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Olofsson IA. Migraine heritability and beyond: A scoping review of twin studies. Headache 2024. [PMID: 39023388 DOI: 10.1111/head.14789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVE This scoping review aimed to summarize current knowledge from twin studies on migraine. Migraine heritability, genetic correlations with migraine comorbid disorders, and the use of discordant twin pairs in migraine research are described. Further, the review considers the unused potential of twin studies in migraine research and reflects on future directions. BACKGROUND Twin studies can be used to understand how heritable and environmental factors influence human traits and disorders. The classical twin design compares the resemblance of a trait in monozygotic twins to that in dizygotic twins. The classical twin design can be extended to estimate the genetic correlation between disorders, model causality, and describe differences within discordant twin pairs. METHODS Studies focusing on migraine and using a twin study design were included. The search was performed on the PubMed-MEDLINE database using the search terms "migraine" AND "twin" OR "twins." It was done in May 2023, rerun in November 2023, and managed with the Covidence software. RESULTS The search identified 52 twin studies on migraine. In 24 papers, the heritability of migraine was estimated with a classical twin design. Heritability estimates ranged from 0.36 to 0.48 for studies with adults, both men and women, and unspecified migraine. Migraine heritability was predominantly estimated with twin cohorts of North European ancestry, and only two studies examined migraine subtypes. A multilevel classical twin design was used in 11 studies to examine the co-occurrence between migraine and comorbid disorders. The differences within migraine discordant twin pairs were examined in nine studies. CONCLUSION The heritability of migraine was estimated with a classical twin design in twin cohorts from seven different countries, with remarkably similar results across studies. Future studies should include migraine subtypes and twin cohorts of non-North European ancestry to better reflect the global population. Beyond heritability estimations, the twin method is a valuable tool for understanding causality and describing differences within discordant twin pairs. Despite more than 80 years of twin studies in migraine research, the twin design has a large unused potential to advance our understanding of migraine.
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Affiliation(s)
- Isa Amalie Olofsson
- Danish Headache Center, Neurological Department, Copenhagen University Hospital, Glostrup, Denmark
- Department of Cellular and Molecular Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Diao T, Zhu J, Yu L, Ma X. Correlation Analysis of Vestibular Symptoms and Migraine and Non-migraine Headaches: An Epidemiological Survey of 708 Female Nurses. Front Neurosci 2022; 16:925095. [PMID: 35844215 PMCID: PMC9280348 DOI: 10.3389/fnins.2022.925095] [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: 04/21/2022] [Accepted: 06/06/2022] [Indexed: 11/13/2022] Open
Abstract
Objective This study is oriented to study the correlation between different vestibular symptoms and migraine and non-migraine headaches. Materials and Methods A questionnaire containing factors related to vestibular symptoms and migraine was designed to survey nurses in a tertiary hospital. Then, all study subjects were divided into three groups: no headache, migraine, and non-migraine headache, and the general physical condition and incidence of different vestibular symptoms were compared among the three groups. Results Among all the 708 subjects, 233 had headaches. The incidence of migraine was 13.3%. There were 235 cases had vestibular symptoms. Dizziness and vertigo are independent factors related to headaches, especially migraine. The risk of migraine and other types of headaches in the vertigo group is 2.808 and 2.526 times of those without vertigo, while in the dizziness group, the risk is 8.248 and 5.732 times of those without dizziness. Conclusion Different vestibular symptoms were all related to migraine. And different vestibular symptoms and non-migraine headaches also showed a clear correlation.
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Häppölä P, Gormley P, Nuottamo ME, Artto V, Sumelahti ML, Nissilä M, Keski-Säntti P, Ilmavirta M, Kaunisto MA, Hämäläinen EI, Ripatti S, Pirinen M, Wessman M, Palotie A, Kallela M. Polygenic risk provides biological validity for the ICHD-3 criteria among Finnish migraine families. Cephalalgia 2021; 42:345-356. [PMID: 34648375 PMCID: PMC8988286 DOI: 10.1177/03331024211045651] [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] [Indexed: 12/15/2022]
Abstract
Background Migraine is diagnosed using the extensively field-tested International Classification of Headache Disorders (ICHD-3) consensus criteria derived by the International Headache Society. To evaluate the criteria in respect to a measurable biomarker, we studied the relationship between the main ICHD-3 criteria and the polygenic risk score, a measure of common variant burden in migraine. Methods We used linear mixed models to study the correlation of ICHD-3 diagnostic criteria, underlying symptoms, and main diagnoses with the polygenic risk score of migraine in a cohort of 8602 individuals from the Finnish Migraine Genome Project. Results Main diagnostic categories and all underlying diagnostic criteria formed a consistent continuum along the increasing polygenic burden. Polygenic risk was associated with the heterogeneous clinical picture starting from the non-migraine headache (mean 0.07; 95% CI 0.02–0.12; p = 0.008 compared to the non-headache group), to probable migraine (mean 0.13; 95% CI 0.08–0.18; p < 0.001), migraine headache (mean 0.17; 95% CI 0.14–0.21; p < 0.001) and migraine with typical visual aura (mean 0.29; 95% CI 0.26–0.33; p < 0.001), all the way to the hemiplegic aura (mean 0.37; 95% CI 0.31–0.43; p < 0.001). All individual ICHD-3 symptoms and the total number of reported symptoms, a surrogate of migraine complexity, demonstrated a clear inclination with an increasing polygenic risk. Conclusions The complex migraine phenotype progressively follows the polygenic burden from individuals with no headache to non-migrainous headache and up to patients with attacks manifesting all the features of the ICHD-3 headache and aura. Results provide further biological support for the ICHD-3 diagnostic criteria.
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Affiliation(s)
- Paavo Häppölä
- Institute for Molecular Medicine Finland FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
| | - Padhraig Gormley
- GlaxoSmithKline, Cambridge, MA, USA.,Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, and Harvard Medical School, Boston, MA, USA.,Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.,The Stanley Center for Psychiatric Research, The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Marjo E Nuottamo
- Institute for Molecular Medicine Finland FIMM, HiLIFE, University of Helsinki, Helsinki, Finland.,Folkhälsan Research Center, Helsinki, Finland
| | - Ville Artto
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Finland
| | | | | | | | - Matti Ilmavirta
- Department of Neurology, Central Hospital Central Finland, Jyväskylä, Finland
| | - Mari A Kaunisto
- Institute for Molecular Medicine Finland FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
| | - Eija I Hämäläinen
- Institute for Molecular Medicine Finland FIMM, HiLIFE, University of Helsinki, Helsinki, Finland
| | - Samuli Ripatti
- Institute for Molecular Medicine Finland FIMM, HiLIFE, University of Helsinki, Helsinki, Finland.,Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Department of Public Health, Clinicum, University of Helsinki, Helsinki, Finland
| | - Matti Pirinen
- Institute for Molecular Medicine Finland FIMM, HiLIFE, University of Helsinki, Helsinki, Finland.,Department of Public Health, Clinicum, University of Helsinki, Helsinki, Finland.,Department of Mathematics and Statistics, University of Helsinki, Helsinki, Finland
| | - Maija Wessman
- Institute for Molecular Medicine Finland FIMM, HiLIFE, University of Helsinki, Helsinki, Finland.,Folkhälsan Research Center, Helsinki, Finland
| | - Aarno Palotie
- Institute for Molecular Medicine Finland FIMM, HiLIFE, University of Helsinki, Helsinki, Finland.,Department of Neurology, Massachusetts General Hospital, Boston, MA, USA.,Program in Medical and Population Genetics, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.,The Stanley Center for Psychiatric Research, The Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Analytic and Translational Genetics Unit, Department of Medicine, and Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Mikko Kallela
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Finland
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Abstract
Globally, headache disorders are an important cause of disability in adults. As many types of headache (eg, migraine, tension-type and medication-overuse) are more common in women and have peak incidence in reproductive years, chronic headache disorders are highly prevalent in pregnant women. Some women with a history of migraine may find that it improves during pregnancy while others may find that their migraines become more unpredictable. Ideally, women with migraine and problematic headache disorder should be offered preconception counselling to address pregnancy-related concerns and advice on the use of medicines, which should be supported by high-quality information. For women with history of headache, the use of effective non-pharmacological options should be maximised, and the smallest number of the safest medicines at the lowest effective doses should be used while preparing for pregnancy and during pregnancy. This article forms part of the series of prescribing for pregnancy and discusses the impact of headache and migraine on pregnancy, the impact of pregnancy on headache and migraine and options for prophylaxis and treatment.
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Affiliation(s)
- Caroline Ovadia
- Department of Women and Children's Health, King's College London, London, UK
- Obstetrics and Gynaecology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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The Diagnosis and Management of Posttraumatic Headache with Associated Painful Cranial Neuralgias: a Review and Case Series. Curr Pain Headache Rep 2021; 25:54. [PMID: 34160700 DOI: 10.1007/s11916-021-00969-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cranial neuralgias are common in the setting of posttraumatic headache. They may exacerbate underlying primary headache disorders and therefore may be overlooked in clinical practice. Frequently, cranial neuralgias generate neuropathic symptoms such as lancinating pain and sensory dysesthesias. Cranial neuralgias are identified based on a clinical history of focal neuropathic pain and physical exam findings including tenderness with palpation and percussion, at times eliciting radiating pain or paresthesias in the corresponding sensory nerve distribution. PURPOSE OF REVIEW This article is a brief review of the literature and a retrospective report of 2 cases of posttraumatic headache with associated painful cranial neuralgias. RECENT FINDINGS Two patients presented with headaches that met criteria for posttraumatic headache, but their history and physical examination suggested the presence of a focal painful cranial neuralgia. One patient was diagnosed with auriculotemporal neuralgia, which was exquisitely responsive to an auriculotemporal nerve block. The second patient was diagnosed with supratrochlear neuralgia, which was effectively treated with a supratrochlear nerve block. In both cases, adequate treatment of the painful cranial neuralgia resulted in significant improvement of the baseline PTH. Painful cranial neuralgias frequently occur within the clinical spectrum of posttraumatic headache, but are often undiagnosed. Treatment options for painful cranial neuralgias are often different than those traditionally employed for posttraumatic headache without cranial neuralgias, which can include peripheral nerve blockade, neuropathic medications, and in refractory cases, peripheral nerve decompression surgery.
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Bhoi SK, Jha M, Chowdhury D. Advances in the Understanding of Pathophysiology of TTH and its Management. Neurol India 2021; 69:S116-S123. [PMID: 34003157 DOI: 10.4103/0028-3886.315986] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background Tension-type headache (TTH) is the most common form of primary headache. Objective The aim of this study was to document and summarize the advances in the understanding of TTH in terms of pathogenesis and management. Material and Methods We reviewed the available literature on the pathogenesis and management of TTH by searches of PubMed between 1969 and October 2020, and references from relevant articles. The search terms "tension-type headache", "episodic tension-type headache", chronic tension-type headache, "pathophysiology", and "treatment" were used. Results TTH occurs in two forms: episodic TTH (ETTH) and chronic TTH (CTTH). Unlike chronic migraine, CTTH has been less thoroughly studied and is a more difficult headache to treat. Frequent ETTH and CTTH are associated with significant disability. The pathogenesis of TTH is multifactorial and varies between the subtypes. Peripheral mechanism (myofascial nociception) and environmental factors are possibly more important in ETTH, whereas genetic and central factors (sensitization and inadequate endogenous pain control) may play a significant role in the chronic variety. The treatment of TTH consists of pharmacologic and non-pharmacologic approaches. Simple analgesics like NSAIDs are the mainstays for acute management of ETTH. CTTH requires a multimodal approach. Preventive drugs like amitriptyline or mirtazapine and non-pharmacologic measures like relaxation and stress management techniques and physical therapies are often combined. Despite these measures, the outcome remains unsatisfactory in many patients. Conclusion There is clearly an urgent need to understand the pathophysiology and improve the management of TTH patients, especially the chronic form.
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Affiliation(s)
- Sanjeev Kumar Bhoi
- Associate Professsor, Department of Neurology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Menka Jha
- Associate Professsor, Department of Neurology, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Debashish Chowdhury
- Director Professor and Head, Department of Neurology, G. B. Pant Hospital, New Delhi, India
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Koning M, Vink J, Visscher TLS, Larsen J. Maternal stress and depressive symptoms and adolescents' body mass index: a prospective study. BMC Public Health 2021; 21:675. [PMID: 33827481 PMCID: PMC8028230 DOI: 10.1186/s12889-021-10721-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 03/28/2021] [Indexed: 11/28/2022] Open
Abstract
Background Growing evidence suggests that maternal mental health issues are associated with (young) children’s weight outcomes. However, most studies have been limited by cross-sectional designs and have been aimed at (younger) children. The current prospective study focuses on the link between maternal mental health (i.e., psychological stress and depressive symptoms) and adolescents’ zBMI development. Methods The participants in the present study were part of wave 1 and 2 of a longitudinal study on Dutch adolescents’ and their parents’ health behavior. Adolescents (aged 10–14) and their parents were recruited through six secondary schools in the South and the East of the Netherlands. For this study, we only included biological mothers and their adolescent children who participated in both waves, with data on the main measures in both waves, leaving a final sample of 336 biological mother-child dyads. Adolescents height and weight were measured, and both parents and adolescents filled in validated questionnaires on perceived stress and depressive symptoms and answered additional questions concerning domain-specific stress. Regression analyses were performed in R to examine longitudinal links between maternal stress and depressive symptoms at baseline (T1) and adolescents’ BMI standard deviation scores (zBMI) 6 months later (T2), corrected for baseline zBMI and covariates. Results Maternal general perceived stress (β = .20, p = .002) at T1 preceded higher adolescents’ zBMI at T2, after controlling for baseline zBMI and other covariates, whereas maternal depressive symptoms at T1 (β = −.05, p = .44) and other domain-specific stress did not (maternal financial stress, maternal stress at work, maternal stress at home). Additionally, lower educational level among adolescents (β = .16, p = .001) and adolescent depressive symptoms (β = .16, p = .001) was associated with a higher zBMI at T2. Conclusions Results suggest that maternal general stress, but not depressive symptoms, may influence adolescents’ weight development. Our findings warrant future investigation on whether and how general stress among mothers may predict weight increases of their adolescent offspring.
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Affiliation(s)
- Maaike Koning
- Developmental Psychology, Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500, HE, Nijmegen, The Netherlands. .,Department of Healthy Society, Knowledge Centre for Health and Social work, Windesheim University of Applied Sciences, Zwolle, The Netherlands.
| | - Jacqueline Vink
- Developmental Psychology, Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500, HE, Nijmegen, The Netherlands
| | | | - Junilla Larsen
- Developmental Psychology, Behavioural Science Institute, Radboud University, P.O. Box 9104, 6500, HE, Nijmegen, The Netherlands
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Ropponen A, Wang M, Narusyte J, Kärkkäinen S, Blom V, Svedberg P. The predictive role of sickness absence spell durations in associations with inpatient- and specialized outpatient care among a population-based Swedish twin sample. BMC Health Serv Res 2021; 21:315. [PMID: 33827571 PMCID: PMC8028110 DOI: 10.1186/s12913-021-06310-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 03/22/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The associations between a sickness absence spell duration and patient care have been rarely studied. An assumption is that associations would differ by spell duration and by the patient care type, inpatient- or specialized outpatient, due to severity of diseases and/or conditions. We aimed to investigate sickness absence spells in various spell durations as a predictor for subsequent inpatient- and specialized outpatient care separately, and to study if familial confounding plays a role in these associations. METHODS We followed a population-based sample of Swedish twins born 1925-90 with national registers from 2001 for first incident sickness absence spell (days to calculate spell duration categorized into ≤30 days, 31-90 days, 91-180 days and ≥ 181 days), or no sickness absence, and for inpatient- and specialized outpatient care until 2013 (n = 24,975). Cox proportional hazards models were applied for hazard ratios (HR) with 95% confidence intervals (CI) while accounting for covariates and familial confounding. RESULTS First incident sickness absence spell across all duration categories was associated with an increased risk of inpatient- (age- and sex adjusted HR 1.28 to 6.05) or specialized outpatient care (HR 1.17-2.50), both in comparison to those without any sickness absence or the shortest sickness absence spell category (1-30 days). The associations remained statistically significant while controlling for covariates or familial confounding. CONCLUSIONS First incident sickness absence spell increases the risk of inpatient care or specialized outpatient care regardless of the duration of the sickness absence spell. Hence, incident sickness absence spells should be noted and targeted to actions at workplaces as well as in primary and occupational health care.
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Affiliation(s)
- Annina Ropponen
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden.
- Finnish Institute of Occupational Health, Helsinki, Finland.
| | - Mo Wang
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Jurgita Narusyte
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden
- Center of Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - Sanna Kärkkäinen
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Victoria Blom
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden
- The Swedish School of Sport and Health Sciences, Stockholm, Sweden
| | - Pia Svedberg
- Department of Clinical Neuroscience, Division of Insurance Medicine, Karolinska Institutet, SE-171 77, Stockholm, Sweden
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Familial and Genetic Influences on the Common Pediatric Primary Pain Disorders: A Twin Family Study. CHILDREN-BASEL 2021; 8:children8020089. [PMID: 33525537 PMCID: PMC7911833 DOI: 10.3390/children8020089] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/12/2021] [Accepted: 01/19/2021] [Indexed: 11/17/2022]
Abstract
The primary pain disorders of childhood are highly prevalent but have infrequently been studied collectively. Genetic influences have been suggested to be causally implicated. Surveys were sent to 3909 Australian twin families, assessing the lifetime prevalence of growing pains, migraine, headache, recurrent abdominal pain, low back pain, and persistent pain (not otherwise specified) in pediatric twins and their immediate family members. Comparisons between monozygous (MZ) and dizygous (DZ) twin pair correlations, concordances and odds ratios were performed to assess the contribution of additive genetic influences. Random-effects logistic regression modelling was used to evaluate relationships between twin individuals and their co-twins, mothers, fathers and oldest siblings with the subject conditions. Twin analyses of responses from 1016 families revealed significant influence of additive genetic effects on the presence of growing pains, migraine, and recurrent abdominal pain. The analyses for headache, low back pain, and persistent pain overall did not conclusively demonstrate that genetic influences were implicated more than shared environmental factors. Regression analyses demonstrated varying levels of significance in relationships between family members and twin individuals for the tested conditions, with strongest support for genetic influences in growing pains and migraine. These data, together with previously published association analyses, suggest common causal influences including genes.
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Moavero R, Papetti L, Bernucci MC, Cenci C, Ferilli MAN, Sforza G, Vigevano F, Valeriani M. Cyclic vomiting syndrome and benign paroxysmal torticollis are associated with a high risk of developing primary headache: A longitudinal study. Cephalalgia 2019; 39:1236-1240. [PMID: 30982347 DOI: 10.1177/0333102419844542] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM Episodic syndromes that may be associated with migraine are a group of disorders affecting patients with migraine or with an increased risk of presenting it, and likely represent an early life expression of migraine. Cyclic vomiting syndrome and benign paroxysmal torticollis are well characterized and represent a frequent cause of request for specialist consultations. The aim of this study is to longitudinally assess the rate of headache in patients presenting with cyclic vomiting syndrome and benign paroxysmal torticollis during infancy, and to define the main clinical features of the disorder. METHODS We administered a questionnaire to the parents of all our pediatric patients with previous diagnosis of cyclic vomiting syndrome and/or benign paroxysmal torticollis according to ICHD-3; questions were focused on the main clinical features of the disorder as well as the prognosis, with particular emphasis on the development of headache. RESULTS For the final analysis we considered 82 patients with cyclic vomiting syndrome and 33 with benign paroxysmal torticollis. Seventy-nine percent of patients with cyclic vomiting syndrome presented with headache during the follow-up, with a mean age at onset of 6 years; 67% of patients with benign paroxysmal torticollis suffered from headache during the follow-up, with a mean age at onset of 5 years. DISCUSSION Cyclic vomiting syndrome and benign paroxysmal torticollis are associated with a very high risk of developing headache, mostly migraine, later in life. In both groups of patients, the vast majority presented with different episodic syndromes that may be associated with migraine at different ages, thus suggesting an age-dependent evolution of migraine-like symptoms before the onset of clear migrainous headache.
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Affiliation(s)
- Romina Moavero
- 1 Headache Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,2 Child Neurology and Psychiatry Unit, Tor Vergata University of Rome, Italy
| | - Laura Papetti
- 1 Headache Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Caterina Cenci
- 1 Headache Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | | | - Giorgia Sforza
- 2 Child Neurology and Psychiatry Unit, Tor Vergata University of Rome, Italy
| | - Federico Vigevano
- 1 Headache Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Massimiliano Valeriani
- 1 Headache Center, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.,3 Center for Sensory Motor Interaction Aalborg University, Aalborg, Denmark
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Abstract
Primary headaches are one of the most prevalent neurological disorders and can occur during a wide range of lifespan. Primary headaches, especially migraine, are cyclic disorders with a complex sequence of symptoms within every headache attack. There is no systematic review of whether these symptoms changes during lifespan. Indeed, the clinical presentation of migraine shows an age-dependent change with a significantly shorter duration of the attacks and occurrence of different paroxysmal symptoms, such as vomiting, abdominal pain or vertigo, in childhood and, in contrast, largely an absence of autonomic signs and a more often bilateral headache in the elderly. The age-dependent differences in the clinical presentation are less distinct in cluster headache and, especially, in tension-type headache. The differences in the clinical presentation are in agreement with the idea that the connectivity of hypothalamic areas with different brainstem areas, especially the central parasympathetic areas, is important for the clinical manifestation of migraine, as well as, the change during lifespan.
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Affiliation(s)
- Andreas Straube
- Department of Neurology, University Hospital LMU, Ludwig-Maximilians-University, 81377, Munich, Germany.
| | - Anna Andreou
- Headache Research, Wolfson CARD, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,The Headache Centre, Guy's and St Thomas' NHS Foundation Trust, London, UK
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