Migraine Pain Location and Measures of Healthcare Use and Distress: An Observational Study

Association between headache laterality in migraine and hemispheric distribution of white matter hyperintensities on MRI

OBJECTIVE

The goal of this study was to clarify whether headache laterality in patients with migraine with "typically" left- or right-sided headache during attacks is associated with the distribution of hemispheric white matter hyperintensities on brain MRI.

BACKGROUND

Cerebral white matter hyperintensities (WMHs) are hyperintense lesions visible on brain MRI believed to result from microvascular disease. WMHs occur four times more commonly in patients with migraine, though the cause and relevance of this association are currently unclear.

METHODS

This is a cross-sectional study in which the MRI of patients with migraine with typically left- or right-sided headache during attacks was evaluated. All WMHs were identified, and their location documented by reviewers blinded to headache laterality. We used Chi-square, Wilcoxon rank-sum, and Poisson regression to compare the characteristics of the two groups and multiple regression models to estimate the association of headache laterality with hemispheric WMH distribution while controlling for potential confounders.

RESULTS

Of 5,627 patients with migraine screened, 340 had typically left- or right-sided headache during attacks. Of these, 159 patients had an eligible brain MRI for review. Patients with left-sided headache were more likely to have hypertension (30.8% vs. 14.5%; p = 0.020) but less likely to smoke cigarettes (34.1% vs. 50.7%; p = 0.036) compared to patients with right-sided headache. Left-sided headache was associated with a higher burden of WMHs overall (9.8 vs. 6.2; p < 0.001), as well as in the left brain (5.1 vs. 3.3; p < 0.001) and right brain (4.7 vs. 3.0; p < 0.001) independently, and a higher periventricular Fazekas score (0.9 vs. 0.7; p = 0.033), compared to patients with right-sided headache. Headache laterality remained significantly associated with hemispheric WMH distribution after adjusting for age, hypertension, diabetes, and cigarette smoking.

CONCLUSION

Patients with typically left-sided headache during migraine attacks have a higher burden of WMHs, both on the left and right sides of the brain, and higher periventricular Fazekas score, than patients with typically right-sided headache during attacks.

Does migraine affect central auditory processing abilities?

OBJECTIVE

Migraine is a neurological disease associated with an altered cortical excitability level. Several studies have investigated the relationship between migraine and central auditory processing (CAP), with deficits in CAP being common among migraine patients. However, studies on the factors affecting these CAP changes observed in migraine patients are still few and controversial. This study aims to investigate CAP changes in migraine patients with Duration Pattern Test (DPT) and Frequency Pattern Test (FPT), which have not been used in previous studies.

METHODS

Sixty subjects were divided into two groups and one migraine subgroup: control group, twenty normal healthy subjects, fourty subjects diagnosed with migraine. They were evaluated using the CAP test including DPT and FPT. To identify the variables and possible effects of the variables, a questionnaire describing the characteristics of migraine features was administered to participants with migraine.

RESULTS

No significant difference was found the between the control and study group in CAP tests scores. No significant correlation was found between migraine characteristics and CAP tests scores. Males had significantly higher FPT scores in both ears than females (p<0.05). Significant statistical negative correlation was found between age and FPT scores for both ears and left DPT scores (p<0.05).

CONCLUSION

Although migraine patients generally showed lower CAP ability than the control group, no significant difference was observed between them. This was also valid for subgroups of migraine. However, as age increased in the migraine group, a significant decrease in CAP performance was observed. It was observed that male migraine patients had better CAP ability, especially FPT scores. Migraine may affect performance in CAP depending on gender and age factors.

Comparison of migraine with left- versus right-sided headache: A cross-sectional study

OBJECTIVE

The goal of this study was to clarify whether clinical differences exist between patients with migraine who experience headache that is typically left-sided ("left-migraine") versus right-sided ("right-migraine") during attacks.

BACKGROUND

Migraine has been associated with unilateral headache for millennia and remains a supportive trait for the clinical diagnosis of migraine of the International Classification of Headache Disorders. It is currently unknown why headache in migraine is commonly unilateral, and whether headache-sidedness is associated with other clinical features.

METHODS

This is a cross-sectional study comparing left- versus right-migraine using all available intake questionnaires of new patients evaluated at an academic tertiary headache center over a 20-year period. Eligibility was based on patient written responses indicating the typical location of headache during attacks. In our analyses, the side of headache (left or right) was the predictor variable. The outcomes included various migraine characteristics and psychiatric comorbidities.

RESULTS

We identified 6527 patients with migraine, of which 340 met study eligibility criteria. Of these, 48.8% (166/340) had left migraine, and 51.2% (174/340) had right migraine. When comparing patients with left- versus right-migraine, patients with left migraine experienced 3.6 fewer headache-free days (95% confidence interval [CI] 1.3-5.9; p = 0.002) and 2.4 more severe headache days (95% CI 0.8-4.1; p = 0.004) in the previous 4 weeks. No significant differences in age, sex, handedness, migraine characteristics, or psychiatric comorbidities were identified between the two groups.

CONCLUSIONS

Patients with migraine with typically left-sided headache during attacks reported a higher burden of headache frequency and severity than those with typically right-sided headache during attacks. These findings may have implications for our understanding of migraine pathophysiology, treatment, and clinical trial design.

Left- vs right-sided migraine: a scoping review

BACKGROUND

Migraine is a historically unilateral head pain condition, the cause of which is not currently known. A growing body of literature suggests individuals who experience migraine with left-sided headache ("left-sided migraine") may be distinguished from those who experience migraine with right-sided headache ("right-sided migraine").

OBJECTIVE

In this scoping review, we explore migraine unilaterality by summarizing what is currently known about left- and right-sided migraine.

METHODS

Two senior medical librarians worked with the lead authors to construct and refine a set of search terms to identify studies of subjects with left- or right-sided migraine published between 1988, which is the year of publication of the first edition of the International Classification of Headache Disorders (ICHD), and December 8, 2021 (the date the searches were conducted). The following databases were searched: Medline, Embase, PsycINFO, PubMed, Cochrane Library, and Web of Science. Abstracts were loaded into Covidence review software, deduplicated, then screened by two authors to determine study eligibility. Eligible studies were those involving subjects diagnosed with migraine (according to ICHD criteria) in which the authors either: a) compared left- to right-sided migraine; or b) described (with analysis) a characteristic that differentiated the two. Data were extracted by the lead author, including ICHD version, the definition of unilateral migraine used by the authors, sample size, whether the findings were collected during or between attacks, and their key findings. The key findings were grouped into the following themes: handedness, symptoms, psychiatric assessments, cognitive testing, autonomic function, and imaging.

RESULTS

After deduplication, the search yielded 5428 abstracts for screening. Of these, 179 met eligibility criteria and underwent full text review. 26 articles were included in the final analysis. All of the studies were observational. One study was performed during attack, nineteen between attacks, and six both during and between attacks. Left- and right-sided migraine were found to differ across multiple domains. In several cases, reciprocal findings were reported in left- and right-migraine. For example, both left- and right-sided migraine were associated with ipsilateral handedness, tinnitus, onset of first Parkinson's symptoms, changes in blood flow across the face, white matter hyperintensities on MRI, activation of the dorsal pons, hippocampal sclerosis, and thalamic NAA/Cho and NAA/Cr concentrations. In other cases, however, the findings were specific to one migraine laterality. For example, left-sided migraine was associated with worse quality of life, anxiety, bipolar disorder, PTSD, lower sympathetic activity, and higher parasympathetic activity. Whereas right-sided migraine was associated with poorer performance on multiple cognitive tests, a greater degree of anisocoria, changes in skin temperature, higher diastolic blood pressure, changes in blood flow through the middle cerebral and basilar arteries, and changes on EEG.

CONCLUSION

Left- and right-sided migraine differed across a wide range of domains, raising the possibility that the pathophysiology of left- and right-migraine may not be identical.

A lateralized model of the pain-depression dyad

Chronic pain and depression are two frequently co-occurring and debilitating conditions. Even though the former is treated as a physical affliction, and the latter as a mental illness, both disorders closely share neural substrates. Here, we review the association of pain with depression, especially when symptoms are lateralized on either side of the body. We also explore the overlapping regions in the forebrain implicated in these conditions. Finally, we synthesize these findings into a model, which addresses gaps in our understanding of comorbid pain and depression. Our lateralized pain-depression dyad model suggests that individuals diagnosed with depression should be closely monitored for pain symptoms in the left hemibody. Conversely, for patients in pain, with the exception of acute pain with a known source, referrals in today's pain centers for psychological evaluation should be part of standard practice, within the framework of an interdisciplinary approach to pain treatment.

Profiling cerebrovascular function in migraine: A systematic review and meta-analysis

Previous studies have investigated whether migraine is a circulatory disorder, as migraineurs are at heightened risk of cerebrovascular disease. However, in most cases, systemic vascular function was evaluated, which may not reflect abnormalities in the cerebral circulation. Therefore, we aimed to determine whether cerebrovascular function differs between migraineurs and controls. A systematic literature search was conducted across three electronic databases to search for studies that compared cerebrovascular function in migraineurs to controls. Where applicable, meta-analyses were used to determine standardised mean differences (SMD) between migraineurs and controls. Seventy articles were identified, 40 of which contained quantitative data. Meta-analyses showed pulsatility index (PI) was higher (SMD = 0.23; 95%CI = 0.05 to 0.42, P = 0.01) and cerebrovascular responsiveness (CVR) to hypercapnia was lower (SMD=-0.34; 95%CI=-0.67 to -0.01, P = 0.04) in the posterior circulation of migraineurs, particularly those without aura. The meta-analyses also indicated that migraineurs have higher resting mean blood flow velocity in both anterior (SMD = 0.14; 95%CI = 0.05 to 0.23, P = 0.003) and posterior circulations (SMD = 0.20; 95%CI = 0.05 to 0.34, P = 0.007). Compared to healthy controls, migraineurs have altered cerebrovascular function, evidenced by elevated PI (representing arterial stiffness) and impaired CVR to hypercapnia (representing cerebral vasodilator function). Future studies should investigate whether improvement of cerebrovascular function is able to alleviate migraine.

Quantitating the art and science of esthetic clinical success

BACKGROUND

Beginning with the biobehavioral bases of esthetic experiences, this article presents a quantitative analytic review of the motives and methods of providers and consumers of orthodontic treatment.

METHOD

A primary focus is determining the anthropometric bases of self and others' perceived preference and satisfaction with changes in facial appearance. These quantitative analyses have been based on determining the frequency and magnitude of reliability and validity measures of diagnosis, treatment, and satisfaction outcome. Socioeconomic considerations are also quantitated regarding the discrepancy between objective need for treatment as determined for example by the Index of Orthodontic Treatment Need and the subjective demand for treatment.

RESULTS

The major contribution of this article is the quantitation of the components of esthetic experience from sensation of perception using psycho physical methods, such as Perceptometrics, for determining the morphological basis of perceived facial attractiveness adjusted for ethnocultural differences updated by 3-dimensional and artificial intelligence technology. Recent quantitation of smile components has also added to the measures of esthetically successful treatment. Further contribution of orthodontists to mental and physical health is demonstrated by the differences between perceived personality attributes in profile and full-frontal views of symmetric and asymmetric faces. Such information can facilitate the clinician's ability to determine the ideational representation of the patients' perceived pre- and post-treatment outcome.

CONCLUSION

The quantitative analysis of the motives and methods involved in the orthodontic treatment process has been combined with the neurophysiological correlates of producing and observing/evaluation of the esthetic experiences of both patients and orthodontists/dentists.

Taking on enduring distress: Building a concept to lead a program of research

Concept building consists of a 10-phase approach using a practice story as the first step in developing a defined concept supported by both scientific and experiential evidence. The purpose of concept building is to guide development of a program of research that informs nursing knowledge and evidence-based practice. Thus, concept building can serve as a teaching strategy for early-stage doctoral students to initiate scholarly inquiry. In this example, the process of concept building occurred as a nurse practitioner in a doctor of philosophy program began to transition ideas that stemmed from practice into phenomenon for scholarly research. The practice story for the concept taking on enduring distress stems from a patient encounter in the nurse practitioner's adolescent headache clinic. Information gained from concept building laid the foundation for an adolescent headache program of research. The purpose of this paper is to demonstrate a step-by-step approach using Liehr and Smith's 10-phase process for concept building and to describe the program of research that followed.