throughout the migraine cycle. Compared to the interictal phase, we found decreased PMBS at the ipsilateral sensorimotor cortex in the ictal phase and increased PMBS in the preictal phase. Lower ictal PMBS was found in bilateral sensorimotor cortices in patients with right side headache predominance. Conclusion The cyclic changes of PMBS in migraine patients may indicate that a dysfunction in deactivation and interhemispheric inhibition of the sensorimotor cortex is involved in the migraine attack cascade.
Collapse
Affiliation(s)
- Martin Syvertsen Mykland
- 1 Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Marte Helene Bjørk
- 2 Department of Clinical Medicine, University of Bergen, Bergen, Norway
- 3 Department of Neurology, Haukeland University Hospital, Bergen, Norway
| | - Marit Stjern
- 1 Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- 4 Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway
| | - Trond Sand
- 1 Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- 4 Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway
| |
Collapse
|
100
|
Akerman S, Romero-Reyes M, Holland PR. Current and novel insights into the neurophysiology of migraine and its implications for therapeutics. Pharmacol Ther 2017; 172:151-170. [PMID: 27919795 DOI: 10.1016/j.pharmthera.2016.12.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Migraine headache and its associated symptoms have plagued humans for two millennia. It is manifest throughout the world, and affects more than 1/6 of the global population. It is the most common brain disorder, and is characterized by moderate to severe unilateral headache that is accompanied by vomiting, nausea, photophobia, phonophobia, and other hypersensitive symptoms of the senses. While there is still a clear lack of understanding of its neurophysiology, it is beginning to be understood, and it seems to suggest migraine is a disorder of brain sensory processing, characterized by a generalized neuronal hyperexcitability. The complex symptomatology of migraine indicates that multiple neuronal systems are involved, including brainstem and diencephalic systems, which function abnormally, resulting in premonitory symptoms, ultimately evolving to affect the dural trigeminovascular system, and the pain phase of migraine. The migraineur also seems to be particularly sensitive to fluctuations in homeostasis, such as sleep, feeding and stress, reflecting the abnormality of functioning in these brainstem and diencephalic systems. Implications for therapeutic development have grown out of our understanding of migraine neurophysiology, leading to major drug classes, such as triptans, calcitonin gene-related peptide receptor antagonists, and 5-HT1F receptor agonists, as well as neuromodulatory approaches, with the promise of more to come. The present review will discuss the current understanding of the neurophysiology of migraine, particularly migraine headache, and novel insights into the complex neural networks responsible for associated neurological symptoms, and how interaction of these networks with migraine pain pathways has implications for the development of novel therapeutics.
Collapse
Affiliation(s)
- Simon Akerman
- Department of Oral and Maxillofacial Pathology, Radiology and Medicine, New York University College of Dentistry, New York, NY 10010, USA.
| | - Marcela Romero-Reyes
- Department of Oral and Maxillofacial Pathology, Radiology and Medicine, New York University College of Dentistry, New York, NY 10010, USA
| | - Philip R Holland
- Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| |
Collapse
|