151
|
Beneficial Effects of Capsaicin in Disorders of the Central Nervous System. Molecules 2022; 27:molecules27082484. [PMID: 35458680 PMCID: PMC9029810 DOI: 10.3390/molecules27082484] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/01/2022] [Accepted: 04/07/2022] [Indexed: 01/13/2023] Open
Abstract
Capsaicin is a natural compound found in chili peppers and is used in the diet of many countries. The important mechanism of action of capsaicin is its influence on TRPV1 channels in nociceptive sensory neurons. Furthermore, the beneficial effects of capsaicin in cardiovascular and oncological disorders have been described. Many recent publications show the positive effects of capsaicin in animal models of brain disorders. In Alzheimer’s disease, capsaicin reduces neurodegeneration and memory impairment. The beneficial effects of capsaicin in Parkinson’s disease and depression have also been described. It has been found that capsaicin reduces the area of infarction and improves neurological outcomes in animal models of stroke. However, both proepileptic and antiepileptic effects of capsaicin in animal models of epilepsy have been proposed. These contradictory results may be caused by the fact that capsaicin influences not only TRPV1 channels but also different molecular targets such as voltage-gated sodium channels. Human studies show that capsaicin may be helpful in treating stroke complications such as dysphagia. Additionally, this compound exerts pain-relieving effects in migraine and cluster headaches. The purpose of this review is to discuss the mechanisms of the beneficial effects of capsaicin in disorders of the central nervous system.
Collapse
|
152
|
Kim DK, Lee HJ, Lee IH, Lee JJ. Risk of Burning Mouth Syndrome in Patients with Migraine: A Nationwide Cohort Study. J Pers Med 2022; 12:620. [PMID: 35455736 PMCID: PMC9029595 DOI: 10.3390/jpm12040620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 04/01/2022] [Accepted: 04/06/2022] [Indexed: 12/19/2022] Open
Abstract
Migraine is a common neurological disease that causes a variety of symptoms, most notably throbbing, which is described as a pulsing headache on one side of the head. Burning mouth syndrome (BMS) is defined as an intra-oral burning sensation. Currently, no medical or dental cause has been identified for BMS. Interestingly, neuropathic pain is a characteristic feature of BMS; however, it remains unclear whether migraine can cause BMS. We aimed to identify the association of migraine with the risk of developing BMS. We used a representative nationwide cohort sample of approximately 1 million patients from 2002 to 2013 to investigate the prospective association between migraine and BMS. A total of 4157 migraine patients (migraine group) and 16,628 patients without migraine (comparison group) were enrolled after 1:4 propensity score matching. The overall incidence of BMS was significantly higher in the migraine group (0.15 per 1000 person-years) than in the comparison group (0.05 per 1000 person-years). The adjusted HR for patients with migraine who reported BMS events during the 10-year follow-up period was 2.96 (95% confidence interval, 1.02-8.56), after adjusting for other covariates. However, in the subgroup analysis, the adjusted HR for BMS events did not show a significant difference between the migraine and comparison group according to sex, age, and comorbidities. This study suggests that migraine is associated with an increased incidence of BMS. Therefore, clinicians should be attentive to detect BMS at an early stage when treating patients with migraine.
Collapse
Affiliation(s)
- Dong-Kyu Kim
- Institute of New Frontier Research, Division of Big Data and Artificial Intelligence, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea;
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea;
| | - Hyun-Joo Lee
- Institute of New Frontier Research, Division of Big Data and Artificial Intelligence, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea;
| | - Il Hwan Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea;
| | - Jae-Jun Lee
- Department of Anesthesiology and Pain Medicine, College of Medicine, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon 24253, Korea
| |
Collapse
|
153
|
Benatto MT, Florencio LL, Bragatto MM, Dach F, Fernández-de-Las-Peñas C, Bevilaqua-Grossi D. Neck-specific strengthening exercise compared with placebo sham ultrasound in patients with migraine: a randomized controlled trial. BMC Neurol 2022; 22:126. [PMID: 35366822 PMCID: PMC8976325 DOI: 10.1186/s12883-022-02650-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 03/21/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Migraine patients have musculoskeletal disorders and pain in the cervical. And, despite the pathophysiology demonstrating the relationship between migraine and the cervical spine, the effectiveness of craniocervical exercises in these patients has not been verified. So, the aimed of this study was verify the effectiveness of craniocervical muscle-strengthening exercise (CMSE) in reducing the frequency and intensity of headache in migraine patients. METHODS: A two-armed, parallel-group randomized controlled trial with a 3-month follow-up was performed. For eight weeks, the volunteers in the intervention group (n = 21) performed a protocol of CMSE, while those in the sham ultrasound group (n = 21) received the application of disconnected therapeutic ultrasound in the upper trapezius and guideline for home-stretching. The primary outcomes were the frequency and intensity of the headache. The secondary outcomes were questionnaires about migraine and neck disability, and satisfaction with the treatment, cervical range of motion, the pressure pain threshold, craniocervical flexion test (CCFT), cervical muscle strength and endurance test, and the cervical muscle activity during the physical tests. RESULTS No differences were observed for the changes observed in primary outcomes after eight weeks and at the 3-months follow up (p > 0.05). For the secondary outcomes, craniocervical exercises improved the sensitivity of the frontal muscle (p = 0.040) and promoted a reduced amplitude of muscle activity of the anterior scalene and upper trapezius in the last stages of CCFT (p ≤ 0.010). There was also reduced muscle activity of the anterior scalene and splenius capitis in the endurance test (p ≤ 0.045), as evaluated by surface electromyography. CONCLUSION CMSE were insufficient in reducing the frequency and intensity of headache, improving the performance of the cervical muscles, or reducing migraine and neck pain-related disabilities. This was found despite a decreased electromyographic activity of the cervical muscles during the last stages of CCFT and increased median frequency during the endurance test. TRIAL REGISTRATION Accession code RBR-8gfv5j , registered 28/11/2016 in the Registro Brasileiro de Ensaios Clínicos (ReBEC).
Collapse
Affiliation(s)
- Mariana Tedeschi Benatto
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Lidiane Lima Florencio
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Marcela Mendes Bragatto
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Fabíola Dach
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, Alcorcón, Spain
| | - Débora Bevilaqua-Grossi
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| |
Collapse
|
154
|
Lenglart L, Raieli V, Sciruicchio V, Caula C, Vitali G, Guedj R, Quatrosi G, D’Agnano D, D’Alonzo R, Moulding T, Rinaldi VE, Titomanlio L. The association between gastro-oesophageal reflux and migraine in the paediatric population: a multicentre case-control study. Eur J Pediatr 2022; 181:1679-1687. [PMID: 35006376 PMCID: PMC8744028 DOI: 10.1007/s00431-021-04368-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 12/23/2021] [Accepted: 12/26/2021] [Indexed: 02/07/2023]
Abstract
Infantile regurgitation is one of the most common discomforts in the first months of life. Infantile colic and, in older children, functional dyspepsia have been linked to migraine. To date, this is the first study to investigate a possible association between infantile regurgitation and primary headaches in children. This is a case-control study of 195 children aged 6-17 years, with primary headache (migraine, or tension type headache) in 5 European paediatric hospitals. The control group is composed of 240 same-aged children attending with minor injuries during the same period - February 1st 2020 to December 1st 2020. A structured questionnaire identified a history of infantile regurgitation and other functional gastrointestinal disorders for case and control participants. The outcome was the difference in the prevalence of infantile regurgitation among children with or without a diagnosis of primary headache. The analysis showed a significant association between infantile regurgitation and migraine (OR = 1.88, CI 95 = 1.01-3.4, p = 0.04). No association was found between infantile regurgitation and tension type headache (p = 0.33). Subgroup analysis confirmed that the association was only significant for migraine without aura (OR = 2.3, CI 95 = 1.2-4.4, p = 0.01). In a further subgroup analysis, the presence of functional dyspepsia, irritable bowel syndrome and abdominal migraine was associated with migraine without aura. CONCLUSION The presence of migraine among children aged 6-17 was associated with a history of infantile regurgitation. Additional longitudinal studies are required to confirm whether infantile regurgitation could be considered as a precursor of migraine. WHAT IS KNOWN • Children suffering from functional gastrointestinal disorders are more likely to be suffering from migraine and tension-type headache as well. • Children suffering from primary headache are more likely to have had infantile colic in their first six month of life. WHAT IS NEW • It is the first study to find an association between migraine and infantile regurgitation in children. • These findings could have an impact on the diagnosis and therapeutics of both migraine and infantile regurgitation.
Collapse
Affiliation(s)
- Léa Lenglart
- Department of Paediatric Emergency Care, DM’UP, APHP, Hôpital Robert Debré, 48 Boulevard Serrurier, Paris, 75019 France
| | - Vincenzo Raieli
- Child Neuropsychiatry Unit, ISMEP, ARNAS Civico, Palermo, Italy
| | | | - Caroline Caula
- Department of Paediatric Emergency Care, DM’UP, APHP, Hôpital Robert Debré, 48 Boulevard Serrurier, Paris, 75019 France
| | - Giulia Vitali
- Department of Paediatric Emergency Care, DM’UP, APHP, Hôpital Robert Debré, 48 Boulevard Serrurier, Paris, 75019 France
| | - Romain Guedj
- Department of Paediatric Emergency Care, Hôpital Armand Trousseau, APHP, Paris, 75012 France
- Faculté de Médecine, UMR153, Sorbonne Université, Paris, Inserm France
| | | | - Daniela D’Agnano
- Children Epilepsy and EEG Centre, S. Paolo Hospital, Bari, Italy
| | - Renato D’Alonzo
- Department of Paediatrics, Ospedale S. Giovanni Battista, Foligno, 06034 Italia
| | - Thomas Moulding
- Department of Specialty and Integrated Medicine, Leeds Teaching Hospitals Trust, Leeds, UK
| | | | - Luigi Titomanlio
- Department of Paediatric Emergency Care, DM’UP, APHP, Hôpital Robert Debré, 48 Boulevard Serrurier, Paris, 75019 France
- University of Paris, HU I2D2 INSERM UMR1141 Paris, France
| |
Collapse
|
155
|
Bahrami S, Hindley G, Winsvold BS, O’Connell KS, Frei O, Shadrin A, Cheng W, Bettella F, Rødevand L, Odegaard KJ, Fan CC, Pirinen MJ, Hautakangas HM, Dale AM, Djurovic S, Smeland OB, Andreassen OA. Dissecting the shared genetic basis of migraine and mental disorders using novel statistical tools. Brain 2022; 145:142-153. [PMID: 34273149 PMCID: PMC8967089 DOI: 10.1093/brain/awab267] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/18/2021] [Accepted: 06/21/2021] [Indexed: 11/24/2022] Open
Abstract
Migraine is three times more prevalent in people with bipolar disorder or depression. The relationship between schizophrenia and migraine is less certain although glutamatergic and serotonergic neurotransmission are implicated in both. A shared genetic basis to migraine and mental disorders has been suggested but previous studies have reported weak or non-significant genetic correlations and five shared risk loci. Using the largest samples to date and novel statistical tools, we aimed to determine the extent to which migraine's polygenic architecture overlaps with bipolar disorder, depression and schizophrenia beyond genetic correlation, and to identify shared genetic loci. Summary statistics from genome-wide association studies were acquired from large-scale consortia for migraine (n cases = 59 674; n controls = 316 078), bipolar disorder (n cases = 20 352; n controls = 31 358), depression (n cases = 170 756; n controls = 328 443) and schizophrenia (n cases = 40 675, n controls = 64 643). We applied the bivariate causal mixture model to estimate the number of disorder-influencing variants shared between migraine and each mental disorder, and the conditional/conjunctional false discovery rate method to identify shared loci. Loci were functionally characterized to provide biological insights. Univariate MiXeR analysis revealed that migraine was substantially less polygenic (2.8 K disorder-influencing variants) compared to mental disorders (8100-12 300 disorder-influencing variants). Bivariate analysis estimated that 800 (SD = 300), 2100 (SD = 100) and 2300 (SD = 300) variants were shared between bipolar disorder, depression and schizophrenia, respectively. There was also extensive overlap with intelligence (1800, SD = 300) and educational attainment (2100, SD = 300) but not height (1000, SD = 100). We next identified 14 loci jointly associated with migraine and depression and 36 loci jointly associated with migraine and schizophrenia, with evidence of consistent genetic effects in independent samples. No loci were associated with migraine and bipolar disorder. Functional annotation mapped 37 and 298 genes to migraine and each of depression and schizophrenia, respectively, including several novel putative migraine genes such as L3MBTL2, CACNB2 and SLC9B1. Gene-set analysis identified several putative gene sets enriched with mapped genes including transmembrane transport in migraine and schizophrenia. Most migraine-influencing variants were predicted to influence depression and schizophrenia, although a minority of mental disorder-influencing variants were shared with migraine due to the difference in polygenicity. Similar overlap with other brain-related phenotypes suggests this represents a pool of 'pleiotropic' variants that influence vulnerability to diverse brain-related disorders and traits. We also identified specific loci shared between migraine and each of depression and schizophrenia, implicating shared molecular mechanisms and highlighting candidate migraine genes for experimental validation.
Collapse
Affiliation(s)
- Shahram Bahrami
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
| | - Guy Hindley
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
- Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London SE5 8AB, UK
| | - Bendik Slagsvold Winsvold
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
- KG Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kevin S O’Connell
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
| | - Oleksandr Frei
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
- Center for Bioinformatics, Department of Informatics, University of Oslo, PO Box 1080, Blindern, 0316 Oslo, Norway
| | - Alexey Shadrin
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
| | - Weiqiu Cheng
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
| | - Francesco Bettella
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
| | - Linn Rødevand
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
| | - Ketil J Odegaard
- NORMENT, Division of Psychiatry, Haukeland University Hospital and Department of Clinical Medicine, University of Bergen, 5020 Bergen, Norway
| | - Chun C Fan
- Multimodal Imaging Laboratory, University of California San Diego, La Jolla, CA 92093, USA
- Department of Cognitive Science, University of California, San Diego, La Jolla, CA, USA
| | - Matti J Pirinen
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, 00014 Helsinki, Finland
- Department of Public Health, Faculty of Medicine, University of Helsinki, 00014 Helsinki, Finland
- Department of Mathematics and Statistics, University of Helsinki, 00014 Helsinki, Finland
| | - Heidi M Hautakangas
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, 00014 Helsinki, Finland
| | - Anders M Dale
- Multimodal Imaging Laboratory, University of California San Diego, La Jolla, CA 92093, USA
- Department of Radiology, University of California, San Diego, La Jolla, CA 92093, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Department of Neurosciences, University of California San Diego, La Jolla, CA 92093, USA
| | - Srdjan Djurovic
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
- NORMENT Centre, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Olav B Smeland
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
| | - Ole A Andreassen
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407 Oslo, Norway
| |
Collapse
|
156
|
Zhu Z, Wu S, Wang Y, Wang J, Zhang Y. Reveal the Antimigraine Mechanism of Chuanxiong Rhizoma and Cyperi Rhizoma Based on the Integrated Analysis of Metabolomics and Network Pharmacology. Front Pharmacol 2022; 13:805984. [PMID: 35401159 PMCID: PMC8987590 DOI: 10.3389/fphar.2022.805984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 02/10/2022] [Indexed: 11/13/2022] Open
Abstract
Migraine is a common neurological disorder that manifests as recurrent attacks of unilateral and throbbing headache. Conioselinum anthriscoides “Chuanxiong” (Apiaceae; Chuanxiong rhizoma) and Cyperus rotundus L. (Cyperaceae; Cyperi rhizoma) (CRCR), is a classic prescription for treating migraine. This study aimed to reveal the potential mechanisms of CRCR extract against migraine using integrated analysis of metabolomics and network pharmacology. Behavioral changes in the nitroglycerin rat migraine model were determined from von Frey withdrawal response. Untargeted serum metabolomics was used to identify the differentially expressed metabolites and metabolic pathways. The differentially expressed metabolites were analyzed to obtain the corresponding targets by a compound–reaction–enzyme–gene network. Network pharmacology was used to construct a compound–target–pathway network. The common targets of metabolomics and network pharmacology were further analyzed. Metabolomics analysis identified 96 differentially expressed metabolites and 77 corresponding targets. Network pharmacology analysis identified 201 potential targets for CRCR against migraine. By intersecting 77 targets with 201 targets, monoamine oxidase A (MAO-A), monoamine oxidase B (MAO-B), and catechol-O-methyltransferase (COMT) were identified as the common targets, and MAO-A, MAO-B, and COMT were involved in the tyrosine metabolism pathway. Further experiments demonstrated that the contents of MAO-A and COMT were significantly increased in serum and brainstem tissue of the migraine rats. CRCR extract significantly decreased the contents of MAO-A and COMT, while no significant difference was found in MAO-B. Metabolomics analysis indicated that the contents of 3,4-dihydroxyphenylacetate (DOPAC) and 3-(4-hydroxyphenyl)pyruvate (HPP) were significantly increased in the migraine rats, and CRCR extract caused significant decreases in DOPAC and HPP. Interestingly, DOPAC and HPP were two differentially expressed metabolites involved in the tyrosine metabolism pathway. Correlation analysis showed that DOPAC and HPP were highly positively correlated with MAO-A and COMT. Taken together, two key differentially expressed metabolites (DOPAC and HPP), two key targets (MAO-A and COMT), and one relevant metabolic pathway (tyrosine metabolism) showed great importance in the treatment of migraine. This research could provide a new understanding of the potential mechanism of CRCR against migraine. More attentions should be paid into the tyrosine metabolism pathway in future studies.
Collapse
Affiliation(s)
- Zhiyao Zhu
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, China
- Beijing Key Lab of Traditional Chinese Medicine Collateral Disease Theory Research, Capital Medical University, Beijing, China
| | - Sha Wu
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, China
- Beijing Key Lab of Traditional Chinese Medicine Collateral Disease Theory Research, Capital Medical University, Beijing, China
- *Correspondence: Sha Wu,
| | - Yuxuan Wang
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, China
- Beijing Key Lab of Traditional Chinese Medicine Collateral Disease Theory Research, Capital Medical University, Beijing, China
| | - Jiayi Wang
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, China
- Beijing Key Lab of Traditional Chinese Medicine Collateral Disease Theory Research, Capital Medical University, Beijing, China
| | - Yujia Zhang
- School of Traditional Chinese Medicine, Capital Medical University, Beijing, China
- Beijing Key Lab of Traditional Chinese Medicine Collateral Disease Theory Research, Capital Medical University, Beijing, China
| |
Collapse
|
157
|
Gross AJ, Hudson JW, Matias C, Jones BJ. Effects of onabotulinumtoxin A in patients concurrently diagnosed with chronic migraine encephalalgia and temporomandibular disorders: A retrospective case series. Cranio 2022:1-11. [PMID: 35285422 DOI: 10.1080/08869634.2022.2045114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Chronic migraine encephalalgia (CME) with concomitant temporomandibular disorder (TMD) is a serious illness with limited effective treatment options. This study explores the effectiveness of onabotulinumtoxinA (BtxA) as an adjunct therapeutic to TMJ arthroscopy in the relief of CME. METHODS A retrospective cohort study of patients receiving TMJ arthroscopy, with or without BtxA injections for CME, was conducted. Variables assessed include pain using a visual analog scale (VAS), maximal incisal opening (MIO), muscle soreness, and headache frequency and duration. RESULTS Sixty patients (44 BtxA, 16 Control), consisting of 56 (93.3%) females, met inclusion criteria. A significant reduction in pain is reported with patients receiving BtxA (p < 0.0001) on VAS as compared to Control group. BtxA treatment also significantly reduced headache frequency and duration (p < 0.05). CONCLUSION These results support the use of adjunctive BtxA treatment with arthroscopy for the treatment of CME in the context of TMD.
Collapse
Affiliation(s)
- Andrew J Gross
- Department of Oral and Maxillofacial Surgery, University of Tennessee Medical Center, Knoxville, TN, USA
| | - John W Hudson
- Department of Oral and Maxillofacial Surgery, University of Tennessee Medical Center, Knoxville, TN, USA
| | - Catalina Matias
- Department of Anatomy, Cell Biology, and Physiology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Brady J Jones
- Department of Oral and Maxillofacial Surgery, University of Tennessee Medical Center, Knoxville, TN, USA
| |
Collapse
|
158
|
Del Moro L, Rota E, Pirovano E, Rainero I. Migraine, Brain Glucose Metabolism and the "Neuroenergetic" Hypothesis: A Scoping Review. THE JOURNAL OF PAIN 2022; 23:1294-1317. [PMID: 35296423 DOI: 10.1016/j.jpain.2022.02.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 02/04/2022] [Accepted: 02/14/2022] [Indexed: 02/06/2023]
Abstract
Increasing evidence suggests that migraine may be the result of an impaired brain glucose metabolism. Several studies have reported brain mitochondrial dysfunction, impaired brain glucose metabolism and gray matter volume reduction in specific brain areas of migraineurs. Furthermore, peripheral insulin resistance, a condition demonstrated in several studies, may extend to the brain, leading to brain insulin resistance. This condition has been proven to downregulate insulin receptors, both in astrocytes and neurons, triggering a reduction in glucose uptake and glycogen synthesis, mainly during high metabolic demand. This scoping review examines the clinical, epidemiologic and pathophysiologic data supporting the hypothesis that abnormalities in brain glucose metabolism may generate a mismatch between the brain's energy reserve and metabolic expenditure, triggering migraine attacks. Moreover, alteration in glucose homeostasis could generate a chronic brain energy deficit promoting migraine chronification. Lastly, insulin resistance may link migraine with its comorbidities, like obesity, depression, cognitive impairment and cerebrovascular diseases. PERSPECTIVE: Although additional experimental studies are needed to support this novel "neuroenergetic" hypothesis, brain insulin resistance in migraineurs may unravel the pathophysiological mechanisms of the disease, explaining the migraine chronification and connecting migraine with comorbidities. Therefore, this hypothesis could elucidate novel potential approaches for migraine treatment.
Collapse
Affiliation(s)
- Lorenzo Del Moro
- Foundation Allineare Sanità and Salute, Scientific Committee, Milan, Italy; LUMEN APS, European Salus Network, Scientific Committee, San Pietro in Cerro (PC), Italy.
| | - Eugenia Rota
- Neurology Unit, ASL AL, San Giacomo Hospital, Novi Ligure, Italy
| | - Elenamaria Pirovano
- Foundation Allineare Sanità and Salute, Scientific Committee, Milan, Italy; LUMEN APS, European Salus Network, Scientific Committee, San Pietro in Cerro (PC), Italy
| | - Innocenzo Rainero
- Headache Center, Department of Neuroscience "Rita Levi Montalcini", University of Torino, Italy
| |
Collapse
|
159
|
Simonetta I, Riolo R, Todaro F, Tuttolomondo A. New Insights on Metabolic and Genetic Basis of Migraine: Novel Impact on Management and Therapeutical Approach. Int J Mol Sci 2022; 23:3018. [PMID: 35328439 PMCID: PMC8955051 DOI: 10.3390/ijms23063018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/05/2022] [Accepted: 03/07/2022] [Indexed: 12/12/2022] Open
Abstract
Migraine is a hereditary disease, usually one-sided, sometimes bilateral. It is characterized by moderate to severe pain, which worsens with physical activity and may be associated with nausea and vomiting, may be accompanied by photophobia and phonophobia. The disorder can occur at any time of the day and can last from 4 to 72 h, with and without aura. The pathogenic mechanism is unclear, but extensive preclinical and clinical studies are ongoing. According to electrophysiology and imaging studies, many brain areas are involved, such as cerebral cortex, thalamus, hypothalamus, and brainstem. The activation of the trigeminovascular system has a key role in the headache phase. There also appears to be a genetic basis behind the development of migraine. Numerous alterations have been identified, and in addition to the genetic cause, there is also a close association with the surrounding environment, as if on the one hand, the genetic alterations may be responsible for the onset of migraine, on the other, the environmental factors seem to be more strongly associated with exacerbations. This review is an analysis of neurophysiological mechanisms, neuropeptide activity, and genetic alterations that play a fundamental role in choosing the best therapeutic strategy. To date, the goal is to create a therapy that is as personalized as possible, and for this reason, steps forward have been made in the pharmacological field in order to identify new therapeutic strategies for both acute treatment and prophylaxis.
Collapse
Affiliation(s)
- Irene Simonetta
- Internal Medicine and Stroke Care Ward, Department of Promoting Health, Maternal-Infant Excellence and Internal and Specialized Medicine (ProMISE) G. D’Alessandro, University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (I.S.); (R.R.); (F.T.)
- Molecular and Clinical Medicine PhD Programme, University of Palermo, P.zza delle Cliniche n.2, 90127 Palermo, Italy
| | - Renata Riolo
- Internal Medicine and Stroke Care Ward, Department of Promoting Health, Maternal-Infant Excellence and Internal and Specialized Medicine (ProMISE) G. D’Alessandro, University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (I.S.); (R.R.); (F.T.)
| | - Federica Todaro
- Internal Medicine and Stroke Care Ward, Department of Promoting Health, Maternal-Infant Excellence and Internal and Specialized Medicine (ProMISE) G. D’Alessandro, University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (I.S.); (R.R.); (F.T.)
| | - Antonino Tuttolomondo
- Internal Medicine and Stroke Care Ward, Department of Promoting Health, Maternal-Infant Excellence and Internal and Specialized Medicine (ProMISE) G. D’Alessandro, University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (I.S.); (R.R.); (F.T.)
- Molecular and Clinical Medicine PhD Programme, University of Palermo, P.zza delle Cliniche n.2, 90127 Palermo, Italy
| |
Collapse
|
160
|
Effectiveness of yoga therapy for migraine: A meta-analysis of randomized controlled studies. J Clin Neurosci 2022; 99:147-151. [PMID: 35279587 DOI: 10.1016/j.jocn.2022.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 11/25/2021] [Accepted: 01/20/2022] [Indexed: 12/27/2022]
Abstract
INTRODUCTION The efficacy of yoga therapy for migraine remains controversial. We conduct this meta-analysis to explore the influence of yoga therapy on the treatment efficacy of migraine. METHODS We have searched PubMed, EMbase, Web of science, EBSCO and Cochrane library databases through February 2021, and included randomized controlled trials (RCTs) assessing the efficacy of yoga therapy for migraine attack. RESULTS Five RCTs involving 356 patients were included in the meta-analysis. Overall, compared with control group for migraine, yoga therapy was associated with substantially reduced headache frequency headache frequency (SMD = -1.43; 95% CI = -2.23 to -0.64; P = 0.0004) and HIT-6 score (SMD = -2.19; 95% CI = -4.09 to -0.28; P = 0.02), but revealed no obvious influence on pain intensity (SMD = -1.37; 95% CI = -2.76 to 0.01; P = 0.05) or McGill Pain Questionnaire (SMD = -2.09; 95% CI = -6.39 to 2.22; P = 0.34). CONCLUSIONS Yoga therapy may benefit to reduce the headache frequency of migraine patients.
Collapse
|
161
|
Klan T, Bräscher A, Klein S, Diezemann‐Prößdorf A, Guth A, Gaul C, Witthöft M. Assessing attack‐related fear in headache disorders—Structure and psychometric properties of the Fear of Attacks in Migraine Inventory. Headache 2022; 62:294-305. [DOI: 10.1111/head.14272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/14/2022] [Accepted: 01/19/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Timo Klan
- Department of Psychology Johannes Gutenberg‐University of Mainz Mainz Germany
| | | | - Silja Klein
- Department of Psychology Johannes Gutenberg‐University of Mainz Mainz Germany
| | | | | | | | - Michael Witthöft
- Department of Psychology Johannes Gutenberg‐University of Mainz Mainz Germany
| |
Collapse
|
162
|
Landis BC, Brooks AE, Digre KB, Seay MD. Coronavirus Disease 2019, Eye Pain, Headache, and Beyond. J Neuroophthalmol 2022; 42:18-25. [PMID: 35051986 DOI: 10.1097/wno.0000000000001526] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), which causes Coronavirus Disease 2019 (COVID-19), emerged in December 2019 and became a devastating pandemic. Although its respiratory effects can be deadly and debilitating, it can lead to other systemic disorders, such as those causing eye pain and headache. This literature review aims to describe presentations of eye pain and headache in relation to COVID-19, with an emphasis on how these disorders help us to understand the pathophysiology of COVID-19. EVIDENCE ACQUISITION Literature was mined from the PubMed database using the key terms: "eye pain," "conjunctivitis," "episcleritis," "optic neuritis," "migraine," and "headache" in conjunction with "COVID-19" and "SARS-CoV-2." With the exception of general background pathology, articles that predated 2006 were excluded. Case reports, literature reviews, and meta-analyses were all included. Where SARS-CoV-2 research was deficient, pathology of other known viruses was considered. Reports of ocular manifestations of vision loss in the absence of eye pain were excluded. The primary search was conducted in June 2021. RESULTS The literature search led to a focused review of COVID-19 associated with conjunctivitis, episcleritis, scleritis, optic neuritis, and myelin oligodendrocyte glycoprotein-associated optic neuritis. Four distinct COVID-19-related headache phenotypes were identified and discussed. CONCLUSIONS Eye pain in the setting of COVID-19 presents as conjunctivitis, episcleritis, scleritis, or optic neuritis. These presentations add to a more complete picture of SARS-CoV-2 viral transmission and mechanism of host infection. Furthermore, eye pain during COVID-19 may provide evidence of hypersensitivity-type reactions, neurovirulence, and incitement of either novel or subclinical autoimmune processes. In addition, investigation of headaches associated with COVID-19 demonstrated 4 distinct phenotypes that follow third edition of the International Classification of Headache Disorders categories: headaches associated with personal protective equipment, migraine, tension-type headaches, and COVID-19-specific headache. Early identification of headache class could assist in predicting the clinical course of disease. Finally, investigation into the COVID-19-associated headache phenotype of those with a history of migraine may have broader implications, adding to a more general understanding of migraine pathology.
Collapse
Affiliation(s)
- Brianna C Landis
- Rocky Vista University College of Osteopathic Medicine (BCL, AEB), Ivins, Utah; and Departments of Ophthalmology and Neurology (KBD, MDS), University of Utah Moran Eye Center, Salt Lake City, Utah
| | | | | | | |
Collapse
|
163
|
Juliani MPB, Rocha AB, Zendrini GO, Bello VA, Poli-Frederico RC, Silva AVD. Evaluation of the genetic variant - 889 C > T Of Il-1α in migraine - partial analysis. HEADACHE MEDICINE 2022. [DOI: 10.48208/headachemed.2021.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
IntroductionThe pathophysiology of migraine integrates inflammatory and genetic aspects, with interleukin-1α being a component of this picture. This pro-inflammatory cytokine, responsible for inducing pyrogenic, hematological, and metabolic phenomena, is produced by macrophages and monocytes. Genetic variants, which can be found in the regulatory region of the gene for this substance, have clinical implications in different systems.ObjectiveTo evaluate the frequency of the -889C>T genetic variant of IL-1α and its association with clinical variables related to migraine. MethodsProspective case-control study composed of migraine patients and healthy controls aged between 18 and 60 years of age. Project approved by the Research Ethics Committee of PUCPR (No. 3,029,972). Demographic, clinical data on migraine classification and characteristics were collected using a structured form and validated questionnaires on anxiety (STAIY2), depression (BDI) and migraine-related disability (MIDAS). Genetic evaluation was performed with blood or saliva samples that were subjected to polymerase chain reaction (PCR), followed by electrophoresis in 1.5% agarose gel. Categorical data were analyzed by chi-square test or Fisher's exact test and continuous data by t-test or Mann-Whitney test. ResultsA total of 156 participants, 73 migraineurs and 83 controls, were evaluated. The -889C>T variant of IL-1α was not associated with increased susceptibility to migraine when evaluated in allelic, codominant, dominant, or recessive models. The C allele, the lowest producer of the cytokine, was associated with a higher frequency of osmophobia in patients with migraine (65.5% vs. 48.2%; p=0.038). ConclusionNo association was identified between the -889C>T variant of IL-1α and susceptibility to migraine. Its effect on osmophobia should be further investigated. However, the present work is a partial analysis whose main limitation is the small sample size.
Collapse
|
164
|
Abo El-Enin HA, Mostafa RE, Ahmed MF, Naguib IA, A. Abdelgawad M, Ghoneim MM, Abdou EM. Assessment of Nasal-Brain-Targeting Efficiency of New Developed Mucoadhesive Emulsomes Encapsulating an Anti-Migraine Drug for Effective Treatment of One of the Major Psychiatric Disorders Symptoms. Pharmaceutics 2022; 14:pharmaceutics14020410. [PMID: 35214142 PMCID: PMC8874718 DOI: 10.3390/pharmaceutics14020410] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Revised: 02/05/2022] [Accepted: 02/08/2022] [Indexed: 12/04/2022] Open
Abstract
Migraine is one of the major symptoms of many psychiatric and mental disorders like depression and anxiety. Eletriptan Hydrobromide (EH) is a well-tolerated drug in migraine treatment, but suffers from low oral bioavailability and low brain targeting after oral delivery. New nasal mucoadhesive EH-emulsomes development could be a new means to direct the drug from the nose-to-brain to achieve rapid onset of action and high drug concentration in the brain for acute migraine treatment. Eletriptan mucoadhesive emulsomes formulations were prepared using thin-film hydration method and 23 full factorial design was adopted to study different formulation factors’ effect on the emulsomes characters. The emulsomes were characterized for entrapment efficiency (EE%), zeta potential (ZP), particle size (PS), morphology, and ex-vivo permeation through the nasal mucosa. The selected formula was evaluated in mice for its in-vivo bio-distribution in comparison with EH intranasal and intravenous solutions. Drug targeting efficacy (DTE%) and nose-to-brain direct transport percentage (DTP%) were calculated. The optimization formulation showed a nanoparticle size of 177.01 nm, EE 79.44%, and ZP = 32.12 ± 3.28 mV. In addition, in-vitro permeability studies revealed enhanced drug permeability with suitable mean residence time up to 120 ± 13 min. EH-emulsomes were stable under different storage conditions for three months. In vivo examination and pharmacokinetic drug targeting parameters revealed EH transport to the CNS after EH nanoparticle nasal administration. Histopathology study showed no ciliotoxic effect on the nasal mucosa. From the results, it can be confirmed that the emulsomes formulation of EH proved safe direct nose-to-brain transport of EH after nasal administration of EH emulsomes.
Collapse
Affiliation(s)
- Hadel A. Abo El-Enin
- Department of Pharmaceutics, College of Pharmacy, Taif University, Taif 21944, Saudi Arabia;
| | - Rasha E. Mostafa
- Pharmacology Department, Medical Research and Clinical Studies Institute, National Research Centre, Giza 12622, Egypt;
| | - Marwa F. Ahmed
- Department of Pharmaceutical Chemistry, College of Pharmacy, Taif University, Taif 21944, Saudi Arabia;
- Correspondence: (M.F.A.); (M.A.A.)
| | - Ibrahim A. Naguib
- Department of Pharmaceutical Chemistry, College of Pharmacy, Taif University, Taif 21944, Saudi Arabia;
| | - Mohamed A. Abdelgawad
- Department of Pharmaceutical Chemistry, College of Pharmacy, Jouf University, Sakaka 72341, Saudi Arabia
- Correspondence: (M.F.A.); (M.A.A.)
| | - Mohammed M. Ghoneim
- Department of Pharmacy Practice, Faculty of Pharmacy, AlMaarefa University, Ad Diriyah 13713, Saudi Arabia;
| | - Ebtsam M. Abdou
- Department of Pharmaceutics, National Organization of Drug Control and Research (NODCAR), Giza 12622, Egypt;
| |
Collapse
|
165
|
Byeon JH. Vestibular migraine of childhood. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2022. [DOI: 10.5124/jkma.2022.65.2.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Background: Vestibular migraine and benign paroxysmal vertigo are the most common causes of vertigo in children and adolescents. This is a review of vestibular migraine of childhood dizziness.Current Concepts: In children and adolescents, the symptoms of dizziness or vertigo are not well defined. Thus, few studies have investigated the characteristics of dizziness or vertigo in children and adolescents. Vestibular migraine is categorized as episodic syndromes associated with migraine in the International Classification of Headache Disorders, 3rd edition. Despite vertigo’s various clinical features and duration, vestibular migraine can be diagnosed only when a migraine accompanies vertigo from 5 minutes to 72 hours. Benign paroxysmal vertigo is more common in children and adolescents than vestibular migraine. Benign paroxysmal vertigo is considered one of the precursor syndrome of migraine, and the duration of vertigo is short from seconds to minutes.Discussion and Conclusion: Vestibular migraine is common in older children and adults who need a differential diagnosis. This review might be helpful to diagnose, evaluate, and treat children with vestibular migraine and to reassure their parents.
Collapse
|
166
|
Deodato M, Granato A, Ceschin M, Galmonte A, Manganotti P. Algometer Assessment of Pressure Pain Threshold After Onabotulinumtoxin-A and Physical Therapy Treatments in Patients With Chronic Migraine: An Observational Study. FRONTIERS IN PAIN RESEARCH 2022; 3:770397. [PMID: 35295800 PMCID: PMC8915742 DOI: 10.3389/fpain.2022.770397] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Accepted: 01/10/2022] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to evaluate pain hypersensitivity in chronic migraine patients 3 months after undergoing onabotulinumtoxin-A therapy, physical therapy (PT), or the combination of the two. Pressure pain threshold (PPT) was assessed in accordance with Andersen's guidelines, focusing on five muscles in the trigeminocervical area (namely, trapezius, levator scapulae, temporalis, sub-occipitalis, and scalenus medius) and one muscle outside of the area, (i.e., tensor fasciae latae). Moreover, three headache parameters, namely, attack frequency, duration, and pain intensity, were recorded in an ad hoc diary kept by the patients. A total of 30 patients were included in three treatment groups: 1. onabotulinumtoxin-A therapy, 2. PT, and 3. a combination of onabotulinumtoxin-A and PT. The results show that, at the final assessment, the PPT was significantly reduced in the combined treatment group compared to the two single-therapy groups. As regards headache parameters, frequency and duration of the attacks were decreased significantly in all three treatment groups, whereas in pain intensity, the reduction was statistically significant in the combined treatment group and the onabotulinumtoxin-A therapy. Results suggest that a better pain modulation in patients with chronic migraine can be achieved with a combined treatment of onabotulinumtoxin-A and physical therapy. Indeed, the combination of both pharmacological and non-pharmacological treatments results in the reduction of both headache-related parameters and widespread pressure hyperalgesia.
Collapse
Affiliation(s)
- Manuela Deodato
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
- Department of Life Sciences, University of Trieste, Trieste, Italy
- Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
- *Correspondence: Manuela Deodato
| | - Antonio Granato
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
- Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| | - Marta Ceschin
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Alessandra Galmonte
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Paolo Manganotti
- Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
- Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy
| |
Collapse
|
167
|
Fernández-Bravo-Rodrigo J, Pascual-Morena C, Flor-García A, Saz-Lara A, Sequí-Dominguez I, Álvarez-Bueno C, Barreda-Hernández D, Cavero-Redondo I. The Safety and Efficacy of Calcitonin Gene-Related Peptide (CGRP) Monoclonal Antibodies for the Preventive Treatment of Migraine: A Protocol for Multiple-Treatment Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1753. [PMID: 35162776 PMCID: PMC8835448 DOI: 10.3390/ijerph19031753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 01/30/2022] [Accepted: 01/31/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Migraine is a common and disabling primary headache disorder, associated with many medical comorbidities, highly prevalent, with complex treatment and management. Currently, monoclonal antibodies targeting the trigeminal sensory neuropeptide, calcitonin gene-related peptide (CGRP), are available. The aim of this protocol is to provide a review comparing the effects and safety profile of different monoclonal antibodies in migraine patients. METHODS The literature search will be performed through the MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP), Web of Science and Scopus databases, following the PICO strategy. Real World studies and randomized clinical trials assessing the effect of monoclonal antibodies against CGRP interventions (erenumab, eptinezumab, fremanezumab and galcanezumab) on monthly migraine days (MMD), monthly headache days (MHD), headache impact test (HIT-6) and triptan days of use (TriD) will be included. In Real World studies, the DerSimonian and Laird method will be used to calculate pooled estimates of the mean change difference and in randomized clinical trials, a network meta-analysis will be performed to estimate the comparative effects of different monoclonal antibodies against CGRP. RESULTS The findings of this study will be reported in a peer-reviewed journal. CONCLUSIONS This study will provide evidence to health professionals on the efficacy and safety of different monoclonal antibodies against CGRP on the outcomes studied.
Collapse
Affiliation(s)
- Jaime Fernández-Bravo-Rodrigo
- Health and Social Research Center, Universidad de Castilla—La Mancha, 16071 Cuenca, Spain; (J.F.-B.-R.); (A.S.-L.); (I.S.-D.); (C.Á.-B.); (I.C.-R.)
- Pharmacy Service, Hospital Virgen de la Luz, 16002 Cuenca, Spain; (A.F.-G.); (D.B.-H.)
| | - Carlos Pascual-Morena
- Health and Social Research Center, Universidad de Castilla—La Mancha, 16071 Cuenca, Spain; (J.F.-B.-R.); (A.S.-L.); (I.S.-D.); (C.Á.-B.); (I.C.-R.)
| | - Amparo Flor-García
- Pharmacy Service, Hospital Virgen de la Luz, 16002 Cuenca, Spain; (A.F.-G.); (D.B.-H.)
| | - Alicia Saz-Lara
- Health and Social Research Center, Universidad de Castilla—La Mancha, 16071 Cuenca, Spain; (J.F.-B.-R.); (A.S.-L.); (I.S.-D.); (C.Á.-B.); (I.C.-R.)
| | - Irene Sequí-Dominguez
- Health and Social Research Center, Universidad de Castilla—La Mancha, 16071 Cuenca, Spain; (J.F.-B.-R.); (A.S.-L.); (I.S.-D.); (C.Á.-B.); (I.C.-R.)
| | - Celia Álvarez-Bueno
- Health and Social Research Center, Universidad de Castilla—La Mancha, 16071 Cuenca, Spain; (J.F.-B.-R.); (A.S.-L.); (I.S.-D.); (C.Á.-B.); (I.C.-R.)
- Universidad Politécnica y Artística del Paraguay, Asuncion 001518, Paraguay
| | | | - Iván Cavero-Redondo
- Health and Social Research Center, Universidad de Castilla—La Mancha, 16071 Cuenca, Spain; (J.F.-B.-R.); (A.S.-L.); (I.S.-D.); (C.Á.-B.); (I.C.-R.)
| |
Collapse
|
168
|
Hautakangas H, Winsvold BS, Ruotsalainen SE, Bjornsdottir G, Harder AVE, Kogelman LJA, Thomas LF, Noordam R, Benner C, Gormley P, Artto V, Banasik K, Bjornsdottir A, Boomsma DI, Brumpton BM, Burgdorf KS, Buring JE, Chalmer MA, de Boer I, Dichgans M, Erikstrup C, Färkkilä M, Garbrielsen ME, Ghanbari M, Hagen K, Häppölä P, Hottenga JJ, Hrafnsdottir MG, Hveem K, Johnsen MB, Kähönen M, Kristoffersen ES, Kurth T, Lehtimäki T, Lighart L, Magnusson SH, Malik R, Pedersen OB, Pelzer N, Penninx BWJH, Ran C, Ridker PM, Rosendaal FR, Sigurdardottir GR, Skogholt AH, Sveinsson OA, Thorgeirsson TE, Ullum H, Vijfhuizen LS, Widén E, van Dijk KW, Aromaa A, Belin AC, Freilinger T, Ikram MA, Järvelin MR, Raitakari OT, Terwindt GM, Kallela M, Wessman M, Olesen J, Chasman DI, Nyholt DR, Stefánsson H, Stefansson K, van den Maagdenberg AMJM, Hansen TF, Ripatti S, Zwart JA, Palotie A, Pirinen M. Genome-wide analysis of 102,084 migraine cases identifies 123 risk loci and subtype-specific risk alleles. Nat Genet 2022; 54:152-160. [PMID: 35115687 PMCID: PMC8837554 DOI: 10.1038/s41588-021-00990-0] [Citation(s) in RCA: 153] [Impact Index Per Article: 76.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 11/22/2021] [Indexed: 12/11/2022]
Abstract
Migraine affects over a billion individuals worldwide but its genetic underpinning remains largely unknown. Here, we performed a genome-wide association study of 102,084 migraine cases and 771,257 controls and identified 123 loci, of which 86 are previously unknown. These loci provide an opportunity to evaluate shared and distinct genetic components in the two main migraine subtypes: migraine with aura and migraine without aura. Stratification of the risk loci using 29,679 cases with subtype information indicated three risk variants that seem specific for migraine with aura (in HMOX2, CACNA1A and MPPED2), two that seem specific for migraine without aura (near SPINK2 and near FECH) and nine that increase susceptibility for migraine regardless of subtype. The new risk loci include genes encoding recent migraine-specific drug targets, namely calcitonin gene-related peptide (CALCA/CALCB) and serotonin 1F receptor (HTR1F). Overall, genomic annotations among migraine-associated variants were enriched in both vascular and central nervous system tissue/cell types, supporting unequivocally that neurovascular mechanisms underlie migraine pathophysiology.
Collapse
Affiliation(s)
- Heidi Hautakangas
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Bendik S Winsvold
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurology, Oslo University Hospital, Oslo, Norway
| | - Sanni E Ruotsalainen
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | | | - Aster V E Harder
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Lisette J A Kogelman
- Danish Headache Center, Department of Neurology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Laurent F Thomas
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway
- BioCore - Bioinformatics Core Facility, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Laboratory Medicine, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Raymond Noordam
- Department of Internal Medicine, Section of Gerontology and Geriatrics, Leiden University Medical Center, Leiden, the Netherlands
| | - Christian Benner
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | | | - Ville Artto
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Karina Banasik
- Novo Nordic Foundation Center for Protein Research, Copenhagen University, Copenhagen, Denmark
| | | | - Dorret I Boomsma
- Netherlands Twin Register, Department of Biological Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Ben M Brumpton
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Julie E Buring
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Mona Ameri Chalmer
- Danish Headache Center, Department of Neurology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Irene de Boer
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Martin Dichgans
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
- Munich Cluster for Systems Neurology (Synergy), Munich, Germany
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Markus Färkkilä
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Maiken Elvestad Garbrielsen
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mohsen Ghanbari
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Knut Hagen
- Department of Neuromedicine and Movement Science, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinical Research Unit Central Norway, St. Olavs University Hospital, Trondheim, Norway
| | - Paavo Häppölä
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Jouke-Jan Hottenga
- Netherlands Twin Register, Department of Biological Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | | | - Kristian Hveem
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- HUNT Research Center, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marianne Bakke Johnsen
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
- Research and Communication Unit for Musculoskeletal Health (FORMI), Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Mika Kähönen
- Department of Clinical Physiology, Tampere University Hospital, and Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Espen S Kristoffersen
- Research and Communication Unit for Musculoskeletal Health (FORMI), Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Tobias Kurth
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Terho Lehtimäki
- Department of Clinical Chemistry, Fimlab Laboratories, and Finnish Cardiovascular Research Center - Tampere, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Lannie Lighart
- Netherlands Twin Register, Department of Biological Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | | | - Rainer Malik
- Institute for Stroke and Dementia Research, University Hospital, LMU Munich, Munich, Germany
| | - Ole Birger Pedersen
- Department of Clinical Immunology, Zealand University Hospital, Køge, Denmark
| | - Nadine Pelzer
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Brenda W J H Penninx
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- GGZ inGeest Specialized Mental Health Care, Amsterdam, the Netherlands
| | - Caroline Ran
- Department of Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Paul M Ridker
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Anne Heidi Skogholt
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | | | | | - Henrik Ullum
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Lisanne S Vijfhuizen
- Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Elisabeth Widén
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
| | - Ko Willems van Dijk
- Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
- Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center, Leiden, the Netherlands
| | - Arpo Aromaa
- National Public Health Institute (Finnish Institute for Health and Welfare - THL), Helsinki, Finland
| | | | - Tobias Freilinger
- Klinikum Passau, Department of Neurology, Passau, Germany
- Centre of Neurology, Hertie Institute for Clinical Brain Research, Tuebingen, Germany
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Marjo-Riitta Järvelin
- Department of Epidemiology and Biostatistics, MRC-PHE Centre for Environment and Health, School of Public Health, Imperial College London, London, UK
- Center for Life Course Health Research, Faculty of Medicine, University of Oulu, Oulu, Finland
- Unit of Primary Health Care, Oulu University Hospital, Oulu, Finland
- Department of Life Sciences, College of Health and Life Sciences, Brunel University London, London, UK
| | - Olli T Raitakari
- Centre for Population Health Research, University of Turku and Turku University Hospital, Turku, Finland
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, Turku University Hospital, Turku, Finland
| | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
| | - Mikko Kallela
- Department of Neurology, Helsinki University Central Hospital, Helsinki, Finland
| | - Maija Wessman
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
- Folkhälsan Research Center, Helsinki, Finland
| | - Jes Olesen
- Danish Headache Center, Department of Neurology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Daniel I Chasman
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Dale R Nyholt
- School of Biomedical Sciences and Centre for Genomics and Personalised Health, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | | | | | - Arn M J M van den Maagdenberg
- Department of Neurology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Human Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | - Thomas Folkmann Hansen
- Danish Headache Center, Department of Neurology, Copenhagen University Hospital, Copenhagen, Denmark
- Novo Nordic Foundation Center for Protein Research, Copenhagen University, Copenhagen, Denmark
| | - Samuli Ripatti
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
- Department of Public Health, University of Helsinki, Helsinki, Finland
| | - John-Anker Zwart
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
- K. G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Aarno Palotie
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland
- Analytic and Translational Genetics Unit, Department of Medicine, Department of Neurology and Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- The Stanley Center for Psychiatric Research and Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Matti Pirinen
- Institute for Molecular Medicine Finland (FIMM), Helsinki Institute of Life Science (HiLIFE), University of Helsinki, Helsinki, Finland.
- Department of Public Health, University of Helsinki, Helsinki, Finland.
- Department of Mathematics and Statistics, University of Helsinki, Helsinki, Finland.
| |
Collapse
|
169
|
Pak K, Kim J, Lee GH, Cho JW, Kim HW. Effectiveness of Calcitonin Gene-Related Peptide Receptor Antagonists for Migraine Treatment: A Meta-Analysis. Eur Neurol 2022; 85:195-201. [PMID: 35100579 DOI: 10.1159/000521697] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 12/11/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION The pathophysiology of migraine has been researched incessantly, and it has been suggested that calcitonin gene-related peptide (CGRP) is associated with migraine attacks. CGRP receptor blockers are attracting attention as potential agents for migraine prevention and treatment of acute episodes. This meta-analysis aimed to assess the effects of available CGRP receptor antagonists, focusing on their therapeutic doses for acute migraine treatment. METHODS We systematically searched MEDLINE and Embase from inception to March 27, 2021, for English-language publications using the keywords "migraine" and "calcitonin gene-related peptide"; the searches were limited to human studies. RESULTS Five studies that focused on examining the effects of CGRP receptor antagonists on acute migraine treatment met the eligibility criteria for this meta-analysis. A pooled analysis demonstrated that CGRP receptor antagonists significantly increased freedom from pain (odds ratio [OR] = 2.066, 95% confidence interval [CI] 1.766-2.418, I2 = 0%) and from bothersome symptoms in general (OR = 1.606, 95% CI = 1.408-1.830, I2 = 0%); reduced the intensity of pain (OR = 1.791, 95% CI = 1.598-2.008, I2 = 0%); and increased freedom from nausea (OR = 1.361, 95% CI = 1.196-1.548, I2 = 0%) compared to a placebo. CONCLUSIONS CGRP receptor antagonists are effective for acute migraine treatment and are expected to be used clinically as emerging therapeutic agents.
Collapse
Affiliation(s)
- Kyoungjune Pak
- Department of Nuclear Medicine and Biomedical Research Institute, Pusan National University Hospital, Busan, Republic of Korea
| | - Jiyoung Kim
- Department of Neurology and BioMedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Gha-Hyun Lee
- Department of Neurology and BioMedical Research Institute, Pusan National University Hospital, Pusan National University School of Medicine, Busan, Republic of Korea
| | - Jae Wook Cho
- Department of Neurology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| | - Hyun-Woo Kim
- Department of Neurology, Pusan National University Yangsan Hospital, Yangsan, Republic of Korea
| |
Collapse
|
170
|
Papiri G, Vignini A, Capriotti L, Verdenelli P, Alia S, Di Paolo A, Fiori C, Baldinelli S, Silvestrini M, Luzzi S. Cerebrospinal Fluid α-Calcitonin Gene-Related Peptide: A Comparison between Alzheimer's Disease and Multiple Sclerosis. Biomolecules 2022; 12:199. [PMID: 35204700 PMCID: PMC8961604 DOI: 10.3390/biom12020199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 02/04/2023] Open
Abstract
Alzheimer's disease (AD) and Multiple Sclerosis (MS) represent an emerging health problem on a global scale, as they are responsible for a significant contribution to the burden of disability in Western countries. Limited numbers of cerebrospinal fluid (CSF) diagnostic markers are available for each disease (amyloid and tau deposition markers for AD and oligoclonal bands for MS) representing mostly state markers that provide few, if any, clues about the severity of the clinical phenotype. α-CGRP is a neuropeptide implied in nociception, vasodilation, synaptic plasticity and immune functions. This neuropeptide is expressed in encephalic regions connected to memory, attention, autonomic and behavioral functions and is also expressed by spinal motor neurons. The present work confronted α-CGRP levels between 19 AD, 27 MS and 17 control subjects using an ELISA/EIA assay. We measured higher CSF α-CGRP contents in control subjects with respect to AD, as shown in previous studies, as well as in MS patients in comparison to AD. The control subjects and MS patients did not significantly differ between each other. We did not observe a relationship between CSF protein content, albumin quotient and α-CGRP. We also describe, retrospectively, an association between higher CSF CGRP content and higher MRI overall lesion count in MS and between lower α-CGRP and worse attention and visuo-perceptual skills in AD. We speculate that α-CGRP could be differentially involved in both disabling diseases.
Collapse
Affiliation(s)
- Giulio Papiri
- Neurology Clinic, Azienda Ospedaliero Universitaria, Ospedali Riuniti di Ancona, 60126 Torrette di Ancona, Italy; (G.P.); (C.F.); (S.B.); (M.S.); (S.L.)
| | - Arianna Vignini
- Section of Biochemistry, Department of Clinical Sciences, Biology and Physics, Università Politecnica delle Marche, 60126 Ancona, Italy; (S.A.); (A.D.P.)
| | - Luigi Capriotti
- Anesthesiology and Intensive Care Unit, Ospedale Provinciale “Madonna del Soccorso”, 63074 San Benedetto del Tronto, Italy; (L.C.); (P.V.)
| | - Paola Verdenelli
- Anesthesiology and Intensive Care Unit, Ospedale Provinciale “Madonna del Soccorso”, 63074 San Benedetto del Tronto, Italy; (L.C.); (P.V.)
| | - Sonila Alia
- Section of Biochemistry, Department of Clinical Sciences, Biology and Physics, Università Politecnica delle Marche, 60126 Ancona, Italy; (S.A.); (A.D.P.)
| | - Alice Di Paolo
- Section of Biochemistry, Department of Clinical Sciences, Biology and Physics, Università Politecnica delle Marche, 60126 Ancona, Italy; (S.A.); (A.D.P.)
| | - Chiara Fiori
- Neurology Clinic, Azienda Ospedaliero Universitaria, Ospedali Riuniti di Ancona, 60126 Torrette di Ancona, Italy; (G.P.); (C.F.); (S.B.); (M.S.); (S.L.)
| | - Sara Baldinelli
- Neurology Clinic, Azienda Ospedaliero Universitaria, Ospedali Riuniti di Ancona, 60126 Torrette di Ancona, Italy; (G.P.); (C.F.); (S.B.); (M.S.); (S.L.)
| | - Mauro Silvestrini
- Neurology Clinic, Azienda Ospedaliero Universitaria, Ospedali Riuniti di Ancona, 60126 Torrette di Ancona, Italy; (G.P.); (C.F.); (S.B.); (M.S.); (S.L.)
| | - Simona Luzzi
- Neurology Clinic, Azienda Ospedaliero Universitaria, Ospedali Riuniti di Ancona, 60126 Torrette di Ancona, Italy; (G.P.); (C.F.); (S.B.); (M.S.); (S.L.)
| |
Collapse
|
171
|
Togha M, Ghorbani Z, Ramazi S, Zavvari F, Karimzadeh F. Evaluation of Serum Levels of Transient Receptor Potential Cation Channel Subfamily V Member 1, Vasoactive Intestinal Polypeptide, and Pituitary Adenylate Cyclase-Activating Polypeptide in Chronic and Episodic Migraine: The Possible Role in Migraine Transformation. Front Neurol 2022; 12:770980. [PMID: 35002925 PMCID: PMC8733698 DOI: 10.3389/fneur.2021.770980] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 11/19/2021] [Indexed: 12/21/2022] Open
Abstract
Objectives: This study aimed to investigate the role of serum levels of transient receptor potential cation channel subfamily V member 1 (TRPV1), vasoacive intestinal peptide (VIP), and pituitary adenylate cyclase-activating polypeptide (PACAP) in the development and also the transformation of migraine in patients suffering from migraine. Methods: Eighty-nine participants with a mean age of 39 years were divided into 23 episodic migraine (EM), 36 chronic migraine (CM), and 30 healthy control groups. Demographic, anthropometric, and headache characteristic information, and also blood samples, was collected. Serum levels of TRPV1, VIP, and PACAP were measured using the enzyme-linked immunosorbent assay (ELISA) technique. Results: Based on our findings, the serum level of TRPV1 was significantly higher in CM compared to the control group (p < 0.05), whereas serum levels of VIP (p < 0.01) and PACAP (p < 0.05) in the EM group were significantly more than the control group. There was no significant difference between EM and CM groups. Conclusions: An elevation in the serum levels of TRVP1 among chronic migraineurs and increments in the levels of VIP and PACAP were observed among EM patients compared to healthy subjects. However, our data failed to demonstrate the probable role of these biomarkers in migraine progression, and more studies are needed to clarify the molecular mechanisms involved in migraine progression.
Collapse
Affiliation(s)
- Mansoureh Togha
- Headache Department, Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zeinab Ghorbani
- Cardiovascular Diseases Research Center, Department of Cardiology, School of Medicine, Heshmat Hospital, Guilan University of Medical Sciences, Rasht, Iran.,Department of Clinical Nutrition, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Samira Ramazi
- Department of Physiology, Medical School, Iran University of Medical Sciences, Tehran, Iran
| | - Fahime Zavvari
- Department of Physiology, Medical School, Iran University of Medical Sciences, Tehran, Iran
| | - Fariba Karimzadeh
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
172
|
Goetz A, McCormick S, Phillips R, Friedman D. CE: Diagnosing and Managing Migraine. Am J Nurs 2022; 122:32-43. [PMID: 34882585 DOI: 10.1097/01.naj.0000805640.82646.ac] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Roughly 90% of the U.S. population will develop a headache within their lifetime, and headache disorders account for more disability-adjusted life-years than all other neurologic disorders combined. Among primary headache disorders, the two most common are tension-type headache and migraine, with migraine identified as the most disabling. Here, the authors describe the importance of differentiating primary and secondary headache disorders and discuss the pathophysiology; clinical assessment; and outpatient management of the debilitating migraine headache, summarizing both acute and prophylactic treatment strategies that can substantially reduce associated disability.
Collapse
Affiliation(s)
- Allene Goetz
- Allene Goetz is a board-certified clinical nurse specialist and Samantha McCormick is a board-certified physician assistant, both in the Headache and Facial Pain program in the Department of Neurology at UT Southwestern Medical Center, Dallas, TX. Rosemary Phillips is a triage nurse in the Department of Neurology and Deborah Friedman is a professor in the Departments of Neurology and Ophthalmology at UT Southwestern Medical Center. Contact author: Deborah Friedman, . The authors acknowledge Karen Lee-Roig for her artwork depicting her personal experience with migraine. Deborah Friedman serves on advisory boards for Allergan/AbbVie, Biohaven Pharmaceuticals, Lundbeck, Impel NeuroPharma, and Eli Lilly, and receives research support from Allergan/AbbVie and Eli Lilly. Lippincott Professional Development has identified and resolved all conflicts of interest concerning this educational activity. The remaining authors have disclosed no potential conflicts of interest, financial or otherwise
| | | | | | | |
Collapse
|
173
|
Hesselbrock RR, Haynes JT. Migraine History and Outcomes in Military Pilots and Flight Surgeons. Aerosp Med Hum Perform 2022; 93:26-31. [PMID: 35063053 DOI: 10.3357/amhp.5980.2022] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND: Migraine is a common disorder with significant aeromedical implications. The variability and unpredictable nature of occurrences hampers accurate assessment of future risk. This uncertainty results in a necessarily conservative approach to aeromedical recommendations, which unfortunately may lead to over-restrictive dispositions. Limited long-term follow up information is available on migraine outcomes in pilots, particularly assessing for impact of potential modifiable aggravating factors.Methods: This retrospective study reviewed 159 U.S. Air Force pilots with migraine who had been granted aeromedical waivers. As a comparison group, 44 U.S. Air Force flight surgeons with migraine who had been granted aeromedical waivers were reviewed.Results: Migraine with aura and isolated migraine aura without headache accounted for the majority of migraine subtypes in both male and female subjects. Self-identified triggering factors were identified by 62% of subjects. The most commonly reported triggers were dietary factors, sleep disturbances, stress, caffeine intake, and hormonal factors. Sleep disturbances, stress, hormonal factors, and ethanol triggers were more frequently noted in female subjects. Self-reported positive response to trigger factor modification was noted in 54% of subjects. Subjects reported an average of only 3 migraine attacks in the previous year. Long-term follow up indicated continued aeromedical waiver in 91% of subjects.Discussion: The majority of subjects had migraine with aura or isolated migraine aura. Significant salutary response to modification of commonly-reported triggering factors was noted. These findings can be incorporated into individualized aeromedically-compatible management strategies to clarify symptom impact on aviation safety, improve symptom control, and increase the possibility of safe return to fly recommendations.Hesselbrock RR, Haynes JT. Migraine history and outcomes in military pilots and flight surgeons. Aerosp Med Hum Perform. 2022; 93(1):26-31.
Collapse
|
174
|
Initial experience with novel CGRP-receptor inhibitor therapy in Migraine in the United Arab Emirates: a retrospective observational study. BMC Neurol 2021; 21:486. [PMID: 34906111 PMCID: PMC8670192 DOI: 10.1186/s12883-021-02507-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/11/2021] [Indexed: 01/03/2023] Open
Abstract
Background Erenumab is a calcitonin gene-related peptide (CGRP)-receptor antibody inhibiting CGRP function. CGRP is prominently involved in the pathophysiology of migraine through nociceptive modulation in the trigeminovascular system. This study aims to explore the treatment effect of erenumab in a real-life setting. Methods In this retrospective observational study, we analyzed the data of 91 patients with migraine receiving at least three consecutive monthly injections of erenumab and followed up for 3–12 months. The primary objective was to describe the reduction in monthly migraine days throughout the follow-up period. To identify patients who responded to treatment, we analyzed the association between different patient characteristics and their treatment outcomes. Results Seventy-three patients (80.2%) responded to erenumab treatment, defined as ≥50% reduction of migraine days per month, across all migraine types. It was noted that ethnicity (p-value = 0.015) and older age (p-value = 0.035) were associated with clinically relevant improvement of symptoms. Middle Eastern ethnicity was related to less improvement of symptoms while Europeans were more likely to benefit from erenumab therapy (odds ratio: 12.788, p = 0.037). Patients aged from 31 to 40 and 41–65 years benefited most from erenumab treatment with a response rate of 77.8 and 89.9%, respectively, also confirmed by logistic regression (p = 0.047). Neither gender nor dose increase of erenumab showed association with the reported clinically relevant improvement of the symptoms. An association between clinically relevant improvement of headaches and the type of migraine was also noted. Around 87.9% of patients with episodic migraine responded to treatment, followed by 84.1% of chronic migraine patients and 50% of medication overuse headache patients. Medication overuse headache showed a lower probability of therapy success with erenumab (odds ratio: 0.126, p = 0.039). An improvement of headaches was eminent in patients who received 140 mg erenumab monthly (2 × 70 mg injections) and patients who had one injection every two weeks. Conclusions Erenumab is a novel preventive treatment for all migraine types. Clinically relevant improvement of headaches and reduction of monthly migraine days were demonstrated in patients that continued the treatment course. In real-life, a substantial number of patients suspended therapy early, reasons for which need further investigation.
Collapse
|
175
|
Hassan M, Belavadi R, Gudigopuram SVR, Raguthu CC, Gajjela H, Kela I, Kakarala CL, Modi S, Sange I. Migraine and Stroke: In Search of Shared Pathways, Mechanisms, and Risk Factors. Cureus 2021; 13:e20202. [PMID: 34900505 PMCID: PMC8647778 DOI: 10.7759/cureus.20202] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2021] [Indexed: 01/01/2023] Open
Abstract
Migraines are one of the emerging causes of disabilities experienced worldwide, and strokes are the second leading cause of death globally. Migraines with aura have been reported to be associated with a higher risk of ischemic strokes, whereas hemorrhagic strokes are more closely associated with migraines without aura, possible mechanisms that link migraines to strokes. These can be categorized into vascular mechanisms such as vasospasm, endothelial and platelet dysfunction, and alteration in the vessel wall seen in migraineurs, further perpetrated by vascular risk factors such as hypertension and hyperlipidemias. Cerebral hypoperfusion that occurs in migraines can cause an electrical aberrance, leading to a phenomenon known as "spreading depression" which can contribute to strokes. In this review, we discuss bloodstream elevation in procoagulants such as antiphospholipid antibodies, homocysteine, von Willebrand factor, and prothrombin. Maintaining pregnant women who actively experience migraines with aura under close observation may be of some value in achieving better outcomes. Women who experience migraines after starting hormonal contraception are at a higher risk of experiencing strokes and stand to benefit from being switched to non-hormonal methods. In this article, we discuss the mechanisms linking migraines and strokes, briefly discuss the pathogenesis, and explore the risk factors contributing to the association therein. In addition, we examine the relationship between migraines and ischemic strokes, as well as hemorrhagic strokes, and review management considerations.
Collapse
Affiliation(s)
- Mohammad Hassan
- Internal Medicine, Mohi-ud-Din Islamic Medical College, Mirpur, PAK
| | - Rishab Belavadi
- Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IND
| | | | | | - Harini Gajjela
- Research, Our Lady of Fatima University College of Medicine, Valenzuela, PHL
| | - Iljena Kela
- Family Medicine, Jagiellonian University Medical College, Krakow, POL
| | - Chandra L Kakarala
- Internal Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, IND
| | - Srimy Modi
- Research, K. J. Somaiya Medical College, Mumbai, IND
| | - Ibrahim Sange
- Research, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Research, K. J. Somaiya Medical College, Mumbai, IND
| |
Collapse
|
176
|
Hammad AB, Elsharkawy RE, Abdel Azim GS. Repetitive transcranial magnetic stimulation as a prophylactic treatment in migraine. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-020-00254-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Clinical applications of transcranial magnetic stimulation (TMS) have shown promising results in the treatment of headache disorders, with migraine being one of the most encountered.
Objective
To assess the role of low-frequency repetitive transcranial magnetic stimulation as a preventive treatment of migraine (with and without aura) and correlate the results with the serum level of the inflammatory biomarker (neurokinin A).
Methods
Forty patients, with age ranging from 15 to 55 years, diagnosed with migraine (30 migraine without aura and 10 with aura) and 20 apparently healthy individuals, who were age and sex matched with the patient group, were included in this study.
A low-frequency (1 Hz) rTMS protocol was applied for all patients for five consecutive days interictally. Assessment of pain intensity using visual analogue scale and frequency and duration of attacks as well as number of pills taken by patients as an abortive treatment according to the Basic Diagnostic Headache Diary for 4 weeks before and 4 weeks after TMS sessions was done. In addition, the Migraine Disability Assessment scale (MIDAS) was applied to assess the severity and degree of disability caused by migraine.
Measurement of neurokinin A serum level was done by using ELISA for all patients before and after TMS and for control group once.
Results
There was a significant reduction in pain intensity, frequency and duration of migraine attacks, migraine disability scores, and number of pills taken as abortive treatment for attacks after rTMS (P < 0.001). Also, serum level of neurokinin A in the patients was significantly reduced after rTMS (P < 0.001).
Conclusion
Low-frequency rTMS is an effective prophylactic treatment for migraine with and without aura.
Collapse
|
177
|
Ornello R, Caponnetto V, Ratti S, D'Aurizio G, Rosignoli C, Pistoia F, Ferrara M, Sacco S, D'Atri A. Which is the best transcranial direct current stimulation protocol for migraine prevention? A systematic review and critical appraisal of randomized controlled trials. J Headache Pain 2021; 22:144. [PMID: 34837963 PMCID: PMC8903540 DOI: 10.1186/s10194-021-01361-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/17/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Transcranial direct current stimulation (tDCS) could counteract the pathophysiological triggers of migraine attacks by modulating cortical excitability. Several pilot randomized controlled trials (RCTs) assessed the efficacy of tDCS for migraine prevention. We reviewed and summarized the state of the art of tDCS protocols for migraine prevention, discussing study results according to the stimulations parameters and patients' populations. MAIN BODY We combined the keywords 'migraine', 'headache', 'transcranial direct current stimulation', and 'tDCS' and searched Pubmed, Scopus, and Web of Science, from the beginning of indexing to June 22, 2021. We only included RCTs comparing the efficacy of active tDCS with sham tDCS to decrease migraine frequency, intensity, and/or acute drug utilization. The risk of bias of each RCT was assessed by using the RoB-2 tool (Cochrane Collaboration). Thirteen RCTs (from 2011 to 2021) were included in the review. The included patients ranged from 13 to 135. RCTs included patients with any migraine (n=3), chronic migraine (n=6), episodic migraine (n=3) or menstrual migraine (n=1). Six RCTs used cathodal and five anodal tDCS, while two RCTs compared the efficacy of both cathodal and anodal tDCS with that of sham. In most of the cathodal stimulation trials, the target areas were the occipital regions, with reference on central or supraorbital areas. In anodal RCTs, the anode was usually placed above the motor cortical areas and the cathode on supraorbital areas. All RCTs adopted repeated sessions (from 5 to 28) at variable intervals, while the follow-up length spanned from 1 day up to 12 months. Efficacy results were variable but overall positive. According to the RoB-2 tool, only four of the 13 RCTs had a low risk of bias, while the others presented some concerns. CONCLUSIONS Both anodal and cathodal tDCS are promising for migraine prevention. However, there is a need for larger and rigorous RCTs and standardized procedures. Additionally, the potential benefits and targeted neurostimulation protocols should be assessed for specific subgroups of patients.
Collapse
Affiliation(s)
- Raffaele Ornello
- Neuroscience Section, Department of Applied Clinical and Biotechnological Sciences, University of L'Aquila, L'Aquila, Italy
| | - Valeria Caponnetto
- Neuroscience Section, Department of Applied Clinical and Biotechnological Sciences, University of L'Aquila, L'Aquila, Italy
| | - Susanna Ratti
- Neuroscience Section, Department of Applied Clinical and Biotechnological Sciences, University of L'Aquila, L'Aquila, Italy
| | - Giulia D'Aurizio
- Neuroscience Section, Department of Applied Clinical and Biotechnological Sciences, University of L'Aquila, L'Aquila, Italy
| | - Chiara Rosignoli
- Neuroscience Section, Department of Applied Clinical and Biotechnological Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesca Pistoia
- Neuroscience Section, Department of Applied Clinical and Biotechnological Sciences, University of L'Aquila, L'Aquila, Italy
| | - Michele Ferrara
- Neuroscience Section, Department of Applied Clinical and Biotechnological Sciences, University of L'Aquila, L'Aquila, Italy
| | - Simona Sacco
- Neuroscience Section, Department of Applied Clinical and Biotechnological Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Aurora D'Atri
- Neuroscience Section, Department of Applied Clinical and Biotechnological Sciences, University of L'Aquila, L'Aquila, Italy
| |
Collapse
|
178
|
Chen Y, Wang S, Wang Y. Role of herbal medicine for prevention and treatment of migraine. Phytother Res 2021; 36:730-760. [PMID: 34818682 DOI: 10.1002/ptr.7339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 10/06/2021] [Accepted: 11/02/2021] [Indexed: 01/18/2023]
Abstract
Migraine is a disabling neurovascular disease with unilateral or bilateral pulsatile headache, which intensively affects human health and quality of life due to high morbidity worldwide. Migraine is commonly accompanied by abnormal pain sensitization, neuroinflammatory response, and vasomotor dysfunction. Owing to the management dilemmas of migraine, there is an urgent need to develop effective and low-cost therapies. In recent years, herbal medicines as a promising strategy with analgesic activity and minor side effect, have been proposed for the prevention and treatment of migraine. Considering the lack of a review integrating experimental studies regarding the herbal treatment of migraine, this review systematically summarizes the important potential applications of herbal medicines in ameliorating migraine via multiple therapeutic targets and pathways, as well as provides a reference for further development of novel antimigraine drugs.
Collapse
Affiliation(s)
- Yulong Chen
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Shengpeng Wang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Yitao Wang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China.,Macau Centre for Research and Development in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| |
Collapse
|
179
|
Malekian N, Bastani PB, Oveisgharan S, Nabaei G, Abdi S. Preventive effect of greater occipital nerve block on patients with episodic migraine: A randomized double-blind placebo-controlled clinical trial. Cephalalgia 2021; 42:481-489. [PMID: 34786992 DOI: 10.1177/03331024211058182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Since the data regarding the efficacy of greater occipital in episodic migraines are rare, we aimed to examine the efficacy of greater occipital block in the prophylaxis of episodic migraines without aura and compare different injectable drug regimens. METHODS In a randomized, double-blind placebo-controlled trial, adult patients suffering from episodic migraines without aura were randomized to one of the following: triamcinolone, lidocaine, triamcinolone plus lidocaine, and saline. Patients were assessed at baseline, one week, two weeks, and four weeks after the injection for severity and duration of headaches and side effects. RESULTS Fifty-five patients completed the study. Repeated measures ANOVA indicated that the severity and duration decreased significantly after the greater occipital block (P < 0.001, P = 0.001 respectively) in all four groups. However, there was no difference between groups at any study time points (P > 0.05). In paired sample T-test, only groups 2 and 3 with lidocaine as a part of the injection showed a significant decrease in frequency compared to the baseline (P = 0.002, P = 0.019). Three patients reported side effects with a possible association with triamcinolone. CONCLUSION Greater occipital block with a local anesthetic significantly decreases the number of attacks in episodic migraine, whereas no injection was superior to the placebo in regards to the duration and severity of the headaches.Trial Registration Information: Iranian Registry of Clinical Trials (IRCT). Registration number: IRCT2017070334879N1. https://www.irct.ir/trial/26537.
Collapse
Affiliation(s)
- Nazila Malekian
- Neurology Department, 48439Tehran University of Medical Sciences, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Pouya B Bastani
- Neurology Department, 48439Tehran University of Medical Sciences, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahram Oveisgharan
- Rush Alzheimer's Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Ghaemeh Nabaei
- Neurology Department, 48439Tehran University of Medical Sciences, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Siamak Abdi
- The Iranian Center of Neurological Research, 48439Tehran University of Medical Sciences, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
180
|
LenglarT L, Caula C, Moulding T, Lyles A, Wohrer D, Titomanlio L. Brain to Belly: Abdominal Variants of Migraine and Functional Abdominal Pain Disorders Associated With Migraine. J Neurogastroenterol Motil 2021; 27:482-494. [PMID: 34642268 PMCID: PMC8521460 DOI: 10.5056/jnm20290] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/22/2021] [Accepted: 04/08/2021] [Indexed: 12/13/2022] Open
Abstract
Migraine is one of the most frequent causes of primary headache and 9% of children suffer from migraines. Most children will continue to experience migraine attacks as adults, therefore it is imperative that we have a thorough understanding of this major health issue. This article considers the so-called abdominal variants of migraine, which are more commonly seen in children rather than adults: abdominal migraine, cyclic vomiting syndrome, and infantile colic. Other functional abdominal pain disorders such as irritable bowel syndrome and functional dyspepsia have also been linked to migraine in clinical studies. The common pathophysiological root of these diseases seems to be the gut-brain axis mechanism. Abdominal variants of migraine are considered pediatric precursors of migraine whereas the functional abdominal pain disorders related to migraine seem to share a pathophysiological root with no temporarily link as for today. In this review we aim to describe the epidemiological background, the current pathophysiological theories and the relationship of each disease to migraine. This review is the first to compile abdominal variants of migraine and functional abdominal pain disorders associated with migraine and we endeavor to elucidate the broad spectrum of migraine-related episodes in children.
Collapse
Affiliation(s)
- Léa LenglarT
- Department of Pediatric Emergency Care, APHP - Hopital Robert Debré, Paris, France
| | - Caroline Caula
- Department of Pediatric Emergency Care, APHP - Hopital Robert Debré, Paris, France
| | - Thomas Moulding
- Department of Specialty and Integrated Medicine, The Leeds Teaching Hospitals, NHS Trust, Leeds, UK
| | - Annabel Lyles
- Department of Oncology, The Leeds Teaching Hospitals, NHS Trust, Leeds, UK
| | - Delphine Wohrer
- Department of Pediatric Emergency Care, APHP - Hopital Robert Debré, Paris, France
| | - Luigi Titomanlio
- Department of Pediatric Emergency Care, APHP - Hopital Robert Debré, Paris, France.,Pediatric Migraine and Neurovascular Diseases Unit, APHP - Hopital Robert Debré, Paris, France.,Paris University, INSERM U1141, DHU Protect, Paris, France
| |
Collapse
|
181
|
A review of migraine genetics: gathering genomic and transcriptomic factors. Hum Genet 2021; 141:1-14. [PMID: 34686893 DOI: 10.1007/s00439-021-02389-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/16/2021] [Indexed: 01/28/2023]
Abstract
Migraine is a common and complex neurologic disorder that affects approximately 15-18% of the general population. Although the cause of migraine is unknown, some genetic studies have focused on unravelling rare and common variants underlying the pathophysiological mechanisms of this disorder. This review covers the advances in the last decade on migraine genetics, throughout the history of genetic methodologies used, including recent application of next-generation sequencing techniques. A thorough review of the literature interweaves the genomic and transcriptomic factors that will allow a better understanding of the mechanisms underlying migraine pathophysiology, concluding with the clinical utility landscape of genetic information and future consideration to creating a new frontier toward advancing the field of personalized medicine.
Collapse
|
182
|
Davies HO, Watkins M, Oliver R, Berhane S, Bradbury AW. Adverse neurological events after sodium tetradecyl sulfate foam sclerotherapy - A prospective, observational study of 8056 treatments. Phlebology 2021; 37:97-104. [PMID: 34657519 DOI: 10.1177/02683555211051490] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Ultrasound guided foam sclerotherapy (UGFS) is a flexible and highly utilised tool in the treatment of varicose veins (VVs), both as a primary treatment and as an adjunct to other treatments. Concern remains regarding the risk of neurological adverse events (AEs) such as migraine, visual disturbance and serious adverse events (SAEs) such as cerebrovascular accident that have been reported after UGFS treatments. AIM To determine the incidence of neurological AEs and SAEs after UGFS. METHODS A prospective, multicentre, post-authorisation safety study across Europe (both private and government) was performed between January 2015-2020. Neurological adverse events after UGFS with Fibrovein® (Sodium Tetradecyl Sulfate) 1 and 3% physician generated foam. RESULTS 8056 patients underwent treatment. There were 46 AE (including 5 SAEs), 30 (65%) SAEs were in female patients. Mean age was 55 years with mean body mass index (BMI) of 27. Univariable logistic regression demonstrate that UGFS only treatment (i.e. no adjunctive treatment), liquid-to-gas ratio, gas type and total foam volume (1% sodium tetradecyl sulfate, STS) were significantly associated with the odds of experiencing the outcome. Multivariable logistic regression model exhibits that migraine and total foam volume (1% STS) maintained statistical significance thus associated with the odds of adverse events. CONCLUSIONS This study demonstrates that UGFS with Fibrovein is safe with a very low incidence of neurological AEs and SAEs. Past history of migraine, use of physiological gas (O2/CO2) and increasing volumes of 1% foam increase the risk of AEs.
Collapse
Affiliation(s)
- Huw Ob Davies
- Department of Vascular Surgery, University Hospital of Wales, Cardiff, UK
| | | | | | - Sarah Berhane
- NIHR Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, UK.,Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Andrew W Bradbury
- Department of Vascular Surgery, University of Birmingham, Solihull Hospital, Birmingham, UK
| |
Collapse
|
183
|
Kobus M, Sitek A, Antoszewski B, Rożniecki J, Pełka J, Żądzińska E. Prenatal oestrogen-testosterone balance as a risk factor of migraine in adults. J Headache Pain 2021; 22:119. [PMID: 34620097 PMCID: PMC8499432 DOI: 10.1186/s10194-021-01326-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/07/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Migraine is a common neurological disease with extremely debilitating, but fully reversible symptoms. Women suffer from migraine more often than men. It was assumed that fluctuation of oestrogen level during menstrual cycle is one of many factors responsible for more frequent migraine attacks. The second-to-fourth digit ratio (2D:4D) is considered as an indicator of prenatal sex steroids. Balance of prenatal androgens (testosterone) and oestrogen has been studied in numerous diseases that are affected by hormones. However, the relationship between migraine and the sex steroids balance in prenatal development is still unexplained. The aim of this paper is to provide an evidence of relationship between prenatal oestrogen and testosterone exposure following 2D:4D digit ratio, and migraine prevalence in adults. METHODS We examined a group of 151 adults (33 males, 118 females) with migraine and a control group of 111 adults (45 males, 66 females). 2D:4D digit ratio of both hands was measured using sliding Vernier calliper. RESULTS Significant differences were found in the right hand. Female migraineurs had lower value of 2D:4D ratio than the control group and the right 2D:4D was lower than left 2D:4D (Δ2D:4D), suggesting prenatal testosterone dominance. The opposite relationship was observed in males. Male migraineurs had higher value of 2D:4D ratio and Δ2D:4D was greater than the control group, suggesting prenatal oestrogen dominance. CONCLUSIONS Our results suggest that depending on sex, different proportion of prenatal sex steroids might be a risk factor of migraine in adults. Women with migraine were presumably exposed in prenatal life to higher testosterone levels relative to oestrogen, while men with migraine were probably exposed in prenatal life to higher levels of oestrogen relative to testosterone.
Collapse
Affiliation(s)
- Magdalena Kobus
- Department of Anthropology, Faculty of Biology and Environmental Protection, University of Lodz, 90-237, Lodz, Poland.
| | - Aneta Sitek
- Department of Anthropology, Faculty of Biology and Environmental Protection, University of Lodz, 90-237, Lodz, Poland
| | - Bogusław Antoszewski
- Department of Plastic, Reconstructive and Aesthetic Surgery, Institute of Surgery, Medical University of Lodz, Lodz, Poland
| | - Jacek Rożniecki
- Department of Neurology, Stroke and Neurorehabilitation, Medical University of Lodz, Lodz, Poland
| | - Jacek Pełka
- Department of Neurology, Norbert Barlicki Memory University Teaching Hospital, Lodz, Poland
| | - Elżbieta Żądzińska
- Department of Anthropology, Faculty of Biology and Environmental Protection, University of Lodz, 90-237, Lodz, Poland
- Biological Anthropology and Comparative Anatomy Research Unit, School of Medicine, The University of Adelaide, Adelaide, South Australia, 5005, Australia
| |
Collapse
|
184
|
ONCU J, BARAN G, MURAT S, ALTINBILEK T, ALPTEKIN HK. Long-term results of therapeutic local anesthesia (neural therapy) in migraine patients: a randomized-controlled-single blind trial. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2021. [DOI: 10.23736/s0393-3660.20.04260-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
185
|
Abstract
BACKGROUND Pain has been qualified under four categories: nociception, perception of pain, suffering, and pain behaviors. Most of the literature on migraine has devoted attention to the first two. The aim of the present cohort study was to investigate patients with migraine enrolled at a tertiary care unit to study suffering and mental pain and identify potential risk factors for migraine. METHODS An observational cross-sectional study was carried out on patients with chronic migraine (CM) and episodic migraine (EM), and healthy subjects (HS). The three groups were matched for age and sex. A comprehensive assessment of migraine disability, pain, psychiatric disorders, psychosomatic syndromes, depressive and anxious symptoms, euthymia, psychosocial variables, mental pain, and pain-proneness (PP) was performed. RESULTS Three hundred subjects were enrolled (100 CM, 100 EM, and 100 HS). Based on the multiple regression analyses, those presenting PP (social impairment: odds ratio [OR] = 3.59, 95% confidence interval [CI] = 1.14-11.29; depressive symptoms: OR = 3.82, 95% CI = 1.74-8.41) were more likely to be CM than HS. Those with higher levels of PP (social impairment: OR = 4.04, 95% CI = 1.60-10.22; depressive symptoms: OR = 2.02, 95% CI = 1.26-3.24) were more likely to be EM than HS. Those presenting higher levels of mental pain were more likely to be CM than EM (OR = 1.45, 95% CI = 1.02-2.07). CONCLUSION Migraine is an unpleasant sensory and emotional experience associated with psychosocial manifestations that might contribute to the level of suffering of the individuals. Mental pain resulted to be the variable that most differentiated patients with CM from EM.
Collapse
|
186
|
Schwedt TJ, Lipton RB, Ailani J, Silberstein SD, Tassorelli C, Guo H, Lu K, Dabruzzo B, Miceli R, Severt L, Finnegan M, Trugman JM. Time course of efficacy of atogepant for the preventive treatment of migraine: Results from the randomized, double-blind ADVANCE trial. Cephalalgia 2021; 42:3-11. [PMID: 34521260 PMCID: PMC8739573 DOI: 10.1177/03331024211042385] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background Atogepant is an oral, small-molecule, calcitonin gene–related peptide receptor antagonist for the preventive treatment of migraine. Methods In the double-blind, phase 3 ADVANCE trial, participants with 4–14 migraine days/month were randomized to atogepant 10 mg, 30 mg, 60 mg, or placebo once daily for 12 weeks. We evaluated the time course of efficacy of atogepant for the preventive treatment of migraine. Analyses included change from baseline in mean monthly migraine days during each of the three 4-week treatment periods, change in weekly migraine days during weeks 1–4, and proportion of participants with a migraine on each day during the first week. Results We analyzed 873 participants (n = 214 atogepant 10 mg, n = 223 atogepant 30 mg, n = 222 atogepant 60 mg, n = 214 placebo). For weeks 1–4, mean change from baseline in mean monthly migraine days ranged from −3.1 to −3.9 across atogepant doses vs −1.6 for placebo (p < 0.0001). For weeks 5–8 and 9–12, reductions in mean monthly migraine days ranged from −3.7 to −4.2 for atogepant vs −2.9 for placebo (p ≤ 0.012) and −4.2 to −4.4 for atogepant vs −3.0 for placebo (p < 0.0002), respectively. Mean change from baseline in weekly migraine days in week 1 ranged from −0.77 to −1.03 for atogepant vs −0.29 with placebo (p < 0.0001). Percentages of participants reporting a migraine on post-dose day 1 ranged from 10.8% to 14.1% for atogepant vs 25.2% with placebo (p ≤ 0.0071). Conclusion Atogepant demonstrated treatment benefits as early as the first full day after treatment initiation, and sustained efficacy across each 4-week interval during the 12-week treatment period. Clinical trial registration: ClinicalTrials.gov identifier: NCT03777059
Collapse
Affiliation(s)
| | | | - Jessica Ailani
- MedStar Georgetown University Hospital, Washington, DC, USA
| | | | - Cristina Tassorelli
- IRCCS Mondino Foundation, Headache Science Center, Pavia, Italy.,Department of Neurology, University of Pavia, Pavia, Italy
| | - Hua Guo
- Neuroscience Development, AbbVie, Madison, NJ, USA
| | - Kaifeng Lu
- Neuroscience Development, AbbVie, Madison, NJ, USA
| | | | - Rosa Miceli
- Neuroscience Development, AbbVie, Madison, NJ, USA
| | | | | | | |
Collapse
|
187
|
Azeem GM, Faheem F, Farooq N, Sohail D, Rehman A, Javed MU. Levetiracetam for the Prophylaxis of Migraine in Adults. Cureus 2021; 13:e16779. [PMID: 34513386 PMCID: PMC8405400 DOI: 10.7759/cureus.16779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2021] [Indexed: 11/05/2022] Open
Abstract
Migraine is the second most common primary headache disorder after tension-type headache and is the leading cause of disability worldwide. Cortical spreading depression involves neuronal excitation and inhibition and is involved in pathophysiology of migraine. Many anti-epileptic drugs act by inhibiting Cortical Spreading Depression and block desensitization. Anti-convulsants are commonly used in Migraine prophylaxis and the ones being more effective than placebo include Sodium Valproate and Topiramate. Levetiracetam has unique mechanism as it targets hyper-excitable neurons by binding to synaptic vesicle protein. This results in inhibition of neurotransmitter release thus decreases hyper-excitability. Levetiracetam has minimal side effect profile (dizziness, somnolence and mood changes) and it can be well tolerated by patients. In this review, a total of seven studies were included (four open-label trials and three randomized-control trials) which evaluated the role of Levetiracetam in the prophylaxis of migraine in adult patients. On review of this evidence, Levetiracetam appears to be effective in treating migraine with and without aura and is considered safe because of its limited side effects. There was a significant reduction in the frequency, severity, and duration of migraine with a high responder rate. Levetiracetam was well tolerated with minimal side effects and no reported interactions. However, larger randomized controlled trials are needed and these studies should be done on special population to see the outcomes. In addition, studies for extended-release formulations should also be done.
Collapse
Affiliation(s)
| | | | | | - Danish Sohail
- Internal Medicine, Jinnah Hospital, Lahore, PAK.,Internal Medicine, Faisalabad Medical University, Faisalabad, PAK
| | | | | |
Collapse
|
188
|
The role of microbiota-gut-brain axis in neuropsychiatric and neurological disorders. Pharmacol Res 2021; 172:105840. [PMID: 34450312 DOI: 10.1016/j.phrs.2021.105840] [Citation(s) in RCA: 233] [Impact Index Per Article: 77.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 08/14/2021] [Accepted: 08/17/2021] [Indexed: 12/12/2022]
Abstract
Emerging evidence indicates that the gut microbiota play a crucial role in the bidirectional communication between the gut and the brain suggesting that the gut microbes may shape neural development, modulate neurotransmission and affect behavior, and thereby contribute to the pathogenesis and/or progression of many neurodevelopmental, neuropsychiatric, and neurological conditions. This review summarizes recent data on the role of microbiota-gut-brain axis in the pathophysiology of neuropsychiatric and neurological disorders including depression, anxiety, schizophrenia, autism spectrum disorders, Parkinson's disease, migraine, and epilepsy. Also, the involvement of microbiota in gut disorders co-existing with neuropsychiatric conditions is highlighted. We discuss data from both in vivo preclinical experiments and clinical reports including: (1) studies in germ-free animals, (2) studies exploring the gut microbiota composition in animal models of diseases or in humans, (3) studies evaluating the effects of probiotic, prebiotic or antibiotic treatment as well as (4) the effects of fecal microbiota transplantation.
Collapse
|
189
|
Neck Active Movements Assessment in Women with Episodic and Chronic Migraine. J Clin Med 2021; 10:jcm10173805. [PMID: 34501252 PMCID: PMC8432227 DOI: 10.3390/jcm10173805] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/17/2021] [Accepted: 08/20/2021] [Indexed: 12/28/2022] Open
Abstract
We aimed to compare movement parameters and muscle activity during active cervical spine movements between women with episodic or chronic migraine and asymptomatic control. We also assessed the correlations between cervical movement measures with neck-related disability and kinesiophobia. Women with episodic (n = 27; EM) or chronic (n = 27; CM) migraine and headache-free controls (n = 27; CG) performed active cervical movements. Cervical range of motion, angular velocity, and percentage of muscular activation were calculated in a blinded fashion. Compared to CG, the EM and CM groups presented a reduced total range of motion (p < 0.05). Reduced mean angular velocity of cervical movement was also observed in both EM and CM compared to CG (p < 0.05). Total cervical range of motion and mean angular velocity showed weak correlations with disability (r = −0.25 and −0.30, respectively; p < 0.05) and weak-to-moderate correlations with kinesiophobia (r = −0.30 and −0.40, respectively; p < 0.05). No significant correlation was observed between headache features and total cervical range of motion or mean angular velocity (p > 0.05). No differences in the percentage of activation of both flexors and extensors cervical muscles during active neck movements were seen (p > 0.05). In conclusion, episodic and chronic migraines were associated with less mobility and less velocity of neck movements, without differences within muscle activity. Neck disability and kinesiophobia are negative and weakly associated with cervical movement.
Collapse
|
190
|
Wang D, Huang X, Wang H, Le S, Du X. Predictors and nomogram models for postoperative headache in patients undergoing heart valve surgery. J Thorac Dis 2021; 13:4236-4249. [PMID: 34422352 PMCID: PMC8339753 DOI: 10.21037/jtd-21-644] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Accepted: 06/04/2021] [Indexed: 12/13/2022]
Abstract
Background Headache is a frequent complication after cardiac surgery. However, studies on the risk factors of postoperative headache (POH) are rare. The purpose of this study was to identify independent risk factors for POH in patients undergoing heart valve surgery (HVS) and to develop and validate risk prediction models. Methods Consecutive patients undergoing open HVS from 2016 to 2019 were enrolled in this study. Patients were randomly assigned to training and validation sets at a 2:1 ratio. Univariate and multivariate analysis were applied to identify independent predictors for POH in the training set. A nomogram predicting POH was developed based on these factors, and was validated in the independent validation set. Results POH developed in 1,061 of the 3,853 patients (27.5%). The overall mortality was 2.9%, and it was significantly higher in patients with POH (4.3% versus 2.4%, P<0.001). In the training set, six independent predictors were identified by multivariate analysis, including female, smoking history, hypertension, headache history, left ventricular ejection fraction, and cardiopulmonary bypass time. The model demonstrated good discrimination in both the training (c-index: 0.811) and validation sets (c-index: 0.814), and calibration was assessed by visual inspection. A second nomogram was also constructed including only preoperative predictors, with good discrimination (c-index: 0.792) and calibration. The decision and clinical impact curves of the models showed good clinical utility. Conclusions We developed and validated two risk prediction models for POH in patients undergoing HVS. The models may have clinical utility in individualized risk assessment and preventive interventions.
Collapse
Affiliation(s)
- Dashuai Wang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaofan Huang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hongfei Wang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Sheng Le
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xinling Du
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
191
|
Chong YJ, Mollan SP, Logeswaran A, Sinclair AB, Wakerley BR. Current Perspective on Retinal Migraine. Vision (Basel) 2021; 5:38. [PMID: 34449754 PMCID: PMC8396291 DOI: 10.3390/vision5030038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/11/2021] [Accepted: 08/18/2021] [Indexed: 12/21/2022] Open
Abstract
Retinal migraine was first formally described in 1882. Various terms such as "ocular migraine" and "ophthalmic migraine" have since been used interchangeably in the literature. The lack of a consistent consensus-based definition has led to controversy and potential confusion for clinicians and patients. Retinal migraine as defined by the International Classification of Headache Disorders (ICHD) has been found to be rare. The latest ICHD defined retinal migraine as 'repeated attacks of monocular visual disturbance, including scintillation, scotoma or blindness, associated with migraine headache', which are fully reversible. Retinal migraine should be considered a diagnosis of exclusion, which requires other causes of transient monocular visual loss to be excluded. The aim of this narrative review is to summarize the literature on retinal migraine, including: epidemiology and risk factors; proposed aetiology; clinical presentation; and management strategies. It is potentially a misnomer as its proposed aetiology is different from our current understanding of the mechanism of migraine.
Collapse
Affiliation(s)
- Yu Jeat Chong
- Birmingham Neuro-Ophthalmology, Ophthalmology Department, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK; (Y.J.C.); (S.P.M.)
| | - Susan P. Mollan
- Birmingham Neuro-Ophthalmology, Ophthalmology Department, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK; (Y.J.C.); (S.P.M.)
| | | | - Alexandra B. Sinclair
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK;
- Metabolic Neurology Group, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| | - Benjamin R. Wakerley
- Department of Neurology, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TH, UK;
- Metabolic Neurology Group, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK
| |
Collapse
|
192
|
Hamamci M, Songur MS, Aslan Bayhan S, Bayhan HA. Is ocular vascularity affected in young migraine patients? A pilot study. J Clin Neurosci 2021; 91:144-151. [PMID: 34373020 DOI: 10.1016/j.jocn.2021.06.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 06/04/2021] [Accepted: 06/27/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aimed to evaluate ocular vascularity in young adult migraine patients with visual aura and without visual aura. MATERIAL AND METHODS The study included 30 patients with migraine with visual aura (MWVA), 30 patients with migraine without visual aura (MWOVA), and 30 healthy control subjects, all between ages ≥18 and <45. Migraine patients were applied Headache Impact Test (HIT) and Migraine Disability Assessment Scale (MIDAS). Retinal nerve fiber layer thickness and ocular vascularity of all participants were evaluated with optical coherence tomography (OCT) and OCT angiography (OCTA). RESULTS The MWVA group had significantly lower superficial and deep foveal vascular density values compared to the control group (p = 0.039, p = 0.028, respectively). The foveal avascular zone was significantly enlarged in the MWVA group compared to the control group (p = 0.033). MWVA patients had significantly lower whole optic disc, optic disc inside, peripapillary, superior hemisphere, inferior hemisphere, superior quadrant, and temporal quadrant vascular density values compared to the control group (p < 0.05 all), while there was no significant difference in the nasal quadrant (p = 0.083). Migraine attack frequency, MIDAS, and HIT were negatively correlated with ocular vascular density values. CONCLUSION The results of our study indicate that young adult patients with MWVA are at risk of decreased ocular vascularity and that this risk may increase with frequency and severity of migraine attacks.
Collapse
Affiliation(s)
- Mehmet Hamamci
- Department of Neurology, Yozgat Bozok University Medical School, Yozgat, Turkey.
| | - Murat Serkan Songur
- Department of Ophthalmology, Yozgat Bozok University Medical School, Yozgat, Turkey
| | - Seray Aslan Bayhan
- Department of Ophthalmology, Yozgat Bozok University Medical School, Yozgat, Turkey
| | - Hasan Ali Bayhan
- Department of Ophthalmology, Yozgat Bozok University Medical School, Yozgat, Turkey
| |
Collapse
|
193
|
Deodato M, Granato A, Borgino C, Galmonte A, Manganotti P. Instrumental assessment of physiotherapy and onabolulinumtoxin-A on cervical and headache parameters in chronic migraine. Neurol Sci 2021; 43:2021-2029. [PMID: 34355296 PMCID: PMC8860953 DOI: 10.1007/s10072-021-05491-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/15/2021] [Indexed: 12/28/2022]
Abstract
Introduction The purpose of the present study is to compare the effect of the physiotherapy to onabolulinumtoxin-A, and their combination, in relation to cervical and headache parameters in patients with chronic migraine. Methods This is an observational cohort study conducted by a headache center and a physiotherapy degree course on 30 patients with chronic migraine. The patients were distributed in three groups of treatments for three months: onabolulinumtoxin-A only, physiotherapy only, and onabolulinumtoxin-A plus physiotherapy. The patients were evaluated, before and after each treatment, using the following: the postural assessment software SAPO for the forward head posture; the CROM goniometer for the cervical range of motion; the Migraine Disability Assessment Score for headache parameters. Results After 3 months of each treatment, the scores obtained for the headache-related disability and the frequency of migraine decreased significantly for all groups, but the pain intensity scores changed significantly only in the onabolulinumtoxin-A (p = 0.01) and in the onabolulinumtoxin-A plus physiotherapy groups (p = 0.007). On the other hand, the forward head posture was reduced significantly in the physiotherapy (p = 0.002) and in the onabolulinumtoxin-A plus physiotherapy groups (p = 0.003). The cervical range of motion increased significantly in certain directions in the physiotherapy group and in the onabolulinumtoxin-A plus physiotherapy groups. Conclusions The physiotherapy improved the cervical parameters. The onabolulinumtoxin-A decreased pain intensity. As a consequence, it can be said that the combined treatment was more useful than a mono-therapy alone. From our results, it can be concluded that onabolulinumtoxin-A plus physiotherapy could be a good option in the management of chronic migraine. Supplementary Information The online version contains supplementary material available at 10.1007/s10072-021-05491-w.
Collapse
Affiliation(s)
- Manuela Deodato
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34100, Trieste, Italy. .,Department of Life Sciences, University of Trieste, 34100, Trieste, Italy. .,Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34128, Trieste, Italy.
| | - Antonio Granato
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34100, Trieste, Italy.,Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34128, Trieste, Italy
| | - Caterina Borgino
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34100, Trieste, Italy
| | - Alessandra Galmonte
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34100, Trieste, Italy
| | - Paolo Manganotti
- Department of Medical, Surgical and Health Sciences, University of Trieste, 34100, Trieste, Italy.,Azienda Sanitaria Universitaria Giuliano Isontina (ASUGI), 34128, Trieste, Italy
| |
Collapse
|
194
|
Chen L, Cai Z. The efficacy of ginger for the treatment of migraine: A meta-analysis of randomized controlled studies. Am J Emerg Med 2021; 46:567-571. [PMID: 33293189 DOI: 10.1016/j.ajem.2020.11.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/04/2020] [Accepted: 11/14/2020] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The efficacy of ginger for migraine remains controversial. We conduct a systematic review and meta-analysis to explore the influence of ginger versus placebo on treatment in migraine patients. METHODS We have searched PubMed, EMbase, Web of science, EBSCO, and Cochrane library databases through September 2020 for randomized controlled trials (RCTs) assessing the effect of ginger versus placebo on treatment efficacy in migraine patients. This meta-analysis is performed using the random-effect model. RESULTS Three RCTs are included in the meta-analysis. Overall, compared with control group in migraine patients, ginger treatment is associated with substantially improved pain free at 2 h (RR = 1.79; 95% CI = 1.04-3.09; P = 0.04) and reduced pain scores at 2 h (MD = -1.27; 95% CI = -1.46 to -1.07; P < 0.00001), but reveals no obvious impact on treatment response (RR = 2.04; 95% CI = 0.35-11.94; P = 0.43) or total adverse events (RR = 0.80; 95% CI = 0.46-1.41; P = 0.44). The incidence of nausea and vomiting is obviously lower in ginger group than that in control group. CONCLUSIONS Ginger is safe and effective in treating migraine patients with pain outcomes assessed at 2 h.
Collapse
Affiliation(s)
- Liyan Chen
- Department of Neurology, Chongqing General Hospital, University of Chinese Academy of Science, Chongqing, PR China; Chongqing key laboratory of Neurodegenerative Disease, Chongqing general hospital, Chongqing, PR China.
| | - Zhiyou Cai
- Department of Neurology, Chongqing General Hospital, University of Chinese Academy of Science, Chongqing, PR China; Chongqing key laboratory of Neurodegenerative Disease, Chongqing general hospital, Chongqing, PR China.
| |
Collapse
|
195
|
Florencio LL, de Oliveira AS, Pinheiro CF, Will-Lemos T, Dach F, Fernández-de-Las-Peñas C, Bevilaqua-Grossi D. Comparison of cervical muscle isometric force between migraine subgroups or migraine-associated neck pain: a controlled study. Sci Rep 2021; 11:15434. [PMID: 34326451 PMCID: PMC8322422 DOI: 10.1038/s41598-021-95078-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 06/28/2021] [Indexed: 12/12/2022] Open
Abstract
This study aimed to verify if migraine frequency or migraine-associated neck pain were associated with a reduction of normalized force and altered electromyographic activity during maximal cervical muscle isometric contractions. Additionally, it aimed to assess the correlation of normalized isometric force with years with migraine, headache frequency, headache intensity, migraine-related disability, and severity of cutaneous allodynia. The sample comprises 71 women with migraine (40/31 episodic/chronic, 42/18 with/without neck pain) and 32 women without headache. Cervical muscle isometric force in flexion, extension, and lateral flexion was assessed synchronized with the acquisition of superficial electromyography from the cervical muscles. Women with episodic migraine presented lower normalized isometric force in extension, flexion, and right and left lateral flexions than controls (P < 0.05). Women with migraine and neck pain exhibited lower cervical extension and right/left lateral-flexions normalized isometric force than controls (P < 0.05). No significant differences were observed in antagonist activity. Normalized isometric force in all directions showed weak to moderate correlations with the severity of self-reported symptoms of cutaneous allodynia (- 0.25 ≥ r ≥ - 0.39). No additional linear correlation with clinical migraine features was observed. In conclusion, cervical muscle weakness may be associated with episodic migraine and neck pain concurrent with migraine attacks without altered antagonist activity. Additionally, it may also be related to the severity of cutaneous allodynia.
Collapse
Affiliation(s)
- Lidiane Lima Florencio
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922, Madri, Spain. .,Department of Health Sciences, Ribeirão Preto Medical School of the University of São Paulo, Ribeirão Preto, 14049-900, Brazil.
| | - Anamaria Siriani de Oliveira
- Department of Health Sciences, Ribeirão Preto Medical School of the University of São Paulo, Ribeirão Preto, 14049-900, Brazil
| | - Carina Ferreira Pinheiro
- Department of Health Sciences, Ribeirão Preto Medical School of the University of São Paulo, Ribeirão Preto, 14049-900, Brazil
| | - Tenysson Will-Lemos
- Department of Health Sciences, Ribeirão Preto Medical School of the University of São Paulo, Ribeirão Preto, 14049-900, Brazil
| | - Fabíola Dach
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School of the University of São Paulo, Ribeirão Preto, 14049-900, Brazil
| | - César Fernández-de-Las-Peñas
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Universidad Rey Juan Carlos, 28922, Madri, Spain
| | - Débora Bevilaqua-Grossi
- Department of Health Sciences, Ribeirão Preto Medical School of the University of São Paulo, Ribeirão Preto, 14049-900, Brazil.
| |
Collapse
|
196
|
Arab A, Khorvash F, Karimi E, Heidari Z, Askari G. The effects of the dietary approaches to stop hypertension (DASH) diet on oxidative stress and clinical indices of migraine patients: a randomized controlled trial. Nutr Neurosci 2021; 25:2259-2268. [PMID: 34269164 DOI: 10.1080/1028415x.2021.1954294] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AIMS The relationship between the Dietary Approaches to Stop Hypertension (DASH) diet and oxidative stress (OS) in patients diagnosed with migraine is unknown and remains to be examined. Hence, we conducted a parallel-group, randomized controlled trial to investigate this issue. METHODS Of the 102 women who met all the inclusion criteria, 51 individuals were randomized to the DASH diet group and 51 to the usual dietary advice group to receive allocated intervention for three months. In order to assess the compliance of participants to the DASH diet, dietary records, and serum vitamin C levels were examined. Parameters of OS status (e.g. nitric oxide (NO), total antioxidant capacity (TAC), total oxidative status (TOS), malondialdehyde (MDA), and oxidative stress index (OSI)) and clinical indices of migraine (e.g. migraine index (MI), headache dairy result (HDR), and migraine headache index score (MHIS)) were assessed at the beginning and the end of the study. RESULTS There was a significant reduction in NO (-5.75 vs. + 4.18, P = 0.025) and TOS (-1.55 vs. + 0.71, P = 0.034), and a marginally significant reduction in OSI (-0.10 vs. + 0.14, P = 0.060) in the DASH group compared with the control. Compliance with the DASH diet resulted in a significant decrease in the score of MI (-31.33 vs. - 15.09), HDR (-5.04 vs. -2.51), and MHIS (-44.21 vs. -26.74). Moreover, no significant change was observed in TAC, MDA, and total thiol content. CONCLUSION This type of dietary approach can be considered as a complementary treatment for migraine patients, also further investigations are needed to replicate our findings.Trial registration: Iranian Registry of Clinical Trials identifier: IRCT20121216011763N38.
Collapse
Affiliation(s)
- Arman Arab
- Department of Community Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fariborz Khorvash
- Isfahan Neurosciences Research Center, Alzahra Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Elham Karimi
- Department of Clinical Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.,Research Development Center, Arash Women's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Heidari
- Department of Biostatistics and Epidemiology, School of Health, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gholamreza Askari
- Department of Community Nutrition, School of Nutrition and Food Science, Food Security Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| |
Collapse
|
197
|
Askari-Zahabi K, Abbasnejad M, Kooshki R, Esmaeili-Mahani S. Orexin one receptors within the basolateral amygdala are involved in the modulation of cognitive deficits associated with a migraine-like state in rats. Neurol Res 2021; 43:1087-1097. [PMID: 34233602 DOI: 10.1080/01616412.2021.1949687] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES This study explored the possible role of orexin one receptors (Orx1R) in the basolateral amygdala (BLA) on the modulation of nitroglycerin (NTG)-induced migraine-like symptoms. In addition, pain-induced subsequent alteration in learning and memory competence was evaluated in the adult male Wistar rats. METHODS The rats were given NTG (5 mg/kg, i.p.) every two days (for nine-day) to induce a migraine-like state. The migraine animals were treated with intra-BLA infusion of an Orx1R antagonist SB 334,867 (10, 20, and 40 nM/rat) or its vehicle DMSO. The NTG-induced migraine symptoms were recorded for 90 min. Spatial and passive avoidance performances were assessed by Morris water maze (MWM) and shuttle box tasks, respectively. RESULTS In comparison with control, NTG produced significant migraine-like symptoms characterized by a decrease in cage climbing and an increase in head-scratching, freezing, and facial grooming behavior. Intra-BLA infusion of SB 334,867 (40 nM/rat) significantly decreased cage climbing and increased facial grooming responses in NTG-treated rats. Moreover, all administrated doses of SB 334,867 increased NTG-evoked head-scratching and freezing behavior. Besides, NTG impaired learning and memory performances in both tests, which were exaggerated by post-injection of SB 334,867 (40 nM/rat). CONCLUSIONS Overall, the data provided an emerging role for the orexin system within BLA in the modulation of cognitive decline comorbid with migraine in rats.
Collapse
Affiliation(s)
- Khadijeh Askari-Zahabi
- Department of Biology, Faculty of Sciences, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Mehdi Abbasnejad
- Department of Biology, Faculty of Sciences, Shahid Bahonar University of Kerman, Kerman, Iran
| | - Razieh Kooshki
- Department of Biology, Faculty of Sciences, Lorestan University, Khorramabad, Iran
| | - Saeed Esmaeili-Mahani
- Department of Biology, Faculty of Sciences, Shahid Bahonar University of Kerman, Kerman, Iran
| |
Collapse
|
198
|
Chaudhary A. Migraine Associated with Menstruation An Overlooked Trigger. JNMA J Nepal Med Assoc 2021; 59:611-613. [PMID: 34508410 PMCID: PMC8369556 DOI: 10.31729/jnma.6332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/14/2021] [Indexed: 11/02/2022] Open
Abstract
Menstrual migraine is a condition in females, where headaches are linked with menstruation and may be debilitating. Hormonal fluctuations could have a key role in migraine etiopathogenesis, as several women experience that their migraine attacks correlate with their menstrual cycle. Estrogen withdrawal appears to have a significant role in migraine associated with menstrual cycles, despite the fact that its pathophysiology is not well known. The treatment method can also vary from that used to treat nonmenstrual migraines. However, with proper identification and management of the condition, it can be bearable. This article highlights some portions of what is known about migraine, its triggers including the experience of a sufferer and aims to provide readers with a better understanding of migraine in women by understanding these aspects of the condition.
Collapse
|
199
|
Qualitative Analysis of Single-Site Headache Surgery: Is It Different From Multiple-Site Surgery? Ann Plast Surg 2021; 87:73-79. [PMID: 34133367 DOI: 10.1097/sap.0000000000002828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Migraine surgery has been shown to be efficacious, but nuanced effects of surgery on pain and individuals' lives remain incompletely understood. Surgery may be performed at a single or multiple "primary" sites. The aims of this study were to investigate patient perceptions following single-site surgery and compare themes in patients undergoing single-site surgery with those from a previously published conceptual framework generated with patients undergoing multisite surgery. METHODS Patients who underwent single-site headache surgery participated in open-ended interviews at least 1 year after surgery. Participants (n = 14) had undergone either occipital, temporal, or nasoseptal site surgery. A multidisciplinary team analyzed transcripts. Recurring themes were identified and compared and contrasted to those observed in patients who underwent multiple-site surgery (n = 15) in a previous study (Plast Reconstr Surg 2019;144(4):956-964). RESULTS Similar recurring themes emerged from the single-site cohort, and the conceptual framework was applicable to all participants. Two new themes emerged from the single-site analysis. First, 5 of 14 participants described being "migraine-free" postoperatively, a finding not observed in the multisite group. Second, several individuals described financial benefits after surgery, via decreased prescription medication requirements, raises at work, and improved productivity. CONCLUSIONS Single-site headache surgery appears to positively impact patients' lives in ways that support and expand upon previously published outcomes. Patients undergoing surgery at a single site may be more likely to experience a "pain-free" state, which may relate to the underlying pathophysiology of chronic headache. The effect of surgery on finances appears to be an outcome of interest to patients, which should be explored further.
Collapse
|
200
|
Altamura C, Cascio Rizzo A, Viticchi G, Maggio P, Costa CM, Brunelli N, Giussani G, Paolucci M, Fiacco F, Di Lazzaro V, Agostoni EC, Silvestrini M, Vernieri F. Shorter visual aura characterizes young and middle-aged stroke patients with migraine with aura. J Neurol 2021; 269:897-906. [PMID: 34169343 DOI: 10.1007/s00415-021-10671-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE To identify the clinical profile and aura characteristics of patients with Migraine with Aura (MwA) having acute cerebral ischemia, we compared stroke phenotype and risk factors in stroke patients with (S+MwA+) or without (S+MwA-) MwA and aura features in MwA patients with (S+MwA+) or without (S-MwA+) stroke. METHODS In this retrospective multicenter case-control study, we reviewed stroke phenotypes and vascular risk factors in S+MwA+ and S+MwA- patients younger than 60 years and risk factors and aura type, duration, onset age, and the frequency in the previous year in S+MwA+ patients and S-MwA+ subjects matched for age and disease history, investigated for patent foramen ovale (PFO). RESULTS 539 stroke (7.7% S+MwA+) and 94 S-MwA + patients were enrolled. S+MwA+ patients were younger (p =.0.004) and more frequently presented PFO [OR 4.89 (95% CI 2.12-11.27)], septal interatrial aneurism [OR 2.69 (95% CI 1.15-6.27)] and cryptogenic ischemic stroke (CIS) [OR 6.80 (95% CI 3.26-14.18)] than S+MwA- subjects. Significant atherosclerosis was not detected in S+MwA+ patients. Compared to S-MwA+, S+MwA+ patients were characterized by visual [OR 3.82 (95% CI 1.36-10.66)] and shorter-lasting (20.0 min IQr 13.1 vs 30.0 min IQr 25.0; p < 0.001) aura, and PFO [OR 1.26 (95% CI 1.03-1.54)]. Regression analysis evidenced that only shorter aura duration associated with stroke (p = 0.001). High-risk PFO was equally represented in S+MwA-, S+MwA+, S-MwA+ groups. CONCLUSIONS Shorter visual aura and CIS characterize MwA patients with stroke. Although more prevalent, PFO can not be considered the main responsible for the increased stroke risk in MwA patients but as a part of a complex multifactorial condition.
Collapse
Affiliation(s)
- Claudia Altamura
- Headache and Neurosonology Unit, Neurology, Università Campus Bio-Medico Di Roma, Campus Bio-Medico University Hospital, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
| | - Angelo Cascio Rizzo
- Neurologia E Stroke Unit ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | | | | | - Carmelina Maria Costa
- Headache and Neurosonology Unit, Neurology, Università Campus Bio-Medico Di Roma, Campus Bio-Medico University Hospital, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Nicoletta Brunelli
- Headache and Neurosonology Unit, Neurology, Università Campus Bio-Medico Di Roma, Campus Bio-Medico University Hospital, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Giuditta Giussani
- Neurologia E Stroke Unit ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Matteo Paolucci
- Headache and Neurosonology Unit, Neurology, Università Campus Bio-Medico Di Roma, Campus Bio-Medico University Hospital, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | | | - Vincenzo Di Lazzaro
- Neurology, Neurophysiology and Neurobiology Unit, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy
| | | | | | - Fabrizio Vernieri
- Headache and Neurosonology Unit, Neurology, Università Campus Bio-Medico Di Roma, Campus Bio-Medico University Hospital, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| |
Collapse
|