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Lagman-Bartolome AM, Im J, Gladstone J. Headaches Attributed to Disorders of Homeostasis. Neurol Clin 2024; 42:521-542. [PMID: 38575264 DOI: 10.1016/j.ncl.2023.12.007] [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: 04/06/2024]
Abstract
Headaches attributed to disorders of homeostasis include those different headache types associated with metabolic and systemic diseases. These are headache disorders occurring in temporal relation to a disorder of homeostasis including hypoxia, high altitude, airplane travel, diving, sleep apnea, dialysis, autonomic dysreflexia, hypothyroidism, fasting, cardiac cephalalgia, hypertension and other hypertensive disorders like pheochromocytoma, hypertensive crisis, and encephalopathy, as well as preeclampsia or eclampsia. The proposed mechanism behind the causation of these headache subtypes including diagnostic criteria, evaluation, treatment, and overall management will be discussed.
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Affiliation(s)
- Ana Marissa Lagman-Bartolome
- Department of Pediatrics, Division of Neurology, The Hospital for Sick Children, University of Toronto; Department of Pediatrics, Division of Neurology, Children's Hospital, London Health Sciences Center, Schulich School of Medicine & Dentistry, University of Western Ontario, 800 Commissioner's Road East, London, Ontario N6A5W9, Canada.
| | - James Im
- Department of Medicine, Division of Adult Neurology, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario M5B1W8, Canada
| | - Jonathan Gladstone
- Department of Pediatrics, Division of Neurology, The Hospital for Sick Children, University of Toronto; Gladstone Headache Clinic, 1333 Sheppard Avenue E, Suite 122, North York, Ontario M2J1V1, Canada
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Glucose-Related Traits and Risk of Migraine—A Potential Mechanism and Treatment Consideration. Genes (Basel) 2022; 13:genes13050730. [PMID: 35627115 PMCID: PMC9141901 DOI: 10.3390/genes13050730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 04/19/2022] [Accepted: 04/19/2022] [Indexed: 12/16/2022] Open
Abstract
Migraine and glucose-related (glycaemic) traits (fasting glucose, fasting insulin, and type 2 diabetes) are common and complex comorbid disorders that cause major economic and social burdens on patients and their families. Studies on the relationship between migraine and glucose-related traits have yielded inconsistent results. The purpose of this review is to synthesise and discuss the information from the available literature on the relationship between fasting glucose, fasting insulin, and type 2 diabetes (T2D) with migraine. Publications on migraine and fasting glucose, migraine and fasting insulin, and migraine and T2D were identified from a PubMed and Google Scholar database search and reviewed for this article. Multiple publications have suggested that the comorbidity of migraine and glucose-related traits may have a similar complex pathogenic mechanism, including impaired glucose homeostasis, insulin resistance, reduced cerebrovascular reactivity, abnormal brain metabolism, shared genetic factors, neurotransmitters, and sex hormones. Furthermore, several studies have found a bi-directional link between migraine with insulin resistance and T2D. There is strong evidence for a biological association between migraine headache and glucose-related traits, and burgeoning evidence for shared genetic influences. Therefore, genetic research into these comorbid traits has the potential to identify new biomarkers and therapeutic targets and provide biological insight into their relationships. We encourage healthcare professionals to consider the co-occurrence of migraine with glucose-related traits in the evaluation and treatment of their patients.
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Slavin M, Li HA, Frankenfeld C, Cheskin LJ. What is Needed for Evidence-Based Dietary Recommendations for Migraine: A Call to Action for Nutrition and Microbiome Research. Headache 2020; 59:1566-1581. [PMID: 31603554 DOI: 10.1111/head.13658] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The gastrointestinal symptoms of migraine attacks have invited numerous dietary hypotheses for migraine etiology through the centuries. Substantial efforts have been dedicated to identifying dietary interventions for migraine attack prevention, with limited success. Meanwhile, mounting evidence suggests that the reverse relationship may also exist - that the biological mechanisms of migraine may influence dietary intake. More likely, the truth involves some combination of both, where the disease influences food intake, and the foods eaten impact the manifestations of the disease. In addition, the gut's microbiota is increasingly suspected to influence the migraine brain via the gut-brain axis, though these hypotheses remain largely unsubstantiated. OBJECTIVE This paper presents an overview of the strength of existing evidence for food-based dietary interventions for migraine, noting that there is frequently evidence to suggest that a dietary risk factor for migraine exists but no evidence for how to best intervene; in fact, our intuitive assumptions on interventions are being challenged with new evidence. We then look to the future for promising avenues of research, notably the gut microbiome. CONCLUSION The evidence supports a call to action for high-quality dietary and microbiome research in migraine, both to substantiate hypothesized relationships and build the evidence base regarding nutrition's potential impact on migraine attack prevention and treatment.
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Affiliation(s)
- Margaret Slavin
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA, USA
| | - Huilun Amber Li
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA, USA
| | - Cara Frankenfeld
- Department of Global and Community Health, George Mason University, Fairfax, VA, USA
| | - Lawrence J Cheskin
- Department of Nutrition and Food Studies, George Mason University, Fairfax, VA, USA
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Finkel AG, Yerry JA, Mann JD. Dietary considerations in migraine management: does a consistent diet improve migraine? Curr Pain Headache Rep 2014; 17:373. [PMID: 24068338 DOI: 10.1007/s11916-013-0373-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The clinical expression of migraine is significantly impacted by dietary and gastrointestinal issues. This includes gut dysfunction during and between attacks, food triggers, increase in migraine with obesity, comorbid GI and systemic inflammation influenced by diet, and specific food allergies such as dairy and gluten. Practitioners often encourage migraineurs to seek consistency in their lifestyle behaviors, and environmental exposures, as a way of avoiding sudden changes that may precipitate attacks. However, rigorous evidence linking consistency of diet with improvement in migraine is very limited and is, at best, indirect, being based mainly on the consistency of avoiding suspected food triggers. A review of current data surrounding the issue of dietary consistency is presented from the perspective of migraine as an illness (vulnerable state), as a disease (symptom expression traits), and with a view toward the role of local and systemic inflammation in its genesis. Firm recommendations await further investigation.
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Affiliation(s)
- Alan G Finkel
- Carolina Headache Institute, 103 Market Street, Chapel Hill, NC, 27516, USA,
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Abstract
This article discusses headaches secondary to disorders of homeostasis, which include headaches attributed to (1) hypoxia and/or hypercapnia (high-altitude, diving, or sleep apnea), (2) dialysis, (3) arterial hypertension (pheochromocytoma, hypertensive crisis without hypertensive encephalopathy, hypertensive encephalopathy, preeclampsia or eclampsia, or autonomic dysreflexia), (4) hypothyroidism, (5) fasting, (6) cardiac cephalalgia, and (7) other disorder of homeostasis. Clinical features and diagnosis as well as therapeutic strategies are discussed for each headache type.
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Affiliation(s)
- Ana Marissa Lagman-Bartolome
- Division of Pediatric Neurology, Hospital for Sick Children, Women's College Hospital, University of Toronto, 555 University Avenue, Toronto, ON M5G1X8, Canada
| | - Jonathan Gladstone
- Gladstone Headache Clinic, 1333 Sheppard Avenue East, Suite 122, Toronto, ON M2J 1V1, Canada.
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Drescher MJ, Wimpfheimer Z, Abu Khalef S, Gammaitoni A, Shehadeh N, Torgovicky R. Prophylactic etoricoxib is effective in preventing "first of Ramadan" headache: a placebo-controlled double-blind and randomized trial of prophylactic etoricoxib for ritual fasting headache. Headache 2011; 52:573-81. [PMID: 21848948 DOI: 10.1111/j.1526-4610.2011.01993.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Religious fasting is associated with headache. This has been documented as "Yom Kippur headache" and "first of Ramadan headache." Etoricoxib, a Cox-2 inhibitor with a 22-hour half-life, has been shown effective in preventing fasting headache when taken just prior to the 25-hour Yom Kippur fast. We hypothesized that etoricoxib would also be effective in preventing headache during Ramadan, despite the different characteristics of the fast. METHODS We performed a double-blind randomized prospective crossover trial of etoricoxib 90mg vs placebo, taken just prior to the onset of fasting, during the first 2 weeks of Ramadan 2010. Healthy adults aged 18-65 years were enrolled. Demographics, headache history and a daily post-fast survey were collected. We compared incidence, time of onset, and intensity of headache on each day and side effects in control and treatment groups. RESULTS We enrolled 222 patients and 189 completed the post-fast questionnaire (87%). Etoricoxib reduced the incidence of "first of Ramadan" headache by 54% (46% in placebo group [n=92] vs 21% [n=96] in etoricoxib group) (P<.0001, OR 3.19 [95% CI 1.68-6.06]). For days 1-6, the mean number of headache days for the placebo group was 1.60 (n=92) and for the treatment group the mean was 0.86 (n=99) headache days (P=.003). Median severity of headache in the treatment group was significantly lower. In the second week, there was no significant difference in incidence of headache between groups, and the incidence of headache in the placebo group dropped markedly over time. CONCLUSION Etoricoxib 90mg taken prior to a 15-hour ritual fast decreases incidence of and attenuates headache during the first 5 days of the month of Ramadan.
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Affiliation(s)
- Michael J Drescher
- Division of Emergency Medicine, Hartford Hospital/University of Connecticut, Hartford, CT 06119, USA.
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Latsko M, Silberstein S, Rosen N. Frovatriptan as preemptive treatment for fasting-induced migraine. Headache 2011; 51:369-374. [PMID: 21269298 DOI: 10.1111/j.1526-4610.2010.01827.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine frovatriptan's efficacy as preemptive treatment for fasting-induced migraine. BACKGROUND Fasting is a common migraine trigger that cannot always be avoided. The development of a short-term preemptive approach would be of benefit. Because of its longer half-life, frovatriptan has been effectively used for short-term daily use to prevent menstrually related migraines and might prove useful in the prevention of fasting-induced migraine. METHODS This was a double-blind, placebo-controlled, randomized, parallel-group trial. SUBJECTS With a history of fasting-induced episodic migraine were randomly assigned to receive either frovatriptan (5.0 mg) or placebo (ratio 1:1). SUBJECTS Took a single dose of study medication at the start of their 20-hour fast. Information about headache intensity, associated symptoms, and use of rescue medication was captured at defined time points from the start of the fast through 20 hours post-fast. RESULTS Of the 75 subjects screened, 74 subjects were randomized and 71 subjects completed the study. Demographic characteristics of the placebo and frovatriptan treatment groups were not statistically different. Thirty-three subjects received active drug. Twelve (36.4%) developed a headache between 6 and 20 hours after the start of the fast (1/33 mild, 11/33 moderate or severe). In the placebo group, 18/34 (52.9%) developed a headache (4/34 mild, 14/34 moderate or severe). The difference between the 2 treatment groups did not achieve statistical significance; Pearson chi-square, P = .172. Kaplan-Meier survival analysis showed no difference between the 2 treatment groups with respect to the time of onset of headache of any intensity (log rank, P = .264) and for the time of onset of a moderate or severe intensity (log rank, P = .634). CONCLUSION More subjects on placebo developed a headache than those on frovatriptan. Perhaps because of the small number of subjects involved, the differences in headache incidences observed did not achieve statistical significance.
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Affiliation(s)
- Meryl Latsko
- From the Thomas Jefferson University-Neurology/Headache, Jefferson Headache Center, Philadelphia, PA, USA (M. Latsko and S. Silberstein); Albert Einstein University-Neurology/Headache, New York, NY, USA (N. Rosen)
| | - Stephen Silberstein
- From the Thomas Jefferson University-Neurology/Headache, Jefferson Headache Center, Philadelphia, PA, USA (M. Latsko and S. Silberstein); Albert Einstein University-Neurology/Headache, New York, NY, USA (N. Rosen)
| | - Noah Rosen
- From the Thomas Jefferson University-Neurology/Headache, Jefferson Headache Center, Philadelphia, PA, USA (M. Latsko and S. Silberstein); Albert Einstein University-Neurology/Headache, New York, NY, USA (N. Rosen)
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Abu-Salameh I, Plakht Y, Ifergane G. Migraine exacerbation during Ramadan fasting. J Headache Pain 2010; 11:513-7. [PMID: 20652352 PMCID: PMC3476230 DOI: 10.1007/s10194-010-0242-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2010] [Accepted: 07/05/2010] [Indexed: 11/21/2022] Open
Abstract
Fasting for approximately 1 month is an obligatory practice for Muslims during the month of Ramadan. We attempted to evaluate the effect of the Ramadan fasting on the frequency of migraine attacks among observant Muslim migraine sufferers using a cohort cross-over study. Thirty-two observant Muslim migraine sufferers filled a migraine diary during the Ramadan month and the following month (control). Two patients failed to complete the fast because of migraine suffering. During the Ramadan month, the patient expressed 9.4 ± 4.3 migraine days in average (range 3-20) when compared with 3.7 ± 2.1 migraine days in average (range 1-10) during the control month (p < 0.001). This phenomenon was associated with longer duration of migraine, lower frequency of migraine attacks, and migraine with aura. It seemed to be less pronounced in patients experiencing throbbing headaches and in married patients. Previous prophylactic therapy did not dampen this. Physicians treating Muslim migraine patients should discuss potential Ramadan month exacerbation with their patients and provide counseling regarding the prevention of dehydration and caffeine withdrawal. Pharmacological prophylactic treatment should be considered.
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Affiliation(s)
- Ibrahim Abu-Salameh
- Headache Clinic, Department of Neurology, Soroka University Medical Center, Beer-Sheva, Israel
| | - Ygal Plakht
- Unit of Nursing Research, Soroka University Medical Center, Beer-Sheva, Israel
- The Leon and Matilda Recanati School, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Gal Ifergane
- Headache Clinic, Department of Neurology, Soroka University Medical Center, Beer-Sheva, Israel
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Dodick DW, Bordini CA. Headache attributed to disorders of homeostasis. HANDBOOK OF CLINICAL NEUROLOGY 2010; 97:627-642. [PMID: 20816459 DOI: 10.1016/s0072-9752(10)97053-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- David W Dodick
- Department of Neurology, Mayo Clinic Arizona, Phoenix, AZ 85054, USA.
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Drescher MJ, Alpert EA, Zalut T, Torgovicky R, Wimpfheimer Z. Prophylactic etoricoxib is effective in preventing Yom Kippur headache: a placebo-controlled double-blind and randomized trial of prophylaxis for ritual fasting headache. Headache 2009; 50:1328-34. [PMID: 20039959 DOI: 10.1111/j.1526-4610.2009.01587.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Religious fasting is associated with headache. This has been documented as "Yom Kippur Headache" and "First-of-Ramadan Headache." Rofecoxib (Vioxx®), a cyclooxygenase-2 (Cox-2) inhibitor with a 17-hour half-life, has been shown to be effective in preventing fasting headache when taken just prior to the 25-hour Yom Kippur fast. Unfortunately for fasters rofecoxib is no longer available. We hypothesized that etoricoxib, another Cox-2 inhibitor with a longer half-life, would also be effective in preventing fasting headache. METHODS We performed a double-blind randomized prospective trial of etoricoxib 120 mg vs placebo, taken just prior to the onset of fasting, Yom Kippur 2008. Healthy adults aged 18-65 years were enrolled from the community. Subjects completed a demographic data form and questions regarding headache history and a post-fast survey on headache during the fast. We compared incidence, time of onset and intensity of headache, general ease of fasting, and side effects in control and treatment groups. RESULTS We enrolled 211 patients and 195 completed the post-fast questionnaire (92%). Of those subjects receiving etoricoxib (n=99), 36 or 36.4% vs 65 or 67.7% of the placebo group (n=96) developed any headache during the fast (P< .0001). Median severity of headache in the treatment group was significantly lower for the treatment group (3.0 vs 5.0 on a visual analog scale of 10; P= .024). Also, participants in the treatment group reported an easier fast than the placebo group, as compared with previous fasting experience (4.0 vs 3.5 on a scale of 1-5; P< .0001). CONCLUSION Etoricoxib 120 mg taken prior to a 25-hour ritual fast decreases incidence of and attenuates fasting headache.
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Affiliation(s)
- Michael J Drescher
- Division of Emergency Medicine, Hartford Hospital/University of Connecticut, Hartford, CT 06102, USA
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Torelli P, Evangelista A, Bini A, Castellini P, Lambru G, Manzoni GC. Fasting Headache: A Review of the Literature and New Hypotheses. Headache 2009; 49:744-52. [DOI: 10.1111/j.1526-4610.2009.01390.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
This review discusses headaches secondary to disorders of homeostasis, formerly known as "headaches associated with metabolic or systemic diseases." They include the headaches attributed to 1) hypoxia and/or hypercapnia (high altitude, diving, sleep apnea); 2) dialysis; 3) arterial hypertension; 4) hypothyroidism; 5) fasting; and 6) cardiac cephalalgia. For each headache type, we discuss the clinical features and diagnosis, as well as therapeutic strategies.
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