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Paparella G, Clemente L, Scannicchio S, Delussi M, De Tommaso M. Sex Differences in the Expression of Central Sensitization Symptoms in Migraine: An Observational Study. J Womens Health (Larchmt) 2024. [PMID: 39034894 DOI: 10.1089/jwh.2024.0297] [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: 07/23/2024] Open
Abstract
Background: Migraine is the fourth most common cause of disability in women and the eighth most common cause in men. Central sensitization phenomena predispose to chronic migraine and are generally more pronounced in women. Objective: The aim of this retrospective observational study was to look for sex differences in a population of migraine subjects attending a tertiary headache center, focusing on symptoms of central sensitization such as allodynia and pericranial tenderness. Methods: This study is based on data collected at a tertiary headache center between January 1, 2018, and December 31, 2022. The clinical interview included the main features of migraine, allodynia, a disability questionnaire, the pericranial tenderness score, and anxiety and depression scales. Results: We selected a total of 1,087 migraine subjects (233 men). Osmophobia predominated in women, as did nausea. Disability scores, headache intensity, allodynia, anxiety, and depression predominated in women, without menopausal age playing a role. The frequency of symptomatic medication use was similar in both sexes. Allodynia score was the largest discriminating factor between women and men. Conclusions: Women with migraine are more likely than men to report acute allodynia, nausea, and osmophobia and are also more likely to be anxious, depressed, and disabled. These features appear to be independent of fertile age and are probably related to sex-specific genetic characteristics. These symptoms represent a tendency toward sensory hypersensitivity and central sensitization that should be carefully assessed in both women and men with migraine with a view to possibly predicting chronic development.
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Affiliation(s)
- Giulia Paparella
- DiBrain Department, Neuro Physiopathology Unit, University of Bari Aldo Moro, Bari, Italy
| | - Livio Clemente
- DiBrain Department, Neuro Physiopathology Unit, University of Bari Aldo Moro, Bari, Italy
| | - Stefania Scannicchio
- DiBrain Department, Neuro Physiopathology Unit, University of Bari Aldo Moro, Bari, Italy
| | - Marianna Delussi
- DiBrain Department, Neuro Physiopathology Unit, University of Bari Aldo Moro, Bari, Italy
| | - Marina De Tommaso
- DiBrain Department, Neuro Physiopathology Unit, University of Bari Aldo Moro, Bari, Italy
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van der Arend BWH, Holwerda LJ, Verhagen IE, van Casteren DS, Timmers T, Terwindt GM. Practical Experience with the Use of Electronic Headache Diaries and Video Consultations in Migraine Care from a Longitudinal Cohort Study. Telemed J E Health 2024. [PMID: 39007201 DOI: 10.1089/tmj.2024.0105] [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: 07/16/2024] Open
Abstract
Background: Telemedicine offers a promising solution to enhance the delivery and personalization of headache care. Integrating electronic (e-)tools enables the objective monitoring of migraine. Objectives: This study aims to demonstrate the relevance of e-tools for personalized headache care, assess patient and caregiver compliance and satisfaction, and present their use in enhancing care. Methods: Firstly, a systematic review was performed to validate the diagnostic accuracy of e-diaries for diagnosing migraine. Secondly, we collected e-diary data prospectively from diagnosed adult migraine patients at the Leiden Headache Center. Finally, questionnaires were sent to evaluate satisfaction of patients and health care providers with the Leiden e-headache diary and video consultations. Results: In the systematic review, the Leiden Headache Center's e-diary was the only validated tool. Patients (n = 1,009) were followed for a median of 181 days (interquartile range [IQR] 84-240). Compliance was 96.4% (IQR 85.2 - 99.1%), with 10.8% of days missing. Factors positively associated with compliance were older age (p < 0.001), female sex (p < 0.001), higher e-diary grade (p < 0.001), and clinical use (p = 0.04). The e-diary received a median score of 8/10 and was well-liked by patients (n = 535) and providers (n = 23). Video consultations were a good alternative for physical visits according to 76.9% of patients and 84.6% of providers. Conclusion: Validated e-headache diaries and video consultations in telemedicine enhance headache care accessibility, providing convenient care at preferred times and locations.
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Affiliation(s)
| | - Linde J Holwerda
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | - Iris E Verhagen
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
| | | | | | - Gisela M Terwindt
- Department of Neurology, Leiden University Medical Center, Leiden, The Netherlands
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de Vries T, Boucherie DM, Chan KY, Rubio-Beltrán E, Labastida-Ramírez A, Labruijere S, Gupta S, van den Bogaerdt A, Vincent A, Dammers R, Danser AHJ, MaassenVanDenBrink A. Sex differences in CGRP-induced vasodilation of human middle meningeal arteries but not human coronary arteries: implications for migraine. Cephalalgia 2024; 44:3331024241254088. [PMID: 39043230 DOI: 10.1177/03331024241254088] [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] [Indexed: 07/25/2024]
Abstract
BACKGROUND Migraine prevalence and levels of calcitonin gene-related peptide (CGRP), a peptide involved in migraine pathophysiology, differ between men and women, and appear to be affected by changes in sex hormones. The present study investigated the sex-specific responses to CGRP in human isolated arteries. METHODS CGRP-induced relaxation of 62 (28 men and 34 women) human isolated middle meningeal arteries (HMMA) and 139 (69 men and 70 women) human isolated coronary arteries (HCA) was compared between men and women in groups <50 years and ≥50 years of age as a proxy for pre- and postmenopausal status in women, as well as matched-age groups for men. RESULTS In HCA, no differences were observed between male and female tissue, or between the different age groups. However, in HMMA, the maximum response was significantly smaller and CGRP was less potent in females <50 compared with males <50 years of age. No differences were observed between the older age groups. CONCLUSIONS Sex differences were observed for CGRP-induced relaxation of HMMA, but not HCA. These differences could arise from differential receptor expression in the vascular beds combined with the effect of sex hormones on CGRP and subsequent receptor desensitization.
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Affiliation(s)
- Tessa de Vries
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Deirdre M Boucherie
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Kayi Y Chan
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Eloísa Rubio-Beltrán
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Alejandro Labastida-Ramírez
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Sieneke Labruijere
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Saurabh Gupta
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | | | - Arnaud Vincent
- Department of Neurosurgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Ruben Dammers
- Department of Neurosurgery, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - A H Jan Danser
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands
| | - Antoinette MaassenVanDenBrink
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, The Netherlands
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Nandyala A, Burch R, Halker Singh R. Migraine in women. Headache 2024. [PMID: 38872458 DOI: 10.1111/head.14783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2024] [Accepted: 06/07/2024] [Indexed: 06/15/2024]
Affiliation(s)
- Arathi Nandyala
- Department of Neurology, Stanford University School of Medicine, Stanford Health Care, Stanford, California, USA
| | - Rebecca Burch
- Department of Neurology, University of Vermont Medical Center, Faulkner Hospital, Boston, Massachusetts, USA
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Storch E, Overeem LH, Terhart M, Fitzek MP, Lange KS, Reuter U, Raffaelli B. PACAP-38 and sex hormones in women with migraine: exploratory analysis of a cross-sectional, matched cohort study. J Headache Pain 2024; 25:98. [PMID: 38858641 PMCID: PMC11165852 DOI: 10.1186/s10194-024-01804-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/04/2024] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND Endogeneous and exogeneous sex hormones can impact the frequency and severity of migraine attacks, but the underlying mechanisms are poorly understood. In this study, we investigate the relationship between female sex hormones and Pituitary Adenylate Cyclase-Activating Polypeptide-38 (PACAP-38) concentrations in plasma of women with migraine and healthy controls, aiming to elucidate potential hormonal influences on PACAP dynamics and their relevance to migraine pathophysiology. METHODS This analysis is part of a cross-sectional, matched-cohort study. We recruited two groups of women with episodic migraine: one with a regular menstrual cycle (M-RMC) and another undergoing combined oral contraceptive treatment (M-COC). Additionally, we included corresponding age-matched control groups without migraine for both categories (C-RMC and C-COC). For participants with a RMC, the study visits were scheduled during the perimenstrual period (menstrual cycle day 2 ± 2) and periovulatory period (day 13 ± 2). Participants using COC were examined at day 4 ± 2 of the hormone-free interval and between day 7-14 of the hormone intake phase. During these visits, PACAP-38 concentrations in plasma were measured using a commercial Enzyme-linked-immunosorbent assay (ELISA) kit. RESULTS The study included 120 women, with 30 participants in each group. Women with migraine and a RMC had significantly higher PACAP-38 plasma concentrations compared to healthy controls at both study visits [day 2 ± 2: M-RMC: 2547.41 pg/ml (IQR 814.27 - 4473.48) vs. C-RMC: 1129.49 pg/ml (IQR 257.34 - 2684.88), p = 0.025; day 13 ± 2: M-RMC: 3098.89 pg/ml (IQR 1186.29 - 4379.47) vs. C-RMC: 1626.89 (IQR 383.83 - 3038.36), p = 0.028]. In contrast, PACAP-38 levels were comparable between migraine and control groups receiving COC. Women with migraine and a RMC exhibited higher PACAP-38 concentrations during menstruation compared to those using COC during the hormone-free interval. CONCLUSION Systemic PACAP-38 concentrations in women vary based on the presence of migraine diagnosis and their hormonal status.
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Affiliation(s)
- Elisabeth Storch
- Department of Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Lucas H Overeem
- Department of Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Maria Terhart
- Department of Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Mira P Fitzek
- Department of Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, Berlin, 10117, Germany
| | - Kristin S Lange
- Department of Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, Berlin, 10117, Germany
- Clinician Scientist Program, Berlin Institute of Health at Charité (BIH), Berlin, Germany
| | - Uwe Reuter
- Department of Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, Berlin, 10117, Germany
- Universitätsmedizin Greifswald, Greifswald, Germany
| | - Bianca Raffaelli
- Department of Neurology, Charité Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Charitéplatz 1, Berlin, 10117, Germany.
- Clinician Scientist Program, Berlin Institute of Health at Charité (BIH), Berlin, Germany.
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Raffaelli B, Lange KS. [Migraine and pregnancy : Gender-specific aspects and current knowledge]. DER NERVENARZT 2024; 95:308-315. [PMID: 38321287 DOI: 10.1007/s00115-024-01615-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/15/2024] [Indexed: 02/08/2024]
Abstract
BACKGROUND Migraine, a frequent and debilitating neurological disease, shows gender-specific differences in prevalence and severity. Pregnancy is associated with numerous unique features in terms of migraine course, treatment options and differential diagnoses. OBJECTIVES How does pregnancy influence the course of migraine? What are the possible treatment options during pregnancy? Which differential diagnoses should be considered? MATERIAL AND METHODS Narrative review with summary and discussion of relevant studies and guidelines on migraine in pregnancy. RESULTS During pregnancy up to three quarters of women experience improvement of their migraine; however, there may be a renewed increase in frequency after childbirth. Choosing an appropriate treatment during pregnancy requires a careful risk-benefit assessment. It is important to consider secondary causes of headache as these can occur more frequently during pregnancy and some can be life-threatening. CONCLUSION Consideration of specific aspects of migraine in pregnancy is crucial to be able to develop the best possible treatment strategies for affected patients.
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Affiliation(s)
- Bianca Raffaelli
- Kopfschmerzzentrum, Klinik für Neurologie, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
- Clinician Scientist Programm, Berlin Institute of Health (BIH), Berlin, Deutschland.
| | - Kristin S Lange
- Kopfschmerzzentrum, Klinik für Neurologie, Charité Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
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Zaranek L, Sobe H, Richter M, Hübler A, Berner R, von der Hagen M, Koch T, Sabatowski R, Klimova A, Goßrau G. [Gender-specific results of the Dresden children and adolescents headache program DreKiP]. Schmerz 2024; 38:107-117. [PMID: 37737282 PMCID: PMC10959813 DOI: 10.1007/s00482-023-00756-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 08/17/2023] [Accepted: 08/18/2023] [Indexed: 09/23/2023]
Abstract
BACKGROUND Girls and women are more frequently affected by headache than boys and men. The influence of gender on the effectiveness of headache therapies has so far been hardly investigated. We examined gender differences in the outpatient multimodal Dresden Child and Adolescent Headache Program DreKiP. METHODS We treated 140 patients with primary headache in a 15-hour structured group program. At baseline (T0) and six (T1) and twelve months (T2) after the end of the program, data on headache-related limitation of daily activities (PedMIDAS) as well as headache frequency, intensity, and pain-related disability (P-PDI) were collected. Retrospectively, these data were analyzed separately for girls and boys. RESULTS For 91 patients (9-19 years, median = 15; 71.4 % female) data were available for at least two measurement time points. Girls showed significantly higher headache frequency than boys at all time points (median headache days/last three months at T0: ♀ 43, ♂ 20; T1: ♀ 32, ♂ 12; T2: ♀ 28, ♂ 9) as well as numerically higher headache-related limitation of daily life. There were significant effects over time with a decrease in headache frequency (F (2.88) = 5.862; p = 0.004) and improvement in daily functioning (F (2.92) = 5.340; p = 0.006). There was no gender-specific treatment response. DISCUSSION The DreKiP therapy shows effects in girls and boys with primary headache. Higher headache frequencies and everyday life restrictions in girls may have hormonal but also psychosocial causes and should be addressed in educational measures.
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Affiliation(s)
- Laura Zaranek
- Klinik für Kinder- und Jugendmedizin, Medizinische Fakultät und Universitätsklinikum "Carl Gustav Carus", TU Dresden, Dresden, Deutschland
| | - Hanna Sobe
- UniversitätsSchmerzCentrum, Medizinische Fakultät und Universitätsklinikum "Carl Gustav Carus", TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - Matthias Richter
- Klinik für Kinder- und Jugendmedizin, Medizinische Fakultät und Universitätsklinikum "Carl Gustav Carus", TU Dresden, Dresden, Deutschland
- UniversitätsSchmerzCentrum, Medizinische Fakultät und Universitätsklinikum "Carl Gustav Carus", TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | - Anke Hübler
- UniversitätsSchmerzCentrum, Medizinische Fakultät und Universitätsklinikum "Carl Gustav Carus", TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
- Klinik für Anästhesiologie und Intensivtherapie, Medizinische Fakultät und Universitätsklinikum "Carl Gustav Carus", TU Dresden, Dresden, Deutschland
| | - Reinhard Berner
- Klinik für Kinder- und Jugendmedizin, Medizinische Fakultät und Universitätsklinikum "Carl Gustav Carus", TU Dresden, Dresden, Deutschland
| | - Maja von der Hagen
- Klinik für Kinder- und Jugendmedizin, Medizinische Fakultät und Universitätsklinikum "Carl Gustav Carus", TU Dresden, Dresden, Deutschland
- Abteilung Neuropädiatrie, Medizinische Fakultät und Universitätsklinikum "Carl Gustav Carus", TU Dresden, Dresden, Deutschland
| | - Thea Koch
- Klinik für Anästhesiologie und Intensivtherapie, Medizinische Fakultät und Universitätsklinikum "Carl Gustav Carus", TU Dresden, Dresden, Deutschland
| | - Rainer Sabatowski
- UniversitätsSchmerzCentrum, Medizinische Fakultät und Universitätsklinikum "Carl Gustav Carus", TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
- Klinik für Anästhesiologie und Intensivtherapie, Medizinische Fakultät und Universitätsklinikum "Carl Gustav Carus", TU Dresden, Dresden, Deutschland
| | - Anna Klimova
- NCT Partner Site Dresden, Institut für Medizinische Informatik und Biometrie, Medizinische Fakultät "Carl Gustav Carus", TU Dresden, Dresden, Deutschland
| | - Gudrun Goßrau
- UniversitätsSchmerzCentrum, Medizinische Fakultät und Universitätsklinikum "Carl Gustav Carus", TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
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Bobker SM. Trainee highlights. Headache 2023; 63:1027-1028. [PMID: 37596851 DOI: 10.1111/head.14621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 08/04/2023] [Indexed: 08/20/2023]
Affiliation(s)
- Sarah M Bobker
- UCSF Headache Center, University of California at San Francisco, San Francisco, California, USA
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