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Wang J, Yang G. Exploring the genetic causal relationship between physical activity and migraine in European population based on Mendelian randomization analysis. Front Neurol 2024; 15:1434433. [PMID: 39224884 PMCID: PMC11367984 DOI: 10.3389/fneur.2024.1434433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Accepted: 08/05/2024] [Indexed: 09/04/2024] Open
Abstract
Background Previous studies have shown a connection between physical activity and migraines, but they don't prove a cause-and-effect relationship due to potential biases in observational methods. Methods Utilizing accelerometer-measured physical activity data from a cohort of 377,234 participants in the UK Biobank and information from 599,356 European migraine patients (including 48,975 cases and 550,381 controls) obtained from 24 cohorts, we performed a bidirectional Mendelian randomization analysis to investigate the genetic bidirectional causal relationship between accelerometer-measured physical activity and migraines. Results Research findings indicated a slight negative genetic correlation between "average acceleration" physical activity (rg = -0.091, p = 0.011), overall physical activity (rg = -0.081, p = 0.017), and migraine. Nevertheless, no shared genetic components were observed between migraine and "fraction of accelerations > 425 mg" of physical activity (rg = -0.124, p = 0.076). The study results also demonstrated a lack of genetic bidirectional causality between accelerometer-measured physical activity and migraine ("average acceleration", OR = 1.002, 95% CI 0.975-1.031, p = 0.855, "fraction of accelerations > 425 mg", OR = 1.127, 95% CI 0.802-1.583, p = 0.488, overall physical activity, OR = 0.961, 95% CI 0.713-1.296, p = 0.799), and vice versa. Additionally, this lack of causal association persists even after adjusting for obesity (OR = 1.005, p = 0.578), education (OR = 1.019, p = 0.143), and depression (OR = 1.005, p = 0.847), either separately or simultaneously. Conclusion The Mendelian randomization results based on genetic data do not provide support for a causal association between physical activity and migraine.
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Affiliation(s)
| | - Guan Yang
- School of Physical Education, South China University of Technology, Guangzhou, Guangdong, China
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Belitardo de Oliveira A, Winter Schytz H, Fernando Prieto Peres M, Peres Mercante JP, Brunoni AR, Wang YP, Carmen B Molina MD, Koji Uchiyama L, Lotufo PA, Højland Jensen R, Benseñor IM, Härter Griep R, Goulart AC. Does physical activity and inflammation mediate the job stress-headache relationship? A sequential mediation analysis in the ELSA-Brasil study. Brain Behav Immun 2024; 120:187-198. [PMID: 38838834 DOI: 10.1016/j.bbi.2024.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 05/24/2024] [Accepted: 06/02/2024] [Indexed: 06/07/2024] Open
Abstract
BACKGROUND Evidence indicates that physical activity reduces stress and promote a myriad of health-enhancing effects through anti-inflammatory mechanisms. However, it is unknown whether these mechanisms interfere in the association between psychosocial job stress and headache disorders. OBJECTIVE To test whether physical activity and its interplay with the systemic inflammation biomarkers high-sensitivity C-reactive protein (hs-CRP) and acute phase glycoproteins (GlycA) would mediate the associations between job stress and headache disorders. METHODS We cross-sectionally evaluated the baseline data from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) regarding job stress (higher demand and lower control and support subscales), migraine and tension-type headache (ICHD-2 criteria), self-reported leisure-time physical activity, and plasma hs-CRP and GlycA levels. Conditional process analyses with a sequential mediation approach were employed to compute path coefficients and 95 % confidence intervals (CI) around the indirect effects of physical activity and biomarkers on the job stress-headache relationship. Separate models were adjusted for sex, age, and depression and anxiety. Further adjustments added BMI smoking status, and socioeconomic factors. RESULTS In total, 7,644 people were included in the study. The 1-year prevalence of migraine and tension-type headache were 13.1 % and 49.4 %, respectively. In models adjusted for sex, age, anxiety, and depression, the association between job stress (lower job control) and migraine was mediated by physical activity [effect = -0.039 (95 %CI: -0.074, -0.010)] but not hs-CRP or GlycA. TTH was associated with higher job control and lower job demand, which was mediated by the inverse associations between physical activity and GlycA [Job Control: effect = 0.0005 (95 %CI: 0.0001, 0.0010); Job Demand: effect = 0.0003 (95 %CI: 0.0001, 0.0007]. Only the mediating effect of physical activity in the job stress-migraine link remained after further adjustments including socioeconomic factors, BMI, smoking, and the exclusion of major chronic diseases. CONCLUSION In the ELSA-Brasil study, physical activity reversed the link between job stress and migraine independently of systemic inflammation, while the LTPA-mediated downregulation of GlycA was associated with lower job stress-related TTH.
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Affiliation(s)
- Arão Belitardo de Oliveira
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de Sao Paulo, Av. Lineu Prestes 2565, Butantan-Cidade Universitária, CEP, 05508-900 Sao Paulo, Brazil.
| | - Henrik Winter Schytz
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Valdemar Hansens Vej 5, 2600 Glostrup, Denmark
| | - Mario Fernando Prieto Peres
- Instituto de Psiquiatria, Hospital das Clínicas, Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, CEP: 05403-903, Sao Paulo, Brazil; Instituto do Cérebro, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627 - Jardim Leonor, CEP: 05652-900, Sao Paulo, Brazil
| | - Juliane Prieto Peres Mercante
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de Sao Paulo, Av. Lineu Prestes 2565, Butantan-Cidade Universitária, CEP, 05508-900 Sao Paulo, Brazil; Instituto de Psiquiatria, Hospital das Clínicas, Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, CEP: 05403-903, Sao Paulo, Brazil; Instituto do Cérebro, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627 - Jardim Leonor, CEP: 05652-900, Sao Paulo, Brazil
| | - André R Brunoni
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de Sao Paulo, Av. Lineu Prestes 2565, Butantan-Cidade Universitária, CEP, 05508-900 Sao Paulo, Brazil; Instituto de Psiquiatria, Hospital das Clínicas, Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, CEP: 05403-903, Sao Paulo, Brazil; School of Medicine, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455 - Cerqueira César • CEP, 01246903 Sao Paulo, Brazil
| | - Yuan-Pang Wang
- Instituto de Psiquiatria, Hospital das Clínicas, Universidade de São Paulo, Rua Dr. Ovídio Pires de Campos, 785, CEP: 05403-903, Sao Paulo, Brazil
| | - Maria Del Carmen B Molina
- Universidade Federal de Ouro Preto, R. Diogo de Vasconcelos, 122, Pilar, CEP: 35402-163, Ouro Preto, Minas Gerais, Brazil
| | - Lucas Koji Uchiyama
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de Sao Paulo, Av. Lineu Prestes 2565, Butantan-Cidade Universitária, CEP, 05508-900 Sao Paulo, Brazil
| | - Paulo A Lotufo
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de Sao Paulo, Av. Lineu Prestes 2565, Butantan-Cidade Universitária, CEP, 05508-900 Sao Paulo, Brazil; School of Medicine, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455 - Cerqueira César • CEP, 01246903 Sao Paulo, Brazil
| | - Rigmor Højland Jensen
- Danish Headache Center, Department of Neurology, Rigshospitalet-Glostrup, University of Copenhagen, Valdemar Hansens Vej 5, 2600 Glostrup, Denmark
| | - Isabela M Benseñor
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de Sao Paulo, Av. Lineu Prestes 2565, Butantan-Cidade Universitária, CEP, 05508-900 Sao Paulo, Brazil; School of Medicine, Universidade de Sao Paulo, Av. Dr. Arnaldo, 455 - Cerqueira César • CEP, 01246903 Sao Paulo, Brazil
| | - Rosane Härter Griep
- Laboratório de Educação em Ambiente e Saúde, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Av. Brasil, 4.365 - Manguinhos, CEP: 21041-250, Rio de Janeiro, Brazil
| | - Alessandra C Goulart
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de Sao Paulo, Av. Lineu Prestes 2565, Butantan-Cidade Universitária, CEP, 05508-900 Sao Paulo, Brazil; Department of Epidemiology, School of Public Health, Universidade de São Paulo, São Paulo, Brazil
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Tolentino GDA, Florencio LL, Pinheiro-Araújo CF, Martins J, Chaves TC, Norato ADCC, Dach F, Bevilaqua-Grossi D. Evaluation of maladaptive beliefs in patients with migraine: measurement properties for three versions (TSK-11, TSK-13, and TSK-17) of the Tampa Scale for Kinesiophobia. Braz J Phys Ther 2024; 28:101093. [PMID: 39043022 PMCID: PMC11327810 DOI: 10.1016/j.bjpt.2024.101093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 05/09/2024] [Accepted: 06/05/2024] [Indexed: 07/25/2024] Open
Abstract
BACKGROUND The Tampa Scale for Kinesiophobia (TSK) is one of the most frequently employed instruments for assessing maladaptive beliefs about pain, injury, and movement in patients with chronic musculoskeletal pain. However, the measurement properties of this tool have so far not been tested for individuals with migraine. OBJECTIVE To evaluate the structural, construct, and criterion validity, and the internal consistency for three versions (TSK-11, TSK-13, and TSK-17) of the TSK for patients with migraine. METHODS A total of 113 individuals aged between 18 and 55 years old with migraine diagnosis were included. All participants completed the TSK with 17 items, the Fear-Avoidance Beliefs Questionnaire, the Headache Impact Test, and the Pain Catastrophizing Scale questionnaires. Confirmatory factor analysis was used to assess the structural validity of the TSK, and Cronbach's α was used to assess internal consistency. For construct and criterion validity, the Spearman's correlation was calculated. RESULTS The TSK structure with one factor and the 17, 13, or 11 items versions were suitable, with suitable values in all fit indices related to structural validity. The three versions showed acceptable internal consistency (α = 0.75). All TSK versions showed moderate positive correlation with the other questionnaires (rho range= 0.31-0.63), confirming most of the predefined hypothesis for the construct validity. Also, the criterion validity of the 13-item and 11-item versions was confirmed (rho=0.95 and rho=0.94, respectively). CONCLUSION All versions of the TSK demonstrated good measurement properties in the assessment of maladaptive beliefs about pain, injury, and movement in individuals with migraine.
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Affiliation(s)
| | - Lidiane Lima Florencio
- Department of Physiotherapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, Madrid, Spain.
| | | | - Jaqueline Martins
- Department of Health Sciences, Ribeirão Preto Medical School, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Thais Cristina Chaves
- Department of Physiotherapy, Universidade Federal de São Carlos, São Carlos, SP, Brazil
| | | | - Fabíola Dach
- Department of Neurosciences and Behavioral Sciences, Ribeirão Preto Medical School, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Débora Bevilaqua-Grossi
- Department of Health Sciences, Ribeirão Preto Medical School, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Finelli F, Catalano A, De Lisa M, Ferraro GA, Genovese S, Giuzio F, Salvia R, Scieuzo C, Sinicropi MS, Svolacchia F, Vassallo A, Santarsiere A, Saturnino C. CGRP Antagonism and Ketogenic Diet in the Treatment of Migraine. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:163. [PMID: 38256423 PMCID: PMC10820088 DOI: 10.3390/medicina60010163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 01/08/2024] [Accepted: 01/12/2024] [Indexed: 01/24/2024]
Abstract
The study of migraine is based on the complexity of the pathology, both at the pathophysiological and epidemiological levels. Although it affects more than a billion people worldwide, it is often underestimated and underreported by patients. Migraine must not be confused with a simple headache; it is a serious and disabling disease that causes considerable limitations in the daily life of afflicted people, including social, work, and emotional effects. Therefore, it causes a daily state of suffering and discomfort. It is important to point out that this pathology not only has a decisive impact on the quality of life of those who suffer from it but also on their families and, more generally, on society as a whole. The clinical picture of migraine is complex, with debilitating unilateral or bilateral head pain, and is often associated with characteristic symptoms such as nausea, vomiting, photophobia, and phonophobia. Hormonal, environmental, psychological, dietary, or other factors can trigger it. The present review focuses on the analysis of the physiopathological and pharmacological aspects of migraine, up to the correct dietary approach, with specific nutritional interventions aimed at modulating the symptoms. Based on the symptoms that the patient experiences, targeted and specific therapy is chosen to reduce the frequency and severity of migraine attacks. Specifically, the role of calcitonin gene-related peptide (CGRP) in the pathogenesis of migraine is analyzed, along with the drugs that effectively target the corresponding receptor. Particularly, CGRP receptor antagonists (gepants) are very effective drugs in the treatment of migraine, given their high diffusion in the brain. Moreover, following a ketogenic diet for only one or two months has been demonstrated to reduce migraine attacks. In this review, we highlight the diverse facets of migraine, from its physiopathological and pharmacological aspects to prevention and therapy.
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Affiliation(s)
- Francesca Finelli
- U.O.C. Pediatrics -S. Giuseppe Moscati Hospital, 83100 Avellino, Italy;
| | - Alessia Catalano
- Department of Pharmacy-Drug Sciences, University of Bari “Aldo Moro”, 70126 Bari, Italy;
| | - Michele De Lisa
- U.O.C. Hygiene, Epidemiology and Public Health Department ASP, 85100 Potenza, Italy;
| | - Giuseppe Andrea Ferraro
- Plastic and Reconstructive Surgery Unit, Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, 80138 Naples, Italy;
| | - Sabino Genovese
- Department of Agriculture, Faculty of Viticulture and Oenology, Federico II University, 83100 Avellino, Italy;
| | - Federica Giuzio
- Department of Sciences, University of Basilicata, 85100 Potenza, Italy; (R.S.); (C.S.); (A.V.); (A.S.); (C.S.)
- U.O.C. Primary Care and Territorial Health, Social and Health Department, State Hospital, 47893 San Marino, San Marino
- Spinoff TNCKILLERS s.r.l., University of Basilicata, 85100 Potenza, Italy
| | - Rosanna Salvia
- Department of Sciences, University of Basilicata, 85100 Potenza, Italy; (R.S.); (C.S.); (A.V.); (A.S.); (C.S.)
- Spinoff XFlies s.r.l., University of Basilicata, 85100 Potenza, Italy
| | - Carmen Scieuzo
- Department of Sciences, University of Basilicata, 85100 Potenza, Italy; (R.S.); (C.S.); (A.V.); (A.S.); (C.S.)
- Spinoff XFlies s.r.l., University of Basilicata, 85100 Potenza, Italy
| | - Maria Stefania Sinicropi
- Department of Pharmacy and Health and Nutrition Sciences, University of Calabria, 87036 Arcavacata di Rende, Italy;
| | | | - Antonio Vassallo
- Department of Sciences, University of Basilicata, 85100 Potenza, Italy; (R.S.); (C.S.); (A.V.); (A.S.); (C.S.)
- Spinoff XFlies s.r.l., University of Basilicata, 85100 Potenza, Italy
| | - Alessandro Santarsiere
- Department of Sciences, University of Basilicata, 85100 Potenza, Italy; (R.S.); (C.S.); (A.V.); (A.S.); (C.S.)
| | - Carmela Saturnino
- Department of Sciences, University of Basilicata, 85100 Potenza, Italy; (R.S.); (C.S.); (A.V.); (A.S.); (C.S.)
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Woldeamanuel YW, Oliveira ABD. What is the efficacy of aerobic exercise versus strength training in the treatment of migraine? A systematic review and network meta-analysis of clinical trials. J Headache Pain 2022; 23:134. [PMID: 36229774 PMCID: PMC9563744 DOI: 10.1186/s10194-022-01503-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 10/03/2022] [Indexed: 12/02/2022] Open
Abstract
Background Multiple clinical trials with different exercise protocols have demonstrated efficacy in the management of migraine. However, there is no head-to-head comparison of efficacy between the different exercise interventions. Methods A systematic review and network meta-analysis was performed involving all clinical trials which determined the efficacy of exercise interventions in reducing the frequency of monthly migraine. Medical journal search engines included Web of Science, PubMed, and Scopus spanning all previous years up to July 30, 2022. Both aerobic and strength/resistance training protocols were included. The mean difference (MD, 95% confidence interval) in monthly migraine frequency from baseline to end-of-intervention between the active and control arms was used as an outcome measure. Efficacy evidence from direct and indirect comparisons was combined by conducting a random effects model network meta-analysis. The efficacy of the three exercise protocols was compared, i.e., moderate-intensity aerobic exercise, high-intensity aerobic exercise, and strength/resistance training. Studies that compared the efficacy of migraine medications (topiramate, amitriptyline) to exercise were included. Additionally, the risk of bias in all included studies was assessed by using the Cochrane Risk of Bias version 2 (RoB2). Results There were 21 published clinical trials that involved a total of 1195 migraine patients with a mean age of 35 years and a female-to-male ratio of 6.7. There were 27 pairwise comparisons and 8 indirect comparisons. The rank of the interventions was as follows: strength training (MD = -3.55 [− 6.15, − 0.95]), high-intensity aerobic exercise (-3.13 [-5.28, -0.97]), moderate-intensity aerobic exercise (-2.18 [-3.25, -1.11]), topiramate (-0.98 [-4.16, 2.20]), placebo, amitriptyline (3.82 [− 1.03, 8.68]). The RoB2 assessment showed that 85% of the included studies demonstrated low risk of bias, while 15% indicated high risk of bias for intention-to-treat analysis. Sources of high risk of bias include randomization process and handling of missing outcome data. Conclusion Strength training exercise regimens demonstrated the highest efficacy in reducing migraine burden, followed by high-intensity aerobic exercise. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-022-01503-y.
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Affiliation(s)
- Yohannes W Woldeamanuel
- Division of Headache & Facial Pain, Department of Neurology & Neurological Sciences, Stanford University School of Medicine, Stanford, USA.
| | - Arão B D Oliveira
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de São Paulo, São Paulo, Brazil
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