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Atalar AÇ, Özge A, Türk BG, Ekizoğlu E, Kurt Gök D, Baykan B, Ayta S, Erdoğan FF, Yeni SN, Taşdelen B, Velioğlu SK, Midi İ, Serap S, Ulufer Ç, Sarıca Darol E, Ağan K, Ayç S, Gazioğlu S, Vildan Okudan Z, Görkem Şirin N, Bebek N, Dericioğlu N, Güçlü Altun İ, Destina Yalçın A, Sürmeli R, Osman Erdinç O, Erdal A, İlhan Algın D, Kutlu G, Bek S, Erdal Y, Övünç Özön A, Reyhani A, Güldiken B, Baklan B, Oğuz Genç B, Aykutlu Altindağ E, Karahan G, Koç G, Mısırlı H, Öztura İ, Aslan-Kara K, Merve MÇ, Türkmen N, Bulut O, Ömer K, Kesim Çahin Ö, Ferik S, Mehmet TP, Topaloğlu P, Üstün Özek S, Düzgün Ü, Yayla V, Gömceli Y, Ünlüsoy Acar Z. Diagnosis of comorbid migraine without aura in patients with idiopathic/genetic epilepsy based on the gray zone approach to the International Classification of Headache Disorders 3 criteria. Front Neurol 2023; 13:1103541. [PMID: 36703639 PMCID: PMC9872152 DOI: 10.3389/fneur.2022.1103541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 12/02/2022] [Indexed: 01/12/2023] Open
Abstract
Background Migraine without aura (MwoA) is a very frequent and remarkable comorbidity in patients with idiopathic/genetic epilepsy (I/GE). Frequently in clinical practice, diagnosis of MwoA may be challenging despite the guidance of current diagnostic criteria of the International Classification of Headache Disorders 3 (ICHD-3). In this study, we aimed to disclose the diagnostic gaps in the diagnosis of comorbid MwoA, using a zone concept, in patients with I/GEs with headaches who were diagnosed by an experienced headache expert. Methods In this multicenter study including 809 consecutive patients with a diagnosis of I/GE with or without headache, 163 patients who were diagnosed by an experienced headache expert as having a comorbid MwoA were reevaluated. Eligible patients were divided into three subgroups, namely, full diagnosis, zone I, and zone II according to their status of fulfilling the ICHD-3 criteria. A Classification and Regression Tree (CART) analysis was performed to bring out the meaningful predictors when evaluating patients with I/GEs for MwoA comorbidity, using the variables that were significant in the univariate analysis. Results Longer headache duration (<4 h) followed by throbbing pain, higher visual analog scale (VAS) scores, increase of pain by physical activity, nausea/vomiting, and photophobia and/or phonophobia are the main distinguishing clinical characteristics of comorbid MwoA in patients with I/GE, for being classified in the full diagnosis group. Despite being not a part of the main ICHD-3 criteria, the presence of associated symptoms mainly osmophobia and also vertigo/dizziness had the distinguishing capability of being classified into zone subgroups. The most common epilepsy syndromes fulfilling full diagnosis criteria (n = 62) in the CART analysis were 48.39% Juvenile myoclonic epilepsy followed by 25.81% epilepsy with generalized tonic-clonic seizures alone. Conclusion Longer headache duration, throbbing pain, increase of pain by physical activity, photophobia and/or phonophobia, presence of vertigo/dizziness, osmophobia, and higher VAS scores are the main supportive associated factors when applying the ICHD-3 criteria for the comorbid MwoA diagnosis in patients with I/GEs. Evaluating these characteristics could be helpful to close the diagnostic gaps in everyday clinical practice and fasten the diagnostic process of comorbid MwoA in patients with I/GEs.
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Affiliation(s)
- Arife Çimen Atalar
- Department of Neurology, Istanbul Education and Research Hospital, University of Health Sciences, Istanbul, Türkiye,*Correspondence: Arife Çimen Atalar ✉
| | - Aynur Özge
- Department of Neurology, Algology and Clinical Neurophysiology, Mersin University School of Medicine, Mersin, Türkiye
| | - Bengi Gül Türk
- Department of Neurology and Clinical Neurophysiology, Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Esme Ekizoğlu
- Department of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Duygu Kurt Gök
- Department of Neurology and Clinical Neurophysiology, Faculty of Medicine, Erciyes University, Kayseri, Türkiye
| | - Betül Baykan
- Department of Neurology and Clinical Neurophysiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Türkiye
| | - Semih Ayta
- Child Neurology Unit, Department of Pediatrics, Haseki Training and Research Hospital, University of Health Sciences, Istanbul, Türkiye
| | - Füsun Ferda Erdoğan
- Department of Neurology and Clinical Neurophysiology, Faculty of Medicine, Erciyes University, Kayseri, Türkiye
| | - Seher Naz Yeni
- Department of Neurology and Clinical Neurophysiology, Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Türkiye
| | - Bahar Taşdelen
- Department of Biostatistics and Medical Informatics, Mersin University School of Medicine, Mersin University, Mersin, Türkiye
| | | | - Sibel K. Velioğlu
- Clinical Neurophysiology Unit, Department of Neurology, School of Medicine, Karadeniz Technical University, Trabzon, Türkiye
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Fu C, Zhang Y, Ye Y, Hou X, Wen Z, Yan Z, Luo W, Feng M, Liu B. Predicting response to tVNS in patients with migraine using functional MRI: A voxels-based machine learning analysis. Front Neurosci 2022; 16:937453. [PMID: 35992927 PMCID: PMC9388938 DOI: 10.3389/fnins.2022.937453] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/13/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMigraine is a common disorder, affecting many patients. However, for one thing, lacking objective biomarkers, misdiagnosis, and missed diagnosis happen occasionally. For another, though transcutaneous vagus nerve stimulation (tVNS) could alleviate migraine symptoms, the individual difference of tVNS efficacy in migraineurs hamper the clinical application of tVNS. Therefore, it is necessary to identify biomarkers to discriminate migraineurs as well as select patients suitable for tVNS treatment.MethodsA total of 70 patients diagnosed with migraine without aura (MWoA) and 70 matched healthy controls were recruited to complete fMRI scanning. In study 1, the fractional amplitude of low-frequency fluctuation (fALFF) of each voxel was calculated, and the differences between healthy controls and MWoA were compared. Meaningful voxels were extracted as features for discriminating model construction by a support vector machine. The performance of the discriminating model was assessed by accuracy, sensitivity, and specificity. In addition, a mask of these significant brain regions was generated for further analysis. Then, in study 2, 33 of the 70 patients with MWoA in study 1 receiving real tVNS were included to construct the predicting model in the generated mask. Discriminative features of the discriminating model in study 1 were used to predict the reduction of attack frequency after a 4-week tVNS treatment by support vector regression. A correlation coefficient between predicted value and actual value of the reduction of migraine attack frequency was conducted in 33 patients to assess the performance of predicting model after tVNS treatment. We vislized the distribution of the predictive voxels as well as investigated the association between fALFF change (post-per treatment) of predict weight brain regions and clinical outcomes (frequency of migraine attack) in the real group.ResultsA biomarker containing 3,650 features was identified with an accuracy of 79.3%, sensitivity of 78.6%, and specificity of 80.0% (p < 0.002). The discriminative features were found in the trigeminal cervical complex/rostral ventromedial medulla (TCC/RVM), thalamus, medial prefrontal cortex (mPFC), and temporal gyrus. Then, 70 of 3,650 discriminative features were identified to predict the reduction of attack frequency after tVNS treatment with a correlation coefficient of 0.36 (p = 0.03). The 70 predictive features were involved in TCC/RVM, mPFC, temporal gyrus, middle cingulate cortex (MCC), and insula. The reduction of migraine attack frequency had a positive correlation with right TCC/RVM (r = 0.433, p = 0.021), left MCC (r = 0.451, p = 0.016), and bilateral mPFC (r = 0.416, p = 0.028), and negative with left insula (r = −0.473, p = 0.011) and right superior temporal gyrus/middle temporal gyrus (r = −0.684, p < 0.001), respectively.ConclusionsBy machine learning, the study proposed two potential biomarkers that could discriminate patients with MWoA and predict the efficacy of tVNS in reducing migraine attack frequency. The pivotal features were mainly located in the TCC/RVM, thalamus, mPFC, and temporal gyrus.
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Affiliation(s)
- Chengwei Fu
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yue Zhang
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yongsong Ye
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Xiaoyan Hou
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Zeying Wen
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Radiology, The First Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou, China
| | - Zhaoxian Yan
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wenting Luo
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Menghan Feng
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Bo Liu
- Department of Radiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
- *Correspondence: Bo Liu
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Terrin A, Mainardi F, Lisotto C, Mampreso E, Fuccaro M, Maggioni F, Zanchin G. A prospective study on osmophobia in migraine versus tension-type headache in a large series of attacks. Cephalalgia 2019; 40:337-346. [DOI: 10.1177/0333102419877661] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background In literature, osmophobia is reported as a specific migrainous symptom with a prevalence of up to 95%. Despite the International Classification of Headache Disorders 2nd edition proposal of including osmophobia among accompanying symptoms, it was no longer mentioned in the ICHD 3rd edition. Methods We conducted a prospective study on 193 patients suffering from migraine without aura, migraine with aura, episodic tension-type headache or a combination of these. After a retrospective interview, each patient was asked to describe in detail osmophobia, when present, in the following four headache attacks. Results In all, 45.7% of migraine without aura attacks were associated with osmophobia, 67.2% of migraineurs reported osmophobia in at least a quarter of the attacks. No episodic tension-type headache attack was associated with osmophobia. It was associated with photophobia or phonophobia in 4.3% of migraine without aura attacks, and it was the only accompanying symptom in 4.7% of migraine without aura attacks. The inclusion of osmophobia in the ICHD-3 diagnostic criteria would enable a 9.0% increased diagnostic sensitivity. Conclusion Osmophobia is a specific clinical marker of migraine, easy to ascertain and able to disentangle the sometimes challenging differential diagnosis between migraine without aura and episodic tension-type headache. We recommend its inclusion among the diagnostic criteria for migraine as it increases sensitivity, showing absolute specificity.
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Affiliation(s)
- Alberto Terrin
- Department of Neuroscience, University of Padova, Padova, Italy
| | - Federico Mainardi
- Headache Centre, Neurological Division, SS. Giovanni e Paolo Hospital, Venezia, Italy
| | - Carlo Lisotto
- Headache Centre, Department of Neurology, Azienda Sanitaria n. 5 Friuli Occidentale, Pordenone, Italy
| | - Edoardo Mampreso
- Headache Centre, Neurology – Euganea – Padova Health Unit, Padova, Italy
| | | | | | - Giorgio Zanchin
- Department of Neuroscience, University of Padova, Padova, Italy
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Chalmer MA, Hansen TF, Olesen J. Nosographic analysis of osmophobia and field testing of diagnostic criteria including osmophobia. Cephalalgia 2018; 39:38-43. [PMID: 29665696 DOI: 10.1177/0333102418771375] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Osmophobia has been suggested as an additional symptom of migraine without aura, and a high prevalence of osmophobia of up to 50% has been reported in the literature. We conducted a nosographic study of osmophobia in all migraineurs and tension-type headache patients and a field testing of suggested diagnostic criteria of osmophobia, presented in the appendix of the second edition of The International Classification of Headache Disorders and suggested by Silva-Néto et al. and Wang et al ., in migraine without aura and tension-type headache patients (n = 1934). MATERIALS AND METHODS Each patient received a validated semi-structured interview. All subjects fulfilled the diagnostic criteria of the second edition of The International Classification of Headache Disorders for migraine or tension-type headache. Statistical analyses were performed using statistical software R. The statistical R package "Caret" was used to construct a confusion matrix and retrieve sensitivity, which is defined as the suggested criteria's ability to correctly diagnose migraine without aura patients, and specificity, defined as the suggested criteria's ability to not wrongly diagnose tension-type headache patients. RESULTS Osmophobia was present in 33.5% of patients with migraine with aura, in 36.0% of patients with migraine without aura, and in 1.2% of patients with tension-type headache. All migraineurs with osmophobia also fulfilled the current criteria for migraine by having nausea or photophobia and phonophobia. The appendix criteria had a sensitivity of 0.96 and a specificity of 0.99 for migraine without aura, and a sensitivity of 0.65 and a specificity of 0.99 for probable migraine without aura. Both the criteria by Silva-Néto et al. and Wang et al. had a sensitivity of 0.98 and a specificity of 0.99 for migraine without aura, and a sensitivity of 0.66 and a specificity of 0.99 for probable migraine without aura. DISCUSSION This study demonstrates the remarkable specificity of osmophobia. The criteria by Silva-Néto et al. and Wang et al. both had a higher sensitivity than the appendix criteria for migraine without aura; all three criteria had a low sensitivity for probable migraine without aura. However, neither the appendix criteria nor the criteria by Silva-Néto et al. or Wang et al. added any extra patients that would not have been diagnosed by the current diagnostic criteria for migraine. Osmophobia is a valuable symptom that may be useful to differentiate between migraine without aura and tension-type headache in difficult clinical cases. CONCLUSION Our results do not suggest that alterations of the current diagnostic criteria for migraine without aura are needed.
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Affiliation(s)
- Mona Ameri Chalmer
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital, Glostrup, Denmark
| | - Thomas Folkmann Hansen
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital, Glostrup, Denmark
| | - Jes Olesen
- Department of Neurology, Danish Headache Center, Copenhagen University Hospital, Glostrup, Denmark
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Zanchin G, Fuccaro M, Battistella P, Ermani M, Mainardi F, Maggioni F. A lost track in ICHD 3 beta: A comprehensive review on osmophobia. Cephalalgia 2016; 38:340-352. [DOI: 10.1177/0333102416678390] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background Osmophobia (Os) has been reported to be much more prevalent in migraine (M) than in other primary headaches, and its high specificity in the differential diagnosis between M and tension-type headache (TTH) has been reported. Os was included in the ICHD II Appendix as a diagnostic criterion of M. It disappeared in ICHD-3 beta. To understand this choice, we reviewed the literature after 2004. Methods This was a systematic review. We searched in PubMed, MEDLINE and Cochrane library for “osmophobia”, “odour/odorphobia AND headache”, “odour/odor hypersensitivity AND headache” and “olfactory hypersensitivity AND headache”. Results 112 papers cited Os as an accompanying symptom of headache; 16 focused on Os in M diagnosis. With the data from 40 articles, we calculated the pooled prevalence of Os in 14,360 patients (2281 pediatric) affected by M (n = 12,496) and TTH (n = 1864). In M, the prevalence was 48.5% (CI 95% 41.4 to 55.8%) in adults and 23.4% (CI 95% 15.7 to 33.4%) in pediatric patients; in TTH, the prevalence was 8.9% (CI 95% 4.6 to 13.5%) in adults and 7.9% (CI 95% 3.3 to 18.1%) in pediatric patients. Ten of these papers allowed us to calculate the sensibility and specificity of Os in differential diagnosis between M and TTH. In adults, the value of specificity was 94.1% (CI 95% 88.9 to 96.9%), and sensitivity was 51.4% (CI 95% 38.4 to 64.2%). In pediatric patients, specificity was 92.0% (CI 95% 81.9 to 96.7%), and sensitivity was 22.1% (CI 95% 10.1 to 41.8%). Conclusion The literature endorses the inclusion of Os among M diagnostic criteria. On this ground, the decision to remove Os from ICHD 3 beta appears unjustified and a revision of this choice is recommended.
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Affiliation(s)
- Giorgio Zanchin
- Interdepartmental Headache Centre, School of Medicine, University of Padua, Padua, Italy
| | - Matteo Fuccaro
- Interdepartmental Headache Centre, School of Medicine, University of Padua, Padua, Italy
| | | | - Mario Ermani
- Interdepartmental Headache Centre, School of Medicine, University of Padua, Padua, Italy
| | - Federico Mainardi
- Headache Centre, Neurological Division, SS Giovanni e Paolo Hospital, Venice, Italy
| | - Ferdinando Maggioni
- Interdepartmental Headache Centre, School of Medicine, University of Padua, Padua, Italy
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Rocha-Filho PAS, Marques KS, Torres RCS, Leal KNR. Migraine, Osmophobia, and Anxiety. PAIN MEDICINE 2015; 17:776-80. [PMID: 26814297 DOI: 10.1093/pm/pnv071] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2015] [Accepted: 10/30/2015] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To evaluate the association between osmophobia and the characteristics of patients and their headaches, among migraine patients. METHODS This was a cross-sectional study. Patients who consecutively sought medical attendance in a primary care unit were asked about their headaches over the last 12 months. Those who had migraine were included. A semi-structured interview, the Headache Impact Test and the Hospital Anxiety and Depression Scale were used. RESULTS 147 patients had migraine; 78 had osmophobia; 60 had significant anxiety symptoms; and 78 had significant depression symptoms. The mean age of these patients was 43.2 years (± 13.7); 91.2% were women. The mean length of time with complaints of headache was 13.8 years (± 12). Among the migraine patients, those with anxiety, more years of headache history, and phonophobia presented significantly more osmophobia (multivariate logistic regression). CONCLUSION Osmophobia in migraine patients is associated with significant anxiety symptoms, length of headache history, and phonophobia.
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Affiliation(s)
- Pedro Augusto Sampaio Rocha-Filho
- *Universidade de Pernambuco, Recife, PE, Brazil Department of Neuropsychiatry, Universidade Federal de Pernambuco, Recife, PE, Brazil
| | | | | | - Kamila Nazare Ribas Leal
- *Universidade de Pernambuco, Recife, PE, Brazil Scientific Initiation Fellowships Institutional Program (CNPq)
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Gelfand AA. Episodic Syndromes That May Be Associated With Migraine: A.K.A. "the Childhood Periodic Syndromes". Headache 2015; 55:1358-64. [PMID: 26234380 DOI: 10.1111/head.12624] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2015] [Indexed: 12/20/2022]
Abstract
Previously called "childhood periodic syndromes that are commonly precursors of migraine" in International Headache Classification of Headache Disorders (ICHD)-II, these disorders were renamed "episodic syndromes that may be associated with migraine" in ICHD-III beta. The specific disorders reviewed in this article include: benign paroxysmal torticollis, benign paroxysmal vertigo, abdominal migraine, and cyclical vomiting syndrome, as well as infantile colic, which was recently added under the appendix section in ICHD-III beta.
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Affiliation(s)
- Amy A Gelfand
- Department of Neurology, UCSF Headache Center, San Francisco, CA, USA.,Department of Neurology, UCSF Child Neurology, San Francisco, CA, USA
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Akdal G, Özge A, Ergör G. Vestibular symptoms are more frequent in migraine than in tension type headache patients. J Neurol Sci 2015; 357:295-6. [PMID: 26163417 DOI: 10.1016/j.jns.2015.06.059] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 06/14/2015] [Accepted: 06/24/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Gülden Akdal
- Department of Neurology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey.
| | - Aynur Özge
- Department of Neurology, Faculty of Medicine, Mersin University, İzmir, Turkey
| | - Gül Ergör
- Department of Public Health, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
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