Phonophobia and brainstem excitability in migraine

Auditory disturbances in patients with complex regional pain syndrome

ABSTRACT

Complex regional pain syndrome (CRPS) is often associated with reduced sound tolerance (hyperacusis) on the affected side, but the mechanism of this symptom is unclear. As compensatory increases in central auditory activity after cochlear injury may trigger hyperacusis, hearing and discomfort thresholds to pure tones (250, 500, 1000, 2000, 3000, 4000, 6000, and 8000 Hz) were assessed in 34 patients with CRPS and 26 pain-free controls. In addition, in 31 patients and 17 controls, auditory-evoked potentials to click stimuli (0.08 ms duration, 6 Hz, 60 dB above the hearing threshold) were averaged across 2000 trials for each ear. Auditory discomfort thresholds were lower at several pitches on the CRPS-affected than contralateral side and lower at all pitches on the affected side than in controls. However, ipsilateral hyperacusis was not associated with psychophysical or physiological signs of cochlear damage. Instead, neural activity in the ipsilateral brainstem and midbrain was greater when repetitive click stimuli were presented on the affected than contralateral side and greater bilaterally than in controls. In addition, click-evoked potentials, reflecting thalamo-cortical signal transfer and early cortical processing, were greater contralaterally in patients than controls. Together, these findings suggest that hyperacusis originates in the ipsilateral brainstem and midbrain rather than the peripheral auditory apparatus of patients with CRPS. Failure of processes that jointly modulate afferent auditory signalling and pain (eg, inhibitory influences stemming from the locus coeruleus) could contribute to ipsilateral hyperacusis in CRPS.

Migraine triggers in Asian countries: a narrative review

Background

Migraine is one of the most common neurological disorders worldwide. Clinical characteristics of migraine may be somewhat different across ethnic groups. Although factors such as stress, lack of sleep, and fasting are known as migraine triggers, the discussion about geographical differences of migraine triggers in Asia is lacking.

Methods

In this study, we performed a narrative review on migraine triggers in Asia. We searched PubMed for relevant papers published between January 2000 and February 2022.

Results

Forty-two papers from 13 Asian countries were included. Stress and sleep are the most frequently reported migraine triggers in Asia. There were some differences in migraine triggers in Asian countries: fatigue and weather common in Eastern Asia and fasting common in Western Asia.

Conclusion

Majority of the common triggers reported by patients with migraine in Asia were stress and sleep, similar to those reported globally, thus showing they are universally important. Some triggers linked to internal homeostasis are influenced by culture (e.g., alcohol, food/eating habit), and triggers related to environmental homeostasis, such as weather, are highly heterogenous between regions.

Dialysis headache: A literature review in the last 30 years

Introduction According to the International Classification of Headache Disorders (ICHD-3), dialysis headache has no specific characteristics occurring during and caused by haemodialysis. It resolves spontaneously within 72 hours after the haemodialysis session has ended. Objective To describe the prevalence, clinical features, associated symptoms and risk factors of dialysis headache. Methods Based on a literature search in the major medical databases and using the descriptors“dialysis headache”, “hemodialysis and headache” and “renal dialysis and headache”we included articles published between 1992 and 2022. Of the 492articles found, only 9 met the inclusion criteria and were analyzed. Results We describe 444 patients (53.1% men and 46.9% women) diagnosed with dialysis headache, corresponding to 24.8% of those who underwent hemodialysis.The age ranged from 15 to 75 years. Pain occurred predominantly from the third hour of hemodialysis (65.8%), lasting less than four hours (71.7%), located bilaterally (63.1%), pulsatile (58.5%) and moderate intensity (68.9%).The most frequent associated symptoms were photophobia or phonophobia (71.5%), vertigo (22.3%) and nausea and/or vomiting (16.5%). Conclusion This review showed a high prevalence of dialysis headache in patients undergoing hemodialysis and that the clinical characteristics, treatment and prevention are still poorly studied.

Pathophysiology and Therapy of Associated Features of Migraine

Migraine is a complex and debilitating disorder that is broadly recognised by its characteristic headache. However, given the wide array of clinical presentations in migraineurs, the headache might not represent the main troublesome symptom and it can even go unnoticed. Understanding migraines exclusively as a pain process is simplistic and certainly hinders management. We describe the mechanisms behind some of the most disabling associated symptoms of migraine, including the relationship between the central and peripheral processes that take part in nausea, osmophobia, phonophobia, vertigo and allodynia. The rationale for the efficacy of the current therapeutic arsenal is also depicted in this article. The associated symptoms to migraine, apart from the painful component, are frequent, under-recognised and can be more deleterious than the headache itself. The clinical anamnesis of a headache patient should enquire about the associated symptoms, and treatment should be considered and individualised. Acknowledging the associated symptoms as a fundamental part of migraine has permitted a deeper and more coherent comprehension of the pathophysiology of migraine.

Sound Tolerance Conditions (Hyperacusis, Misophonia, Noise Sensitivity, and Phonophobia): Definitions and Clinical Management

Purpose: For some people, exposure to everyday sounds presents a significant problem. The purpose of this tutorial was to define and differentiate between the various sound tolerance conditions and to review some options for their clinical management.

METHOD

We informally reviewed the literature regarding sound tolerance conditions. The terminology and definitions provided are mostly consistent with how these terms are defined. However, many inconsistencies are noted. Methods of assessment and treatment also differ, and different methodologies are briefly described.

RESULTS

Hyperacusis describes physical discomfort or pain when any sound reaches a certain level of loudness that would be tolerable for most people. Misophonia refers to intense emotional reactions to certain sounds (often body sounds such as chewing and sniffing) that are not influenced by the perceived loudness of those sounds. Noise sensitivity refers to increased reactivity to sounds that may include general discomfort (annoyance or feeling overwhelmed) due to a perceived noisy environment, regardless of its loudness. Phonophobia, as addressed in the audiology profession, describes anticipatory fear of sound. Phonophobia is an emotional response such as anxiety and avoidance of sound due to the "fear" that sound(s) may occur that will cause a comorbid condition to get worse (e.g., tinnitus) or the sound itself will result in discomfort or pain. (Note that phonophobia is a term used by neurologists to describe "migraineur phonophobia"-a different condition not addressed herein.) Conclusions: The literature addresses sound tolerance conditions but reveals many inconsistencies, indicating lack of consensus in the field. When doing an assessment for decreased sound tolerance, it is important to define any terms used so that the patient and all health care professionals involved in the care of the patient are aligned with the goals of the treatment plan. Treatment generally involves gradual and systematic sound desensitization and counseling.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.20164130.

Development and Validation of the Predictive Model for the Differentiation between Vestibular Migraine and Meniere's Disease

(1) Background: Vestibular migraine (VM) and Meniere’s disease (MD) share multiple features in terms of clinical presentations and auditory-vestibular dysfunctions, e.g., vertigo, hearing loss, and headache. Therefore, differentiation between VM and MD is of great significance. (2) Methods: We retrospectively analyzed the medical records of 110 patients with VM and 110 patients with MD. We at first established a regression equation by using logistic regression analysis. Furthermore, sensitivity, specificity, accuracy, positive predicted value (PV), and negative PV of screened parameters were assessed and intuitively displayed by receiver operating characteristic curve (ROC curve). Then, two visualization tools, i.e., nomograph and applet, were established for convenience of clinicians. Furthermore, other patients with VM or MD were recruited to validate the power of the equation by ROC curve and the Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva (GiViTI) calibration belt. (3) Results: The clinical manifestations and auditory-vestibular functions could help differentiate VM from MD, including attack frequency (X5), phonophobia (X13), electrocochleogram (ECochG) (X18), head-shaking test (HST) (X23), ocular vestibular evoked myogenic potential (o-VEMP) (X27), and horizontal gain of vestibular autorotation test (VAT) (X30). On the basis of statistically significant parameters screened by Chi-square test and multivariable double logistic regression analysis, we established a regression equation: P = 1/[1 + e^{−(−2.269× X5 − 2.395× X13 + 2.141× X18 + 3.949 × X23 + 2.798× X27 − 4.275× X30(1) − 5.811× X30(2) + 0.873)}] (P, predictive value; e, natural logarithm). Nomographs and applets were used to visualize our result. After validation, the prediction model showed good discriminative power and calibrating power. (4) Conclusions: Our study suggested that a diagnostic algorithm based on available clinical features and an auditory-vestibular function regression equation is clinically effective and feasible as a differentiating tool and could improve the differential diagnosis between VM and MD.

Avoidance behaviour modulates but does not condition phonophobia in migraine

Background

Past studies do not account for avoidance behaviour in migraine as a potential confounder of phonophobia.

Objective

To analyse whether phonophobia is partially driven by avoidance behaviour when using the classic methodology (method of limits).

Methods

This is a case-control study where we tested phonophobia in a cohort of high-frequency/chronic migraine patients (15.5 ± 0.74 headache days/month) and non-headache controls. Auditory stimuli, delivered in both ears, were presented using three different paradigms: the method of limits, the method of constant stimuli, and the adaptive method. Participants were asked to report how bothersome each tone was until a sound aversion threshold was estimated for each method.

Results

In this study, we successfully replicate previously reported reduction in sound aversion threshold using three different methods in a group of 35 patients and 25 controls (p < 0.0001). Avoidance behaviour in migraine reduced sound aversion threshold in the method of limits (p = 0.0002) and the adaptive method (p < 0.0001) when compared to the method of constant stimuli. While thresholds in controls remained the same across methods (method of limits, p = 0.9877 and adaptive method, p = 1).

Conclusion

Avoidance behaviour can exacerbate phonophobia. The current methodology to measure phonophobia needs to be revised.

The electrophysiological markers of hyperacusis: a scoping review

OBJECTIVE

Hyperacusis is known as a reduced tolerance to sounds perceived as normal to the majority of the population. There is currently no agreed definition, diagnostic tool, or objective measure of its occurrence. The purpose of this review is to catalogue the research to date on the use of auditory evoked potentials (AEP) to assess hyperacusis.

DESIGN

A step-by-step methodology was conducted following guidelines. Four databases were searched. A total of 3343 papers were identified. A final yield of 35 articles were retained for analysis.

RESULTS

The analysis identified four types of aetiologies to describe the hyperacusic population in AEP studies; developmental disorders (n = 19), neurological disorders (n = 3), induced hearing damage (n = 8) and idiopathic aetiology (n = 5). Electrophysiological measures were of short (n = 16), middle (n = 13) and long (n = 19) latencies, believed to reflect the activity of the ascending and descending pathways of the auditory system from periphery to cortex.

CONCLUSIONS

The results of this review revealed the potential use of electrophysiological measures for further understanding the mechanisms of hyperacusis. However, according to the disparity of concepts to define hyperacusis, definitions and populations need to be clarified before biomarkers specific to hyperacusis can be identified.