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Pavelić AR, Zebenholzer K, Wöber C. Reconceptualizing autonomic function testing in migraine: a systematic review and meta-analysis. J Headache Pain 2024; 25:54. [PMID: 38600467 PMCID: PMC11005222 DOI: 10.1186/s10194-024-01758-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 03/26/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Autonomic nervous system (ANS) testing has aided in our ability to evaluate autonomic dysfunction in migraine patients. We reviewed the literature in multiple databases which investigate ANS function in migraine patients and healthy subjects. METHODS This systematic review and meta-analysis examined the respective deep breathing, Valsalva manoeuvre, orthostatic and isometric challenge results, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and Meta-analyses of Observational Studies in Epidemiology (MOOSE) statements. RESULTS Seven articles met all inclusion criteria. Fixed-effects meta-analysis showed migraine patients (n = 424), collectively, had lower interictal autonomic test results compared with healthy controls (n = 268). In detail, this was true for the standardized mean difference (g) of deep breathing (g= -0.32; 95% confidence interval (CI) -0.48, -0.16), orthostatic challenge (g= -0.28; 95% CI -0.44, -0.13) and isometric challenge (g= -0.55; 95% CI -0.71, -0.39) and for the difference of means (MD) of the Valsalva ratio (MD = -0.17; 95% CI -0.23, -0.10). CONCLUSIONS Interictal ANS dysfunction can be identified in migraine patients when compared to healthy controls. These findings indicate the importance to evaluate ANS function in migraine patients - especially, as migraine-specific prophylactic therapies (such as anti-calcitonin gene-related peptide (CGRP) antibodies) may affect the function of the ANS.
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Affiliation(s)
- Antun R Pavelić
- Department of Neurology, University Hospital Tulln, Alter Ziegelweg 10, Tulln, 3430, Austria
- Karl Landsteiner University of Health Sciences, Dr. Karl-Dorrek-Straße 30, 3500, Krems, Austria
| | - Karin Zebenholzer
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria.
- Medical University of Vienna Comprehensive Center for Clinical Neurosciences & Mental Health, Vienna, 1090, Austria.
| | - Christian Wöber
- Department of Neurology, Medical University of Vienna, Währinger Gürtel 18-20, Vienna, 1090, Austria
- Medical University of Vienna Comprehensive Center for Clinical Neurosciences & Mental Health, Vienna, 1090, Austria
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Mazzacane F, Vaghi G, Cotta Ramusino M, Perini G, Costa A. Arterial hypertension in the chronic evolution of migraine: bystander or risk factor? An overview. J Headache Pain 2024; 25:13. [PMID: 38311745 PMCID: PMC10840219 DOI: 10.1186/s10194-024-01720-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 01/17/2024] [Indexed: 02/06/2024] Open
Abstract
BACKGROUND Several risk factors are associated with the chronic evolution of migraine. Clinical and preclinical studies have provided data about the role of hypertension (HT) as one of the potential modifiable risk factors of chronic migraine (CM). This review is focused on the biological and clinical evidence supporting common mechanisms underlying HT and migraine and the potential role of HT in the transition from episodic to chronic migraine. METHODS We conducted a narrative review from a literature search covering the available evidence from studies investigating: i) the role of HT in the transition to CM in clinical practice; ii) the biological mechanisms potentially underpinning the association between HT and evolution to CM; iii) the role of antihypertensive medications in migraine prophylaxis. RESULTS HT proved to be at the base of multiple mechanisms underlying migraine and migraine chronicization. Endothelial dysfunction, blood-brain barrier alterations, calcitonin gene-related peptide signaling, and renin-angiotensin-aldosterone system dysregulation are involved in the worsening effect of HT on migraine frequency, and the role of HT in the transition to CM is supported by clinical observations. CONCLUSIONS The observed evidence supports HT contribution to CM evolution due to shared pathophysiologic mechanisms. While a bidirectional influence appears to be ascertained, data are still lacking about the one-way role of HT as direct risk factor for CM transition. Further research is needed to confirm a causal role of HT in this process.
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Affiliation(s)
- Federico Mazzacane
- Department of Brain and Behavioral Sciences, University of Pavia, 27100, Pavia, Italy
- Unit of Behavioral Neurology, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Gloria Vaghi
- Department of Brain and Behavioral Sciences, University of Pavia, 27100, Pavia, Italy.
- Headache Science & Neurorehabilitation Center, IRCCS Mondino Foundation, 27100, Pavia, Italy.
| | - Matteo Cotta Ramusino
- Unit of Behavioral Neurology, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Giulia Perini
- Unit of Behavioral Neurology, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
| | - Alfredo Costa
- Department of Brain and Behavioral Sciences, University of Pavia, 27100, Pavia, Italy
- Unit of Behavioral Neurology, IRCCS Mondino Foundation, Via Mondino 2, 27100, Pavia, Italy
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Faubion SS, Smith T, Thielen J, Kling JM, Shufelt CL, Mara K, Enders F, Kapoor E. Association of Migraine and Vasomotor Symptoms. Mayo Clin Proc 2023; 98:701-712. [PMID: 37137642 PMCID: PMC10157023 DOI: 10.1016/j.mayocp.2023.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2022] [Revised: 12/21/2022] [Accepted: 01/03/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To further examine a potential link between migraine and vasomotor symptoms as well as hypertension as a cardiovascular disease risk factor, potentially explaining the association in midlife women. PATIENTS AND METHODS We conducted a cross-sectional analysis from the Data Registry on Experiences of Aging, Menopause, and Sexuality using questionnaire data from women aged 45 to 60 years seen in women's clinics at a tertiary care center from May 15, 2015, through January 31, 2022. A history of migraine was self-reported; menopause symptoms were assessed with the Menopause Rating Scale. Associations between migraine and vasomotor symptoms were evaluated utilizing multivariable logistic regression models adjusting for multiple factors. RESULTS Of 5708 women included in the analysis, 1354 (23.7%) reported a migraine history. The total cohort had a mean age of 52.8 years, most (5184 [90.8%]) were White, and 3348 (58.7%) were postmenopausal. In adjusted analysis, women with migraine were significantly more likely to have severe/very severe hot flashes vs no hot flashes compared with women without migraine (odds ratio, 1.34; 95% CI, 1.08 to 1.66; P=.007). Migraine was associated with a diagnosis of hypertension in adjusted analysis (odds ratio, 1.31; 95% CI, 1.11 to 1.55; P=.002). CONCLUSION This large cross-sectional study confirms an association between migraine and vasomotor symptoms. Migraine also was associated with hypertension, potentially providing a link with cardiovascular disease risk. Given the high prevalence of migraine in women, this association may help identify those at risk for more severe menopause symptoms.
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Affiliation(s)
- Stephanie S Faubion
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL; Mayo Clinic Center for Women's Health, Mayo Clinic, Rochester, MN.
| | - Taryn Smith
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL; Mayo Clinic Center for Women's Health, Mayo Clinic, Rochester, MN
| | - Jacqueline Thielen
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL; Mayo Clinic Center for Women's Health, Mayo Clinic, Rochester, MN
| | - Juliana M Kling
- Mayo Clinic Center for Women's Health, Mayo Clinic, Rochester, MN; Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, AZ
| | - Chrisandra L Shufelt
- Division of General Internal Medicine, Mayo Clinic, Jacksonville, FL; Mayo Clinic Center for Women's Health, Mayo Clinic, Rochester, MN
| | - Kristin Mara
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Felicity Enders
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Ekta Kapoor
- Mayo Clinic Center for Women's Health, Mayo Clinic, Rochester, MN; Division of General Internal Medicine, Mayo Clinic, Rochester, MN; Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN
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Investigation of the correlation between diabetic retinopathy and prevalent and incident migraine in a national cohort study. Sci Rep 2022; 12:12443. [PMID: 35859157 PMCID: PMC9300720 DOI: 10.1038/s41598-022-16793-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 07/15/2022] [Indexed: 11/21/2022] Open
Abstract
Migraine is a disease characterized by cerebral vasodilation. While diabetes has previously been associated with a lower risk of migraine, it is not known if diabetic retinopathy (DR), a retinal peripheral vascular occlusive disease, is a potential biomarker of protection against migraine. Therefore, we aimed to examine diabetic retinopathy as a marker of prevalent and 5-year incident migraine. In a national cohort, we compared patients with diabetes attending DR screening from The Danish National Registry of Diabetic Retinopathy (cases, n = 205,970) to an age- and gender-matched group of patients without diabetes (controls, n = 1,003,170). In the cross-sectional study, a multivariable model demonstrated a lower prevalence of migraine among cases compared with controls (OR 0.83, 95% CI 0.81–0.85), with a lower risk in cases with DR than in those without (OR 0.69, 95% CI 0.65–0.72). In the prospective study, a lower risk of incident migraine was found in a multivariable model in cases (HR 0.76, 95% CI 0.70–0.82), but this did not depend upon the presence of DR. To conclude, in a national study of more than 1.2 million people, patients screened for DR had a lower risk of present migraine, but DR was not a protective marker of incident migraine.
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Öcal S, Öcal R, Suna N. Relationship between Helicobacter pylori infection and white matter lesions in patients with migraine. BMC Neurol 2022; 22:187. [PMID: 35597897 PMCID: PMC9123779 DOI: 10.1186/s12883-022-02715-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 05/16/2022] [Indexed: 11/28/2022] Open
Abstract
Background/aim White matter lesions (WML) are more frequently observed in migraine patients than in the average population. Associations between Helicobacter pylori (H. pylori) infection and different extraintestinal pathologies have been identified. Here, we aimed to investigate the association between H. pylori infection and WML in patients diagnosed with episodic migraine. Materials and methods A retrospective study was conducted with 526 subjects with a diagnosis of episodic migraine. Hyperintensity of WML had been previously evaluated in these patients with brain magnetic resonance imaging (MRI) examinations. Previous endoscopic gastric biopsy histopathological examination of the same patients and reports on H. pylori findings were recorded. The demographic characteristics of the patients, such as age, gender and chronic systemic diseases such as hypertension and diabetes mellitus (DM) were recorded. Statistical evaluation was made. Results Evaluation was made among 526 migraine patients who met the inclusion criteria, comprising 397 (75.5%) females and 129 (24.5%) males with a mean age of 45.57 ± 13.46 years (range, 18–69 years). WML was detected on brain MRI in 178 (33.8%) patients who were also positive for H. pylori (p < 0.05). Subjects who are H. pylori-positive with migraine, WML were observed at a 2.5-fold higher incidence on brain MRI (odds ratio: 2.562, 95% CI 1.784–3.680). WML was found to be more significant in patients with hypertension and migraine than those without (p < 0.001). Older age was also found to be associated with WML (OR = 1.07, 95% CI: 0.01–0.04, p < 0.001). The age (p < 0.001), H. pylori (p < 0.001), hypertension (p < 0.001), and hypertension + DM (p < 0.05), had significant associations in predicting WML according to the multivariate logistic regression analysis. The presence of hypertension had a higher odds ratio value than the other variables. Conclusion It was concluded that H. pylori infection, as a chronic infection, can be considered a risk factor in developing WML in subjects with migraine. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02715-0.
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Affiliation(s)
- Serkan Öcal
- Department of Gastroenterology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey.
| | - Ruhsen Öcal
- Antalya Training and Research Hospital Department of Neurology, Antalya, Turkey
| | - Nuretdin Suna
- Department of Gastroenterology, Faculty of Medicine, Başkent University, Ankara, Turkey
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Levels of Lipid Parameters in Children with Arterial Ischemic Stroke and Headache: Case-Control Study and Meta-Analysis. Brain Sci 2021; 11:brainsci11040417. [PMID: 33810303 PMCID: PMC8065863 DOI: 10.3390/brainsci11040417] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/17/2021] [Accepted: 03/23/2021] [Indexed: 12/26/2022] Open
Abstract
Background: Abnormalities in levels of lipid parameters are one of the main causes of cardiovascular and cerebrovascular disease in adults. There are limited data on the role of disturbances of lipid metabolism in the etiopathogenesis of arterial ischemic stroke (AIS) in children and the results provided are ambiguous. The aim of the study was to compare the levels of lipid parameters (total cholesterol [TC], triglycerides [TG], high-density lipoprotein [HDL] and low-density lipoprotein [LDL]) between children with AIS, children with headache and healthy children. In addition, we performed meta-analysis of available data on lipid parameters in young patients with AIS. Methods: We retrospectively analyzed 218 children hospitalized between 2002 and 2018 in the Upper-Silesian Child’s Health Center (n = 82 children with AIS, n = 45 children with headache, n = 91 healthy children) with available data on lipid levels, i.e., TC, TG, and HDL. The levels of LDL, non-HDL cholesterol, and a very-low density lipoprotein (VLDL) were calculated. The ratios of TC/HDL, TG/HDL and LDL/HDL were also assessed. Data between cases and controls were analyzed using STATISTICA 13.0 whereas meta-analysis was performed with RevMan version 5.4 software. Results: Children with headache were significantly older than children with AIS (p = 0.001). Ten percent of children with AIS had posterior stroke. The mean TC level was significantly higher in the AIS children than in controls or in children with headache. Mean TG and VLDL levels were significantly different between all groups (p < 0.001 each). The hypertriglyceridemia was more prevalent in AIS children than in children with headache (39% vs. 13%, OR = 4.16 95% CI 1.58–10.94, p = 0.004). Similarly, the frequency of dyslipidemia was higher in children with AIS compared to children with headache (38% vs. 22%, OR = 2.13 95% CI 0.93–4.89, p = 0.078). The meta-analysis was conducted based on data from 4 studies (3 studies published previously plus the results we obtained in the present case-control analysis) with total number of 236 young patients with AIS and 272 healthy controls. Significant Standard Mean Difference (SMD) was found in triglycerides level between young patients with AIS and controls (0.78 95%CI 0.30–1.26 p = 0.002). Conclusions: Lipid abnormalities, especially levels of triglycerides, seem to be of particular importance in children with AIS, as confirmed in meta-analysis. The results of the present study may be a significant contribution to the further research on the role of lipid metabolism disorders in the development of childhood stroke.
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Miri A, Nasiri M, Zonoori S, Yarahmad F, Dabbagh-Moghadam A, Askari G, Sadeghi O, Asadi M. The association between obesity and migraine in a population of Iranian adults: a case-control study. Diabetes Metab Syndr 2018; 12:733-736. [PMID: 29706311 DOI: 10.1016/j.dsx.2018.04.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 04/09/2018] [Indexed: 12/21/2022]
Abstract
AIM To assess the association between obesity and risk of migraine with aura and features of migraine attacks among a population of Iranian adults. METHODS In this case-control study, 102 confirmed cases of migraine with aura were matched based on age and gender with 102 healthy subjects. Data on demographic characteristics and anthropometric measurements were collected from all cases and controls by the same methods. Overweight and obesity were considered as body mass index ≥25-30 kg/m2 and ≥ 30 kg/m2, respectively. Features of migraine attacks including frequency, duration and headache daily result were determined for patients based on international headache society criteria. RESULTS Mean age of subjects was 34.5 ± 7.4 years and 77.9% of them were female. Compared with subjects with normal body mass index, those with obesity had greater odds for having migraine with aura (OR: 3.06, 95% CI: 1.11-8.43). Such finding was also seen even after adjusting for confounding variables; in a way that subjects with obesity were 2.92 times more likely for having migraine with aura compared with those with normal weight (OR: 2.92, 95% CI: 1.03-8.33). Among migraine with aura patients, we found that those with obesity had higher headache daily result compared with subjects with normal weight. However, obesity was not associated with frequency and duration of migraine attacks. CONCLUSIONS We found that obesity was positively associated with risk of migraine with aura. In addition, subjects with obesity had higher headache daily result compared with those with normal weight.
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Affiliation(s)
- Ali Miri
- Department of Nutrition, School of Health, Zabol University of Medical Sciences, Zabol, Iran
| | - Morteza Nasiri
- Department of Operation Room Technology, School of Paramedicine, Qom University of Medical Sciences, Qom, Iran
| | - Sahar Zonoori
- Department of Nursing, Brojerd School of Nursing, Lorestan University of Medical Sciences, Lorestan, Iran
| | - Fatemeh Yarahmad
- Department of Nursing, Brojerd School of Nursing, Lorestan University of Medical Sciences, Lorestan, Iran
| | - Arasb Dabbagh-Moghadam
- Department of Health, School of Health, AJA University of Medical Sciences, Tehran, Iran
| | - Gholamreza Askari
- Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omid Sadeghi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
| | - Masoumeh Asadi
- Department of Nursing and Midwifery, Abadan School of Medical Sciences, Abadan, Iran
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Abedin-Do A, Pouriamanesh S, Kamaliyan Z, Mirfakhraie R. Angiotensin-converting enzyme gene rs4343 polymorphism increases susceptibility to migraine. CNS Neurosci Ther 2017. [PMID: 28626926 DOI: 10.1111/cns.12712] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Atieh Abedin-Do
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Pouriamanesh
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zeeba Kamaliyan
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Mirfakhraie
- Department of Medical Genetics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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