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Walha Y, Sonda Moalla K, Rekik M, Kammoun S, Ayedi O, Mhiri C, Dammak M, Trigui A. Evaluation of retinal perfusion density and foveal avascular zone in migraine subjects with and without aura. J Clin Neurosci 2024; 126:348-352. [PMID: 39032387 DOI: 10.1016/j.jocn.2024.07.010] [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: 02/08/2024] [Revised: 06/28/2024] [Accepted: 07/15/2024] [Indexed: 07/23/2024]
Abstract
Migraine, classified as a neurovascular disease, has been identified as a potential risk factor for ocular vascular complications. Our study aimed to compare retinal vessel density and perfusion density between subjects with migraine and healthy subjects using optical coherence tomography angiography (OCTA). In this cross-sectional case-control study, we enrolled 30 migraine subjects with aura (MWA), 30 migraine subjects without aura (MWOA) and 30 age and gender-matched healthy controls (HC). The foveal avascular zone (FAZ) in superficial capillary plexus (SCP), Vessel density (VD) and perfusion density (PD) in SCP and deep capillary plexus (DCP) were assessed in a 3 × 3 mm scan of the macula with the swept source OCT. Results indicated that the FAZ of MWA and MWOA subjects was significantly larger from HC. Also, FAZ of MWA was larger from MWOA. VD and PD in both SCP and DCP were significantly reduced in both MWA and MWOA groups compared to HC. However, VD and PD did not show significant differences among MWA and MWOA. Additionally, the duration of disease was the main determinant of the FAZ. In conclusion, the FAZ in the SCP, VD and PD in the SCP and DCP of the macula were affected in both MWA and MWOA. FAZ, specifically, was increased with the evolution of the disease. These findings might contribute to an increased risk of ocular vascular complications among subjects with migraine and could potentially use OCTA as a biomarker for this population.
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Affiliation(s)
- Yasmin Walha
- Department of Ophthalmology, Habib Bourguiba Hospital, 3029 Sfax, Tunisia.
| | | | - Mona Rekik
- Department of Ophthalmology, Habib Bourguiba Hospital, 3029 Sfax, Tunisia
| | - Sonda Kammoun
- Department of Ophthalmology, Habib Bourguiba Hospital, 3029 Sfax, Tunisia
| | - Omar Ayedi
- Department of Ophthalmology, Habib Bourguiba Hospital, 3029 Sfax, Tunisia
| | - Chokri Mhiri
- Department of Neurology, Habib Bourguiba Hospital, 3029 Sfax, Tunisia
| | - Mariem Dammak
- Department of Neurology, Habib Bourguiba Hospital, 3029 Sfax, Tunisia
| | - Amira Trigui
- Department of Ophthalmology, Habib Bourguiba Hospital, 3029 Sfax, Tunisia
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Pietramaggiori G, Bastin A, Ricci F, Bassetto F, Scherer S. Minimally invasive nerve and artery sparing surgical approach for temporal migraines. JPRAS Open 2024; 39:32-41. [PMID: 38162535 PMCID: PMC10755679 DOI: 10.1016/j.jpra.2023.11.005] [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: 11/06/2023] [Accepted: 11/10/2023] [Indexed: 01/03/2024] Open
Abstract
Background Temporal migraines (TM) present with throbbing, pulsating headaches in the temporal area. Different surgical techniques ranging from resecting the auriculotemporal nerve (ATN) and or ligating the superficial temporal artery (STA) have shown similar good results to decrease TM symptoms. No conclusive data supports a specific disease of the STA in TM patients. A minimally invasive technique is proposed to preserve both vascular and nerve structures. Methods Patients with drug resistant TM were selected and treated with two techniques: nerve sparing and nerve and artery sparing. The study included 57 patients with TM, with an average age of 47.5 years. TM improvement was quantified after at least one year of follow up time. STA biopsies were sent for histological analysis. Results Forty-two patients underwent nerve-sparing decompression, with a therapeutic success rate of 78.6%, corresponding to 22.1 days with migraine per month decreasing to 6.2. Histological analysis of the STA showed varying degrees of endofibrosis in 75% of the samples. Histological results do not correlate with the intensity of symptoms before or after surgery. Fifteen patients underwent nerve and artery sparing arteriolysis, with an overall therapeutic success rate of 86.6% of which 80% had >90% improvement. The average migraine days dropped from 24 to 2.5 days per month in this group. Conclusion Minimally invasive nerve sparing approaches are an effective and safe treatment to improve drug resistant TM symptoms. Endofibrosis of the STA was present in 75% of the cases, but it was found to be unrelated to pre-operative symptoms and outcome. Results are promising, but the limited numbers of patients treated with artery and nerve sparing technique needs further investigations.
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Affiliation(s)
- Giorgio Pietramaggiori
- Global Medical Institute, Division of Aesthetic and Migraine Surgery, Avenue Jomini 8, 1004 Lausanne, Switzerland
| | - Alessandro Bastin
- University of Padua, Department of Neurosciences, Division of plastic Surgery, Via Giustiniani 2, 35128 Padova, Italy
| | - Federico Ricci
- University of Padua, Department of Neurosciences, Division of plastic Surgery, Via Giustiniani 2, 35128 Padova, Italy
| | - Franco Bassetto
- University of Padua, Department of Neurosciences, Division of plastic Surgery, Via Giustiniani 2, 35128 Padova, Italy
| | - Saja Scherer
- Global Medical Institute, Division of Aesthetic and Migraine Surgery, Avenue Jomini 8, 1004 Lausanne, Switzerland
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Oba T, Gulec ZEK, Çiçek MF, Uygunoglu U, Onder F. Retinal and peripapillary vascular density in episodic and chronic migraine cases without aura. Photodiagnosis Photodyn Ther 2023; 44:103809. [PMID: 37739046 DOI: 10.1016/j.pdpdt.2023.103809] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/17/2023] [Accepted: 09/19/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND Migraine is a neurovascular disease that can cause ocular and systemic ischemic damage. Despite from aura, a limited number of studies have considered the effect of the chronic migraine in cases without aura. Our aim was to evaluate the differences in the retinal and optic disk microvasculature among episodic and chronic migraine cases without aura using optical coherence tomography angiography (OCTA) imaging. METHODS 45 cases with migraine, and 25 control subjects were included in this prospective, cross-sectional study. OCTA was performed at 3 × 3 mm and 6 × 6 mm of the macula and at 4.5 × 4.5 mm of the optic disk. Retinal nerve fiber layer (RNFL) thickness, ganglion cell complex thickness, and vessel densities of the optic nerve and macula were compared among the three groups: a control group, an episodic migraine without aura (EMWOA) group, and a chronic migraine without aura (CMWOA) group. RESULTS In EMWOA group, circumpapillary vascular density (cpVD) was not decreased significantly in any quadrants (all, p>0.05). Compared to the control group, CMWOA group had significantly lower RNFL thickness in superior-temporal quadrants (p = 0.002 and 0.006, respectively), while cpVD differed only in the temporal quadrant and temporal inferior sector (p = 0.002 and p = 0.009, respectively). CONCLUSIONS Temporal peripapillary perfusion is valuable in the follow-up of chronic migraine cases. Longitudinal studies are needed to determine the place of OCTA in the follow-up of migraine.
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Affiliation(s)
- Turker Oba
- Department of Ophthalmology, Karaman Training and Research Hospital, Karaman, Turkey.
| | | | | | - Ugur Uygunoglu
- Department of Neurology, Cerrahpasa School of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Feyza Onder
- Department of Ophthalmology, University of Health Science, Haseki Training and Research Hospital, Istanbul, Turkey
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4
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Biringer RG. Migraine signaling pathways: purine metabolites that regulate migraine and predispose migraineurs to headache. Mol Cell Biochem 2023; 478:2813-2848. [PMID: 36947357 DOI: 10.1007/s11010-023-04701-7] [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: 10/05/2022] [Accepted: 03/06/2023] [Indexed: 03/23/2023]
Abstract
Migraine is a debilitating disorder that afflicts over 1 billion people worldwide, involving attacks that result in a throbbing and pulsating headache. Migraine is thought to be a neurovascular event associated with vasoconstriction, vasodilation, and neuronal activation. Understanding signaling in migraine pathology is central to the development of therapeutics for migraine prophylaxis and for mitigation of migraine in the prodrome phase before pain sets in. The fact that both vasoactivity and neural sensitization are involved in migraine indicates that agonists which promote these phenomena may very well be involved in migraine pathology. One such group of agonists is the purines, in particular, adenosine phosphates and their metabolites. This manuscript explores what is known about the relationship between these metabolites and migraine pathology and explores the potential for such relationships through their known signaling pathways. Reported receptor involvement in vasoaction and nociception.
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Affiliation(s)
- Roger Gregory Biringer
- College of Osteopathic Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, FL, 34211, USA.
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5
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Chen Y, Cheng Q, Zeng S, Lv S. Potential analgesic effect of Foshousan oil-loaded chitosan-alginate nanoparticles on the treatment of migraine. Front Pharmacol 2023; 14:1190920. [PMID: 37680717 PMCID: PMC10482050 DOI: 10.3389/fphar.2023.1190920] [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: 03/21/2023] [Accepted: 08/07/2023] [Indexed: 09/09/2023] Open
Abstract
Background: Migraine is a common neurovascular disorder with typical throbbing and unilateral headaches, causing a considerable healthcare burden on the global economy. This research aims to prepare chitosan-alginate (CS-AL) nanoparticles (NPs) containing Foshousan oil (FSSO) and investigate its potential therapeutic effects on the treatment of migraine. Methods: FSSO-loaded CS-AL NPs were prepared by using the single emulsion solvent evaporation method. Lipopolysaccharide (LPS)-stimulated BV-2 cells and nitroglycerin (NTG)-induced migraine mice were further used to explore anti-migraine activities and potential mechanisms of this botanical drug. Results: FSSO-loaded CS-AL NPs (212.1 ± 5.2 nm, 45.1 ± 6.2 mV) had a well-defined spherical shape with prolonged drug release and good storage within 4 weeks. FSSO and FSSO-loaded CS-AL NPs (5, 10, and 15 μg/mL) showed anti-inflammatory activities in LPS-treated BV-2 cells via reducing the levels of pro-inflammatory cytokines such as tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), interleukin-6 (IL-6), and nitric oxide (NO), but elevating interleukin-10 (IL-10) expressions. Moreover, FSSO-loaded CS-AL NPs (52 and 104 mg/kg) raised pain thresholds against the hot stimulus and decreased acetic acid-induced writhing frequency and foot-licking duration in NTG-induced migraine mice. Compared with the model group, calcitonin gene-related peptide (CGRP) and NO levels were downregulated, but 5-hydroxytryptamine (5-HT) and endothelin (ET) levels were upregulated along with rebalanced ET/NO ratio, and vasomotor dysfunction was alleviated by promoting cerebral blood flow (CBF) in the FSSO-loaded CS-AL NPs (104 mg/kg) group. Conclusion: FSSO-loaded CS-AL NPs could attenuate migraine via inhibiting neuroinflammation in LPS-stimulated BV-2 cells and regulating vasoactive substances in NTG-induced migraine mice. These findings suggest that the FSS formula may be exploited as new phytotherapy for treating migraine.
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Affiliation(s)
- Yulong Chen
- College of Medicine and Health Science, Wuhan Polytechnic University, Wuhan, China
| | - Qingzhou Cheng
- College of Medicine and Health Science, Wuhan Polytechnic University, Wuhan, China
| | - Shan Zeng
- School of Mathematics and Computer Science, Wuhan Polytechnic University, Wuhan, China
| | - Site Lv
- School of Mathematics and Computer Science, Wuhan Polytechnic University, Wuhan, China
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Russo AF, Hay DL. CGRP physiology, pharmacology, and therapeutic targets: migraine and beyond. Physiol Rev 2023; 103:1565-1644. [PMID: 36454715 PMCID: PMC9988538 DOI: 10.1152/physrev.00059.2021] [Citation(s) in RCA: 63] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 11/23/2022] [Accepted: 11/27/2022] [Indexed: 12/03/2022] Open
Abstract
Calcitonin gene-related peptide (CGRP) is a neuropeptide with diverse physiological functions. Its two isoforms (α and β) are widely expressed throughout the body in sensory neurons as well as in other cell types, such as motor neurons and neuroendocrine cells. CGRP acts via at least two G protein-coupled receptors that form unusual complexes with receptor activity-modifying proteins. These are the CGRP receptor and the AMY1 receptor; in rodents, additional receptors come into play. Although CGRP is known to produce many effects, the precise molecular identity of the receptor(s) that mediates CGRP effects is seldom clear. Despite the many enigmas still in CGRP biology, therapeutics that target the CGRP axis to treat or prevent migraine are a bench-to-bedside success story. This review provides a contextual background on the regulation and sites of CGRP expression and CGRP receptor pharmacology. The physiological actions of CGRP in the nervous system are discussed, along with updates on CGRP actions in the cardiovascular, pulmonary, gastrointestinal, immune, hematopoietic, and reproductive systems and metabolic effects of CGRP in muscle and adipose tissues. We cover how CGRP in these systems is associated with disease states, most notably migraine. In this context, we discuss how CGRP actions in both the peripheral and central nervous systems provide a basis for therapeutic targeting of CGRP in migraine. Finally, we highlight potentially fertile ground for the development of additional therapeutics and combinatorial strategies that could be designed to modulate CGRP signaling for migraine and other diseases.
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Affiliation(s)
- Andrew F Russo
- Department of Molecular Physiology and Biophysics, University of Iowa, Iowa City, Iowa
- Department of Neurology, University of Iowa, Iowa City, Iowa
- Center for the Prevention and Treatment of Visual Loss, Department of Veterans Affairs Health Center, Iowa City, Iowa
| | - Debbie L Hay
- Department of Pharmacology and Toxicology, University of Otago, Dunedin, New Zealand
- Maurice Wilkins Centre for Molecular Biodiscovery, School of Biological Sciences, The University of Auckland, Auckland, New Zealand
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Amani H, Soltani Khaboushan A, Terwindt GM, Tafakhori A. Glia Signaling and Brain Microenvironment in Migraine. Mol Neurobiol 2023; 60:3911-3934. [PMID: 36995514 DOI: 10.1007/s12035-023-03300-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 02/27/2023] [Indexed: 03/31/2023]
Abstract
Migraine is a complicated neurological disorder affecting 6% of men and 18% of women worldwide. Various mechanisms, including neuroinflammation, oxidative stress, altered mitochondrial function, neurotransmitter disturbances, cortical hyperexcitability, genetic factors, and endocrine system problems, are responsible for migraine. However, these mechanisms have not completely delineated the pathophysiology behind migraine, and they should be further studied. The brain microenvironment comprises neurons, glial cells, and vascular structures with complex interactions. Disruption of the brain microenvironment is the main culprit behind various neurological disorders. Neuron-glia crosstalk contributes to hyperalgesia in migraine. In the brain, microenvironment and related peripheral regulatory circuits, microglia, astrocytes, and satellite cells are necessary for proper function. These are the most important cells that could induce migraine headaches by disturbing the balance of the neurotransmitters in the nervous system. Neuroinflammation and oxidative stress are the prominent reactions glial cells drive during migraine. Understanding the role of cellular and molecular components of the brain microenvironment on the major neurotransmitters engaged in migraine pathophysiology facilitates the development of new therapeutic approaches with higher effectiveness for migraine headaches. Investigating the role of the brain microenvironment and neuroinflammation in migraine may help decipher its pathophysiology and provide an opportunity to develop novel therapeutic approaches for its management. This review aims to discuss the neuron-glia interactions in the brain microenvironment during migraine and their potential role as a therapeutic target for the treatment of migraine.
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Affiliation(s)
- Hanieh Amani
- Student Research Committee, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Soltani Khaboushan
- Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Abbas Tafakhori
- Iranian Center of Neurological Research, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Neurology, Imam Khomeini Hospital, Keshavarz Blvd., Tehran, Iran.
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Martin VT, Feoktistov A, Solomon GD. A rational approach to migraine diagnosis and management in primary care. Ann Med 2021; 53:1979-1990. [PMID: 34714201 PMCID: PMC8567924 DOI: 10.1080/07853890.2021.1995626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 10/15/2021] [Indexed: 12/23/2022] Open
Abstract
Migraine is a chronic neurologic disease estimated to affect approximately 50 million Americans. It is associated with a range of symptoms, which contribute to disability and substantial negative impacts on quality of life for many patients. Still, migraine continues to be underdiagnosed, undertreated, and optimising treatment for individual patients has proven difficult. As many migraine patients will be seen first in primary care settings, internists and other primary care providers are ideally positioned to improve diagnosis and migraine management for many patients. In this review, we discuss some of the challenges in diagnosing migraine and suggest strategies to overcome them, summarise the current understanding of migraine pathophysiology and clinical evidence on acute and preventive treatment options, and offer practical approaches to diagnosis and contemporary management of migraine in the primary care setting.Key messagesMigraine is a prevalent disease with substantial impact. Primary care providers are ideally positioned to improve care for migraine patients with streamlined approaches to diagnosis and management.A stepwise diagnostic approach to migraine involves taking a thorough headache history, excluding secondary headache, and identifying primary headache disorder using screening tools or ICHD-3 criteria.The FDA approved seven new migraine therapies from 2018 to 2020 (four monoclonal antibodies, two gepants, one ditan), expanding acute and preventive therapeutic options.
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Affiliation(s)
- Vincent T. Martin
- Department of Internal Medicine, University of Cincinnati, Cincinnati, OH, USA
| | | | - Glen D. Solomon
- Department of Internal Medicine, Wright State University, Dayton, OH, USA
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Dey K, Roy Chowdhury S. Inverse neurovascular coupling and associated spreading depolarization models for traumatic brain injury. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2021; 2021:4242-4248. [PMID: 34892160 DOI: 10.1109/embc46164.2021.9629956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The paper presents the mathematical model of cortical spreading depolarisation and its effect on inverse neurovascular coupling. The paper considers the potassium ion channels present in the neuron-astrocyte blood vascular network to access the role of potassium ions during spreading depolarisation and associated inverse neurovascular coupling. Simulation of our proposed mathematical model confirms the experimental results that an increase in concentration of potassium ions beyond 20mM in the perivascular space essentially leads to vasoconstriction and hence inverse neurovascular coupling. The propagatory nature of depolarizing potassium waves has been unraveled though our proposed mathematical model.
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Marichal-Cancino BA, González-Hernández A, Guerrero-Alba R, Medina-Santillán R, Villalón CM. A critical review of the neurovascular nature of migraine and the main mechanisms of action of prophylactic antimigraine medications. Expert Rev Neurother 2021; 21:1035-1050. [PMID: 34388955 DOI: 10.1080/14737175.2021.1968835] [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: 10/20/2022]
Abstract
INTRODUCTION Migraine involves neurovascular, functional, and anatomical alterations. Migraineurs experience an intense unilateral and pulsatile headache frequently accompanied with vomiting, nausea, photophobia, etc. Although there is no ideal preventive medication, frequency in migraine days may be partially decreased by some prophylactics, including antihypertensives, antidepressants, antiepileptics, and CGRPergic inhibitors. However, the mechanisms of action involved in antimigraine prophylaxis remain elusive. AREAS COVERED This review recaps some of the main neurovascular phenomena related to migraine and currently available preventive medications. Moreover, it discusses the major mechanisms of action of the recommended prophylactic medications. EXPERT OPINION In the last three years, migraine prophylaxis has evolved from nonspecific to specific antimigraine treatments. Overall, nonspecific treatments mainly involve neural actions, whereas specific pharmacotherapy (represented by CGRP receptor antagonists and CGRPergic monoclonal antibodies) is predominantly mediated by neurovascular mechanisms that may include, among others: (i) reduction in the cortical spreading depression (CSD)-associated events; (ii) inhibition of pain sensitization; (iii) blockade of neurogenic inflammation; and/or (iv) increase in cranial vascular tone. Accordingly, the novel antimigraine prophylaxis promises to be more effective, devoid of significant adverse effects (unlike nonspecific treatments), and more beneficial for the quality of life of migraineurs.
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Affiliation(s)
- Bruno A Marichal-Cancino
- Departamento de Fisiología y Farmacología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes, Ags, México
| | | | - Raquel Guerrero-Alba
- Departamento de Fisiología y Farmacología, Centro de Ciencias Básicas, Universidad Autónoma de Aguascalientes, Aguascalientes, Ags, México
| | - Roberto Medina-Santillán
- Sección de Estudios de Posgrado e Investigación, Escuela Superior de Medicina IPN, Ciudad de México C.P, México
| | - Carlos M Villalón
- Departamento de Farmacobiología, Cinvestav-Coapa, Ciudad de México, México
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Riyazuddin M, Shahid A, Nagaraj RB, Alam MA. Migraine ( Shaqeeqa) and its management in Unani medicine. Drug Metab Pers Ther 2021; 37:1-5. [PMID: 35385897 DOI: 10.1515/dmpt-2021-0146] [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: 05/29/2021] [Accepted: 07/11/2021] [Indexed: 11/15/2022]
Abstract
Out of many disease conditions suffered by mankind since ancient ages, Migraine holds a significant position. It is derived from the word "hemi-crania" and is a type of primary headache. This disease is mentioned in the ancient scriptures dating back to the Mesopotamian era. It has been documented by Hippocrates (460-377 BC) in his treatise, further explored and explained on the basis of cause and location by Galen (131-201 AD). Later its etiopathogenesis clinical features and management was described by Al-Razi (850-923 AD), an eminent Unani physician. Migraine is a disease majorly affecting one side of the head and characterized by recurrent attacks of pulsating headache, mostly associated with nausea, vomiting, photophobia and phonophobia, with or without an aura. It is triggered by noise and light, based on the brightness, intensity, wavelengths or type of light that is being emitted. According to Unani physicians, the word Shaqeeqa is derived from Arabic word 'Shiq', meaning 'a part' or 'a side', hence the name Shaqeeqa. They describe it as a type of headache (Suda) in which pain occurs only in one side of head, and the causative factors for it are the morbid matters and morbid vapours (Bukharat e Radiya) arising from morbid humours which are either excessive in amount, too hot or too cold. It often results due to abnormal substantial temperament (Su-e-Mizaj Maddi) giving two variants acute (Shaqeeqa haar) and chronic (Shaqeeqa barid). The treatment mainly consists of elimination of morbid matter which is accumulated in the body, and strengthening the brain using brain tonics (Muqawwiyat-e-Dimagh).
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Affiliation(s)
- Mohd Riyazuddin
- Department of Moalajat (Medicine), National Institute of Unani Medicine (under ministry of AYUSH), Bangalore, India
| | - Arisha Shahid
- Department of Moalajat (Medicine), National Institute of Unani Medicine (under ministry of AYUSH), Bangalore, India
| | - Renuka Bangalore Nagaraj
- Department of Pathology, National Institute of Unani Medicine (under ministry of AYUSH), Bangalore, India
| | - Md Anzar Alam
- Department of Moalajat (Medicine), National Institute of Unani Medicine (under ministry of AYUSH), Bangalore, India
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Riyazuddin M, Shahid A, Nagaraj RB, Alam MA. Migraine ( Shaqeeqa) and its management in Unani medicine. Drug Metab Pers Ther 2021; 0:dmdi-2021-0146. [PMID: 34391218 DOI: 10.1515/dmdi-2021-0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 07/11/2021] [Indexed: 11/15/2022]
Abstract
Out of many disease conditions suffered by mankind since ancient ages, Migraine holds a significant position. It is derived from the word "hemi-crania" and is a type of primary headache. This disease is mentioned in the ancient scriptures dating back to the Mesopotamian era. It has been documented by Hippocrates (460-377 BC) in his treatise, further explored and explained on the basis of cause and location by Galen (131-201 AD). Later its etiopathogenesis clinical features and management was described by Al-Razi (850-923 AD), an eminent Unani physician. Migraine is a disease majorly affecting one side of the head and characterized by recurrent attacks of pulsating headache, mostly associated with nausea, vomiting, photophobia and phonophobia, with or without an aura. It is triggered by noise and light, based on the brightness, intensity, wavelengths or type of light that is being emitted. According to Unani physicians, the word Shaqeeqa is derived from Arabic word 'Shiq', meaning 'a part' or 'a side', hence the name Shaqeeqa. They describe it as a type of headache (Suda) in which pain occurs only in one side of head, and the causative factors for it are the morbid matters and morbid vapours (Bukharat e Radiya) arising from morbid humours which are either excessive in amount, too hot or too cold. It often results due to abnormal substantial temperament (Su-e-Mizaj Maddi) giving two variants acute (Shaqeeqa haar) and chronic (Shaqeeqa barid). The treatment mainly consists of elimination of morbid matter which is accumulated in the body, and strengthening the brain using brain tonics (Muqawwiyat-e-Dimagh).
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Affiliation(s)
- Mohd Riyazuddin
- Department of Moalajat (Medicine), National Institute of Unani Medicine (under ministry of AYUSH), Bangalore, India
| | - Arisha Shahid
- Department of Moalajat (Medicine), National Institute of Unani Medicine (under ministry of AYUSH), Bangalore, India
| | - Renuka Bangalore Nagaraj
- Department of Pathology, National Institute of Unani Medicine (under ministry of AYUSH), Bangalore, India
| | - Md Anzar Alam
- Department of Moalajat (Medicine), National Institute of Unani Medicine (under ministry of AYUSH), Bangalore, India
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Mirzoyan RS, Gan’shina TS, Kurdyumov IN, Maslennikov DV, Gnezdilova AV, Gorbunov AA, Kursa EV, Turilova AI, Kostochka LM, Mirzoyan NR. Migraine pharmacology and brain ischemia. RESEARCH RESULTS IN PHARMACOLOGY 2021. [DOI: 10.3897/rrpharmacology.7.67463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2023] Open
Abstract
Introduction: The aim of this review article was to analyze in details the mechanism of drugs’ effects in the treatment and prevention of a migraine attack, as well as to discuss the hypotheses of migraine pathogenesis.
Migraine attack treatment agents: The main agents for migraine attack treatment have an anti-nociceptive activity.
Agents for migraine preventive treatment: β-blocker propranolol also has anti-serotonin and analgesic activities, and most drugs used for the prophylactic treatment of migraine have a vasodilating activity.
Vascular hypothesis of migraine pathogenesis: Despite numerous studies that have expanded our understanding of migraine pathogenesis, the importance of the vascular component in the pathogenesis of this disease has not questioned yet.
Neurogenic hypotheses of cortical spreading depression: It is necessary to take into account the points of this hypothesis in the context of the pathophysiology of migraine.
Neurochemical serotonin hypotheses of migraine pathogenesis: Serotonin plays an important role in the pathogenesis of migraine.
Trigemino-vascular hypotheses of migraine pathogenesis: The trigemino-vascular hypothesis claims to solve the problem of migraine pain.
Migraine and ischemic brain damage: Migraine is a risk factor for ischemic stroke and cognitive disorders.
Search for the new anti-ischemic anti-migraine preparations: A methodology for the search for new anti-ischemic anti-serotonin drugs for the treatment of migraine is proposed.
Conclusion: Belonging of a drug to one or another pharmacological group does not always correspond to its therapeutic effect on the pathogenetic processes of migraine. Migraine with its variety of forms cannot fit only one of the proposed hypotheses on the pathogenesis of this disease.
Graphical abstract:
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14
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Roberts B, Makar AE, Canaan R, Pazdernik V, Kondrashova T. Effect of occipitoatlantal decompression on cerebral blood flow dynamics as evaluated by Doppler ultrasonography. J Osteopath Med 2021; 121:171-179. [PMID: 33567080 DOI: 10.1515/jom-2020-0100] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Context Osteopathic manipulative treatment reduces symptoms in patients with headache disorders, but the underlying mechanisms are unclear. Objective To evaluate blood flow in the intracranial and extracranial vasculature before and after occipitoatlantal decompression (OAD) using Doppler ultrasonography. Methods Healthy, first-year osteopathic medical students from A.T. Still University's Kirksville College of Osteopathic Medicine participated in a randomized, single-blinded, two-period, two-treatment crossover study. The participants were randomly assigned to 1 of 2 treatment interventions: OAD or sham touch. After one week, participants returned to have the other intervention performed. Blood flow parameters-peak systolic velocity (PSV) and end-diastolic velocity (EDV)-in the middle cerebral artery (MCA), internal carotid artery (ICA), and vertebral artery (VA) were evaluated before, immediately after, 5 minutes after, and 10 minutes after treatment. Differences in PSV, EDV, heart rate (HR), and blood pressure (BP) for both interventions were analyzed for the four time points using mixed-effects models. Results Thirty healthy medical students (11 men, 19 women; mean age, 24 years) participated in this study. EDV increased after OAD in the MCA, ICA, and VA (all p<0.001); no change occurred after sham touch (all p>0.05). EDV was greater for all post-treatment timepoints after OAD in the MCA, ICA, and VA than after sham touch (all p<0.001). Although baseline PSV in the MCA measured before treatment was different between treatment interventions (p=0.01), no difference was found between interventions at any post-treatment time point (all p>0.59). Changes in PSV in the ICA and VA and for HR and BP did not depend on treatment intervention (p>0.06). Conclusion Increases in EDV occurred in major cranial arteries after OAD but not after sham touch, indicating that OAD improves blood flow to the brain. The exact mechanism of this increase is unknown; however, it can be explained by either parasympathetic stimulation through the secretion of vasodilating neurotransmitters or by a decrease in external tissue pressure on ICA and VA, with the resulting flow causing further dilation in the MCA.
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Affiliation(s)
- Bryan Roberts
- Kirksville College of Osteopathic Medicine , A.T. Still University , Kirksville , MO , USA
| | - Andrew E Makar
- Kirksville College of Osteopathic Medicine , A.T. Still University , Kirksville , MO , USA
| | - Ryan Canaan
- Kirksville College of Osteopathic Medicine , A.T. Still University , Kirksville , MO , USA
| | - Vanessa Pazdernik
- Department of Research Support , A.T. Still University , Kirksville , MO , USA
| | - Tatyana Kondrashova
- Department of Family Medicine, Preventive Medicine, and Community Health , A.T. Still University , Kirksville , MO , USA
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Bao X, Liu H, Liu HY, Long Y, Tan JW, Zhu ZM. The effect of intermittent hypoxia training on migraine: a randomized controlled trial. Am J Transl Res 2020; 12:4059-4065. [PMID: 32774759 PMCID: PMC7407698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 06/03/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To study the effect of intermittent hypoxia training (IHT) for migraine. DESIGN A single-blind, randomized controlled trial. All participants were recruited from a rehabilitation department in an acute university-affiliated hospital. METHODS Participants with migraines were randomly assigned to two groups (IHT group and control group). The Migraine Disability Assessment (MIDAS), Visual Analog Scale (VAS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Vascular endothelial growth factor (VEGF), calcitonin gene related peptide (CGRP) and cerebrovascular hemodynamic parameters were collected at baseline and end of the 8th week. The attack frequencies of migraines were evaluated at 3 months. RESULTS Among the 48 subjects, five males and forty-three females, the ages ranged from 19 to 53 years old (mean ± SD = 31.3±7.78). MIDAS, SF-36, VAS, BAI, BDI, VEGF, CGRP and cerebrovascular hemodynamic parameters were improved after IHT intervention. There were significant differences between IHT group and the control group in MIDAS, SF-36, VAS, BAI, BDI, VEGF, CGRP and cerebrovascular hemodynamic parameters at the end of the 8th weeks (P<0.05). Attack frequencies were improved within 3 months after IH training intervention (P<0.01), but not in the control group (P>0.05). No adverse events occurred during the study. CONCLUSION IHT could improve migraines after intervention up to three months. IHT could be an effective method for relieving a migraine.
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Affiliation(s)
- Xiao Bao
- Department of Rehabilitation Medicine, Yue Bei People’s HospitalShaoguan, China
| | - Howe Liu
- Department of Physical Therapy, University of North Texas Health Science CenterFort Worth, USA
| | - Hui-Yu Liu
- Department of Rehabilitation Medicine, Yue Bei People’s HospitalShaoguan, China
| | - Ying Long
- Department of Hyperbaric Oxygen Medicine, Shenzhen People’s HospitalShenzhen, China
| | - Jie-Wen Tan
- Department of Rehabilitation Medicine, Xinhua College of Sun Yat-sen UniversityGuangzhou, China
| | - Zhi-Min Zhu
- Department of Rehabilitation Medicine, Lianjiang People’s HospitalLianjiang, China
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Bingöl Kızıltunç P, Özcan G, Özer F, Togay Işıkay C, Atilla H. Evaluation of retinal vessel density and choriocapillaris flow in migraine patients with and without aura. Graefes Arch Clin Exp Ophthalmol 2020; 258:2517-2521. [PMID: 32591975 DOI: 10.1007/s00417-020-04805-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/04/2020] [Accepted: 06/15/2020] [Indexed: 11/26/2022] Open
Abstract
PURPOSE Migraine is thought to be a neurovascular disorder and increases the likelyhood to develop ischemic complications. Studies have shown that vascular disorders such as ischemic optic neuropathy, retinal artery and vein obstructions are more common in patients with migraine. This study aimed to evaluate the differences between retinal and optic disc microvasculature between migraine patients with and without aura and healthy controls using optical coherence tomography angiography (OCTA) imaging. METHODS Thirty-three patients with migraine and 28 healthy subjects were included in this prospective cross sectional study. Optical coherence tomography angiography imaging was performed for the macula and optic disc. Vessel densities (VD) and choriocapillaris flow values were compared between three groups: control group, migraine with aura (MWA), and migraine without aura (MWOA). RESULTS There was no difference between the three groups for the VDs of the foveal, perifoveal, parafoveal, and the whole area. The choriocapillaris flow of patients with MWA was significantly less than that of the MWOA and control groups. The VDs of the optic disc revealed no significant difference between the three groups. CONCLUSION A lack of choriocapillaris autoregulatory mechanisms may be a possible cause of the decrease in choriocapillaris flow in patients with MWA.
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Affiliation(s)
| | - Gökçen Özcan
- Department of Ophthalmology, Ankara University School of Medicine, Ankara, Turkey
| | - Ferhad Özer
- Department of Ophthalmology, Ankara University School of Medicine, Ankara, Turkey
| | - Canan Togay Işıkay
- Department of Neurology, Ankara University School of Medicine, Ankara, Turkey
| | - Huban Atilla
- Department of Ophthalmology, Ankara University School of Medicine, Ankara, Turkey
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Schain AJ, Melo A, Ashina S, Strassman AM, Burstein R. Celecoxib reduces cortical spreading depression-induced macrophage activation and dilatation of dural but not pial arteries in rodents: implications for mechanism of action in terminating migraine attacks. Pain 2020; 161:1019-1026. [PMID: 31895267 PMCID: PMC7166151 DOI: 10.1097/j.pain.0000000000001789] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Nonsteroidal anti-inflammatory drugs, commonly known as COX-1/COX-2 inhibitors, can be effective in treating mild to moderate migraine headache. However, neither the mechanism by which these drugs act in migraine is known, nor is the specific contribution of COX-1 vs COX-2. We sought to investigate these unknowns using celecoxib, which selectively inhibits the enzymatic activity of COX-2, by determining its effects on several migraine-associated vascular and inflammatory events. Using in vivo 2-photon microscopy, we determined intraperitoneal celecoxib effects on cortical spreading depression (CSD)-induced blood vessel responses, plasma protein extravasation, and immune cell activation in the dura and pia of mice and rats. Compared to vehicle (control group), celecoxib reduced CSD-induced dilatation of dural arteries and activation of dural and pial macrophages significantly, but not dilatation or constriction of pial arteries and veins, or the occurrence of plasma protein extravasation. Collectively, these findings suggest that a mechanism by which celecoxib-mediated COX-2 inhibition might ease the intensity of migraine headache and potentially terminate an attack is by attenuating dural macrophages' activation and arterial dilatation outside the blood-brain barrier, and pial macrophages' activation inside the blood-brain barrier.
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Affiliation(s)
- Aaron J. Schain
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston MA 02115
- Harvard Medical School, Boston, MA 02215, USA
| | - Agustin Melo
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston MA 02115
- Harvard Medical School, Boston, MA 02215, USA
| | - Sait Ashina
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston MA 02115
- Harvard Medical School, Boston, MA 02215, USA
| | - Andrew M. Strassman
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston MA 02115
- Harvard Medical School, Boston, MA 02215, USA
| | - Rami Burstein
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Boston MA 02115
- Harvard Medical School, Boston, MA 02215, USA
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La Touche R, Fernández Pérez JJ, Proy Acosta A, González Campodónico L, Martínez García S, Adraos Juárez D, Serrano García B, Angulo‐Díaz‐Parreño S, Cuenca‐Martínez F, Suso‐Martí L, Paris‐Alemany A. Is aerobic exercise helpful in patients with migraine? A systematic review and meta‐analysis. Scand J Med Sci Sports 2020; 30:965-982. [DOI: 10.1111/sms.13625] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 12/18/2019] [Accepted: 01/02/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Roy La Touche
- Departamento de Fisioterapia Centro Superior de Estudios Universitarios La Salle Universidad Autónoma de Madrid Madrid Spain
- Motion in Brains Research Group Institute of Neuroscience and Sciences of the Movement (INCIMOV) Centro Superior de Estudios Universitarios La Salle Universidad Autónoma de Madrid Madrid Spain
- Instituto de Neurociencia y Dolor Craneofacial (INDCRAN) Madrid Spain
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ) Madrid Spain
| | - Juan José Fernández Pérez
- Departamento de Fisioterapia Centro Superior de Estudios Universitarios La Salle Universidad Autónoma de Madrid Madrid Spain
| | - Alejandro Proy Acosta
- Departamento de Fisioterapia Centro Superior de Estudios Universitarios La Salle Universidad Autónoma de Madrid Madrid Spain
| | - Lisandro González Campodónico
- Departamento de Fisioterapia Centro Superior de Estudios Universitarios La Salle Universidad Autónoma de Madrid Madrid Spain
| | - Sergio Martínez García
- Departamento de Fisioterapia Centro Superior de Estudios Universitarios La Salle Universidad Autónoma de Madrid Madrid Spain
| | - Daniel Adraos Juárez
- Departamento de Fisioterapia Centro Superior de Estudios Universitarios La Salle Universidad Autónoma de Madrid Madrid Spain
| | - Beatriz Serrano García
- Departamento de Fisioterapia Centro Superior de Estudios Universitarios La Salle Universidad Autónoma de Madrid Madrid Spain
| | - Santiago Angulo‐Díaz‐Parreño
- Motion in Brains Research Group Institute of Neuroscience and Sciences of the Movement (INCIMOV) Centro Superior de Estudios Universitarios La Salle Universidad Autónoma de Madrid Madrid Spain
- Facultad de Medicina Universidad CEU San Pablo Madrid Spain
| | - Ferran Cuenca‐Martínez
- Departamento de Fisioterapia Centro Superior de Estudios Universitarios La Salle Universidad Autónoma de Madrid Madrid Spain
- Motion in Brains Research Group Institute of Neuroscience and Sciences of the Movement (INCIMOV) Centro Superior de Estudios Universitarios La Salle Universidad Autónoma de Madrid Madrid Spain
| | - Luis Suso‐Martí
- Motion in Brains Research Group Institute of Neuroscience and Sciences of the Movement (INCIMOV) Centro Superior de Estudios Universitarios La Salle Universidad Autónoma de Madrid Madrid Spain
- Departamento de Fisioterapia Universidad CEU Cardenal Herrera CEU Universities Valencia Spain
| | - Alba Paris‐Alemany
- Departamento de Fisioterapia Centro Superior de Estudios Universitarios La Salle Universidad Autónoma de Madrid Madrid Spain
- Motion in Brains Research Group Institute of Neuroscience and Sciences of the Movement (INCIMOV) Centro Superior de Estudios Universitarios La Salle Universidad Autónoma de Madrid Madrid Spain
- Instituto de Neurociencia y Dolor Craneofacial (INDCRAN) Madrid Spain
- Instituto de Investigación Sanitaria del Hospital Universitario La Paz (IdiPAZ) Madrid Spain
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Alstadhaug KB, Andreou AP. Caffeine and Primary (Migraine) Headaches-Friend or Foe? Front Neurol 2019; 10:1275. [PMID: 31849829 PMCID: PMC6901704 DOI: 10.3389/fneur.2019.01275] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 11/18/2019] [Indexed: 12/19/2022] Open
Abstract
Background: The actions of caffeine as an antagonist of adenosine receptors have been extensively studied, and there is no doubt that both daily and sporadic dietary consumption of caffeine has substantial biological effects on the nervous system. Caffeine influences headaches, the migraine syndrome in particular, but how is unclear. Materials and Methods: This is a narrative review based on selected articles from an extensive literature search. The aim of this study is to elucidate and discuss how caffeine may affect the migraine syndrome and discuss the potential pathophysiological pathways involved. Results: Whether caffeine has any significant analgesic and/or prophylactic effect in migraine remains elusive. Neither is it clear whether caffeine withdrawal is an important trigger for migraine. However, withdrawal after chronic exposure of caffeine may cause migraine-like headache and a syndrome similar to that experienced in the prodromal phase of migraine. Sensory hypersensitivity however, does not seem to be a part of the caffeine withdrawal syndrome. Whether it is among migraineurs is unknown. From a modern viewpoint, the traditional vascular explanation of the withdrawal headache is too simplistic and partly not conceivable. Peripheral mechanisms can hardly explain prodromal symptoms and non-headache withdrawal symptoms. Several lines of evidence point at the hypothalamus as a locus where pivotal actions take place. Conclusion: In general, chronic consumption of caffeine seems to increase the burden of migraine, but a protective effect as an acute treatment or in severely affected patients cannot be excluded. Future clinical trials should explore the relationship between caffeine withdrawal and migraine, and investigate the effects of long-term elimination.
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Affiliation(s)
- Karl B. Alstadhaug
- Nordland Hospital Trust, Bodø, Norway
- Institute of Clinical Medicine, The Arctic University of Norway, Tromsø, Norway
| | - Anna P. Andreou
- Headache Research, Wolfson CARD, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
- The Headache Centre, Guy's and St Thomas', NHS Foundation Trust, London, United Kingdom
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Khan FA, McIntyre C, Khan AM, Maslov A. Headache and Methemoglobinemia. Headache 2019; 60:291-297. [PMID: 31724752 DOI: 10.1111/head.13696] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2019] [Indexed: 11/27/2022]
Abstract
AIM This basic review is intended to summarize the current knowledge of methemoglobinemia as an important cause of secondary headache with the hope of generating a growing interest in studying this phenomenon. BACKGROUND We describe the pathological underpinnings of headaches generated by hypoxia. Possible mechanisms include cerebral vasodilation-associated stretching of the vessel nociceptors, sensitization of perivascular nociceptors mediated by nitric oxide, cerebral calcitonin gene-related peptide, activation of the cyclic adenosine monophosphate pathway, cortical spreading depression, disruption of the blood-brain barrier, and neurogenic inflammation. We review the clinical features, pathophysiology, and management of methemoglobinemia. We conducted a literature review of reports of symptomatic methemoglobinemia with headache. In addition, we describe a case report of a patient who presented with an acute onset of severe holocranial headache associated with rapidly progressive perioral paresthesia, cyanosis in lips and hands, nausea, and mild dyspnea on exertion. These features can be misinterpreted as an acute attack of migraine with pain-related hyperventilation syndrome and anxiety leading to clinically detrimental delay in the management of the progressive hypoxia. Her symptoms resolved following treatment with methylene blue. The complex relationship of migraine and hypoxia-related headaches is also reviewed. We propose that methemoglobinemia-associated headaches are possibly generated by stretching of the nociceptor nerve endings during cerebral vasodilation and hypoxia-mediated oxidative stress. CONCLUSIONS The case highlights the need to broaden the formulated differential diagnosis of an acute onset severe holocranial headache and pay careful attention to other signs and symptoms that may provide hints on potential mechanism(s) for secondary headaches. We provide justification for the need to incorporate "Headache attributed to Methemoglobinemia" as a subtype under the section "Headache attributed to hypoxia and/or hypercapnia" of the International Classification of Headache Disorders to support clinical decision making.
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Affiliation(s)
- Fawad Ahmed Khan
- The McCasland Family Comprehensive Headache Center, Ochsner Neuroscience Institute, Ochsner Clinic Foundation, New Orleans, LA, USA.,The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA, USA.,Tulane University School of Medicine, New Orleans, LA, USA
| | - Caley McIntyre
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA, USA.,Department of Hospital Medicine, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Abdul Mukhtadir Khan
- Department of Pulmonary and Critical Care Medicine, Ochsner Clinic Foundation, New Orleans, LA, USA
| | - Alexander Maslov
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA, USA
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Kroos JM, de Tommaso M, Stramaglia S, Vecchio E, Burdi N, Gerardo-Giorda L. Clinical correlates of mathematical modeling of cortical spreading depression: Single-cases study. Brain Behav 2019; 9:e01387. [PMID: 31503424 PMCID: PMC6790336 DOI: 10.1002/brb3.1387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 07/13/2019] [Accepted: 07/28/2019] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Considerable connections between migraine with aura and cortical spreading depression (CSD), a depolarization wave originating in the visual cortex and traveling toward the frontal lobe, lead to the hypothesis that CSD is underlying migraine aura. The highly individual and complex characteristics of the brain cortex suggest that the geometry might impact the propagation of cortical spreading depression. METHODS In a single-case study, we simulated the CSD propagation for five migraine with aura patients, matching their symptoms during a migraine attack to the CSD wavefront propagation. This CSD wavefront was simulated on a patient-specific triangulated cortical mesh obtained from individual MRI imaging and personalized diffusivity tensors derived locally from diffusion tensor imaging data. RESULTS The CSD wave propagation was simulated on both hemispheres, despite in all but one patient the symptoms were attributable to one hemisphere. The CSD wave diffused with a large wavefront toward somatosensory and prefrontal regions, devoted to pain processing. DISCUSSION This case-control study suggests that the cortical geometry may contribute to the modality of CSD evolution and partly to clinical expression of aura symptoms. The simulated CSD is a large and diffuse phenomenon, possibly capable to activate trigeminal nociceptors and to involve cortical areas devoted to pain processing.
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Affiliation(s)
- Julia M Kroos
- Basque Center for Applied Mathematics, Bilbao, Spain
| | - Marina de Tommaso
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Bari Aldo Moro University, Bari, Italy
| | - Sebastiano Stramaglia
- Center of Innovative Technologies for Signal Detection and Processing TIRES, Physic Department, Bari Aldo Moro University, Bari, Italy.,INFN, Bari, Italy
| | - Eleonora Vecchio
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Bari Aldo Moro University, Bari, Italy
| | - Nicola Burdi
- Department of Radiology-Neuroradiology, Santissima Annunziata Hospital, Taranto, Italy
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Retinal vascular density evaluation of migraine patients with and without aura and association with white matter hyperintensities. Acta Neurol Belg 2019; 119:411-417. [PMID: 30762208 DOI: 10.1007/s13760-019-01094-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Accepted: 02/05/2019] [Indexed: 12/23/2022]
Abstract
Underlying pathophysiological mechanism of migraine is not all clear; however, recent reports suggested that neurovascular system is involved. We aimed to evaluate the retinal vessel densities of migraine patients with and without aura and the associations with white matter hyperintensities (WMH), using optical coherence tomography angiography (OCTA). We recruited 28 migraine with aura (MWA) patients, 26 migraine without aura (MWO) and age and sex-matched 34 healthy controls in our study. All participants were evaluated with optical coherence tomography (OCT) and OCTA for optic nerve parameters and retinal vessel densities with RTVue XR AVANTI. On macular OCTA, superficial and deeper retinal foveal vessel density (VD) were significantly lesser in MWA and MWO than controls. On optic nerve OCTA, whole optic disc, peripapillary, superior hemisphere, superior layer and temporal layer VD were significantly lesser in MWA and MWO. In group of MWA with the WMH, deeper foveal VD and superior hemisphere VD, average RNFL, superior hemisphere and superior layer were significantly lesser and also foveal avascular zone was significantly larger than the group of without WMH. Alterations of VD in patients with migraine are showed in our study. In addition, in group of MWA these alterations have associations with WMH. Supporting these findings with further reports can be useful to understand the pathophysiology of this disease.
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Sasayama D, Asano S, Nogawa S, Takahashi S, Saito K, Kunugi H. Possible association between photic sneeze syndrome and migraine and psychological distress. Neuropsychopharmacol Rep 2019; 39:217-222. [PMID: 31287245 PMCID: PMC7292289 DOI: 10.1002/npr2.12067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 05/23/2019] [Accepted: 06/06/2019] [Indexed: 12/04/2022] Open
Abstract
Background Photic sneeze syndrome (PSS) is a condition that causes sneezing when the eye is exposed to sudden bright light. Because alterations in the parasympathetic and trigeminal nerve systems have been implicated in PSS, and such systems are involved in migraine and stress‐related disorders, we examined the possible associations of PSS with migraine and psychological distress. Methods The presence of PSS and migraine was examined in 11 840 participants from the general population using a self‐report questionnaire. Psychological distress was assessed by the 6‐item Kessler Psychological Distress Scale (K6). Results The overall prevalence of PSS was 3.1%. Individuals with PSS were more likely to suffer from migraine (odds ratio = 1.97, P = 2.18 × 10–9), clinically relevant psychological distress (K6 score ≥ 5: odds ratio = 1.40, P = 0.00143), and severe psychological distress (K6 score ≥ 13: odds ratio = 1.49, P = 0.0486). Overall, K6 scores were significantly higher in those with PSS than in those without (P = 0.000013). Analysis controlling for sex and the presence of migraine showed that PSS was associated with higher K6 scores irrespective of sex or the presence of migraine. Conclusions The low prevalence of PSS identified in the present study may be due to the inadequate ability of the self‐report questionnaire to identify PSS. Despite such limitation, the present study suggests that individuals with PSS are more likely to suffer from migraine and psychological distress than those without PSS. PSS may be a potential target for the research of migraine and stress‐related disorders. Our data obtained through a self‐report questionnaire administered to 11,840 participants showed that individuals with photic sneeze syndrome were more likely to suffer from migraine and psychological distress than those without photic sneeze syndrome. Photic sneeze syndrome may be a potential target for the research of migraine and stress‐related disorders.![]()
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Affiliation(s)
- Daimei Sasayama
- Department of Mental Disorder Research, National Center of Neurology and Psychiatry, National Institute of Neuroscience, Kodaira, Japan.,Department of Psychiatry, Shinshu University School of Medicine, Matsumoto, Japan.,Child and Adolescent Developmental Psychiatry, Shinshu University School of Medicine, Matsumoto, Japan
| | | | | | | | | | - Hiroshi Kunugi
- Department of Mental Disorder Research, National Center of Neurology and Psychiatry, National Institute of Neuroscience, Kodaira, Japan
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Demartini C, Greco R, Zanaboni AM, Sances G, De Icco R, Borsook D, Tassorelli C. Nitroglycerin as a comparative experimental model of migraine pain: From animal to human and back. Prog Neurobiol 2019; 177:15-32. [DOI: 10.1016/j.pneurobio.2019.02.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 01/19/2019] [Accepted: 02/10/2019] [Indexed: 12/13/2022]
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Abstract
Migraine is a strongly disabling disease characterized by a unilateral throbbing headache lasting for up to 72 h for each individual attack. There have been many theories on the pathophysiology of migraine throughout the years. Currently, the neurovascular theory dominates, suggesting clear involvement of the trigeminovascular system. The most recent data show that a migraine attack most likely originates in the hypothalamus and activates the trigeminal nucleus caudalis (TNC). Although the mechanisms are unknown, activation of the TNC leads to peripheral release of calcitonin gene-related protein (CGRP), most likely from C-fibers. During the past year monoclonal antibodies against CGRP or the CGRP receptor have emerged as the most promising targets for migraine therapy, and at the same time established the strong involvement of CGRP in the pathophysiology of migraine. The viewpoint presented here focuses further on the activation of the CGRP receptor on the sensory Aδ-fiber, leading to the sensation of pain. The CGRP receptor activates adenylate cyclase, which leads to an increase in cyclic adenosine monophosphate (cAMP). We hypothesize that cAMP activates the hyperpolarization-activated cyclic nucleotide-gated (HCN) channels, triggering an action potential sensed as pain. The mechanisms behind migraine pain on a molecular level, particularly their importance to cAMP, provide clues to potential new anti-migraine targets. In this article we focus on the development of targets related to the CGRP system, and further include novel targets such as the pituitary adenylate cyclase-activating peptide (PACAP) system, the serotonin 5-HT1F receptor, purinergic receptors, HCN channels, adenosine triphosphate-sensitive potassium channels (KATP), and the glutaminergic system.
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Glutamate affects the CYP1B1- and CYP2U1-mediated hydroxylation of arachidonic acid metabolism via astrocytic mGlu5 receptor. Int J Biochem Cell Biol 2019; 110:111-121. [DOI: 10.1016/j.biocel.2019.03.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 01/27/2019] [Accepted: 03/01/2019] [Indexed: 01/10/2023]
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Davenport AP, Kuc RE, Southan C, Maguire JJ. New drugs and emerging therapeutic targets in the endothelin signaling pathway and prospects for personalized precision medicine. Physiol Res 2018; 67:S37-S54. [PMID: 29947527 DOI: 10.33549/physiolres.933872] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
During the last thirty years since the discovery of endothelin-1, the therapeutic strategy that has evolved in the clinic, mainly in the treatment of pulmonary arterial hypertension, is to block the action of the peptide either at the ET(A) subtype or both receptors using orally active small molecule antagonists. Recently, there has been a rapid expansion in research targeting ET receptors using chemical entities other than small molecules, particularly monoclonal antibody antagonists and selective peptide agonists and antagonists. While usually sacrificing oral bio-availability, these compounds have other therapeutic advantages with the potential to considerably expand drug targets in the endothelin pathway and extend treatment to other pathophysiological conditions. Where the small molecule approach has been retained, a novel strategy to combine two vasoconstrictor targets, the angiotensin AT(1) receptor as well as the ET(A) receptor in the dual antagonist sparsentan has been developed. A second emerging strategy is to combine drugs that have two different targets, the ET(A) antagonist ambrisentan with the phosphodiesterase inhibitor tadalafil, to improve the treatment of pulmonary arterial hypertension. The solving of the crystal structure of the ET(B) receptor has the potential to identify allosteric binding sites for novel ligands. A further key advance is the experimental validation of a single nucleotide polymorphism that has genome wide significance in five vascular diseases and that significantly increases the amount of big endothelin-1 precursor in the plasma. This observation provides a rationale for testing this single nucleotide polymorphism to stratify patients for allocation to treatment with endothelin agents and highlights the potential to use personalized precision medicine in the endothelin field.
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Affiliation(s)
- A P Davenport
- Experimental Medicine and Immunotherapeutics, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom.
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Wainsztein N, Rodríguez Lucci F. Cortical Spreading Depression and Ischemia in Neurocritical Patients. Neurosurg Clin N Am 2018; 29:223-229. [PMID: 29502713 DOI: 10.1016/j.nec.2017.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Spreading depolarization in cerebral cortex is associated with swelling of neurons, distortion of dendritic spines, massive ion translocation with a large change of the slow electrical potential, and silencing of brain electrical activity. The term spreading depression represents a wave of spontaneous activity of the electrocorticogram that propagates through contiguous cerebral gray matter at a characteristic velocity. Spreading depression is a consequence of cortical spreading depolarization. Therefore, spreading depolarization is not always accompanied by spreading depression and the terms are not synonymous.
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Affiliation(s)
- Néstor Wainsztein
- Department of Internal Medicine, Neurocritical Care Unit, Institute of Neurological Research, FLENI, Montañeses 2325, Buenos Aires, Argentina
| | - Federico Rodríguez Lucci
- Department of Internal Medicine, Neurocritical Care Unit, Institute of Neurological Research, FLENI, Montañeses 2325, Buenos Aires, Argentina; Stroke Unit, Comprehensive Stroke Center, Institute of Neurological Research, FLENI, Montañeses 2325, Buenos Aires, Argentina.
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29
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Fuglsang CH, Johansen T, Kaila K, Kasch H, Bach FW. Treatment of acute migraine by a partial rebreathing device: A randomized controlled pilot study. Cephalalgia 2018; 38:1632-1643. [PMID: 30134739 PMCID: PMC6158684 DOI: 10.1177/0333102418797285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Impaired brain oxygen delivery can trigger and exacerbate migraine attacks. Normoxic hypercapnia increases brain oxygen delivery markedly by vasodilation of the cerebral vasculature, and hypercapnia has been shown to abort migraine attacks. Stable normoxic hypercapnia can be induced by a compact partial rebreathing device. This pilot study aimed to provide initial data on the device's efficacy and safety. Methods Using a double-blinded, randomized, cross-over study design, adult migraine-with-aura patients self-administered the partial rebreathing device or a sham device for 20 minutes at the onset of aura symptoms. Results Eleven participants (mean age 35.5, three men) self-treated 41 migraine attacks (20 with the partial rebreathing device, 21 with sham). The partial rebreathing device increased mean End Tidal CO2 by 24%, while retaining mean oxygen saturation above 97%. The primary end point (headache intensity difference between first aura symptoms and two hours after treatment (0-3 scale) - active/sham difference) did not reach statistical significance (-0.55 (95% CI: -1.13-0.04), p = 0.096), whereas the difference in percentage of attacks with pain relief at two hours was significant ( p = 0.043), as was user satisfaction ( p = 0.022). A marked efficacy increase was seen from first to second time use of the partial rebreathing device. No adverse events occurred, and side effects were absent or mild. Conclusion Normoxic hypercapnia shows promise as an adjunctive/alternative migraine treatment, meriting further investigation in a larger population. Clinical study registered at ClinicalTrials.gov with identifier NCT03472417.
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Affiliation(s)
| | - Troels Johansen
- 2 Aarhus University School of Engineering, Aarhus University, Aarhus, Denmark.,3 BalancAir, Kongens Lyngby, Denmark
| | - Kai Kaila
- 4 Molecular and Integrative Biosciences Research Program and HiLife, University of Helsinki, Helsinki, Finland
| | - Helge Kasch
- 5 Spinal Cord Injury Center of Western Denmark, Department of Neurology, Regional Hospital of Viborg, Viborg, Denmark
| | - Flemming W Bach
- 1 Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
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Abstract
To explore alterations in γ-aminobutyric acid (GABA) levels in response to levetiracetam (LEV) treatment in patients with migraine. Patients with migraine (N=14) were treated with LEV for 12 weeks. The levels of GABA+ in the anterior cingulate cortex/medial prefrontal cortex (ACC/mPFC) and the posterior cingulate cortex (PCC) were examined by proton magnetic resonance spectroscopy before (baseline) and after treatment. LEV showed good efficacy in the reduction of headache frequency and intensity in patients with migraine. Among the 14 patients, good-quality spectral data of GABA+ in the PCC region were obtained in 11 patients. There was a significant decrease in GABA+ levels in the PCC region after LEV treatment. ACC/mPFC GABA+ was assessed by proton magnetic resonance spectroscopy in eight patients with migraine. LEV had no significant effect on GABA+ levels in the ACC/mPFC region. The decreased GABA+ levels after LEV treatment in patients with migraine suggest that GABA is a migraine biomarker.
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32
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Liu R, Xu H, Zhang X, Wang X, Yuan Z, Sui Z, Wang D, Bi K, Li Q. Metabolomics Strategy Using High Resolution Mass Spectrometry Reveals Novel Biomarkers and Pain-Relief Effect of Traditional Chinese Medicine Prescription Wu-Zhu-Yu Decoction Acting on Headache Modelling Rats. Molecules 2017; 22:E2110. [PMID: 29258229 PMCID: PMC6149820 DOI: 10.3390/molecules22122110] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 11/26/2017] [Accepted: 11/30/2017] [Indexed: 11/16/2022] Open
Abstract
Headache is a common episodic or chronic neurologic disorder. Treatment options and diagnosis are restricted by an incomplete understanding of disease pathology and the lack of diagnostic markers. Wu-Zhu-Yu decoction (WZYD), a traditional Chinese medicine (TCM) formula containing four TCM herbs, is commonly used in the treatment of headache in China. To deeply understand more about headache and investigate the pain-relief mechanism of WZYD, a comprehensive metabolomics study combined with multivariate data processing strategy was carried out. An LC-high resolution mass spectrometry-based metabolomics approach was applied to characterize metabolic biomarker candidates. Multiple pattern recognition including principal component analysis-discriminant analysis, partial least squares-discriminant analysis and hierarchical cluster analysis were used to determine groups and confirm important variables. A total of 17 potential biomarkers were characterized and related metabolic pathways were identified. The study demonstrated that the established metabolomics strategy is a powerful approach for investigating the mechanism of headache attack and WZYD. In addition, the approach may highlight biomarkers and metabolic pathways and can capture subtle metabolite changes from headache, which may lead to an improved mechanism understanding of central nervous system diseases and TCM treatment.
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Affiliation(s)
- Ran Liu
- National and Local Joint Engineering Laboratory for Key Technology of Chinese Material Medica Quality Control, School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Rd., Shenyang 110016, China.
| | - Huarong Xu
- National and Local Joint Engineering Laboratory for Key Technology of Chinese Material Medica Quality Control, School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Rd., Shenyang 110016, China.
| | - Xiaowen Zhang
- Guangzhou Bristol Drug Delivery Co., Ltd., 11 Kaiyuan Ave, Guangzhou 510320, China.
| | - Xiaotong Wang
- National and Local Joint Engineering Laboratory for Key Technology of Chinese Material Medica Quality Control, School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Rd., Shenyang 110016, China.
| | - Ziyue Yuan
- National and Local Joint Engineering Laboratory for Key Technology of Chinese Material Medica Quality Control, School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Rd., Shenyang 110016, China.
| | - Zhenyu Sui
- China Food and Drug Administration Institute of Executive Development, 16 Xi Zhan Nan Rd., Beijing 100073, China.
| | - Dong Wang
- Dalian Institute for Drug Control, 888a Huanghe Rd., Dalian 116000, China.
| | - Kaishun Bi
- National and Local Joint Engineering Laboratory for Key Technology of Chinese Material Medica Quality Control, School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Rd., Shenyang 110016, China.
| | - Qing Li
- National and Local Joint Engineering Laboratory for Key Technology of Chinese Material Medica Quality Control, School of Pharmacy, Shenyang Pharmaceutical University, 103 Wenhua Rd., Shenyang 110016, China.
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Abstract
Spreading depolarization in cerebral cortex is associated with swelling of neurons, distortion of dendritic spines, massive ion translocation with a large change of the slow electrical potential, and silencing of brain electrical activity. The term spreading depression represents a wave of spontaneous activity of the electrocorticogram that propagates through contiguous cerebral gray matter at a characteristic velocity. Spreading depression is a consequence of cortical spreading depolarization. Therefore, spreading depolarization is not always accompanied by spreading depression and the terms are not synonymous.
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Affiliation(s)
- Néstor Wainsztein
- Department of Internal Medicine, Neurocritical Care Unit, Institute of Neurological Research, FLENI, Montañeses 2325, Buenos Aires, Argentina
| | - Federico Rodríguez Lucci
- Department of Internal Medicine, Neurocritical Care Unit, Institute of Neurological Research, FLENI, Montañeses 2325, Buenos Aires, Argentina; Stroke Unit, Comprehensive Stroke Center, Institute of Neurological Research, FLENI, Montañeses 2325, Buenos Aires, Argentina.
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Role of astrocyte connexin hemichannels in cortical spreading depression. BIOCHIMICA ET BIOPHYSICA ACTA-BIOMEMBRANES 2017; 1860:216-223. [PMID: 28864364 DOI: 10.1016/j.bbamem.2017.08.014] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 08/08/2017] [Accepted: 08/23/2017] [Indexed: 11/21/2022]
Abstract
Cortical spreading depression (CSD) is an intriguing phenomenon consisting of massive slow brain depolarizations that affects neurons and glial cells. It has been recognized since 1944, but its pathogenesis has only been uncovered during the last decade. Acute brain injuries can be further complicated by CSD in >50% of severe cases. This phenomenon is repetitive and produces a metabolic overload that increments secondary damage. Propagation of CSD is known to be linked to excitotoxicity, but the mechanisms associated with its initiation remain less understood. It has been shown that CSD can be initiated by increases in extracellular [K+] ([K+]e), and animal models use high [K+]e to promote CSD. Connexin hemichannel activity increases due to high [K+]e and low extracellular [Ca2+], conditions that occur after brain injury. Moreover, glial cell gap junction channels are fundamental in controlling extracellular medium composition, particularly in maintaining normal extracellular glutamate and K+ concentrations through "spatial buffering". However, the role of astrocytic gap junctions under tissue stress can change to damage spread in the acute damage zone whereas the reduced communication in adjacent zone would reduce cell dead propagation. Here, we review the main findings associated with CSD, and discuss the possible involvement of astrocytic connexin-based channels in secondary damage propagation. This article is part of a Special Issue entitled: Gap Junction Proteins edited by Jean Claude Herve.
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Kheirollahi M, Pourreza MR, Khorvash F, Kazemi M, Amini G. A Report of a Novel Mutation in Human Prostacyclin Receptor Gene in Patients Affected with Migraine. IRANIAN JOURNAL OF PSYCHIATRY 2017; 12:219-222. [PMID: 29062375 PMCID: PMC5640585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Objective: The human prostacyclin receptor gene encodes the human prostacyclin receptor, which is a part of the vasodilator system, during migraine attacks and almost certainly plays an important role in the mechanism of this disease. Method: The present study aimed at determining any variants in PTGIR gene by means of PCR and direct sequencing. Blood samples were taken from the patients, and genomic DNA was extracted. Polymerase chain reaction was performed on the extracted DNA. The PCR products were then sequenced using the Sanger method. Results: When reviewing the familial and clinicopathological history of the 2 patients, we found that both had symptoms of migraine with visual aura and that their mothers were also suffering from migraine. Their parents were not relatives prior to marriage. Direct sequencing of Exon 2 of the PTGIR gene showed the presence of 2 mutations. These mutations were heterozygous and made the following changes: g.1626T>A, c.754T>A, cDNA.867T>A, and p.S252T for the first mutation, and c.753C>T, cDNA866C>T, g.1625C>T, and p.C251C for the second mutation. The first mutation altered the amino acid and was a novel mutation. The second change was a conservative mutation that has already been reported. Conclusion: The prediction results of silico studies indicated that the c.754T>A change would negatively affect the protein's function and seemed to cause the disease. However, functional analysis is required to confirm the association between the variant and the disease.
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Affiliation(s)
- Majid Kheirollahi
- Pediatric Inherited Diseases Research Center, Research Institute for Primordial Prevention of Non-Communicable Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran.,Corresponding Author: Address: Pediatric Inherited Diseases Research Center, Research Institute for Primordial Prevention of Non-Communicable Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, 8174673461, Isfahan, Iran. Tel: +98 31 37929086, Fax: +98 31 36688597,
| | - Mohammad Reza Pourreza
- Pediatric Inherited Diseases Research Center, Research Institute for Primordial Prevention of Non-Communicable Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fariborz Khorvash
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Kazemi
- Pediatric Inherited Diseases Research Center, Research Institute for Primordial Prevention of Non-Communicable Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gilda Amini
- Pediatric Inherited Diseases Research Center, Research Institute for Primordial Prevention of Non-Communicable Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Department of Genetics and Molecular Biology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Hartings JA, Shuttleworth CW, Kirov SA, Ayata C, Hinzman JM, Foreman B, Andrew RD, Boutelle MG, Brennan KC, Carlson AP, Dahlem MA, Drenckhahn C, Dohmen C, Fabricius M, Farkas E, Feuerstein D, Graf R, Helbok R, Lauritzen M, Major S, Oliveira-Ferreira AI, Richter F, Rosenthal ES, Sakowitz OW, Sánchez-Porras R, Santos E, Schöll M, Strong AJ, Urbach A, Westover MB, Winkler MK, Witte OW, Woitzik J, Dreier JP. The continuum of spreading depolarizations in acute cortical lesion development: Examining Leão's legacy. J Cereb Blood Flow Metab 2017; 37:1571-1594. [PMID: 27328690 PMCID: PMC5435288 DOI: 10.1177/0271678x16654495] [Citation(s) in RCA: 271] [Impact Index Per Article: 38.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A modern understanding of how cerebral cortical lesions develop after acute brain injury is based on Aristides Leão's historic discoveries of spreading depression and asphyxial/anoxic depolarization. Treated as separate entities for decades, we now appreciate that these events define a continuum of spreading mass depolarizations, a concept that is central to understanding their pathologic effects. Within minutes of acute severe ischemia, the onset of persistent depolarization triggers the breakdown of ion homeostasis and development of cytotoxic edema. These persistent changes are diagnosed as diffusion restriction in magnetic resonance imaging and define the ischemic core. In delayed lesion growth, transient spreading depolarizations arise spontaneously in the ischemic penumbra and induce further persistent depolarization and excitotoxic damage, progressively expanding the ischemic core. The causal role of these waves in lesion development has been proven by real-time monitoring of electrophysiology, blood flow, and cytotoxic edema. The spreading depolarization continuum further applies to other models of acute cortical lesions, suggesting that it is a universal principle of cortical lesion development. These pathophysiologic concepts establish a working hypothesis for translation to human disease, where complex patterns of depolarizations are observed in acute brain injury and appear to mediate and signal ongoing secondary damage.
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Affiliation(s)
- Jed A Hartings
- 1 Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,2 Mayfield Clinic, Cincinnati, OH, USA
| | - C William Shuttleworth
- 3 Department of Neuroscience, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Sergei A Kirov
- 4 Department of Neurosurgery and Brain and Behavior Discovery Institute, Medical College of Georgia, Augusta, GA, USA
| | - Cenk Ayata
- 5 Neurovascular Research Unit, Department of Radiology, and Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jason M Hinzman
- 1 Department of Neurosurgery, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Brandon Foreman
- 6 Department of Neurology and Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - R David Andrew
- 7 Department of Biomedical & Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Martyn G Boutelle
- 8 Department of Bioengineering, Imperial College London, London, United Kingdom
| | - K C Brennan
- 9 Department of Neurology, University of Utah, Salt Lake City, UT, USA.,10 Department of Neurobiology and Anatomy, University of Utah, Salt Lake City, UT, USA
| | - Andrew P Carlson
- 11 Department of Neurosurgery, University of New Mexico School of Medicine, Albuquerque, NM, USA
| | - Markus A Dahlem
- 12 Department of Physics, Humboldt University of Berlin, Berlin, Germany
| | | | - Christian Dohmen
- 14 Department of Neurology, University of Cologne, Cologne, Germany
| | - Martin Fabricius
- 15 Department of Clinical Neurophysiology, Rigshospitalet, Glostrup, Denmark
| | - Eszter Farkas
- 16 Department of Medical Physics and Informatics, Faculty of Medicine, and Faculty of Science and Informatics, University of Szeged, Szeged, Hungary
| | - Delphine Feuerstein
- 17 Multimodal Imaging of Brain Metabolism, Max-Planck-Institute for Metabolism Research, Cologne, Germany
| | - Rudolf Graf
- 17 Multimodal Imaging of Brain Metabolism, Max-Planck-Institute for Metabolism Research, Cologne, Germany
| | - Raimund Helbok
- 18 Medical University of Innsbruck, Department of Neurology, Neurocritical Care Unit, Innsbruck, Austria
| | - Martin Lauritzen
- 15 Department of Clinical Neurophysiology, Rigshospitalet, Glostrup, Denmark.,19 Department of Neuroscience and Pharmacology and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Sebastian Major
- 13 Department of Neurology, Charité University Medicine, Berlin, Germany.,20 Center for Stroke Research Berlin, Charité University Medicine, Berlin, Germany.,21 Department of Experimental Neurology, Charité University Medicine, Berlin, Germany
| | - Ana I Oliveira-Ferreira
- 20 Center for Stroke Research Berlin, Charité University Medicine, Berlin, Germany.,21 Department of Experimental Neurology, Charité University Medicine, Berlin, Germany
| | - Frank Richter
- 22 Institute of Physiology/Neurophysiology, Jena University Hospital, Jena, Germany
| | - Eric S Rosenthal
- 5 Neurovascular Research Unit, Department of Radiology, and Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Oliver W Sakowitz
- 23 Department of Neurosurgery, Klinikum Ludwigsburg, Ludwigsburg, Germany.,24 Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Renán Sánchez-Porras
- 24 Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Edgar Santos
- 24 Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Michael Schöll
- 24 Department of Neurosurgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Anthony J Strong
- 25 Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London
| | - Anja Urbach
- 26 Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany
| | - M Brandon Westover
- 5 Neurovascular Research Unit, Department of Radiology, and Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Maren Kl Winkler
- 20 Center for Stroke Research Berlin, Charité University Medicine, Berlin, Germany
| | - Otto W Witte
- 26 Hans Berger Department of Neurology, Jena University Hospital, Jena, Germany.,27 Brain Imaging Center, Jena University Hospital, Jena, Germany
| | - Johannes Woitzik
- 20 Center for Stroke Research Berlin, Charité University Medicine, Berlin, Germany.,28 Department of Neurosurgery, Charité University Medicine, Berlin, Germany
| | - Jens P Dreier
- 13 Department of Neurology, Charité University Medicine, Berlin, Germany.,20 Center for Stroke Research Berlin, Charité University Medicine, Berlin, Germany.,21 Department of Experimental Neurology, Charité University Medicine, Berlin, Germany
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Unlu M, Sevim DG, Gultekin M, Baydemir R, Karaca C, Oner A. Changes in retinal vessel diameters in migraine patients during attack-free period. Int J Ophthalmol 2017; 10:439-444. [PMID: 28393037 DOI: 10.18240/ijo.2017.03.18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 09/04/2016] [Indexed: 11/23/2022] Open
Abstract
AIM To evaluate the retinal vessel diameters in patients with migraine by optical coherence tomography (OCT). METHODS In this cross-sectional study, 124 eyes of 62 patients with a diagnosis of unilateral migraine during attack-free period and 42 age- and sex-matched control subjects were included. Migraine patients were divided into the ≤2 migraine attacks per month group and the ≥5 migraine attacks per month group. All subjects underwent complete ophthalmological and neurological examinations before measurements. Retinal vessel diameters and choroidal thickness were examined with the Spectralis OCT. RESULTS The mean diameters of the arteries in the eyes on the headache side of control group, ≥5 migraine attacks per month and ≤2 migraine attacks per month group at 480 µm from the optic disk (Raster 3) were 119.54±46.69, 136.68±25.93 and 119.34±31.75 µm respectively with a steady decline to 105.57±32.15, 118.18±31.87 and 108.05±38.77 µm at 1440 µm (Raster 7), the last measurement point, respectively. The retinal artery diameter measurements were significantly increased in ≥5 migraine attacks per month patients at four out of five measured points compared to control group (P<0.05). There were no statistical differences at any of the points of vein measurements. The choroidal thickness measurements were significantly decreased in ≥5 migraine attacks per month patients at all measured points compared to control group (P<0.05). CONCLUSION The retinal artery diameter is found to increase significantly and the choroidal thickness is found to decrease in the eyes on the headache side in ≥5 migraine attacks per month patients compared to control group.
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Affiliation(s)
- Metin Unlu
- Ophthalmology Department, School of Medicine, Erciyes University, Kayseri 38039, Turkey
| | - Duygu Gulmez Sevim
- Ophthalmology Department, School of Medicine, Erciyes University, Kayseri 38039, Turkey
| | - Murat Gultekin
- Neurology Department, School of Medicine, Erciyes University, Kayseri 38039, Turkey
| | - Recep Baydemir
- Neurology Department, School of Medicine, Erciyes University, Kayseri 38039, Turkey
| | - Cagatay Karaca
- Ophthalmology Department, School of Medicine, Erciyes University, Kayseri 38039, Turkey
| | - Ayse Oner
- Ophthalmology Department, School of Medicine, Erciyes University, Kayseri 38039, Turkey
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Kaufmann D, Bates EA, Yagen B, Bialer M, Saunders GH, Wilcox K, White HS, Brennan KC. sec-Butylpropylacetamide (SPD) has antimigraine properties. Cephalalgia 2016; 36:924-35. [PMID: 26568161 PMCID: PMC4887413 DOI: 10.1177/0333102415612773] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 08/30/2015] [Indexed: 12/24/2022]
Abstract
BACKGROUND Though migraine is disabling and affects 12%-15% of the population, there are few drugs that have been developed specifically for migraine prevention. Valproic acid (VPA) is a broad-spectrum antiepileptic drug (AED) that is also used for migraine prophylaxis, but its clinical use is limited by its side effect profile. sec-Butylpropylacetamide (SPD) is a novel VPA derivative, designed to be more potent and tolerable than VPA, that has shown efficacy in animal seizure and pain models. METHODS We evaluated SPD's antimigraine potential in the cortical spreading depression (CSD) and nitroglycerin (NTG) models of migraine. To evaluate SPD's mechanism of action, we performed whole-cell recordings on cultured cortical neurons and neuroblastoma cells. RESULTS In the CSD model, the SPD-treated group showed a significantly lower median number of CSDs compared to controls. In the NTG-induced mechanical allodynia model, SPD dose-dependently reduced mechanical sensitivity compared to controls. SPD showed both a significant potentiation of GABA-mediated currents and a smaller but significant decrease in NMDA currents in cultured cortical neurons. Kainic acid-evoked currents and voltage-dependent sodium channel currents were not changed by SPD. CONCLUSIONS These results demonstrate SPD's potential as a promising novel antimigraine compound, and suggest a GABAergic mechanism of action.
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Affiliation(s)
- Dan Kaufmann
- Anticonvulsant Drug Development Program, Department of Pharmacology and Toxicology, University of Utah, USA Department of Neurology, University of Utah, USA
| | - Emily A Bates
- Department of Pediatrics, University of Colorado Denver School of Medicine, USA
| | - Boris Yagen
- Institute for Drug Research, School of Pharmacy, Hebrew University of Jerusalem, Israel David R. Bloom Center for Pharmacy, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Meir Bialer
- Institute for Drug Research, School of Pharmacy, Hebrew University of Jerusalem, Israel David R. Bloom Center for Pharmacy, Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Gerald H Saunders
- Anticonvulsant Drug Development Program, Department of Pharmacology and Toxicology, University of Utah, USA
| | - Karen Wilcox
- Anticonvulsant Drug Development Program, Department of Pharmacology and Toxicology, University of Utah, USA
| | - H Steve White
- Anticonvulsant Drug Development Program, Department of Pharmacology and Toxicology, University of Utah, USA
| | - K C Brennan
- Department of Neurology, University of Utah, USA
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Le Gal J, Michel JF, Rinaldi VE, Spiri D, Moretti R, Bettati D, Romanello S, Berlese P, Lualdi R, Boizeau P, Viala J, Bellaiche M, Zuccotti GV, Crichiutti G, Alberti C, Titomanlio L. Association between functional gastrointestinal disorders and migraine in children and adolescents: a case-control study. Lancet Gastroenterol Hepatol 2016; 1:114-121. [PMID: 28404068 DOI: 10.1016/s2468-1253(16)30038-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 07/21/2016] [Accepted: 07/22/2016] [Indexed: 12/19/2022]
Abstract
BACKGROUND Functional gastrointestinal disorders and migraine are both common causes of medical attention. We have previously shown an association between migraine and infant colic. In this case-control study, we aimed to establish whether there is an association between migraine and other functional gastrointestinal disorders in children and adolescents. METHODS We included children and adolescents aged 6-17 years presenting to the emergency department of four tertiary hospitals in France and Italy. Patients diagnosed with either migraine or tension-type headache by the hospital's paediatric neurologist were enrolled as cases. Patients presenting to the emergency department with minor trauma and no history of recurrent headache were enrolled as controls. Investigators masked to a patient's group allocation diagnosed functional gastrointestinal disorders using the Rome III diagnostic criteria. Univariable and multivariable analyses were done to identify specific disorders and baseline factors associated with migraines and tension-type headache. FINDINGS Between Nov 1, 2014, and Jan 31, 2015, we enrolled 648 controls and 424 cases (257 patients with migraine and 167 with tension-type headache). 83 (32%) children and adolescents in the migraine group were diagnosed with functional gastrointestinal disorders compared with 118 (18%) in the control group (p<0·0001). Multivariable logistic regression showed a significant association between migraine and three gastrointestinal disorders: functional dyspepsia (odds ratio 10·76, 95% CI 3·52-32·85; p<0·0001), irritable bowel syndrome (3·47, 1·81-6·62; p=0·0002), and abdominal migraine (5·87, 1·95-17·69; p=0·002). By contrast, there was an inverse association between migraine and functional constipation (0·34, 0·14-0·84, p=0·02). 41 (25%) participants with tension-type headache had functional gastrointestinal disorders, which did not significantly differ from the prevalence of these disorders in the control group (p=0·07); no significant association was noted between any functional gastrointestinal disease and tension-type headaches. INTERPRETATION Three abdominal-pain-related functional gastrointestinal disorders were associated with migraine in children and adolescents. These findings are of value to the diagnosis and management of these common diseases. Future studies should investigate whether antimigraine drugs are of benefit in functional gastrointestinal disorders. FUNDING None.
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Affiliation(s)
- Julie Le Gal
- Department of Pediatric Emergency Care, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France
| | - Jean-Francois Michel
- Department of Pediatric Emergency Care, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France
| | - Victoria Elisa Rinaldi
- Department of Pediatrics, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Perugia, Italy
| | - Daniele Spiri
- Department of Pediatrics, Luigi Sacco Hospital, Università degli Studi di Milano, Milan, Italy
| | - Raffaella Moretti
- Pediatric Migraine and Neurovascular Diseases Unit, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France; Department of Pediatrics, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Udine, Italy; INSERM, U1141, DHU PROTECT, Paris, France
| | - Donatella Bettati
- Department of Pediatric Emergency Care, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France
| | - Silvia Romanello
- Department of Pediatric Emergency Care, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France; Pediatric Migraine and Neurovascular Diseases Unit, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France
| | - Paola Berlese
- Department of Pediatric Emergency Care, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France; Department of Women's and Children's Health, University of Padova, Padova, Italy
| | - Rosa Lualdi
- Department of Pediatrics, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Udine, Italy
| | - Priscilla Boizeau
- Unit of Clinical Epidemiology, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France; INSERM, CIC 1426, Paris, France
| | - Jerome Viala
- Department of Pediatric Gastroenterology, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France; INSERM UMR1149 Paris, France
| | - Marc Bellaiche
- Department of Pediatric Gastroenterology, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France
| | - Gian Vincenzo Zuccotti
- Department of Pediatrics, Luigi Sacco Hospital, Università degli Studi di Milano, Milan, Italy
| | - Giovanni Crichiutti
- Department of Pediatrics, Azienda Ospedaliero-Universitaria Santa Maria della Misericordia, Udine, Italy
| | - Corinne Alberti
- Unit of Clinical Epidemiology, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France; INSERM, CIC 1426, Paris, France
| | - Luigi Titomanlio
- Department of Pediatric Emergency Care, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France; Pediatric Migraine and Neurovascular Diseases Unit, Assistance Publique Hôpitaux (APHP) Hospital Robert Debré, Paris, France; INSERM, U1141, DHU PROTECT, Paris, France.
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Effects of Voluntary Locomotion and Calcitonin Gene-Related Peptide on the Dynamics of Single Dural Vessels in Awake Mice. J Neurosci 2016; 36:2503-16. [PMID: 26911696 DOI: 10.1523/jneurosci.3665-15.2016] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The dura mater is a vascularized membrane surrounding the brain and is heavily innervated by sensory nerves. Our knowledge of the dural vasculature has been limited to pathological conditions, such as headaches, but little is known about the dural blood flow regulation during behavior. To better understand the dynamics of dural vessels during behavior, we used two-photon laser scanning microscopy (2PLSM) to measure the diameter changes of single dural and pial vessels in the awake mouse during voluntary locomotion. Surprisingly, we found that voluntary locomotion drove the constriction of dural vessels, and the dynamics of these constrictions could be captured with a linear convolution model. Dural vessel constrictions did not mirror the large increases in intracranial pressure (ICP) during locomotion, indicating that dural vessel constriction was not caused passively by compression. To study how behaviorally driven dynamics of dural vessels might be altered in pathological states, we injected the vasodilator calcitonin gene-related peptide (CGRP), which induces headache in humans. CGRP dilated dural, but not pial, vessels and significantly reduced spontaneous locomotion but did not block locomotion-induced constrictions in dural vessels. Sumatriptan, a drug commonly used to treat headaches, blocked the vascular and behavioral the effects of CGRP. These findings suggest that, in the awake animal, the diameters of dural vessels are regulated dynamically during behavior and during drug-induced pathological states.
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41
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Aguila MER, Rebbeck T, Leaver AM, Lagopoulos J, Brennan PC, Hübscher M, Refshauge KM. The Association Between Clinical Characteristics of Migraine and Brain GABA Levels: An Exploratory Study. THE JOURNAL OF PAIN 2016; 17:1058-1067. [PMID: 27369186 DOI: 10.1016/j.jpain.2016.06.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 06/07/2016] [Accepted: 06/18/2016] [Indexed: 01/01/2023]
Abstract
UNLABELLED Migraine is prevalent and disabling yet is poorly understood. One way to better understand migraine is to examine its clinical characteristics and potential biomarkers such as gamma-aminobutyric acid (GABA). The primary objective of this study was to explore whether relevant disease characteristics of migraine are associated with brain GABA levels. Twenty adults fulfilling the established diagnostic criteria for migraine and 20 age- and gender-matched controls completed this cross-sectional study. Pain, central sensitization, negative emotional state, and perceived disability were measured using Short-form McGill Pain Questionnaire-2, Central Sensitization Inventory, Depression Anxiety Stress Scales-21, and Headache Impact Test-6, respectively. Secondary analysis of brain GABA levels of the same cohort measured using proton magnetic resonance spectroscopy was conducted. The migraine group had significantly higher scores than the control group on pain, central sensitization, and disability. Correlation analyses showed fair positive association between GABA levels and pain and central sensitization scores. No association was found between GABA levels and emotional state and disability. These findings are preliminary evidence supporting the use of questionnaires and GABA levels in characterizing migraine better and broadening the diagnostic process. These findings also strengthen the rationale for the role of GABA in migraine pathophysiology and corroborate the potential of GABA as a migraine biomarker. PERSPECTIVE Higher pain and central sensitization scores were associated with increased brain GABA levels in individuals with migraine. These findings offer preliminary evidence for the usefulness of measuring pain and central sensitization in migraine and provide some support for the possible role of GABA in migraine pathophysiology and its potential as a diagnostic marker.
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Affiliation(s)
- Maria-Eliza R Aguila
- The University of Sydney Faculty of Health Sciences, Lidcombe, New South Wales, Australia; University of the Philippines College of Allied Medical Professions, Manila, Philippines.
| | - Trudy Rebbeck
- The University of Sydney Faculty of Health Sciences, Lidcombe, New South Wales, Australia
| | - Andrew M Leaver
- The University of Sydney Faculty of Health Sciences, Lidcombe, New South Wales, Australia
| | - Jim Lagopoulos
- Brain and Mind Centre, Sydney Medical School, Camperdown, New South Wales, Australia; Sunshine Coast Mind and Neuroscience - Thompson Institute, University of the Sunshine Coast, Birtinya, Queensland, Australia
| | - Patrick C Brennan
- The University of Sydney Faculty of Health Sciences, Lidcombe, New South Wales, Australia
| | - Markus Hübscher
- The University of Sydney Faculty of Health Sciences, Lidcombe, New South Wales, Australia; Neuroscience Research Australia and The University of New South Wales, Randwick, New South Wales, Australia
| | - Kathryn M Refshauge
- The University of Sydney Faculty of Health Sciences, Lidcombe, New South Wales, Australia
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Hodkinson DJ, Veggeberg R, Wilcox SL, Scrivani S, Burstein R, Becerra L, Borsook D. Primary Somatosensory Cortices Contain Altered Patterns of Regional Cerebral Blood Flow in the Interictal Phase of Migraine. PLoS One 2015; 10:e0137971. [PMID: 26372461 PMCID: PMC4570777 DOI: 10.1371/journal.pone.0137971] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 08/24/2015] [Indexed: 01/01/2023] Open
Abstract
The regulation of cerebral blood flow (CBF) is a complex integrated process that is critical for supporting healthy brain function. Studies have demonstrated a high incidence of alterations in CBF in patients suffering from migraine with and without aura during different phases of attacks. However, the CBF data collected interictally has failed to show any distinguishing features or clues as to the underlying pathophysiology of the disease. In this study we used the magnetic resonance imaging (MRI) technique—arterial spin labeling (ASL)—to non-invasively and quantitatively measure regional CBF (rCBF) in a case-controlled study of interictal migraine. We examined both the regional and global CBF differences between the groups, and found a significant increase in rCBF in the primary somatosensory cortex (S1) of migraine patients. The CBF values in S1 were positively correlated with the headache attack frequency, but were unrelated to the duration of illness or age of the patients. Additionally, 82% of patients reported skin hypersensitivity (cutaneous allodynia) during migraine, suggesting atypical processing of somatosensory stimuli. Our results demonstrate the presence of a disease-specific functional deficit in a known region of the trigemino-cortical pathway, which may be driven by adaptive or maladaptive functional plasticity. These findings may in part explain the altered sensory experiences reported between migraine attacks.
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Affiliation(s)
- Duncan J. Hodkinson
- Center for Pain and the Brain, Department of Anesthesiology, Perioperative & Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States of America
- * E-mail:
| | - Rosanna Veggeberg
- Center for Pain and the Brain, Department of Anesthesiology, Perioperative & Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Sophie L. Wilcox
- Center for Pain and the Brain, Department of Anesthesiology, Perioperative & Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Steven Scrivani
- Center for Pain and the Brain, Department of Anesthesiology, Perioperative & Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States of America
- Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Boston, MA, United States of America
| | - Rami Burstein
- Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, United States of America
| | - Lino Becerra
- Center for Pain and the Brain, Department of Anesthesiology, Perioperative & Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States of America
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, United States of America
| | - David Borsook
- Center for Pain and the Brain, Department of Anesthesiology, Perioperative & Pain Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, MA, United States of America
- Department of Psychiatry, McLean Hospital, Harvard Medical School, Boston, MA, United States of America
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Abstract
The term spreading depolarization (SD) refers to waves of abrupt, sustained mass depolarization in gray matter of the CNS. SD, which spreads from neuron to neuron in affected tissue, is characterized by a rapid near-breakdown of the neuronal transmembrane ion gradients. SD can be induced by hypoxic conditions--such as from ischemia--and facilitates neuronal death in energy-compromised tissue. SD has also been implicated in migraine aura, where SD is assumed to ascend in well-nourished tissue and is typically benign. In addition to these two ends of the "SD continuum," an SD wave can propagate from an energy-depleted tissue into surrounding, well-nourished tissue, as is often the case in stroke and brain trauma. This review presents the neurobiology of SD--its triggers and propagation mechanisms--as well as clinical manifestations of SD, including overlaps and differences between migraine aura and stroke, and recent developments in neuromonitoring aimed at better diagnosis and more targeted treatments.
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Affiliation(s)
- Jens P Dreier
- Department of Neurology, Charité University Medicine Berlin, 10117 Berlin, Germany; Department of Experimental Neurology, Charité University Medicine Berlin, 10117 Berlin, Germany; Center for Stroke Research, Charité University Medicine Berlin, 10117 Berlin, Germany.
| | - Clemens Reiffurth
- Department of Experimental Neurology, Charité University Medicine Berlin, 10117 Berlin, Germany; Center for Stroke Research, Charité University Medicine Berlin, 10117 Berlin, Germany
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44
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Aguila MER, Lagopoulos J, Leaver AM, Rebbeck T, Hübscher M, Brennan PC, Refshauge KM. Elevated levels of GABA+ in migraine detected using (1) H-MRS. NMR IN BIOMEDICINE 2015; 28:890-897. [PMID: 25997981 DOI: 10.1002/nbm.3321] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 04/09/2015] [Accepted: 04/09/2015] [Indexed: 06/04/2023]
Abstract
γ-Aminobutyric acid (GABA) has been implicated in several pain conditions, yet no study has systematically evaluated GABA levels in migraine using (1) H-MRS. The accurate detection, separation and quantification of GABA in individuals with migraine could elucidate the role of this neurotransmitter in migraine pathophysiology. Such information may eventually be useful in the diagnosis and development of more effective treatments for migraine. The aims of this study were therefore to compare the concentration of GABA+ in individuals with migraine with that in asymptomatic individuals, and to determine the diagnostic potential of GABA+ in the classification of those with or without migraine. In this case-control study, GABA+ levels in the brain were determined in 19 participants with migraine and 19 matched controls by (1) H-MRS using Mescher-Garwood point-resolved spectroscopy (MEGA-PRESS) sequence. The diagnostic accuracy of GABA+ for the detection of migraine and the optimal cut-off value were determined by receiver operating characteristic analysis. GABA+ levels were significantly higher (p = 0.002) in those with migraine [median, 1.41 institutional units (IU); interquartile range, 1.31-1.50 IU] than in controls (median, 1.18 IU; interquartile range, 1.12-1.35 IU). The GABA+ concentration appears to have good accuracy for the classification of individuals with or without migraine [area under the curve (95% confidence interval), 0.837 (0.71-0.96); p < 0.001]. The optimal GABA+ cut-off value for migraine was 1.30 IU, with a sensitivity of 84.2%, specificity of 68.4% and positive likelihood ratio of +2.67. The outcomes of this study suggest altered GABA metabolism in migraine. These results add to the scarce evidence on the putative role of GABA in migraine and provide a basis to further explore the causal relationship between GABA+ and the pathophysiology of migraine. This study also demonstrates that GABA+ concentration has good diagnostic accuracy for migraine. These findings offer new research and practice directions for migraine diagnosis.
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Affiliation(s)
- Maria-Eliza R Aguila
- The University of Sydney Faculty of Health Sciences, Lidcombe, NSW, Australia
- University of the Philippines College of Allied Medical Professions, Manila, Philippines
| | - Jim Lagopoulos
- Brain and Mind Research Institute, Sydney Medical School, Camperdown, NSW, Australia
| | - Andrew M Leaver
- The University of Sydney Faculty of Health Sciences, Lidcombe, NSW, Australia
| | - Trudy Rebbeck
- The University of Sydney Faculty of Health Sciences, Lidcombe, NSW, Australia
| | - Markus Hübscher
- The University of Sydney Faculty of Health Sciences, Lidcombe, NSW, Australia
- Neuroscience Research Australia and The University of New South Wales, Randwick, NSW, Australia
| | - Patrick C Brennan
- The University of Sydney Faculty of Health Sciences, Lidcombe, NSW, Australia
| | - Kathryn M Refshauge
- The University of Sydney Faculty of Health Sciences, Lidcombe, NSW, Australia
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45
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Kheirollahi M, Kazemi M, Amini G, Khorvash F, Ahangari F, Kolahdouz M, Koulivand L. Expression of prostaglandin I2 (prostacyclin) receptor in blood of migraine patients: A potential biomarker. Adv Biomed Res 2015; 4:121. [PMID: 26261823 PMCID: PMC4513332 DOI: 10.4103/2277-9175.158030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 01/18/2015] [Indexed: 11/18/2022] Open
Abstract
Background: Migraine is the most common chronic neurological disorders that may be associated with vasodilatation. According to the role of prostaglandin I2 (prostacyclin) receptor (PTGIR) in migraine as a receptor, which acts in vasodilatation, we decided to study the changes of PTGIR expression in migraine patients in relation to a suitable control group. Materials and Methods: Extracted mRNA from lymphocytes of 50 cases and 50 controls was used to synthesize cDNA. Real-time polymerase chain reaction was performed, and the data were analyzed. Our results show that PTGIR mRNA expression in cases was significantly higher than the control group (P = 0.010). Results: In conclusion, mRNA expression of PTGIR in the blood of people with migraines could be considered as a biomarker. Conclusion: In addition, repression of PTGIR gene expression by methods such as using siRNA is probably suitable for therapy of migraine patients.
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Affiliation(s)
- Majid Kheirollahi
- Department of Genetics and Molecular Biology, Pediatric Inherited Diseases Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Kazemi
- Department of Genetics and Molecular Biology, Pediatric Inherited Diseases Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Gilda Amini
- Department of Genetics and Molecular Biology, Pediatric Inherited Diseases Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fariborz Khorvash
- Department of Neurology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Fatemeh Ahangari
- Department of Genetics and Molecular Biology, Pediatric Inherited Diseases Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahsa Kolahdouz
- Department of Genetics and Molecular Biology, Pediatric Inherited Diseases Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Leila Koulivand
- Department of Genetics and Molecular Biology, Pediatric Inherited Diseases Research Center, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Raieli V, Giordano G, Spitaleri C, Consolo F, Buffa D, Santangelo G, Savettieri G, Vanadia F, D'Amelio M. Migraine and cranial autonomic symptoms in children and adolescents: a clinical study. J Child Neurol 2015; 30:182-6. [PMID: 24846900 DOI: 10.1177/0883073814535494] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The frequency of cranial autonomic symptoms in children affected by primary headaches is uncertain. The aim of our study was to estimate the frequency of symptoms in pediatric headaches and correlate it with main migraine characteristics. A questionnaire investigating the presence of cranial autonomic symptoms was administered to all children with primary headache for 2 years. A total of 230 children with primary headache (105 males, 125 females) were included. Two hundred two children were affected by migraine and 28 (12.2%) by other primary headaches. Cranial autonomic symptoms were significantly complained by migraineurs (55% vs. 17.8%) (P < .001) and by children with higher frequency of migraine attacks (odds ratio = 2.6, confidence interval = 1.4-4.7, P = .001). Our findings show that cranial autonomic symptoms are rather common during pediatric migraine attacks. The association between cranial autonomic symptoms and higher frequency of attacks might suggest the role of the trigeminal-autonomic reflex in migraine pathophysiology.
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Affiliation(s)
- V Raieli
- Child Neuropsychiatry Unit, Di Cristina Hospital -ARNAS CIVICO Palermo, Palermo, Italy
| | - G Giordano
- Child Neuropsychiatry School, University of Palermo, Palermo, Italy
| | - C Spitaleri
- Child Neuropsychiatry School, University of Palermo, Palermo, Italy
| | - F Consolo
- Child Neuropsychiatry Unit, Di Cristina Hospital -ARNAS CIVICO Palermo, Palermo, Italy
| | - D Buffa
- Child Neuropsychiatry Unit, Di Cristina Hospital -ARNAS CIVICO Palermo, Palermo, Italy
| | - G Santangelo
- Child Neuropsychiatry Unit, Di Cristina Hospital -ARNAS CIVICO Palermo, Palermo, Italy
| | - G Savettieri
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
| | - F Vanadia
- Child Neuropsychiatry Unit, Di Cristina Hospital -ARNAS CIVICO Palermo, Palermo, Italy
| | - M D'Amelio
- Department of Experimental Biomedicine and Clinical Neurosciences, University of Palermo, Palermo, Italy
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Shiue I. Chronic diseases and life events accounted for 2-18 % population attributable risks for adult hearing loss: UK Adult Psychiatric Morbidity Survey, 2007. Eur Arch Otorhinolaryngol 2015; 273:93-103. [PMID: 25575844 DOI: 10.1007/s00405-015-3504-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 01/06/2015] [Indexed: 11/29/2022]
Abstract
Links between chronic diseases and hearing loss in adults have emerged. However, previous investigations were not complete, and the role of life events was unclear. Therefore, it was aimed to examine the relationships of common chronic diseases and life events and adult hearing loss in a country-wide and population-based study. Data were retrieved from UK Adult Psychiatric Morbidity Survey, 2007, being cross-sectional, including demographics, self-reported prior health conditions and hearing loss (ever and in the last 12 months), and several major life events. Analyses included Chi square test, t test, logistic regression model, and population attributable risk estimation. People who had prior health conditions including cancer, migraine, dementia, depression, cataracts, chronic bronchitis, allergy, bowel problem, bladder problem, arthritis, muscle problem or skin problem tended to report hearing loss than their counterparts. People who have experienced major life events including post-traumatic stress disorder, serious illness of close relatives, death of family, serious problems with friends, major financial crisis, valuables stolen, being bullied, violence at home, sexual abuse or running away from home were also more likely to experience ever hearing loss problem or that in the last 12 months. 2.0-13.1 % adult hearing loss could be delayed or prevented by managing chronic diseases while 4.1-18.1 % might be delayed or prevented by minimizing the negative effects of life events. Chronic diseases and life events were associated with hearing loss in adults. Better managing lifestyle to minimize detrimental impacts in future health and nursing programs would be suggested.
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Affiliation(s)
- Ivy Shiue
- School of Energy, Geoscience, Infrastructure and Society, Heriot-Watt University, Riccarton, Edinburgh, EH14 4AS, Scotland, UK. .,Owens Institute for Behavioral Research, University of Georgia, Athens, USA.
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48
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Abstract
Migraine is a neurological disorder that manifests as a debilitating headache associated with altered sensory perception. The neuropeptide calcitonin gene-related peptide (CGRP) is now firmly established as a key player in migraine. Clinical trials carried out during the past decade have proved that CGRP receptor antagonists are effective for treating migraine, and antibodies to the receptor and CGRP are currently under investigation. Despite this progress in the clinical arena, the mechanisms by which CGRP triggers migraine remain uncertain. This review discusses mechanisms whereby CGRP enhances sensitivity to sensory input at multiple levels in both the periphery and central nervous system. Future studies on epistatic and epigenetic regulators of CGRP actions are expected to shed further light on CGRP actions in migraine. In conclusion, targeting CGRP represents an approachable therapeutic strategy for migraine.
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49
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He Q, Lin X, Wang F, Xu J, Ren Z, Chen W, Xing X. Associations of a polymorphism in the intercellular adhesion molecule-1 (ICAM1) gene and ICAM1 serum levels with migraine in a Chinese Han population. J Neurol Sci 2014; 345:148-53. [DOI: 10.1016/j.jns.2014.07.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 07/09/2014] [Accepted: 07/12/2014] [Indexed: 10/25/2022]
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50
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Eröz R, Bahadir A, Dikici S, Tasdemir S. Association of endothelial nitric oxide synthase gene polymorphisms (894G/T, -786T/C, G10T) and clinical findings in patients with migraine. Neuromolecular Med 2014; 16:587-93. [PMID: 24845269 DOI: 10.1007/s12017-014-8311-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 05/06/2014] [Indexed: 02/07/2023]
Abstract
Migraine is a common neurological disorder characterized by recurrent attacks, unilateral head pain, and related symptoms. The aim of this study was to investigate three endothelial nitric oxide synthase (eNOS) polymorphisms in 176 patients with migraine and 123 healthy individuals. Clinical and biochemical parameters were investigated. Genetic analysis was performed using the polymerase chain reaction-restriction fragment length polymorphism method. The differences between migraine cases and the control group were significant for two polymorphisms (-786T/C and 894G/T) (p = 0.000). Homocysteine and body mass index (BMI) were significantly higher in the migraine group than in the control group (p = 0.001 and p = 0.000). The relation between -786T/C genotype and BMI and allodynia was significant. TC heterozygotes and CC homozygotes were significantly higher in the migraine group than in the control group (OR 2.843 and 95 % CI 1.681-4.808 and OR 3.729 and 95 % CI 1.784-7.792, respectively). The 894G/T genotype was correlated with BMI, pain intensity, age at the onset of migraine, nausea, tension, compression, and allodynia. For this polymorphism, GT heterozygotes and TT homozygotes were significantly higher in the migraine group than in the control group (OR 3.027 and 95 % CI 1.830-5.008 and OR 3.221 and 95 % CI 1.223-8.484, respectively). The G10T genotype was correlated with attack duration and age at the onset of migraine (p = 0.008 and p = 0.040). eNOS polymorphisms may be useful markers for assessing migraine risk and clinical diagnosis.
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Affiliation(s)
- Recep Eröz
- Department of Medical Genetics, Medical School, Duzce University, Duzce, 81620, Turkey,
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