1
|
Messina R, Rocca MA, Goadsby PJ, Filippi M. Insights into migraine attacks from neuroimaging. Lancet Neurol 2023; 22:834-846. [PMID: 37478888 DOI: 10.1016/s1474-4422(23)00152-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 03/15/2023] [Accepted: 04/12/2023] [Indexed: 07/23/2023]
Abstract
Migraine is one of the most common neurological diseases and it has a huge social and personal impact. Although head pain is the core symptom, individuals with migraine can have a plethora of non-headache symptoms that precede, accompany, or follow the pain. Neuroimaging studies have shown that the involvement of specific brain areas can explain many of the symptoms reported during the different phases of migraine. Recruitment of the hypothalamus, pons, spinal trigeminal nucleus, thalamus, and visual and pain-processing cortical areas starts during the premonitory phase and persists through the headache phase, contributing to the onset of pain and associated symptoms. Once the pain stops, the involvement of most brain areas ends, although the pons, hypothalamus, and visual cortex remain active after acute treatment intake and resolution of migraine symptoms. A better understanding of the correlations between imaging findings and migraine symptomatology can provide new insight into migraine pathophysiology and the mechanisms of novel migraine-specific treatments.
Collapse
Affiliation(s)
- Roberta Messina
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Maria A Rocca
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Peter J Goadsby
- NIHR King's Clinical Research Facility, King's College, London, UK; Department of Neurology, University of California, Los Angeles, CA, USA
| | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy; Neurorehabilitation Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy; Neurophysiology Service, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| |
Collapse
|
2
|
Li Y, Chen G, Lv J, Hou L, Dong Z, Wang R, Su M, Yu S. Abnormalities in resting-state EEG microstates are a vulnerability marker of migraine. J Headache Pain 2022; 23:45. [PMID: 35382739 PMCID: PMC8981824 DOI: 10.1186/s10194-022-01414-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/15/2022] [Indexed: 12/31/2022] Open
Abstract
Background Resting-state EEG microstates are thought to reflect brief activations of several interacting components of resting-state brain networks. Surprisingly, we still know little about the role of these microstates in migraine. In the present study, we attempted to address this issue by examining EEG microstates in patients with migraine without aura (MwoA) during the interictal period and comparing them with those of a group of healthy controls (HC). Methods Resting-state EEG was recorded in 61 MwoA patients (50 females) and 66 HC (50 females). Microstate parameters were compared between the two groups. We computed four widely identified canonical microstate classes A-D. Results Microstate classes B and D displayed higher time coverage and occurrence in the MwoA patient group than in the HC group, while microstate class C exhibited significantly lower time coverage and occurrence in the MwoA patient group. Meanwhile, the mean duration of microstate class C was significantly shorter in the MwoA patient group than in the HC group. Moreover, among the MwoA patient group, the duration of microstate class C correlated negatively with clinical measures of headache-related disability as assessed by the six-item Headache Impact Test (HIT-6). Finally, microstate syntax analysis showed significant differences in transition probabilities between the two groups, primarily involving microstate classes B, C, and D. Conclusions By exploring EEG microstate characteristics at baseline we were able to explore the neurobiological mechanisms underlying altered cortical excitability and aberrant sensory, affective, and cognitive processing, thus deepening our understanding of migraine pathophysiology.
Collapse
|
3
|
Chen G, Li Y, Dong Z, Wang R, Zhao D, Obeso I, Yu S. Response inhibition alterations in migraine: evidence from event-related potentials and evoked oscillations. J Headache Pain 2020; 21:119. [PMID: 33008328 PMCID: PMC7531083 DOI: 10.1186/s10194-020-01187-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Accepted: 09/24/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Migraine is characterized by a hypersensitivity to environmental stimulation which climaxes during headache attacks but persists during attack-free period. Despite ongoing debates about the nature of the mechanisms giving rise to this abnormality, the presence of deficient inhibitory cortical processes has been proposed to be one possible mechanism underlying its pathogenesis. Empirical evidence supporting this claim is mainly based on previous accounts showing functional cortical disexcitability in the sensory domain. Considering that a general inhibitory control process can play an important role across early to later stage of information processing, this may indicate the important role other dimensions of inhibitory control can play in migraine disability. The present study examined the pathophysiological features of inhibitory control that takes place during suppression of prepotent responses in migraineurs. METHODS Twenty-two patients with migraine without aura (mean age = 30.86 ± 5.69 years; 19 females) during the interictal period and 25 healthy controls (mean age = 30.24 ± 3.52 years; 18 females) were recruited. We used a stop signal task in combination with event-related potentials (ERPs) to examine participants' neural activity supporting response inhibition. RESULTS Behaviorally, migraineurs exhibited prolonged stop signal reaction times relative to healthy controls. At the neural level, the amplitude of the stop-N2 over fronto-central, central and centro-parietal scalp regions, a component of the ERPs related to conflict monitoring during early, non-motoric stages of inhibition, was significantly increased in migraineurs. Meanwhile, the amplitude of the stop-P3 over central and centro-parietal scalp regions, a component of the ERPs reflecting late-stage inhibition of the motor system and cognitive evaluation of motor inhibition, was also significantly increased in migraineurs. Ultimately, our time-frequency analysis further revealed increased delta activity in migraineurs. CONCLUSIONS Consistent with the theory that alterations in cognitive cortical processes are a key signature of migraine, our findings revealed an abnormal state of suppressing prepotent responses in migraineurs, which can be attributed to cortical disexcitability of the pre-frontal executive network and centro-parietal sensorimotor network. These novel findings extend to show the existence of dysfunctional inhibition control that occurs during suppression of prepotent responses in migraneurs.
Collapse
Affiliation(s)
- Guoliang Chen
- Medical School of Chinese PLA, Beijing, China
- Department of Neurology, The first Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
- Department of Psychiatry, The 967th Hospital of Joint Logistic Support Force of PLA, Dalian, China
| | - Yansong Li
- Reward, Competition and Social Neuroscience Lab, Department of Psychology, School of Social and Behavioral Sciences, 210023, Nanjing, China
- Institute for Brain Sciences, Nanjing University, 210023, Nanjing, China
| | - Zhao Dong
- Medical School of Chinese PLA, Beijing, China
- Department of Neurology, The first Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Rongfei Wang
- Medical School of Chinese PLA, Beijing, China
- Department of Neurology, The first Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Dengfa Zhao
- Medical School of Chinese PLA, Beijing, China
- Department of Neurology, The first Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China
| | - Ignacio Obeso
- HM Hospitales - Centro Integral en Neurociencias HM CINAC, Móstoles, Madrid, Spain
| | - Shengyuan Yu
- Medical School of Chinese PLA, Beijing, China.
- Department of Neurology, The first Medical Center, Chinese PLA General Hospital, Fuxing Road 28, Haidian District, Beijing, 100853, China.
| |
Collapse
|
4
|
Wesner MF, Brazeau J. The Psychophysical Assessment of Hierarchical Magno-, Parvo- and Konio-Cellular Visual Stream Dysregulations in Migraineurs. Eye Brain 2019; 11:49-62. [PMID: 31819693 PMCID: PMC6890234 DOI: 10.2147/eb.s225171] [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: 07/29/2019] [Accepted: 11/08/2019] [Indexed: 01/03/2023] Open
Abstract
Introduction Although conscious, image-forming illusions have been noted in migraine, few studies have specifically sought to collectively evaluate the role of all three parallel visual processing streams in the retinogeniculostriate pathway involved with image-forming vision and their implications in the development of migraine symptoms. Methods We psychophysically assessed the functionality of the inferred magnocellular (MC), parvocellular (PC), and koniocellular (KC) streams at different hierarchical loci across three clinical groups: individuals who experience migraine with aura (MA; n=13), experience migraine without aura (MWO; n=14), and Controls (n=15). Participants completed four experiments: Experiment 1 designed to assess retinal short-wavelength-sensitive (S-) cone sensitivities; Experiment 2 intended to measure postretinal temporal and spatiochromatic contrast sensitivities; Experiment 3 intended to assess postretinal spatiotemporal achromatic contrast sensitivities; and Experiment 4 designed to measure thalamocortical color discriminations along the three cone-excitation axes. Results S-cone deficits were revealed with greater retinal areas being affected in MA compared to MWO participants. Findings across the four experiments suggest a prominent retinal locus of dysfunction in MA (lesser in MWO) with potential feedforward compensations occurring within the KC visual stream. Conclusion Complex, integrative network compensations need to be factored in when considering the dysregulating influences of migraine along the visual pathway.
Collapse
Affiliation(s)
- Michael F Wesner
- Psychology Department, Lakehead University, Thunder Bay, Ontario P7B 5E1, Canada
| | - James Brazeau
- Center for Pediatric Excellence, Ottawa, ON K2G 1W2, Canada
| |
Collapse
|
5
|
Ong JJY, Wei DYT, Goadsby PJ. Recent Advances in Pharmacotherapy for Migraine Prevention: From Pathophysiology to New Drugs. Drugs 2019; 78:411-437. [PMID: 29396834 DOI: 10.1007/s40265-018-0865-y] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Migraine is a common and disabling neurological disorder, with a significant socioeconomic burden. Its pathophysiology involves abnormalities in complex neuronal networks, interacting at different levels of the central and peripheral nervous system, resulting in the constellation of symptoms characteristic of a migraine attack. Management of migraine is individualised and often necessitates the commencement of preventive medication. Recent advancements in the understanding of the neurobiology of migraine have begun to account for some parts of the symptomatology, which has led to the development of novel target-based therapies that may revolutionise how migraine is treated in the future. This review will explore recent advances in the understanding of migraine pathophysiology, and pharmacotherapeutic developments for migraine prevention, with particular emphasis on novel treatments targeted at the calcitonin gene-related peptide (CGRP) pathway.
Collapse
Affiliation(s)
- Jonathan Jia Yuan Ong
- Headache Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital, Wellcome Foundation Building, London, SE5 9PJ, UK.,Division of Neurology, Department of Medicine, National University Health System, University Medicine Cluster, Singapore, Singapore
| | - Diana Yi-Ting Wei
- Headache Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.,NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital, Wellcome Foundation Building, London, SE5 9PJ, UK
| | - Peter J Goadsby
- Headache Group, Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. .,NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital, Wellcome Foundation Building, London, SE5 9PJ, UK.
| |
Collapse
|
6
|
The role of nutrients in the pathogenesis and treatment of migraine headaches: Review. Biomed Pharmacother 2018; 102:317-325. [DOI: 10.1016/j.biopha.2018.03.059] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 03/09/2018] [Accepted: 03/11/2018] [Indexed: 12/28/2022] Open
|
7
|
Huang Q, Lv X, He Y, Wei X, Ma M, Liao Y, Qin C, Wu Y. Structural differences in interictal migraine attack after epilepsy: A diffusion tensor imaging analysis. Epilepsy Behav 2017; 77:8-12. [PMID: 29073475 DOI: 10.1016/j.yebeh.2017.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 09/05/2017] [Accepted: 09/05/2017] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Patients with epilepsy (PWE) are more likely to suffer from migraine attack, and aberrant white matter (WM) organization may be the mechanism underlying this phenomenon. This study aimed to use diffusion tensor imaging (DTI) technique to quantify WM structural differences in PWE with interictal migraine. METHODS Diffusion tensor imaging data were acquired in 13 PWE with migraine and 12 PWE without migraine. Diffusion metrics were analyzed using tract-atlas-based spatial statistics analysis. Atlas-based and tract-based spatial statistical analyses were conducted for robustness analysis. Correlation was explored between altered DTI metrics and clinical parameters. RESULTS The main results are as follows: (i) Axonal damage plays a key role in PWE with interictal migraine. (ii) Significant diffusing alterations included higher fractional anisotropy (FA) in the fornix, higher mean diffusivity (MD) in the middle cerebellar peduncle (CP), left superior CP, and right uncinate fasciculus, and higher axial diffusivity (AD) in the middle CP and right medial lemniscus. (iii) Diffusion tensor imaging metrics has the tendency of correlation with seizure/migraine type and duration. CONCLUSION Results indicate that characteristic structural impairments exist in PWE with interictal migraine. Epilepsy may contribute to migraine by altering WMs in the brain stem. White matter tracts in the fornix and right uncinate fasciculus also mediate migraine after epilepsy. This finding may improve our understanding of the pathological mechanisms underlying migraine attack after epilepsy.
Collapse
Affiliation(s)
- Qi Huang
- Department of Neurology, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Xin Lv
- Department of Neurology, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | | | - Xing Wei
- Department of Neurology, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Meigang Ma
- Department of Neurology, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Yuhan Liao
- Department of Neurology, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Chao Qin
- Department of Neurology, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Yuan Wu
- Department of Neurology, First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China.
| |
Collapse
|
8
|
Puledda F, Messina R, Goadsby PJ. An update on migraine: current understanding and future directions. J Neurol 2017; 264:2031-2039. [PMID: 28321564 PMCID: PMC5587613 DOI: 10.1007/s00415-017-8434-y] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 02/20/2017] [Indexed: 01/16/2023]
Abstract
Migraine is a common brain disorder with high disability rates which involves a series of abnormal neuronal networks, interacting at different levels of the central and peripheral nervous system. An increase in the interest around migraine pathophysiology has allowed researchers to unravel certain neurophysiological mechanisms and neurotransmitter involvement culminating in the recent development of novel therapies, which might substantially change the clinical approach to migraine patients. The present review will highlight the current aspects of migraine pathophysiology, covering an understanding of the complex workings of the migraine state and the brain regions responsible for them. We will further discuss the therapeutic agents which have appeared in the most recent years for migraine care, from calcitonin gene-related peptide (CGRP) receptor antagonists, gepants; through serotonin 5-HT1F receptor agonists, ditans, and CGRP or CGRP receptor monoclonal antibodies to invasive and non-invasive neuromodulation techniques.
Collapse
Affiliation(s)
- Francesca Puledda
- Headache Group, Department of Basic and Clinical Neuroscience, King's College London, London, UK
- NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital, London, UK
| | - Roberta Messina
- Headache Group, Department of Basic and Clinical Neuroscience, King's College London, London, UK
- NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital, London, UK
| | - Peter J Goadsby
- Headache Group, Department of Basic and Clinical Neuroscience, King's College London, London, UK.
- NIHR-Wellcome Trust King's Clinical Research Facility, King's College Hospital, London, UK.
| |
Collapse
|
9
|
Hu X, Liu Z, Chen W, Zheng J, Su N, Wang W, Lin C, Luo L. Individual Differences in the Accuracy of Judgments of Learning Are Related to the Gray Matter Volume and Functional Connectivity of the Left Mid-Insula. Front Hum Neurosci 2017; 11:399. [PMID: 28824403 PMCID: PMC5539074 DOI: 10.3389/fnhum.2017.00399] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 07/19/2017] [Indexed: 11/20/2022] Open
Abstract
The judgment of learning (JOL) is an important form of prospective metamemory judgment, and the biological basis of the JOL process is an important topic in metamemory research. Although previous task-related functional magnetic resonance imaging (MRI) studies have examined the brain regions underlying the JOL process, the neural correlates of individual differences in JOL accuracy require further investigation. This study used structural and resting-state functional MRI to investigate whether individual differences in JOL accuracy are related to the gray matter (GM) volume and functional connectivity of the bilateral insula and medial Brodmann area (BA) 11, which are assumed to be related to JOL accuracy. We found that individual differences in JOL accuracy were related to the GM volume of the left mid-insula and to the functional connectivity between the left mid-insula and various other regions, including the left superior parietal lobule/precuneus, bilateral inferior parietal lobule/intraparietal sulcus, right frontal pole and left parahippocampal gyrus/fusiform gyrus/cerebellum. Further analyses indicated that the functional connectivity related to individual differences in JOL accuracy could be divided into two factors and might support information integration and selective attention processes underlying accurate JOLs. In addition, individual differences in JOL accuracy were not related to the GM volume or functional connectivity of the medial BA 11. Our findings provide novel evidence for the role of the left mid-insula and its functional connectivity in the JOL process.
Collapse
Affiliation(s)
- Xiao Hu
- Collaborative Innovation Center of Assessment Toward Basic Education Quality, Beijing Normal UniversityBeijing, China.,State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal UniversityBeijing, China
| | - Zhaomin Liu
- School of Sociology, China University of Political Science and LawBeijing, China
| | - Wen Chen
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal UniversityBeijing, China
| | - Jun Zheng
- Collaborative Innovation Center of Assessment Toward Basic Education Quality, Beijing Normal UniversityBeijing, China.,State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal UniversityBeijing, China
| | - Ningxin Su
- Collaborative Innovation Center of Assessment Toward Basic Education Quality, Beijing Normal UniversityBeijing, China.,State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal UniversityBeijing, China
| | - Wenjing Wang
- State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal UniversityBeijing, China
| | - Chongde Lin
- Institute of Developmental Psychology, Beijing Normal UniversityBeijing, China
| | - Liang Luo
- Collaborative Innovation Center of Assessment Toward Basic Education Quality, Beijing Normal UniversityBeijing, China.,State Key Laboratory of Cognitive Neuroscience and Learning, Beijing Normal UniversityBeijing, China.,Institute of Developmental Psychology, Beijing Normal UniversityBeijing, China
| |
Collapse
|
10
|
Baratloo A, Mirbaha S, Delavar Kasmaei H, Payandemehr P, Elmaraezy A, Negida A. Intravenous caffeine citrate vs. magnesium sulfate for reducing pain in patients with acute migraine headache; a prospective quasi-experimental study. Korean J Pain 2017; 30:176-182. [PMID: 28757917 PMCID: PMC5532524 DOI: 10.3344/kjp.2017.30.3.176] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 03/26/2017] [Accepted: 03/27/2017] [Indexed: 01/03/2023] Open
Abstract
Background Current evidence suggests that intravenous magnesium sulfate might be effective for reducing migraine pain. In a recent pilot study, we showed that intravenous caffeine citrate could reduce the severity of migraine headache. The objective of this study is to investigate the efficacy of intravenous caffeine citrate vs. magnesium sulfate for management of acute migraine headache. Methods We conducted a prospective quasi-experimental study from January until May 2016 in two educational medical centers of Shahid Beheshti University of Medical Sciences (Shoahadaye Tajrish Hospital and Imam Hossein Hospital), Tehran, Iran. The study included patients who were referred to the emergency department and met the migraine diagnosis criteria of the International Headache Society. Patients were allocated into 2 groups receiving either 60 mg intravenous caffeine or 2 g intravenous magnesium sulfate. The pain scores, based on the visual analog scale, were recorded on admission, as well as one and two hours after receiving the drug. A Chi-Square test and student t-test were used for analysis of baseline characteristics. A Mann-Whitney U test and Wilcoxon singed rank test were used to analyze differences in the visual analogue scale (VAS) score between and within the groups respectively. Results In total, 70 patients (35 patients in each group) with the mean age of 33.1 ± 11.3 years were included (64.3% female). For the Caffeine citrate group, the median pain score decreased from 9.0 (2.0) to 5.0 (4.0) after one hour and to 3.0 (4.0) after two hours. For the magnesium sulfate group, the pain score decreased from 8.0 (2.0) to 2.0 (2.0) after one hour and to 0.0 (1.0) after two hours. Both intravenous caffeine citrate and intravenous magnesium sulfate reduced pain scores significantly but the magnesium sulfate group showed more improvement than the Caffeine citrate group after one hour (P < 0.001) and after two hours (P < 0.001). Conclusions It is likely that both intravenous caffeine and intravenous magnesium sulfate can reduce the severity of migraine headache. Moreover, intravenous magnesium sulfate at a dose of 2 g might be superior to intravenous caffeine citrate 60 mg for the short term management of migraine headache in emergency departments.
Collapse
Affiliation(s)
- Alireza Baratloo
- Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Mirbaha
- Department of Emergency Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Pooya Payandemehr
- Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmed Elmaraezy
- Faculty of Medicine, Al Azhar University, Cairo, Egypt.,Medical Research Group of Egypt, El-Sharkia, Egypt
| | - Ahmed Negida
- Medical Research Group of Egypt, El-Sharkia, Egypt.,Faculty of Medicine, Zagazig University, El-Sharkia, Egypt
| |
Collapse
|
11
|
Snijder RJR, Luermans JGLM, de Heij AH, Thijs V, Schonewille WJ, Van De Bruaene A, Swaans MJ, Budts WIHL, Post MC. Patent Foramen Ovale With Atrial Septal Aneurysm Is Strongly Associated With Migraine With Aura: A Large Observational Study. J Am Heart Assoc 2016; 5:e003771. [PMID: 27930349 PMCID: PMC5210450 DOI: 10.1161/jaha.116.003771] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 10/26/2016] [Indexed: 12/13/2022]
Abstract
BACKGROUND A patent foramen ovale (PFO) with atrial septal aneurysm (ASA) has been identified as a risk factor for cryptogenic stroke. Patients with migraine with aura (MA) appear to be at risk for silent brain infarction, which might be related to the presence of a PFO. However, the association between MA and PFO with ASA has never been reported. We examined this association in a large observational study. METHODS AND RESULTS Patients (>18 years) who underwent an agitated saline transesophageal echocardiography (cTEE) at our outpatient clinics within a timeframe of 4 years were eligible to be included. Before cTEE they received a validated headache questionnaire. Two neurologists diagnosed migraine with or without aura according to the International Headache Criteria. A total of 889 patients (mean age 56.4±14.3 years, 41.7% women) were included. A PFO was present in 23.2%, an isolated ASA in 2.7%, and a PFO with ASA in 6.9%. The occurrence of migraine was 18.9%; the occurrence of MA was 8.1%. The prevalence of PFO with ASA was significantly higher in patients with MA compared to patients without migraine (18.1% vs 6.1%; OR 3.72, 95% CI 1.86-7.44, P<0.001). However, a PFO without ASA was not significantly associated with MA (OR 1.50, 95% CI 0.79-2.82, P=0.21). Interestingly, a PFO with ASA was strongly associated with MA (OR 2.71, 95% CI 1.23-5.95, P=0.01). CONCLUSION In this large observational study, PFO with ASA was significantly associated with MA only. PFO closure studies should focus on this specific intra-atrial anomaly.
Collapse
Affiliation(s)
- Roel J R Snijder
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Justin G L M Luermans
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Albert H de Heij
- Department of Internal Medicine, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Vincent Thijs
- Florey Institute of Neuroscience and Mental Health, University of Melbourne, Victoria, Australia
- Department of Neurology, Austin Health, Victoria, Australia
| | | | | | - Martin J Swaans
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Werner I H L Budts
- Department of Cardiology, University Hospital Gasthuisberg, Leuven, Belgium
| | - Martijn C Post
- Department of Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands
| |
Collapse
|
12
|
Yu ZB, Peng J, Lv YB, Zhao M, Xie B, Liang ML, Li HT, Zhou ZH. Different mean thickness implicates involvement of the cortex in migraine. Medicine (Baltimore) 2016; 95:e4824. [PMID: 27631235 PMCID: PMC5402578 DOI: 10.1097/md.0000000000004824] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Revised: 08/17/2016] [Accepted: 08/18/2016] [Indexed: 11/25/2022] Open
Abstract
The results of neuroimaging studies on migraines have shown that the functions and functional connectivity networks of some brain regions are altered in migraine patients, and different brain structure volumes have also been observed in recent years. However, it is still not known whether the mean thickness of the cortex is different in migraine patients.A total of 48 migraine without aura (MWoA) patients in interictal phase and 48 healthy controls were enrolled in this study. All subjects received neurological and magnetic resonance imaging (MRI) examinations. Automatic segmentation processing of high-resolution MRI structure images was performed using FreeSurfer software.The mean cortical thickness of many brain regions in the frontal lobe, temporal lobe, occipital lobe, parietal lobe, and insula in the migraine patient group was significantly decreased compared with that in the healthy control group. The mean cortical thickness of the insula anterior was positively correlated with the duration of the disease course, while the mean cortical thickness of insula superior and insula inferior was negatively correlated with the duration of the disease course.The results showed that MWoA results from a complex interactive reaction involving many brain regions and many brain network systems together. However, it is still not clear whether the difference in the brain structure of migraine patients is the result or the cause of headache, which is a topic that must be better elucidated. Therefore, longitudinal neuroimaging studies on migraine patients with large samples sizes should be performed using more advanced neuroimaging techniques.
Collapse
Affiliation(s)
- Zhi-bo Yu
- Department of Radiology, The First Affiliated Hospital, Third Military Medical University
- Department of Medical Imaging, PLA No.324 Hospital
| | - Jing Peng
- Department of Neurology, The First Affiliated Hospital, Third Military Medical University
| | - Yan-bing Lv
- Department of General Surgery, PLA No.324 Hospital, Chongqing, China
| | - Ming Zhao
- Department of Radiology, The First Affiliated Hospital, Third Military Medical University
| | - Bing Xie
- Department of Radiology, The First Affiliated Hospital, Third Military Medical University
| | - Ming-long Liang
- Department of Radiology, The First Affiliated Hospital, Third Military Medical University
| | - Hai-tao Li
- Department of Radiology, The First Affiliated Hospital, Third Military Medical University
| | - Zhen-hua Zhou
- Department of Neurology, The First Affiliated Hospital, Third Military Medical University
| |
Collapse
|
13
|
Kwong KK, Chan ST. Neuroprotection and acidosis induced by cortical spreading depression. Neuropsychiatr Dis Treat 2016; 12:3191-3194. [PMID: 28003755 PMCID: PMC5161389 DOI: 10.2147/ndt.s125677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Kenneth K Kwong
- Department of Radiology, MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
| | - Suk-Tak Chan
- Department of Radiology, MGH/MIT/HMS Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, USA
| |
Collapse
|
14
|
Lukács M, Haanes KA, Majláth Z, Tajti J, Vécsei L, Warfvinge K, Edvinsson L. Dural administration of inflammatory soup or Complete Freund's Adjuvant induces activation and inflammatory response in the rat trigeminal ganglion. J Headache Pain 2015; 16:564. [PMID: 26329487 PMCID: PMC4556720 DOI: 10.1186/s10194-015-0564-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 08/19/2015] [Indexed: 03/31/2024] Open
Abstract
Background Migraine is a painful disorder with a huge impact on individual and public health. We hypothesize that migraine pain originates from a central mechanism that results secondarily in hypersensitivity in peripheral afferents associated with the cerebral and cranial blood vessels. It has previously been shown that application of inflammatory or algesic substances onto the dura mater or chemical stimulation of the dural receptive fields causes hypersensitivity to mechanical and thermal stimulation together with direct activation of the TG. We asked whether local inflammation of dura mater induces inflammatory activation in the trigeminal ganglion. Methods We performed topical administration of inflammatory soup (IS) or Complete Freund’s Adjuvant (CFA) onto an exposed area of the rat dura mater in vivo for 20 min. The window was closed and the rats were sacrificed after 4 h and up to 7 days. Myography was performed on middle meningeal arteries. The trigeminal ganglia were removed and processed for immunohistochemistry or Western blot. Results Both CFA and IS induced enhanced expression of pERK1/2, IL-1β and CGRP in the trigeminal ganglia. The pERK1/2 immunoreactivity was mainly seen in the satellite glial cells, while IL-1β reactivity was observed in the neuronal cytoplasm, close to the cell membrane, seemingly as sign of neuro-glial interaction. The CGRP expression in the neurons and nerve fibres was enhanced after the application of either inflammatory agent. Myography resulted in a strong vasoconstrictor response to IS, but not to CFA. Conclusions These results suggest that the application of IS or CFA onto the dura mater causes long-term activation of the TG and demonstrate the importance of the neuro-glial interaction in the activation of the trigeminovascular system. Electronic supplementary material The online version of this article (doi:10.1186/s10194-015-0564-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- M Lukács
- Department of Medicine, Institute of Clinical Sciences, Division of Experimental Vascular Research, Lund University, Sölvegatan 17, SE 221 84, Lund, Sweden
| | | | | | | | | | | | | |
Collapse
|
15
|
Wang M, Li Y, Lin Y. GABAA receptor α2 subtype activation suppresses retinal spreading depression. Neuroscience 2015; 298:137-44. [DOI: 10.1016/j.neuroscience.2015.04.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 03/25/2015] [Accepted: 04/08/2015] [Indexed: 11/27/2022]
|
16
|
Abstract
Cephalic pain and psychiatric disease physiopathology is one of the most elusive issues in medical research, and the cause might be common. Going through the possible reasons of the failure in understanding the physiopathology of these diseases might be helpful to project new studies that might overcome the difficulties encountered and thus open a window on cephalic pain and psychiatric disease. New approaches to psychiatric disease might be applied to cephalic pain.
Collapse
Affiliation(s)
- Alberto E Panerai
- Dipartimento di Scienze Farmacologiche e Biomolecolari, Università degli Studi di Milano, Via Balzaretti 9, 20133, Milan, Italy,
| |
Collapse
|
17
|
Bilgiç B, Kocaman G, Arslan AB, Noyan H, Sherifov R, Alkan A, Asil T, Parman Y, Baykan B. Volumetric differences suggest involvement of cerebellum and brainstem in chronic migraine. Cephalalgia 2015; 36:301-8. [DOI: 10.1177/0333102415588328] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 04/29/2015] [Indexed: 11/16/2022]
Abstract
Background Chronic migraine (CM) is a disabling neurologic condition that often evolves from episodic migraine. There has been mounting evidence on the volumetric changes detected by magnetic resonance imaging (MRI) technique in migraineurs. These studies mainly focused on episodic migraine patients and less is known about the differences in CM patients. Method A total of 24 CM patients and 24 healthy control individuals (all females) were included in this study. All participants underwent neurological examination and MRI. High-resolution anatomical MRI images were processed with an automated segmentation method (FreeSurfer). White-matter abnormalities of the brain were also evaluated with the Age-Related White-Matter-Changes Scale. Results The volumes of the cerebellum and brainstem were found to be smaller in CM patients compared to healthy controls. White-matter abnormalities were also found in CM patients, specifically in the bilateral parieto-occipital areas. There was no correlation between the clinical variables and volume decrease in these regions. Conclusion CM patients showed significant volume differences in infratentorial areas and white-matter abnormalities in the posterior part of the brain. It is currently unclear whether the structural brain changes seen in migraine patients are the cause or the result of headaches. Longitudinal volumetric neuroimaging studies with larger groups, especially on the chronification of migraine, are needed to shed light on this topic.
Collapse
Affiliation(s)
- Başar Bilgiç
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Turkey
- Hulusi Behçet Life Sciences Neuroscience Research Center, Istanbul University, Turkey
| | - Gülşen Kocaman
- Department of Neurology, Faculty of Medicine, Bezmialem University, Turkey
| | - Ali Bilgin Arslan
- Department of Cognitive, Linguistic and Psychological Sciences, Brown University, USA
| | - Handan Noyan
- Hulusi Behçet Life Sciences Neuroscience Research Center, Istanbul University, Turkey
| | - Resul Sherifov
- Department of Radiology, Faculty of Medicine, Bezmialem University, Turkey
| | - Alpay Alkan
- Department of Radiology, Faculty of Medicine, Bezmialem University, Turkey
| | - Talip Asil
- Department of Neurology, Faculty of Medicine, Bezmialem University, Turkey
| | - Yeşim Parman
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Turkey
| | - Betül Baykan
- Department of Neurology, Istanbul Faculty of Medicine, Istanbul University, Turkey
| |
Collapse
|
18
|
Teigen L, Boes CJ. An evidence-based review of oral magnesium supplementation in the preventive treatment of migraine. Cephalalgia 2014; 35:912-22. [DOI: 10.1177/0333102414564891] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 11/10/2014] [Indexed: 12/22/2022]
Abstract
Background Migraine is an incompletely understood, debilitating disorder that lacks a universally effective treatment. Magnesium participates in a variety of biochemical processes related to migraine pathophysiology, and a deficiency could contribute to migraine development. Methods A review of the literature from 1990 to the present on magnesium and migraine was conducted. Review The authors identified 16 studies aimed at magnesium status assessment in migraine, and four intervention trials assessing the efficacy of oral magnesium supplementation, independent of other therapies, in the prevention of migraine. Conclusion The strength of evidence supporting oral magnesium supplementation is limited at this time. With such limited evidence, a more advantageous alternative to magnesium supplementation, in patients willing to make lifestyle changes, may be to focus on increasing dietary magnesium intake.
Collapse
Affiliation(s)
- Levi Teigen
- Mayo Clinic College of Medicine, USA
- Mayo Clinic Department of Clinical Dietetics, USA
| | - Christopher J Boes
- Mayo Clinic College of Medicine, USA
- Mayo Clinic Department of Neurology, USA
| |
Collapse
|
19
|
Prooxidant versus antioxidant brain action of ascorbic acid in well-nourished and malnourished rats as a function of dose: A cortical spreading depression and malondialdehyde analysis. Neuropharmacology 2014; 86:155-60. [DOI: 10.1016/j.neuropharm.2014.06.027] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2014] [Revised: 06/25/2014] [Accepted: 06/27/2014] [Indexed: 11/21/2022]
|
20
|
DosSantos MF, Holanda-Afonso RC, Lima RL, DaSilva AF, Moura-Neto V. The role of the blood-brain barrier in the development and treatment of migraine and other pain disorders. Front Cell Neurosci 2014; 8:302. [PMID: 25339863 PMCID: PMC4189386 DOI: 10.3389/fncel.2014.00302] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2014] [Accepted: 09/08/2014] [Indexed: 12/23/2022] Open
Abstract
The function of the blood-brain barrier (BBB) related to chronic pain has been explored for its classical role in regulating the transcellular and paracellular transport, thus controlling the flow of drugs that act at the central nervous system, such as opioid analgesics (e.g., morphine) and non-steroidal anti-inflammatory drugs. Nonetheless, recent studies have raised the possibility that changes in the BBB permeability might be associated with chronic pain. For instance, changes in the relative amounts of occludin isoforms, resulting in significant increases in the BBB permeability, have been demonstrated after inflammatory hyperalgesia. Furthermore, inflammatory pain produces structural changes in the P-glycoprotein, the major efflux transporter at the BBB. One possible explanation for these findings is the action of substances typically released at the site of peripheral injuries that could lead to changes in the brain endothelial permeability, including substance P, calcitonin gene-related peptide, and interleukin-1 beta. Interestingly, inflammatory pain also results in microglial activation, which potentiates the BBB damage. In fact, astrocytes and microglia play a critical role in maintaining the BBB integrity and the activation of those cells is considered a key mechanism underlying chronic pain. Despite the recent advances in the understanding of BBB function in pain development as well as its interference in the efficacy of analgesic drugs, there remain unknowns regarding the molecular mechanisms involved in this process. In this review, we explore the connection between the BBB as well as the blood-spinal cord barrier and blood-nerve barrier, and pain, focusing on cellular and molecular mechanisms of BBB permeabilization induced by inflammatory or neuropathic pain and migraine.
Collapse
Affiliation(s)
- Marcos F. DosSantos
- Universidade Federal do Rio de Janeiro – Campus MacaéRio de Janeiro, Brazil
- Laboratório de Morfogênese Celular, Instituto de Ciências Biomédicas, Universidade Federal do Rio de JaneiroRio de Janeiro, Brazil
- Headache and Orofacial Pain Effort, Department of Biologic and Materials Sciences and Michigan Center for Oral Health Research, School of Dentistry, University of MichiganAnn Arbor, MI, USA
| | - Rosenilde C. Holanda-Afonso
- Laboratório de Morfogênese Celular, Instituto de Ciências Biomédicas, Universidade Federal do Rio de JaneiroRio de Janeiro, Brazil
| | - Rodrigo L. Lima
- Departamento de Ortodontia e Odontopediatria, Faculdade de Odontologia, Universidade Federal do Rio de Janeiro, Rio de JaneiroBrazil
| | - Alexandre F. DaSilva
- Headache and Orofacial Pain Effort, Department of Biologic and Materials Sciences and Michigan Center for Oral Health Research, School of Dentistry, University of MichiganAnn Arbor, MI, USA
| | - Vivaldo Moura-Neto
- Laboratório de Morfogênese Celular, Instituto de Ciências Biomédicas, Universidade Federal do Rio de JaneiroRio de Janeiro, Brazil
- Instituto Estadual do Cérebro Paulo NiemeyerRio de Janeiro, Brazil
| |
Collapse
|
21
|
Abstract
Despite the growing awareness of mild traumatic brain injury in military and civilian populations, understanding of the acute and chronic effects of concussion on central nervous system structure and function is limited. Even less is understood about the underpinnings of the cardinal postconcussive symptom, post-traumatic headache (PTH). Here, we review recent advances in PTH, with special emphasis on the migraine-like phenotype, the most disabling form. Considerations for future research in PTH are discussed, including diagnostic classification, and applications with advanced neuroimaging techniques, biomarkers, and treatments.
Collapse
|
22
|
Seghatoleslam M, Ghadiri MK, Ghaffarian N, Speckmann EJ, Gorji A. Cortical spreading depression modulates the caudate nucleus activity. Neuroscience 2014; 267:83-90. [DOI: 10.1016/j.neuroscience.2014.02.029] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2014] [Revised: 02/13/2014] [Accepted: 02/16/2014] [Indexed: 12/24/2022]
|