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Can Y, Uçaroğlu Can N, Akçay Ç, Ulaş SB, Kocayiğit I, Kocayiğit H, Ağaç MT. Increased Cardio-ankle Vascular Index Values in Migraine Patients With Aura. Angiology 2024:33197241228043. [PMID: 38236077 DOI: 10.1177/00033197241228043] [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: 01/19/2024]
Abstract
Patients with migraine with aura are at an increased risk of cardiovascular disease. There are limited data on arterial stiffness in migraine patients with aura. The present study evaluated arterial stiffness in these patients using the cardio-ankle vascular index (CAVI). This prospective study included 50 patients with migraine with aura (43 female, mean age 38.9 ± 9.9 years). The patient group was matched for age and gender with 50 healthy individuals with no history of migraine (43 female, mean age 39.3 ± 10.3 years). All patients and control subjects underwent a comprehensive clinical evaluation by an experienced neurologist and were interviewed about their headache histories. There was no significant difference in baseline demographic characteristics and echocardiographic parameters between migraine with aura patients and the control group. Both right and left CAVI values were significantly higher in the patients with migraine with aura (6.5 ± 1.2 vs 6.1 ± 0.7, P = .043 and 6.6 ± 1.2 vs 6.1 ± 0.7, P = .009, respectively). Arterial stiffness is an important mediator of cardiovascular diseases. We found that CAVI, a novel marker of the arterial stiffness, is increased in patients with migraine with aura.
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Affiliation(s)
- Yusuf Can
- Department of Cardiology, School of Medicine, Sakarya University, Turkey
| | - Nimet Uçaroğlu Can
- Department of Neurology, Training and Research Hospital, Sakarya University, Turkey
| | - Çağla Akçay
- Department of Cardiology, School of Medicine, Sakarya University, Turkey
| | | | - Ibrahim Kocayiğit
- Department of Cardiology, School of Medicine, Sakarya University, Turkey
| | - Havva Kocayiğit
- Department of Anaesthesiology and Reanimation, School of Medicine, Sakarya University, Turkey
| | - Mustafa Tarık Ağaç
- Department of Cardiology, School of Medicine, Sakarya University, Turkey
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Bohra SK, Achar RR, Chidambaram SB, Pellegrino C, Laurin J, Masoodi M, Srinivasan A. CURRENT PERSPECTIVES ON MITOCHONDRIAL DYSFUNCTION IN MIGRAINE. Eur J Neurosci 2022; 56:3738-3754. [PMID: 35478208 DOI: 10.1111/ejn.15676] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 04/11/2022] [Accepted: 04/13/2022] [Indexed: 11/29/2022]
Abstract
Mitochondria is an autonomous organelle that plays a crucial role in the metabolic aspects of a cell. Cortical Spreading Depression (CSD) and fluctuations in the cerebral blood flow have for long been mechanisms underlying migraine. It is a neurovascular disorder with a unilateral manifestation of disturbing, throbbing and pulsating head pain. Migraine affects 2.6 and 21.7% of the general population and is the major cause of partial disability in the age group 15-49. Higher mutation rates, imbalance in concentration of physiologically relevant molecules, oxidative stress biomarkers have been the main themes of discussion in determining the role of mitochondrial disability in migraine. The correlation of migraine with other disorders like hemiplegic migraine, MELAS, TTH, CVS, ischemic stroke and hypertension has helped in the assessment of the physiological and morphogenetic basis of migraine. Here, we have reviewed the different nuances of mitochondrial dysfunction and migraine. The different mtDNA polymorphisms that can affect the generation and transmission of nerve impulse has been highlighted and supported with research findings. In addition to this, the genetic basis of migraine pathogenesis as a consequence of mutations in nuclear DNA that can in turn affect the synthesis of defective mitochondrial proteins is discussed along with a brief overview of epigenetic profile. This review gives an overview of the pathophysiology of migraine and explores mitochondrial dysfunction as a potential underlying mechanism. Also, therapeutic supplements for managing migraine have been discussed at different junctures in this paper.
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Affiliation(s)
- Shraman Kumar Bohra
- Department of Life Sciences, Pooja Bhagavat Memorial Mahajana Education Center, Mysore
| | - Raghu Ram Achar
- Division of Biochemistry, Faculty of Life Sciences, JSS Academy of Higher Education & Research. Mysore
| | - Saravana Babu Chidambaram
- Department of Pharmacology, JSS College of Pharmacy, JSS Academy of Higher Education & Research, Mysore
| | - Christophe Pellegrino
- Institut National de la Santé et de la Recherche Médicale, Institute of Mediterranean Neurobiology, Aix-Marseille University, Marseille, France
| | - Jerome Laurin
- Aix-Marseille University. Sport Science Faculty. Marseille. Institut de Neurobiologie de la Méditerranée, INMED (INSERM- AMU)., France
| | - Mojgan Masoodi
- Institute of Clinical Chemistry, University hospital Bern, Bern
| | - Asha Srinivasan
- Division of Nanoscience & Technology, School of Life Sciences & Centre for Excellence in Molecular Biology and Regenerative Medicine, JSS Academy of Higher Education & Research
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Ahadi P, Rezaei M, Salahzadeh Z, Talebi M, Sarbakhsh P, Azghani MR. Assessment of the head, cervical spine, thoracic spine and shoulder girdle postures in people with and without chronic headache. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2022. [DOI: 10.12968/ijtr.2019.0140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims Cervical dysfunction is one of the common symptoms of chronic headaches. This study was conducted to assess the posture of the head, cervical and thoracic spine and the shoulder girdle in people with and without cervicogenic and migraine headaches. Methods The postural angles of the head, cervical and thoracic spine and the shoulder girdle in frontal and sagittal planes, as well as thoracic spine curvature, were measured on 90 people who were split into three groups: 20 people with cervicogenic headache, 20 people with migraine and 50 people as the control group. Results There were significant differences among the three groups in the craniovertebral angle, coronal head tilt angle and scapular upward rotation angle (P<0.05). There was no relationship between postural angles. Conclusions The results of this study revealed that forward head posture was evident in people with cervicogenic and migraine headache. Decreased scapular upward rotation seen in the migraine headache group highlights the importance of shoulder girdle-related dysfunctions in people with chronic headaches.
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Affiliation(s)
- Parisa Ahadi
- Department of Physiotherapy, Faculty of Rehabilitation Sciences, Tabriz University of Medical Sciences, Iran
| | - Mandana Rezaei
- Department of Physiotherapy, Faculty of Rehabilitation Sciences, Tabriz University of Medical Sciences, Iran
| | - Zahra Salahzadeh
- Department of Physiotherapy, Faculty of Rehabilitation Sciences, Tabriz University of Medical Sciences, Iran
| | - Mahnaz Talebi
- Department of Neurology Imam Hospital, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Parvin Sarbakhsh
- Road Traffic Injury Research Centre, Tabriz University of Medical Sciences, Tabriz, Iran
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Paolucci M, Altamura C, Vernieri F. The Role of Endothelial Dysfunction in the Pathophysiology and Cerebrovascular Effects of Migraine: A Narrative Review. J Clin Neurol 2021; 17:164-175. [PMID: 33835736 PMCID: PMC8053543 DOI: 10.3988/jcn.2021.17.2.164] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 12/17/2022] Open
Abstract
Background and Purpose Migraine is a complex neurovascular disorder whose triggers are not entirely understood. Endothelial dysfunction might play a role in migraine, and there have been numerous reports on endothelium dysfunction and migraine pathophysiology, but their reciprocal cause–effect relationship remains unclear. This review reports the current evidence on endothelium dysfunction, its link with migraine, and its possible consequences for cerebral hemodynamics. Methods We performed a systematic literature search of PubMed up to March 2020. We included 115 articles in a narrative review. Results Several studies have demonstrated that endothelium dysfunction may play an important role in migraine. Despite the lack of specific biomarkers, there is evidence of oxidative stress and inflammation—two of the primary causes of endothelial damage—in migraine. The main consequences of endothelial dysfunction are increased vascular tone, thrombosis, inflammation, and increased vascular permeability. As a consequence of oxidative stress, the activity of endothelin-1 is not counterbalanced by nitric oxide (NO), whose levels decrease to lead to vasoconstriction and a possible contribution to cortical spreading depression. NO is involved in pain perception via the cyclic guanosine monophosphate (cGMP) pathway and the induction of calcitonin gene-related peptide. Oxidative stress may induce a hypercoagulable state that mainly affects platelet function through different mechanisms. Endothelial dysfunction seems to be particularly pronounced in migraine with aura (MA). Endothelial dysfunction in migraine particularly involves intracranial vessels, since flow-mediated dilation cannot detect overt peripheral vascular dysfunction. Conclusions Endothelial dysfunction is a vascular risk marker. How it impacts migraine, and particularly MA, needs to be understood better by defining its possible role in increasing the stroke risk in migraine patients.
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Affiliation(s)
- Matteo Paolucci
- Headache and Neurosonology Unit, Neurology, Campus Bio-Medico University of Rome, Rome, Italy.,Neurology Unit, M. Bufalini Hospital, Cesena, AUSL Romagna, Italy.
| | - Claudia Altamura
- Headache and Neurosonology Unit, Neurology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Fabrizio Vernieri
- Headache and Neurosonology Unit, Neurology, Campus Bio-Medico University of Rome, Rome, Italy
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Dogru MT, Dilekoz E, Alpua M, Eroglu O, Kandemir H, Alp C, Bolay H. Endothelial and Autonomic Functions in Patients with Migraine. PAIN MEDICINE 2020; 21:e222-e231. [PMID: 31603510 DOI: 10.1093/pm/pnz223] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE It has been shown that patients with migraine have endothelial dysfunction. Migraine patients with aura, especially, have more clinical manifestations of autonomic nervous system dysfunction. We aimed to evaluate the endothelial and autonomic functions in migraine patients during both migraine headache attack and headache-free periods. DESIGN This was a cross-sectional, randomized study. SUBJECTS AND METHODS A total of 130 participants (67 male and 63 female patients, minimum age = 19 years, maximum age = 71 years, mean age = 38.8 ± 12.2 years) were enrolled into the study. For the statistical evaluation of data, we classified the participants of the study as follows: group 1: headache (+) aura (+); group 2: headache (+) aura (-); group 3: headache (-) aura (+); group 4: headache (-) aura (-). Noninvasive evaluation of endothelial function was performed by flow-mediated dilation (FMD) and pulse wave analysis methods. Heart rate variability measurements were used for noninvasive evaluation of autonomic functions. RESULTS Group 1 had a higher FMD ratio than the control group, group 3, or group 4 (P < 0.001, P < 0.001, and P = 0.003, respectively). Group 4 had lower FMD ratio levels than the other migraine groups and or the control group (P < 0.001). Group 3 had the highest high-frequency (HF) power levels among all migraine groups (P < 0.001). Group 2 had higher low-frequency/HF ratio values than other migraineurs (P < 0.001). CONCLUSIONS We concluded that endothelial dysfunction and headache are closely related. Additionally, higher parasympathetic tonus might be associated with the presence of aura.
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Affiliation(s)
- Mehmet Tolga Dogru
- Cardiology Department, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Ergin Dilekoz
- Pharmacology Department, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Murat Alpua
- Neurology Department, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Oguz Eroglu
- Neurology Department, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey.,Emergency Medicine Department, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Hüseyin Kandemir
- Cardiology Department, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Caglar Alp
- Cardiology Department, Faculty of Medicine, Kırıkkale University, Kırıkkale, Turkey
| | - Hayrunnisa Bolay
- Neurology & Algology Department, Faculty of Medicine, Neuropsychiatry Centre, Gazi University, Ankara, Turkey
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Demartini C, Greco R, Zanaboni AM, Sances G, De Icco R, Borsook D, Tassorelli C. Nitroglycerin as a comparative experimental model of migraine pain: From animal to human and back. Prog Neurobiol 2019; 177:15-32. [DOI: 10.1016/j.pneurobio.2019.02.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 01/19/2019] [Accepted: 02/10/2019] [Indexed: 12/13/2022]
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Yetkin E, Öztürk S. Endothelium-dependent and -independent functions in migraineurs. J Med Ultrason (2001) 2018; 46:167-168. [PMID: 30350247 DOI: 10.1007/s10396-018-0909-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 07/06/2018] [Indexed: 10/28/2022]
Affiliation(s)
- Ertan Yetkin
- Department of Cardiology, Private Yenisehir Hospital, Mersin, Turkey.
| | - Selçuk Öztürk
- Department of Cardiology, Ankara Education and Research Hospital, Ankara, Turkey
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Fujioka K. Reply to: Endothelium-dependent and -independent functions in migraineurs. J Med Ultrason (2001) 2018; 46:169-170. [PMID: 30350246 PMCID: PMC6339882 DOI: 10.1007/s10396-018-0910-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 09/10/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Kazumi Fujioka
- Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan.
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Fujioka K, Oishi M, Fujioka A, Nakayama T. Increased nitroglycerin-mediated vasodilation in migraineurs without aura in the interictal period. J Med Ultrason (2001) 2018; 45:605-610. [PMID: 29796732 PMCID: PMC6339883 DOI: 10.1007/s10396-018-0880-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 04/03/2018] [Indexed: 01/03/2023]
Abstract
PURPOSE Migraine is associated with vascular disorders, but the underlying mechanism is unknown. Nitric oxide (NO) sensitivity is believed to play a major role in migraine pathophysiology. We investigated flow-mediated vasodilatation (FMD) and nitroglycerin-mediated vasodilatation (NMD) of the brachial artery by means of a key molecular mediator, NO, in patients with migraine without aura in the interictal period whether the abnormality is found. METHODS A total of 12 patients with migraine without aura and 12 matched healthy controls were enrolled in this study. FMD and NMD were measured in all patients and controls using brachial artery ultrasonography. RESULTS There was no significant difference in brachial artery diameter between migraineurs and nonmigraineurs (3.39 ± 0.68 vs 3.89 ± 0.67 mm, respectively; p = 0.083). A significant difference in FMD was not found between migraineurs and nonmigraineurs (6.94 ± 5.72 vs 6.08 ± 2.98%, respectively; p = 0.651). However, NMD in migraineurs was significant higher than that in nonmigraineurs (21.56 ± 7.36 vs 14.23 ± 7.41%, respectively; p = 0.024). CONCLUSION We think that patients with migraine without aura in the interictal period have selective sensitivity in dilator response to nitroglycerin and may have systemic NO sensitivity.
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Affiliation(s)
- Kazumi Fujioka
- Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
| | - Minoru Oishi
- Department of Internal Medicine, Izutobu General Hospital, Shizuoka, Japan
| | | | - Tomohiro Nakayama
- Division of Laboratory Medicine, Department of Pathology and Microbiology, Nihon University School of Medicine, 30-1 Oyaguchi-kamicho, Itabashi-ku, Tokyo, 173-8610, Japan
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Witvoet EH, Pelzer N, Terwindt GM, Rinkel GJ, Vlak MH, Algra A, Wermer MJ. Migraine prevalence in patients with unruptured intracranial aneurysms: A case-control study. Brain Behav 2017; 7:e00662. [PMID: 28523215 PMCID: PMC5434178 DOI: 10.1002/brb3.662] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 01/16/2017] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Migraine is a suggested risk factor for aneurysmal subarachnoid hemorrhage (aSAH). An increased risk of aSAH in migraineurs may be explained by an increased prevalence of unruptured intracranial aneurysms (UIA). We performed a case-control study to compare lifetime migraine prevalence in patients with UIA, patients with a history of transient ischemic attact (TIA) or ischemic stroke and controls without a history of aSAH, TIA or ischemic stroke. MATERIALS AND METHODS Patients with UIA were recruited from two university hospitals. Data on patients with TIA/stroke were retrieved from a previous study. Partners of patients with UIA or TIA/stroke were included as controls. Migraine history was assessed via a telephone interview based on the International Classification of Headache Disorders, second edition criteria. We calculated odds ratios (OR) for migraine with univariable and multivariable logistic regression analyses, adjusted for age, sex, hypertension and smoking. RESULTS We included 172 patients with UIA, 221 patients with TIA or stroke, and 164 controls. In UIA patients, migraine prevalence was 24.4% compared with 14.6% in controls (UIA vs. controls; OR 1.9; 95% confidence interval [CI] 1.1-3.5) and 22.2% in TIA/stroke patients (UIA vs. TIA/stroke; OR 1.1; 95% CI 0.7-1.8). After adjustments, the OR for migraine in UIA patients versus controls were 1.7 (95% CI 1.0-3.1) and 0.9 (95% CI 0.5-1.0) versus TIA/stroke. Results were comparable for migraine with and without aura. CONCLUSIONS Migraine prevalence is possibly increased in patients with UIA compared with controls and comparable with the prevalence in patients with TIA or stroke. Further studies are needed to confirm our findings and to investigate the underlying pathophysiology.
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Affiliation(s)
- Elbert H. Witvoet
- Department of NeurologyLeiden University Medical CenterLeidenThe Netherlands
| | - Nadine Pelzer
- Department of NeurologyLeiden University Medical CenterLeidenThe Netherlands
| | - Gisela M. Terwindt
- Department of NeurologyLeiden University Medical CenterLeidenThe Netherlands
| | - Gabriël J.E. Rinkel
- Department of Neurology and NeurosurgeryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrechtThe Netherlands
| | - Monique H.M. Vlak
- Department of NeurologyHaaglanden Medical CenterThe HagueThe Netherlands
| | - Ale Algra
- Department of Neurology and NeurosurgeryBrain Center Rudolf MagnusUniversity Medical Center UtrechtUtrechtThe Netherlands
- Department of Clinical EpidemiologyLeiden University Medical CenterLeidenThe Netherlands
| | - Marieke J.H. Wermer
- Department of NeurologyLeiden University Medical CenterLeidenThe Netherlands
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Larsen JS, Skaug EA, Wisløff U, Ellingsen Ø, Stovner LJ, Linde M, Hagen K. Migraine and endothelial function: The HUNT3 Study. Cephalalgia 2016; 36:1341-1349. [DOI: 10.1177/0333102416631961] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/08/2016] [Accepted: 01/17/2016] [Indexed: 11/17/2022]
Abstract
Background Reduced endothelial function is associated with elevated risk of cardiovascular disease, but evidence on the association between migraine and endothelial function is conflicting. The aim of this population-based study was to examine the relationship between flow-mediated dilatation (FMD) and migraine with aura, migraine without aura and tension-type headache. Methods In the third Nord-Trøndelag Healthy Study (HUNT3) FMD was measured by ultrasound during reactive hyperaemia of the brachial artery in a sample of 4739 healthy adult participants, 3929 of whom answered headache questions. The cross-sectional association between different headache diagnoses and FMD was evaluated by logistic regression, using a categorical approach. Results Mean FMD did not differ between the headache groups and headache-free controls. In multi-adjusted analyses, no consistent association was found between FMD quintiles and headache groups. Conclusions There was no relationship between FMD and migraine or other headache diagnoses in this large cross-sectional study of otherwise healthy respondents including freedom from pulmonary and cardiovascular diseases.
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Affiliation(s)
| | - Eli-Anne Skaug
- K.G. Jebsen Center of Exercise in Medicine, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Norway
| | - Ulrik Wisløff
- K.G. Jebsen Center of Exercise in Medicine, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Norway
- Department of Cardiology, St. Olavs Hospital, Norway
| | - Øyvind Ellingsen
- K.G. Jebsen Center of Exercise in Medicine, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Norway
- Department of Cardiology, St. Olavs Hospital, Norway
| | - Lars Jacob Stovner
- Department of Neuroscience, Norwegian University of Science and Technology, Norway
- Norwegian Advisory Unit on Headaches, St Olavs Hospital, Norway
| | - Mattias Linde
- Department of Neuroscience, Norwegian University of Science and Technology, Norway
- Norwegian Advisory Unit on Headaches, St Olavs Hospital, Norway
| | - Knut Hagen
- Department of Neuroscience, Norwegian University of Science and Technology, Norway
- Norwegian Advisory Unit on Headaches, St Olavs Hospital, Norway
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Butt JH, Franzmann U, Kruuse C. Endothelial function in migraine with aura - a systematic review. Headache 2014; 55:35-54. [PMID: 25546573 DOI: 10.1111/head.12494] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND An increased risk of ischemic stroke is repeatedly reported in young subjects with migraine with aura (MA). Such may be caused by changes in endothelial function. The present review evaluates current evidence on endothelial function in MA patients. METHODS A systematic search of electronic databases (Medline, Embase, Cochrane library) was performed, and a search in associated reference lists of identified studies was done. RESULTS In total, 27 studies met inclusion criteria for this review. Six studies assessed endothelial function by flow-mediated dilation; four reported no differences compared with healthy subjects, one study reported an increase and one study a decrease in migraineurs. Peripheral arterial tonometry was applied in one study where no changes were detected between groups. Likewise, applying venous occlusion plethysmography elicited comparable responses. Arterial function was investigated in six studies; increased augmentation index and decreased arterial distensibility were reported in migraineurs, whereas findings regarding pulse wave velocity were dissimilar. However, when investigating levels of endothelial progenitor cells, two studies reported reduced levels in migraineurs, and several studies on endothelial markers in the areas of inflammation, oxidative stress, and coagulation found increased endothelial activation in migraineurs, particularly in MA. One study, assessing cerebral endothelial function using transcranial Doppler sonography, reported lower cerebrovascular reactivity to L-arginine in the posterior cerebral arteries in migraineurs. CONCLUSION Endothelial dysfunction appears not to be of importance in MA patients. However, the studies were few with a wide variety of techniques applied in small groups of patients. Endothelial biomarkers were increased in patients indicating a possible subtle change in the endothelium. Further investigations on larger groups of patients combining testing of endothelial dysfunction as well as biomarkers are warranted to identify whether or not endothelial changes may play a role in the increased risk of stroke in young MA patients.
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Affiliation(s)
- Jawad H Butt
- Department of Neurology, Neurovascular Research Unit, Copenhagen University Hospital Herlev, Herlev, Denmark
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Buettner C, Burstein R. Association of statin use and risk for severe headache or migraine by serum vitamin D status: a cross-sectional population-based study. Cephalalgia 2014; 35:757-66. [PMID: 25424706 DOI: 10.1177/0333102414559733] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Accepted: 10/12/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objective of this article is to evaluate whether statin use and vitamin D status is associated with severe headache or migraine in a nationally representative sample. METHODS We conducted a cross-sectional study of US individuals aged ≥40 years for whom information on statin use, serum 25-hydroxy vitamin D (25(OH)D), and self-reported severe headache or migraine had been collected. We calculated prevalence estimates of headache according to statin and 25(OH)D, and conducted adjusted logistic regression analyses stratified by the median 25(OH)D (≤57 and >57 nmol/l). RESULTS Among 5938 participants, multivariable-adjusted logistic regression showed that statin use was significantly associated with a lower prevalence of severe headache or migraine (OR 0.67; 95% CI 0.46, 0.98, p = 0.04). We found a significant interaction between statin use and 25(OH)D with the prevalence of severe headache or migraine (p for interaction = 0.005). Among participants who had serum 25(OH)D > 57 nmol/l, statin use was associated with a multivariable-adjusted odds ratio of 0.48 (95% CI 0.32, 0.71, p = 0.001) for having severe headache or migraine. Among those with 25(OH)D ≤ 57 nmol/l, no significant association was observed between statin use and severe headache or migraine. CONCLUSION Statin use in those with higher serum vitamin D levels is significantly associated with lower odds of having severe headache or migraine.
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Affiliation(s)
- Catherine Buettner
- Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, USA Harvard Medical School, USA
| | - Rami Burstein
- Harvard Medical School, USA Department of Anesthesia and Critical Care, Beth Israel Deaconess Medical Center, USA
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Abstract
BACKGROUND Migraine, particularly with aura, increases the risk for ischemic stroke, at least in a subset of patients. The underlying mechanisms are poorly understood and probably multifactorial. METHODS We carried out an extended literature review of experimental and clinical evidence supporting the association between migraine and ischemic stroke to identify potential mechanisms that can explain the association. RESULTS Observational, imaging and genetic evidence support a link between migraine and ischemic stroke. Based on clinical and experimental data, we propose mechanistic hypotheses to explain the link, such as microembolic triggers of migraine and enhanced sensitivity to ischemic injury in migraineurs. DISCUSSION We discuss the possible practical implications of clinical and experimental data, such as aggressive risk factor screening and management, stroke prophylaxis and specific acute stroke management in migraineurs. However, evidence from prospective clinical trials is required before modifying the practice in this patient population.
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Affiliation(s)
- Jerome Mawet
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, MA, USA Emergency Headache Center, Lariboisiere Hospital, Assistance Publique-Hopitaux de Paris, France DHU NeuroVasc, France
| | - Tobias Kurth
- Inserm Research Center for Epidemiology and Biostatistics (U897), Team Neuroepidemiology, France University of Bordeaux, College of Health Sciences, France Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, MA, USA
| | - Cenk Ayata
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, MA, USA Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, MA, USA
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Liman TG, Bachelier-Walenta K, Neeb L, Rosinski J, Reuter U, Böhm M, Endres M. Circulating endothelial microparticles in female migraineurs with aura. Cephalalgia 2014; 35:88-94. [PMID: 24715500 DOI: 10.1177/0333102414529671] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND PURPOSE Endothelial microparticles (EMPs) are vesicles that are released from activated endothelial cells and serve as a surrogate for endothelial dysfunction (ED). ED may be involved in migraine pathophysiology and contribute to the increased risk of ischemic stroke, particularly in female migraineurs with aura (MA). We sought to determine whether EMPs are elevated in women with MA. METHODS In this case-control study, EMPs were detected by analysing surface markers using fluorescence-activated cell sorting (FACS). Surface markers were measured covering the main cell lines relevant in cardiovascular disease like endothelial cells, platelets, monocytes and leucocytes. Microparticles (MPs) were identified in correlation to calibration by 1 -µm calibrator beads (Beckman Coulter). Arterial stiffness was assessed using fingertip tonometry and the heart rate-adjusted augmentation index (AI). RESULTS We included 29 patients with MA and 29 matched controls. MA patients had significantly higher EMPs (CD62E(+)AnnexinV(+): 5142/µl vs 1535/µl; p < 0.001; CD144(+)AnnexinV(+): 6683/µl vs 3107/µl; p < 0.001), monocytic (CD14(+)AnnexinV(+) 6378 vs 3161; p < 0.001), and platelet MPs (CD62P(+)CD42b(+)AnnexinV(+) 5450 vs 3204; p < 0.001). Activated EMPs (CD62E(+)AnnexinV(+)) correlated with heart-rate adjusted AI (r = 0.46; p < 001). CONCLUSION EMP levels are significantly elevated in women with MA and correlated with increased AI. Our findings suggest that endothelial activation is present in women with MA. This might contribute to higher stroke risk in MA.
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Affiliation(s)
- Thomas G Liman
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Germany Klinik und Poliklinik für Neurologie, Charité - Universitätsmedizin Berlin, Germany
| | - Katrin Bachelier-Walenta
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Germany
| | - Lars Neeb
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Germany Klinik und Poliklinik für Neurologie, Charité - Universitätsmedizin Berlin, Germany
| | - Jana Rosinski
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Germany
| | - Uwe Reuter
- Klinik und Poliklinik für Neurologie, Charité - Universitätsmedizin Berlin, Germany
| | - Michael Böhm
- Klinik für Innere Medizin III, Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Germany
| | - Matthias Endres
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Germany Klinik und Poliklinik für Neurologie, Charité - Universitätsmedizin Berlin, Germany Excellence Cluster NeuroCure, Charité - Universitätsmedizin, Germany German Center for Cardiovascular Research (DZHK), Charité - Universitätsmedizin, Germany
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Xu H, Li K, Chen Y, Zhang Y, Tang S, Wang S, Shen D, Wang X, Lei Y, Li D, Zhang Y, Jin L, Yang H, Huang L. Study on the absorbed fingerprint-efficacy of yuanhu zhitong tablet based on chemical analysis, vasorelaxation evaluation and data mining. PLoS One 2013; 8:e81135. [PMID: 24339904 PMCID: PMC3858225 DOI: 10.1371/journal.pone.0081135] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Accepted: 10/18/2013] [Indexed: 11/19/2022] Open
Abstract
Yuanhu Zhitong Tablet (YZT) is an example of a typical and relatively simple clinical herb formula that is widely used in clinics. It is generally believed that YZT play a therapeutical effect in vivo by the synergism of multiple constituents. Thus, it is necessary to build the relationship between the absorbed fingerprints and bioactivity so as to ensure the quality, safety and efficacy. In this study, a new combinative method, an intestinal absorption test coupled with a vasorelaxation bioactivity experiment in vitro, was a simple, sensitive, and feasible technique to study on the absorbed fingerprint-efficacy of YZT based on chemical analysis, vasorelaxation evaluation and data mining. As part of this method, an everted intestinal sac method was performed to determine the intestinal absorption of YZT solutions. YZT were dissolved in solution (n = 12), and the portion of the solution that was absorbed into intestinal sacs was analyzed using rapid-resolution liquid chromatography coupled with quadruple time-of-flight mass spectrometry (RRLC-Q-TOF/MS). Semi-quantitative analysis indicated the presence of 34 compounds. The effect of the intestinally absorbed solution on vasorelaxation of rat aortic rings with endothelium attached was then evaluated in vitro. The results showed that samples grouped by HCA from chemical profiles have similar bioactivity while samples in different groups displayed very different. Moreover, it established a relationship between the absorbed fingerprints and their bioactivity to identify important components by grey relational analysis, which could predict bioactive values based on chemical profiles and provide an evidence for the quantification of multi-constituents.
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Affiliation(s)
- Haiyu Xu
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, P.R. China
| | - Ke Li
- Shandong Provincial Key Laboratory of Automotive Electronic Technology, Institute of Automation, Shandong Academy of Sciences, Jinan, P.R. China
| | - Yanjun Chen
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, P.R. China
| | - Yingchun Zhang
- National Resource Center for Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, P.R. China
| | - Shihuan Tang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, P.R. China
| | - Shanshan Wang
- Analysis and Test Center, Shandong Academy of Sciences, Jinan, PR China
| | - Dan Shen
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, P.R. China
| | - Xuguang Wang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, P.R. China
- Laboratory of Drug Metabolism and Pharmacokinetics, Shenyang Pharmaceutical University, Shenyang, PR China
| | - Yun Lei
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, P.R. China
| | - Defeng Li
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, P.R. China
| | - Yi Zhang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, P.R. China
| | - Lan Jin
- National Glycoengineering Research Center, Shandong University, Jinan, PR China
| | - Hongjun Yang
- Institute of Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, P.R. China
- * E-mail: (HY); (LH)
| | - Luqi Huang
- National Resource Center for Chinese Materia Medica, China Academy of Chinese Medical Sciences, Beijing, P.R. China
- * E-mail: (HY); (LH)
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Sacco S, Ripa P, Grassi D, Pistoia F, Ornello R, Carolei A, Kurth T. Peripheral vascular dysfunction in migraine: a review. J Headache Pain 2013; 14:80. [PMID: 24083826 PMCID: PMC3849862 DOI: 10.1186/1129-2377-14-80] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 09/20/2013] [Indexed: 12/13/2022] Open
Abstract
Numerous studies have indicated an increased risk of vascular disease among migraineurs. Alterations in endothelial and arterial function, which predispose to atherosclerosis and cardiovascular diseases, have been suggested as an important link between migraine and vascular disease. However, the available evidence is inconsistent. We aimed to review and summarize the published evidence about the peripheral vascular dysfunction of migraineurs.We systematically searched in BIOSIS, the Cochrane database, Embase, Google scholar, ISI Web of Science, and Medline to identify articles, published up to April 2013, evaluating the endothelial and arterial function of migraineurs.Several lines of evidence for vascular dysfunction were reported in migraineurs. Findings regarding endothelial function are particularly controversial since studies variously indicated the presence of endothelial dysfunction in migraineurs, the absence of any difference in endothelial function between migraineurs and non-migraineurs, and even an enhanced endothelial function in migraineurs. Reports on arterial function are more consistent and suggest that functional properties of large arteries are altered in migraineurs.Peripheral vascular function, particularly arterial function, is a promising non-invasive indicator of the vascular health of subjects with migraine. However, further targeted research is needed to understand whether altered arterial function explains the increased risk of vascular disease among patients with migraine.
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Affiliation(s)
- Simona Sacco
- Department of Neurology and Regional Headache Center, University of L'Aquila, Piazzale Salvatore Tommasi 1, L'Aquila, 67100, Italy.
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Zaproudina N, Närhi M, Lipponen JA, Tarvainen MP, Karjalainen PA, Karhu J, Airaksinen O, Giniatullin R. Nitroglycerin-induced changes in facial skin temperature: 'cold nose' as a predictor of headache? Clin Physiol Funct Imaging 2013; 33:409-17. [PMID: 23701267 DOI: 10.1111/cpf.12042] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 03/25/2013] [Indexed: 11/27/2022]
Abstract
Nitroglycerin (NTG) often induces headaches when used to treat cardiac diseases. Such property of NTG has been widely used in modelling of migraine-like headaches. However, background reasons, predisposing to the development of NTG-headache, are less studied. The main aim of our study was to find, using NTG model, easily accessible markers of the vascular changes associated with headache. Because changes in the blood flow alter the local skin temperature (Tsk), we studied the relationship between the regional changes in the facial Tsk and NTG-induced headaches. Tsk was measured with infrared thermography in 11 healthy women during 3 h after sublingual NTG administration. NTG caused headache in five women, and four of them were the first-degree relatives of migraine patients. Notably, before NTG administration, subjects in the headache group had lower Tsk values, especially in the nose area, than women in the pain-free group (n = 6). NTG-induced headache was associated with a long-lasting increase of Tsk over the baseline. In sharp contrast, in the pain-free group, the Tsk reduced and returned rapidly to the baseline. Thus, the low baseline level and greater increase of regional Tsk correlated with the incidence of headache that supports a role of greater vascular changes in headache happening on the basis of the dissimilarities in vascular tone. An easily accessible phenomenon of 'cold nose' may indicate background vascular dysfunctions in individuals with predisposition to headache. Facial infrared thermography, coupled with NTG administration, suggests a novel temporally controlled approach for non-invasive investigation of vascular processes accompanying headaches.
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Affiliation(s)
- Nina Zaproudina
- Institute of Biomedicine, University of Eastern Finland, Kuopio, Finland; Institute of Dentistry, University of Eastern Finland, Kuopio, Finland
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Jiménez Caballero PE, Muñoz Escudero F. Peripheral endothelial function and arterial stiffness in patients with chronic migraine: a case-control study. J Headache Pain 2013; 14:8. [PMID: 23565915 PMCID: PMC3619990 DOI: 10.1186/1129-2377-14-8] [Citation(s) in RCA: 24] [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: 11/16/2012] [Accepted: 01/16/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Migraine is a complex and disabilitating neurovascular disorder predominantly affecting women. There is strong evidence that nitric oxide is critically involved in migraine pathophysiology. The aim of the present study was to test the hypothesis that chronic migraine is associated with ultrasonographic endothelial dysfunction and increase in arterial stiffness. These parameters were assessed using a novel plethysmograph by peripheral arterial tonometry. METHODS Twenty-one patients with chronic migraine and twenty-one healthy controls matched by sex and gender were recruited. Measurement of the ultrasonographic endothelial function and augmentation index were made according to manufacturer's protocol. RESULTS The mean of patient's peripheral arterial tonometry ratios was 1.93 ± 0.39 and for healthy control 2.21 ± 0.44 (p=0.040). The median of patients' augmentation index was -6,0 (IQR: 6.5 to -15) in healthy controls and 9.0 (IQR: 4 to 12) in chronic migraine, (p=0.002). CONCLUSIONS Patients with chronic migraine have ultrasonographic endothelial dysfunction and increase in the arterial stiffness. An improved understanding of the role in the endothelial system of migraine may provide a basis for preventive drugs in migraine and restore the endothelial function.
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Affiliation(s)
| | - Francisco Muñoz Escudero
- Department of Neurology, Virgen de la Salud Hospital, Avenida de Barber 32, Toledo, 45005, Spain
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20
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Oterino A, Toriello M, Palacio E, Quintanilla VG, Ruiz-Lavilla N, Montes S, Vega MSDL, Martinez-Nieto R, Castillo J, Pascual J. Analysis of endothelial precursor cells in chronic migraine: a case-control study. Cephalalgia 2012; 33:236-44. [PMID: 23223547 DOI: 10.1177/0333102412469737] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Migraine has been considered a vascular risk factor especially in young women. Factors predisposing to endothelial damage in migraine are still being debated. The insufficiency of circulating endothelial precursor circulating cells (EPCs) suggested a link between migraine and cardiovascular risk. This research aimed to study a subtype of EPCs, those expressing e-selectin, to assess endothelial activation and, therefore, endothelial dysfunction in migraine. METHODS Consecutive headache patients (n = 99) and 35 adjusted controls were recruited. Total EPCs, defined as CD34+/KDR+ cells, and EPC colony-forming units (CFUs) were assayed. We identified as "early" EPCs those CD62E- EPCs, and "late" EPCs, CD62E+, a surrogate marker for endothelial damage. Plasmatic calcitonin-gene related protein (CGRP) and vascular-endothelial growth factor (VEGF) were analyzed. RESULTS We did not find differences in the total number of CFUs among clinical groups. Means of total CD34+/KDR+ and "early" EPCs were not significant among clinical groups. Nevertheless, the mean of "late" EPCs was lower (log(10)-transformed mean = 1.715; SD = 0.393) in the control group than in the migraine patients (log(10)-transformed mean = 2.167; SD = 0.685), even after adjustment by VEGF plasma level and other confounding factors. Linear regression analyses disclosed significant predictors for "late" EPCs for controls vs migraine (β = 0.452 SE ± 0.13; p = 0.001). We did not observe differences between migraine with or without aura. CONCLUSION We observed higher number of activated EPCs in migraine patients than in controls. CD62E+ EPCs might be considered a marker for vascular damage in migraine patients.
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Perko D, Pretnar-Oblak J, Žvan B, Zaletel M. Are impaired endothelial function in the posterior cerebral circulation and intact endothelial function in the anterior cerebral and systemic circulation associated with migraine: A post hoc study. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.permed.2012.02.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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22
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Sivri N, Tekin G, Erbay AR, Yalta K, Senen K, Gür M, Yetkin E. Headache response to nitrate in patients with coronary artery disease and systolic heart failure. Int J Cardiol 2012; 158:453-4. [PMID: 22633669 DOI: 10.1016/j.ijcard.2012.05.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2012] [Accepted: 05/04/2012] [Indexed: 11/28/2022]
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23
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Liman TG, Neeb L, Rosinski J, Wellwood I, Reuter U, Doehner W, Heuschmann PU, Endres M. Peripheral endothelial function and arterial stiffness in women with migraine with aura: a case-control study. Cephalalgia 2012; 32:459-66. [PMID: 22523187 DOI: 10.1177/0333102412444014] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Vascular dysfunction may be involved in migraine pathophysiology and contribute to the increased risk of ischemic stroke in migraine, particularly in women with migraine with aura (MA). However, data on endothelial function in MA are controversial. Here, we investigated whether systemic endothelial function and arterial stiffness are altered in women with MA, using a novel peripheral arterial tonometry device for the first time. METHODS Twenty-nine female MA patients without comorbidities and 30 healthy women were included, and carotid intima-media thickness was assessed by a standardized procedure. Endothelial function was assessed using peripheral arterial tonometry. Reactive hyperaemic response of digital pulse amplitude was measured following 5 minutes of forearm occlusion of the brachial artery. Arterial stiffness was assessed by fingertip tonometry derived and heart-rate-adjusted augmentation index. RESULTS No differences were found in peripheral arterial tonometry ratio (2.3 ± 0.6 vs 2.2 ± 0.8; p = 0.58) and left carotid intima-media thickness (in µm: 484 ± 119 vs 508 ± 60; p = 0.37). Women with MA had higher heart-rate-averaged augmentation index [median (interquartile range, IQR) of 5 (IQR 0.5 to 18) vs -5 (IQR -16.8 to 8.3), p = 0.005] and heart-rate-adjusted augmentation index [1 (IQR -6 to 12.5) vs -8 (IQR -20.3 to 2.5), p = 0.008] than healthy controls. CONCLUSION Peripheral endothelial function is not impaired in women with MA, but they have greater arterial stiffness. This may contribute to the increased stroke risk in women with MA.
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Affiliation(s)
- T G Liman
- Charité-Universitätsmedizin Berlin, Germany.
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Perko D, Pretnar-Oblak J, Šabovič M, Zaletel M, Žvan B. Associations between cerebral and systemic endothelial function in migraine patients: a post-hoc study. BMC Neurol 2011; 11:146. [PMID: 22085841 PMCID: PMC3254070 DOI: 10.1186/1471-2377-11-146] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Accepted: 11/15/2011] [Indexed: 01/22/2023] Open
Abstract
Background There is a growing interest in the role of the endothelium in migraine. Recently, our group showed differences in endothelial function between the anterior and posterior cerebral circulation in healthy subjects, reduced vasodilatatory capacity of the posterior cerebral circulation and unimpaired systemic endothelial function in migraine patients without comorbidities. However, the relationship between cerebral and systemic endothelial function and the anterior and posterior cerebral endothelial function in migraine patients is still not clear. Methods We compared cerebral and systemic endothelial function through post-hoc linear regression analysis of cerebrovascular reactivity (CVR) to L-arginine between the middle cerebral artery (MCA) and flow-mediated vasodilatation (FMD) of the right brachial artery and the posterior cerebral artery (PCA) and FMD in migraine patients without comorbidities and in healthy subjects. The anterior and posterior cerebral endothelial function was also compared using post-hoc linear regression analysis between CVR to L-arginine in the MCA and the PCA. Results No significant correlation was found between CVR to L-arginine in the MCA and FMD and in the PCA and FMD in migraine patients with aura (p = 0.880 vs. p = 0.682), without aura (p = 0.153 vs. p = 0.179) and in healthy subjects (p = 0.869 vs. p = 0.662). On the other hand, we found a significant correlation between CVR to L-arginine in the MCA and PCA in migraine patients with aura (p = 0.004), without aura (p = 0.001) and in healthy subjects (p = 0.002). Detailed analysis of the linear regression between all migraine patients and healthy subjects did not show any difference in the regression coefficient (slope) (p = 0.382). However, a significant difference in curve elevation (intercept) was found (p = 0.002). Conclusions Our study suggests that the endothelial function in the cerebral and systemic circulation might be different in migraine patients without comorbidities, while that of the anterior and posterior cerebral circulation might be coupled. These results could improve understanding of endothelial function in migraine patients without comorbidities.
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Affiliation(s)
- Denis Perko
- Department of Neurology, University Medical Centre Ljubljana, Zaloška cesta 2, 1000 Ljubljana, Slovenia.
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Perko D, Pretnar-Oblak J, Sabovic M, Zvan B, Zaletel M. Endothelium-dependent vasodilatation in migraine patients. Cephalalgia 2011; 31:654-60. [PMID: 21296807 DOI: 10.1177/0333102410390396] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Endothelial dysfunction could be involved in the pathophysiology of migraine. The results obtained from a few studies on endothelial dysfunction in migraine are controversial. We investigated brachial flow-mediated dilatation (FMD), which reflects systemic endothelial dysfunction, in migraine patients without comorbidities. By employing strict inclusion criteria we avoided the possible changes to FMD from confounding factors. METHODS Forty migraine patients without comorbidities (20 with and 20 without aura) and 20 healthy subjects were included. FMD of brachial arteries and carotid intima-media thickness were measured by using standard procedures. RESULTS We did not find any difference in FMD between migraine patients and healthy subjects (p = .96). Also, no differences were found among healthy subjects, migraine patients with aura and without aura (p = .99). CONCLUSION Our study showed that systemic endothelial function is not impaired in migraine patients without comorbidities, neither in those with or without aura. Considering these findings, the investigation of cerebral endothelial function would be useful in a further investigation of the role of endothelial (dys)function in migraine pathophysiology.
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Affiliation(s)
- Denis Perko
- University Medical Center Ljubljana, Department of Neurology, Ljubljana, Slovenia.
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Vanmolkot FH, de Hoon JN. Endothelial function in migraine: a cross-sectional study. BMC Neurol 2010; 10:119. [PMID: 21122149 PMCID: PMC3017034 DOI: 10.1186/1471-2377-10-119] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Accepted: 12/01/2010] [Indexed: 12/22/2022] Open
Abstract
Background Migraine has been associated with cardiovascular disorders. Endothelial dysfunction may be a mechanism underlying this association. The present study tested the hypothesis that endothelium-dependent vasodilation, basal endothelial nitric oxide release and endothelial fibrinolytic capacity are impaired in migraine patients. Methods Graded doses of sodium nitroprusside (SNP, 0.2 to 0.8 μg.min-1.dL-1 forearm), substance P (0.2 to 0.8 pmol.min-1.dL-1 forearm) and NG-monomethyl-L-arginine (L-NMMA, 0.1 to 0.4 μmol.min-1.dL-1 forearm) were infused into the brachial artery of 16 migraine patients with or without aura during a headache-free interval and 16 age- and sex-matched subjects without a history of migraine. Forearm blood flow (FBF) was measured by strain-gauge venous occlusion plethysmography. Local forearm release of tissue plasminogen activator (t-PA) in response to substance P infusion was assessed using the arteriovenous plasma concentration gradient. Responses to infused drugs were compared between patients and matched controls by analysis of variance. Results In both migraine patients and control subjects, SNP and substance P caused a dose-dependent increase, and L-NMMA a dose-dependent decrease in FBF (P < 0.001 for all responses). In both groups, substance P caused an increase in t-PA release (P < 0.001). FBF responses and t-PA release were comparable between migraine patients and control subjects. Conclusions The absence of differences in endothelium-dependent vasodilation, basal endothelial nitric oxide production and stimulated t-PA release between migraine patients and healthy control subjects argues against the presence of endothelial dysfunction in forearm resistance vessels of migraine patients.
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Affiliation(s)
- Floris H Vanmolkot
- Department of Internal Medicine, Maastricht University Medical Center, P, Debyelaan 25, 6202 AZ Maastricht, The Netherlands.
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Tfelt-Hansen PC. Verisimilitude (or "truthlikeness") as an alternative to pro and cons: migraine and cluster headache mechanisms. J Headache Pain 2010; 11:379-89. [PMID: 20607582 PMCID: PMC3452275 DOI: 10.1007/s10194-010-0232-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Accepted: 06/04/2010] [Indexed: 12/13/2022] Open
Abstract
Calculating verisimilitude (or "truthlikeness") ad modum Popper is a quantitative alternative to the usual pros and cons in migraine and cluster headache mechanisms. The following items were evaluated: dilation of large cranial arteries during migraine; CGRP increase during migraine; migraine as a brain disorder; aura and migraine headache; brain stem activation during migraine; rCBF in migraine without aura; NO and pathophysiology of migraine; neurogenic inflammation and migraine; aura in cluster headache; and hypothalamic activation in cluster headache. It is concluded that verisimilitude calculations can be helpful when judging pathophysiological problems in migraine and cluster headache.
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Affiliation(s)
- Peer Carsten Tfelt-Hansen
- Department of Neurology, Danish Headache Centre, Glostrup Hospital, University of Copenhagen, Glostrup, Denmark.
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Hamed SA, Hamed EA, Ezz Eldin AM, Mahmoud NM. Vascular risk factors, endothelial function, and carotid thickness in patients with migraine: relationship to atherosclerosis. J Stroke Cerebrovasc Dis 2010; 19:92-103. [PMID: 20189084 DOI: 10.1016/j.jstrokecerebrovasdis.2009.04.007] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2009] [Revised: 04/11/2009] [Accepted: 04/21/2009] [Indexed: 12/28/2022] Open
Abstract
Recent studies indicated that migraine is associated with specific vascular risk profile. However, the functional and structural vascular abnormalities in migraine are rarely addressed. We evaluated the vascular risk factors, endothelial function, and carotid artery (CA)-intima-media thickness (IMT), segregators of preclinical atherosclerosis, in migraineurs. This preliminary study included 63 adults with headache (migraine with aura [n=14], migraine without aura [n=24], transformed migraine [n=6], and tension headache [n=19]) and 35 matched healthy subjects. The following vascular risks were assessed: body mass index (BMI), systolic blood pressure (SBP) and diastolic blood pressures (DBP), serum levels of C-reactive protein, fasting glucose, fasting insulin, total cholesterol, and triglycerides. Plasma endothelin (ET)-1, a vasoactive peptide produced by vascular smooth muscle cells and marker for endothelial injury and atherosclerosis, was measured. Endothelial-dependent vasoreactivity was assessed using brachial artery flow-mediated dilatation (FMD) in response to hyperemia. CA-IMT, structural marker of early atherosclerosis, was measured. Compared with control subjects, SBP, DBP, glucose, insulin, ET-1, and CA-IMT were elevated with migraine. FMD% was inversely correlated with SBP (P < .001), DBP (P < .01), glucose (P < .001), and insulin levels (P < .01). CA-IMT was correlated with BMI (P < .05), SBP (P < .01), total cholesterol (P < .01), triglycerides (P < .001), glucose (P < .001), insulin (P < .01), and FMD% (P < .05). In multivariate analysis, ET-1 was correlated with duration of illness, SBP, DBP, glucose, insulin, IMT, and FMD%. We conclude that endothelial injury, impaired endothelial vasoreactivity, and increased CA-IMT occur with migraine and are associated with vascular risk factors that strongly suggest that migraine could be a risk for atherosclerosis.
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Boutouyrie P, Corvisier R, Ong KT, Vulser C, Lassalle C, Azizi M, Laloux B, Laurent S. Acute and chronic effects of acupuncture on radial artery: A randomized double blind study in migraine. Artery Res 2010. [DOI: 10.1016/j.artres.2009.12.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Stam AH, Haan J, van den Maagdenberg AMJM, Ferrari MD, Terwindt GM. Migraine and Genetic and Acquired Vasculopathies. Cephalalgia 2009; 29:1006-17. [PMID: 19689610 DOI: 10.1111/j.1468-2982.2009.01940.x] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
It is remarkable that migraine is a prominent part of the phenotype of several genetic vasculopathies, including cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy (CADASIL), retinal vasculopathy with cerebral leukodystrophy (RVCL) and hereditary infantile hemiparessis, retinal arteriolar tortuosity and leukoencephalopahty (HIHRATL). The mechanisms by which these genetic vasculopathies give rise to migraine are still unclear. Common genetic susceptibility, increased susceptibility to cortical spreading depression (CSD) and vascular endothelial dysfunction are among the possible explanations. The relation between migraine and acquired vasculopathies such as ischaemic stroke and coronary heart disease has long been established, further supporting a role of the (cerebral) blood vessels in migraine. This review focuses on genetic and acquired vasculopathies associated with migraine. We speculate how genetic and acquired vascular mechanisms might be involved in migraine.
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Affiliation(s)
- AH Stam
- Department of Neurology, Leiden University Medical Centre, Leiden
| | - J Haan
- Department of Neurology, Leiden University Medical Centre, Leiden
- Department of Neurology, Rijnland Hospital, Leiderdorp, the Netherlands
| | - AMJM van den Maagdenberg
- Department of Neurology, Leiden University Medical Centre, Leiden
- Department of Human Genetics, Leiden University Medical Centre, Leiden
| | - MD Ferrari
- Department of Neurology, Leiden University Medical Centre, Leiden
| | - GM Terwindt
- Department of Neurology, Leiden University Medical Centre, Leiden
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Hamed SA. The vascular risk associations with migraine: relation to migraine susceptibility and progression. Atherosclerosis 2008; 205:15-22. [PMID: 19054516 DOI: 10.1016/j.atherosclerosis.2008.10.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Revised: 10/03/2008] [Accepted: 10/14/2008] [Indexed: 01/09/2023]
Abstract
Migraine is a common disorder in which changes in cortical excitability, neuroinflammation and dysfunction of the vascular wall contribute to its pathophysiology. Repeated attacks of migraine over prolonged periods result in inflammatory arteriopathy of the cranial vessels. Several studies indicate that migraine is associated with special pattern of inflammatory markers and some adverse vascular risk factors including: increased levels of CRP, ILs, TNF-alpha and adhesion molecules which are markers of systemic inflammation, oxidative stress and thrombosis, increased body weight, high blood pressure, hypercholesterolemia, impaired insulin sensitivity, high homocysteine levels, stroke and coronary heart disease. Such comorbidities are not explained by bias but indicate possible shared underlying pathogenic mechanisms. Recent studies have shown involvement of cranial as well as peripheral vascular dysfunction with migraine indicating that migraine may be a local manifestation of a systemic disease rather than a primary brain phenomenon. The associated inflammatory process of migraine together with the associated adverse medical comorbidities exposes patients to endothelial vascular wall injury which further increases migraine susceptibility and progression as well as increases the risk for atherogenesis. The knowledge that migraine is a risk for vascular diseases raises important clinical implications, recommendations and future perspectives in migraine treatment and prevention.
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Affiliation(s)
- Sherifa A Hamed
- Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt.
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