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Sîrbu CA, Rotaru AR, Antochi FA, Plesa A, Manole AM, Roceanu AM. Headache and Other Pain Syndromes in Multiple Sclerosis: A Narrative Review. Life (Basel) 2024; 14:87. [PMID: 38255702 PMCID: PMC10817285 DOI: 10.3390/life14010087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/30/2023] [Accepted: 01/01/2024] [Indexed: 01/24/2024] Open
Abstract
Multiple sclerosis is a chronic and progressive neurological disease, with an important socio-economic burden. Over time, an increased incidence of headaches like migraines and tension headaches has been observed among these patients. Headaches have not been considered as multiple sclerosis-related symptoms, even representing a red flag for multiple sclerosis diagnosis. It is uncertain whether the headache-multiple sclerosis association could be explained by the presence of common triggers or a common physiopathological mechanism (involvement of tertiary B-cell follicles). An important differential diagnosis is between multiple sclerosis attacks and migraines with aura, which can also be associated with neurological deficits. Another important aspect is the occurrence or exacerbation of the cephalalgic syndrome after the initiation of therapy for multiple sclerosis (DMTs), or the improvement of headache after the initiation of certain DMT drugs. In addition to headaches, individuals diagnosed with multiple sclerosis often report experiencing diverse pain syndromes, contributing to an additional decline in their overall quality of life. These syndromes are frequently neglected, the focus being on slowing down the progression of neurological deficits. This review aims to evaluate the characteristics of multiple-sclerosis-related headaches (frequency, possible correlation with attacks, and disease-modifying therapies) and the key distinctions in imaging characteristics between demyelinating lesions in multiple sclerosis and those observed in cases of primary headaches.
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Affiliation(s)
- Carmen Adella Sîrbu
- Clinical Neurosciences Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- Department of Neurology, “Dr. Carol Davila” Central Military Emergency University Hospital, 134 Calea Plevnei, 010242 Bucharest, Romania;
- Academy of Romanian Scientists, 050045 Bucharest, Romania
| | - Andreea Ruxandra Rotaru
- Department of Neurology, “Dr. Carol Davila” Central Military Emergency University Hospital, 134 Calea Plevnei, 010242 Bucharest, Romania;
| | | | - Andreea Plesa
- Doctoral School, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.P.); (A.M.M.)
| | - Aida Mihaela Manole
- Doctoral School, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.P.); (A.M.M.)
| | - Adina Maria Roceanu
- Neurology Department, University Emergency Hospital, 050098 Bucharest, Romania;
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Jeon CW, Lim GY, Moon JU. Dedicated neuroimaging analysis in children with primary headaches: prevalence of lesions and a comparison between patients with and without migraines. BMC Med Imaging 2023; 23:152. [PMID: 37817100 PMCID: PMC10563304 DOI: 10.1186/s12880-023-01122-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 10/05/2023] [Indexed: 10/12/2023] Open
Abstract
BACKGROUND This study evaluated the prevalence and types of intracranial lesions through dedicated imaging analysis of primary headaches in children and compared them between patients with and without migraine. METHODS This study included 190 children diagnosed with primary headache who underwent neuroimaging, including brain computed tomography (CT), CT angiography (CTA), and brain magnetic resonance imaging (MRI). All patients with primary headaches was divided into two groups, namely, the migraine and non-migraine groups, on the basis of data from electronic medical records. Clinical characteristics and imaging findings were evaluated and compared between the two groups. RESULTS Patients with migraine were old and had a longer period from symptom onset to diagnosis. CT was normal in 71 of 95 patients, whereas 7 of 29 patients who underwent CTA had vascular lesions; the migraine group (n = 6/20, [30%]) had higher incidence of vascular lesions than the non-migraine group (n = 1/9, [11.1%]); however, there was no statistically significant difference (p = 0.382). Furthermore, 57.5% (61/106) of children showed normal brain MRI. The most common brain MRI finding was dilated perivascular space (n = 18, [16.8%]). Most perivascular spaces were located in the basal ganglia (n = 72, [75.8%]) and were in linear patterns (n = 58, [63.0%]). There was no statistically significant difference between the two groups. CONCLUSION A low prevalence of significant abnormalities was found in children with primary headaches. Dilated perivascular space was the most common finding in both groups on MRI. CTA showed more vascular lesions in the migraine group than in the non-migraine group. Therefore, further evaluations are needed to reveal the relationship between vascular lesions or dilated perivascular space and pediatric primary headaches.
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Affiliation(s)
- Cha Woong Jeon
- Department of Radiology & Pediatrics, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 10, 63- ro, Yeongdeungpo-gu, Seoul, 07345, Republic of Korea
| | - Gye Yeon Lim
- Department of Radiology & Pediatrics, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 10, 63- ro, Yeongdeungpo-gu, Seoul, 07345, Republic of Korea.
| | - Ja Un Moon
- Department of Radiology & Pediatrics, Yeouido St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 10, 63- ro, Yeongdeungpo-gu, Seoul, 07345, Republic of Korea
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Ahmed SR, Mohamed AAM, Salem HH, Helmy S, Moustafa RR, Borham SMF. Association of white matter hyperintensities with migraine phenotypes and response to treatment. Acta Neurol Belg 2023; 123:1725-1733. [PMID: 35854172 PMCID: PMC10505107 DOI: 10.1007/s13760-022-02015-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 06/23/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION White matter hyperintensities (WMHs) are frequently found in migraineurs. However, their clinical significance and correlation to different migraine phenotypes and treatment responses are not well defined. The study aimed to examine the association of WMHs with migraine clinical patterns and treatment response. AIM OF WORK We aimed to evaluate the association between WMHs and migraine phenotypes and explore the relationship of WMHs to treatment response. METHODS Our cross-sectional study formed of 500 migraineurs who sought treatment in Kafr el-sheik university hospital and underwent (3 T) MRI to evaluate WMHs. Different migraine phenotypes were compared between patients with and without WMHs. According to reduced headache pain intensity and frequency, these patients were divided into treatment responder and non-responder groups. RESULTS A total of 145 patients (29%) had WMHs. Patients with WMHs were significantly older, had a longer disease duration, and higher attack frequency. Patients who did not respond to acute and maintenance medications had a higher frequency of WMHs and high WMHs Scheltens score. Migraine with Aura and the presence of vomiting and dizziness were predictors for the development of WMHs. CONCLUSION WMHs are more common in migraine with aura. It is more frequent in migraine associated with vomiting and dizziness. WMHs increased with advancing age and more severe disease burden. Poorer response to acute and prophylactic medications was found in patients with WMHs.
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Affiliation(s)
- Sherihan Rezk Ahmed
- Department of Neurology, Faculty of Medicine, Kafr el-Sheikh University, 12 Elgeish street, Kafr el-sheikh, 33511 Egypt
| | | | - Haitham Hamdy Salem
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Shahinaz Helmy
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ramez Reda Moustafa
- Department of Neurology, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Ornello R, Bruno F, Frattale I, Curcio G, Pistoia F, Splendiani A, Sacco S. White matter hyperintensities in migraine are not mediated by a dysfunction of the glymphatic system-A diffusion tensor imaging magnetic resonance imaging study. Headache 2023; 63:1128-1134. [PMID: 37594440 DOI: 10.1111/head.14607] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/28/2023] [Accepted: 05/31/2023] [Indexed: 08/19/2023]
Abstract
OBJECTIVE We assessed whether brain magnetic resonance imaging (MRI) markers of glymphatic function are altered in patients with migraine and brain white matter hyperintensities (WMHs). BACKGROUND The glymphatic system is responsible for the outflow of waste products from the brain. An impaired glymphatic system has been associated with WMH; however, this impairment has not been shown in patients with migraine. METHODS The present cross-sectional study included consecutive patients with migraine from a single tertiary headache center. Glymphatic function was assessed by measuring the diffusion tensor imaging along the perivascular space (DTI-ALPS) technique, resulting in an index value. WMHs were assessed and quantified by using the Scheltens semi-quantitative score. RESULTS We included 147 patients (120 women [81.6%]) with a median (interquartile range [IQR]) age of 45 (36-50) years. In all, 74 (50.3%) patients had WMHs. The median (IQR) ALPS index was similar in patients with WMHs compared with those without, at 2.658 (2.332-3.199) versus 2.563 (2.222-3.050) (p = 0.344). The Scheltens score did not correlate with ALPS index (rho = 0.112, p = 0.268). CONCLUSIONS Our results suggest that the presence of WMHs is not associated with an impairment in the glymphatic system in patients with migraine. Although negative and worthy of further confirmation, our finding has implications for the understanding of the nature of WMH in patients with migraine.
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Affiliation(s)
- Raffaele Ornello
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Federico Bruno
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Ilaria Frattale
- Child Neurology and Neuropsychiatry Unit, Department of Systems Medicine, Tor Vergata University, Rome, Italy
| | - Giuseppe Curcio
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Francesca Pistoia
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alessandra Splendiani
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Simona Sacco
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Huang SY, Salomon M, Eikermann-Haerter K. Advanced brain MRI may help understand the link between migraine and multiple sclerosis. J Headache Pain 2023; 24:113. [PMID: 37596546 PMCID: PMC10439604 DOI: 10.1186/s10194-023-01645-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 08/04/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND There is a clinical association between migraine and multiple sclerosis. MAIN BODY Migraine and MS patients share similar demographics, with the highest incidence among young, female and otherwise healthy patients. The same hormonal constellations/changes trigger disease exacerbation in both entities. Migraine prevalence is increased in MS patients, which is further enhanced by disease-modifying treatment. Clinical data show that onset of migraine typically starts years before the clinical diagnosis of MS, suggesting that there is either a unidirectional relationship with migraine predisposing to MS, and/or a "shared factor" underlying both conditions. Brain imaging studies show white matter lesions in both MS and migraine patients. Neuroinflammatory mechanisms likely play a key role, at least as a shared downstream pathway. In this review article, we provide an overview of the literature about 1) the clinical association between migraine and MS as well as 2) brain MRI studies that help us better understand the mechanistic relationship between both diseases with implications on their underlying pathophysiology. CONCLUSION Studies suggest a migraine history predisposes patients to develop MS. Advanced brain MR imaging may shed light on shared and distinct features, while helping us better understand mechanisms underlying both disease entities.
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Affiliation(s)
- Susie Y Huang
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Marc Salomon
- Department of Radiology, New York University Langone Medical Center, 660 First Ave, New York, NY, 10016, USA
| | - Katharina Eikermann-Haerter
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
- Department of Radiology, New York University Langone Medical Center, 660 First Ave, New York, NY, 10016, USA.
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Huo J, Zhang G, Wang W, Cao W, Wan M, Huang T, Fan D, Fu Y. Migraine and white matter lesions: a mendelian randomization study. Sci Rep 2023; 13:10984. [PMID: 37415088 PMCID: PMC10326014 DOI: 10.1038/s41598-023-38182-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Accepted: 07/04/2023] [Indexed: 07/08/2023] Open
Abstract
Previous studies have found that migraine patients are associated with white matter lesions (WMLs), but the causal relationship between the two remains unclear. We intend to explore the bidirectional causal relationship between migraine and WMLs using a two-sample mendelian randomization (MR) method. We employed summary-level data from a recent large-scale genome-wide association study (GWAS) that characterized three white matter (WM) phenotypes: white matter hyperintensities (WMH, N = 18,381), fractional anisotropy (FA, N = 17,673), and mean diffusivity (MD, N = 17,467), as well as migraine (N = 589,356). The inverse variance-weighted (IVW) method was used as the main approach for analyzing causality. Weighted median analysis, simple median analysis, and MR-Egger regression served as complementary methods. The bidirectional MR study affords no support for causality between WMLs and migraine. In all MR methods, there was no obvious causal evidence between them. In our bidirectional MR study, we didn't reach this conclusion that WMLs can cause migraine, migraine wouldn't increase the risk of WMLs, either.
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Affiliation(s)
- Junyan Huo
- Department of Neurology, Peking University Third Hospital, No. 49, North Garden Rd., Haidian District, Beijing, 100191, China
| | - Gan Zhang
- Department of Neurology, Peking University Third Hospital, No. 49, North Garden Rd., Haidian District, Beijing, 100191, China
| | - Wenjing Wang
- Department of Neurology, Peking University Third Hospital, No. 49, North Garden Rd., Haidian District, Beijing, 100191, China
| | - Wen Cao
- Department of Neurology, Peking University Third Hospital, No. 49, North Garden Rd., Haidian District, Beijing, 100191, China
| | - Mengxia Wan
- Department of Neurology, Peking University Third Hospital, No. 49, North Garden Rd., Haidian District, Beijing, 100191, China
| | - Tao Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Peking University, Beijing, China
- Key Laboratory of Molecular Cardiovascular Sciences, Peking University, Ministry of Education, Beijing, China
| | - Dongsheng Fan
- Department of Neurology, Peking University Third Hospital, No. 49, North Garden Rd., Haidian District, Beijing, 100191, China.
| | - Yu Fu
- Department of Neurology, Peking University Third Hospital, No. 49, North Garden Rd., Haidian District, Beijing, 100191, China.
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Ackley E, Asamoah P, Mirsky D, White C, Maloney J, Stence N, Silveira L, Yonker M, Neuberger I. Dots and spots: A retrospective review of T2-hyperintense white matter lesions in pediatric patients with and without headache. Headache 2023; 63:611-620. [PMID: 37114889 DOI: 10.1111/head.14503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 03/10/2023] [Accepted: 03/14/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE We aimed to determine if T2-weighted hyperintense white matter lesions (WMLs) on brain magnetic resonance imaging (MRI) occur more frequently in pediatric patients with migraine and other primary headache disorders compared to the general pediatric population. BACKGROUND Small foci of T2 hyperintensity in the white matter are frequently identified on brain MRI during the workup of pediatric headache. Such lesions have been reported to be more common among adults with migraine versus adults without migraine; however, this association has not been well established in the pediatric population. METHODS We performed a retrospective cross-sectional single-center study of electronic medical records and radiologic studies, examining pediatric patients from 3 to 18 years old who underwent brain MRI between 2016 and 2021. Patients with existing intracranial disease or abnormalities were excluded. Patients with reports of headache were categorized. Imaging was reviewed to determine the number and location of WMLs. Headache-associated disability scores (Pediatric Migraine Disability Assessment) were noted, when available. RESULTS Brain MRI of 248 patients with a diagnosis of headache (144 with migraine, 42 with non-migraine primary headache, and 62 with headache that could not be further classified) and 490 controls were reviewed. WMLs were encountered commonly among all study participants, with a prevalence of 40.5% (17/42) to 54.1% (265/490). There was no statistically significant difference comparing the number of lesions between each of the headache groups and the control group: migraine group versus control group median [interquartile range (IQR)], 0 [0-3] versus 1 [0-4], incidence rate ratio [95% confidence interval (CI)], 0.99 [0.69-1.44], p = 0.989, non-migraine headache group versus control group median [IQR], 0 [0-3] versus 1 [0-4], 0.71 [0.46-1.31], p = 0.156, headache not otherwise specified group versus control group median [IQR], 0 [0-4] versus 1 [0-4], 0.77 [0.45-1.31], p = 0.291. There was no significant correlation between headache-associated disability and the number of WMLs (0.07 [-0.30 to 0.17], rho [95% CI]). CONCLUSION T2 hyperintense WMLs are common within the pediatric population and are not encountered more frequently in pediatric patients with migraine or other primary headache disorders. Thus, such lesions are presumably incidental and unlikely related to headache history.
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Affiliation(s)
- Elizabeth Ackley
- Department of Pediatrics (Neurology), Children's Hospital Colorado, University of Colorado School of Medicine, Colorado, Aurora, USA
| | - Philip Asamoah
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, Colorado, Aurora, USA
| | - David Mirsky
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, Colorado, Aurora, USA
| | - Christina White
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, Colorado, Aurora, USA
| | - John Maloney
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, Colorado, Aurora, USA
| | - Nicholas Stence
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, Colorado, Aurora, USA
| | - Lori Silveira
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Colorado, Aurora, USA
| | - Marcy Yonker
- Department of Pediatrics (Neurology), Children's Hospital Colorado, University of Colorado School of Medicine, Colorado, Aurora, USA
| | - Ilana Neuberger
- Department of Radiology, Children's Hospital Colorado, University of Colorado School of Medicine, Colorado, Aurora, USA
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Laukka D, Parkkola R, Hirvonen J, Ylikotila P, Vahlberg T, Salo E, Kivelev J, Rinne J, Rahi M. Brain white matter hyperintensities in Kawasaki disease: A case–control study. Front Neurosci 2022; 16:995480. [PMID: 36330348 PMCID: PMC9623056 DOI: 10.3389/fnins.2022.995480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 09/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background Cerebrovascular involvement of Kawasaki disease (KD) is poorly studied. White matter hyperintensities (WMH) indicate cerebral small vessel disease and increase the risk for stroke. Purpose To investigate whether childhood KD is associated with WMHs and other cerebrovascular findings later in adulthood. Materials and methods In this case-control study, patients diagnosed with KD (cases) at our tertiary hospital between 1978 and 1995 were invited to brain magnetic resonance (MRI) between 2016 and 2017. Migraine patients (controls) with available brain MRI were matched with cases (ratio 4:1) by age (±2 years) and sex. Two blinded neuroradiologists evaluated independently cerebrovascular findings from the brain MRI scans. Modified Scheltens' visual rating scale was used to evaluate WMH burden and the total WMH volume was measured using manual segmentation. Results Mean age [years, (SD)] at the time of brain MRI was 33.3 (3.8) and 32.8 (4.0) for cases (n = 40) and controls (n = 160), respectively (P = 0.53). Mean follow-up time for cases was 29.5 years (4.3). Total volume of WMHs (median) was 0.26 cm3 (IQR 0.34) for cases and 0.065 cm3 (IQR 0.075) for controls, P = 0.039. Cases had higher total WMH burden (P = 0.003), deep WMH burden (P = 0.003), and more periventricular WMHs (prevalence 7.5 vs. 0%, P = 0.008) than controls. Cases had greater risk of having total Scheltens' score ≥2 vs. < 2 (odds ratio, 6.88; 95% CI: 1.84–25.72, P = 0.0041) and ≥3 vs. < 3 (odds ratio, 22.71; 95% CI: 2.57–200.53, P = 0.0049). Diabetes type 1/type 2, hypertension, smoking status or hypercholesterolemia were not risk factors for WMH burden, p > 0.1. Myocarditis at the acute phase of KD increased the risk for periventricular WMHs (P < 0.05). Three cases (7.5%) and three controls (1.9%) had lacune of presumed vascular origin (P = 0.0096). Conclusion History of KD could be associated with an increased WMH burden. More studies are needed to confirm our results.
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Affiliation(s)
- Dan Laukka
- Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
- Clinical Neurosciences, University of Turku, Turku, Finland
- *Correspondence: Dan Laukka
| | - Riitta Parkkola
- Department of Radiology, Turku University Hospital, University of Turku, Turku, Finland
| | - Jussi Hirvonen
- Department of Radiology, Turku University Hospital, University of Turku, Turku, Finland
| | - Pauli Ylikotila
- Clinical Neurosciences, University of Turku, Turku, Finland
- Neurocenter, Turku University Hospital, Turku, Finland
| | - Tero Vahlberg
- Department of Clinical Medicine, Biostatistics, University of Turku, Turku, Finland
| | - Eeva Salo
- Children's Hospital, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Juri Kivelev
- Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
- Clinical Neurosciences, University of Turku, Turku, Finland
| | - Jaakko Rinne
- Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
- Clinical Neurosciences, University of Turku, Turku, Finland
| | - Melissa Rahi
- Department of Neurosurgery, Neurocenter, Turku University Hospital, Turku, Finland
- Clinical Neurosciences, University of Turku, Turku, Finland
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Lei M, Zhang J, Wu D. A Functional Magnetic Resonance Imaging Study on Activation of Anterior Cingulate Cortex at Episode and Interictal Phases in Migraine. J BIOMATER TISS ENG 2022. [DOI: 10.1166/jbt.2022.2815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
<sec> <title>Objective:</title> By using amplitude of low-frequency fluctuations (ALFF) we have analyzed activationsin brain regions at different phases in migraineurs. </sec> <sec> <title>Methods:</title> Participants
included 41 patients with migraine, 19 in episode and 22 in interictal phase, and 22 controls in the healthy condition. To analyze the brain function of patients and controls, ALFF was used for performing the post-processing in the resting state by scores of Montreal Cognitive Assessment (MoCA)
scale, Mini-Mental State Examination (MMSE), Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HAM-D). </sec> <sec> <title>Results:</title> The comparison between groups of patients with migraine in the episode or interictal phases,
and healthy controls showed that both episode and interictal migraine groups had the similar HAM-A and HAM-D scores (P > 0.05), but higher than that in controls (P < 0.01). For ALFF values of Episode and Interictal groups, the Montreal Neurological Institute (MNI) coordinates
of the decreased ALFF were (−9, 42, 9), the voxel size = 215, including the bilateral anterior cingulate cortex (ACC), T =−4.15, without significant differences. Patients in Interictal group were with a stronger activation at MNI coordinates (12, 51, 12), in the bilateral
ACC, voxel size = 90, T =3.87. </sec> <sec> <title>Conclusion:</title> ACC plays an adaptive, regulatory role in migraine and is related to multiple brain regions, which may mediate activation through descending anti-nociceptive pathways. ACC is related
to opioid receptor and glutamate excitatory regulation. </sec>
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Affiliation(s)
- Ming Lei
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China
| | - Junjian Zhang
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China
| | - Dongmei Wu
- Department of Neurology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei 430071, China
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Rashid S, Weaver S, Al-Robaidi K, Dure L, Singh S. Brain Magnetic Resonance Imaging (MRI) White Matter Hyperintensities in Cyclic Vomiting Syndrome With or Without Migraine. J Child Neurol 2022; 37:218-221. [PMID: 34875915 DOI: 10.1177/08830738211027972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Cyclic vomiting syndrome is classified as a possible subset of migraine. Brain magnetic resonance imaging (MRI) findings of white matter hyperintensities are well documented in migraineurs, but not in patients with cyclic vomiting syndrome. This study focuses on white matter hyperintensities in children with cyclic vomiting syndrome. METHODS We investigated our database of outpatient medical records for the diagnosis codes associated with cyclic vomiting syndrome from January 2008 to October 2018. RESULTS Brain MRIs were obtained in 31 of 185 patients (∼17%) with a diagnosis code related to cyclic vomiting syndrome. We excluded 13 of 31 patients because of the inaccessibility of images or a confounding diagnosis. Remaining patients were divided into 2 groups: 13 of 18 cyclic vomiting syndrome with migraine (CVS+M), and 5 of 18 cyclic vomiting syndrome without migraine (CVS-M). We found that 3 of the 13 patients in the CVS+M group had migraine-like white matter hyperintensities compared to 0 of the 5 in the CVS-M group. CONCLUSION This small study suggests a possible relationship between white matter hyperintensities and CVS+M. A larger study is required to validate these findings.
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Affiliation(s)
- Salman Rashid
- Division of Pediatric Neurology, Department of Pediatrics, University of Alabama at Birmingham, School of Medicine, Birmingham, AL, USA
| | - Samantha Weaver
- Division of Pediatric Neurology, Department of Pediatrics, University of Alabama at Birmingham, School of Medicine, Birmingham, AL, USA
| | - Khaled Al-Robaidi
- Division of Pediatric Neurology, Department of Pediatrics, University of Alabama at Birmingham, School of Medicine, Birmingham, AL, USA
| | - Leon Dure
- Division of Pediatric Neurology, Department of Pediatrics, University of Alabama at Birmingham, School of Medicine, Birmingham, AL, USA
| | - Sumit Singh
- Department of Pediatric Radiology, Children's of Alabama, University of Alabama at Birmingham, School of Medicine, Birmingham, AL, USA
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Kim SK, Nikolova S, Schwedt TJ. Structural aberrations of the brain associated with migraine: A narrative review. Headache 2021; 61:1159-1179. [PMID: 34407215 DOI: 10.1111/head.14189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/01/2021] [Accepted: 06/07/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE To summarize major results from imaging studies investigating brain structure in migraine. BACKGROUND Neuroimaging studies, using several different imaging and analysis techniques, have demonstrated aberrations in brain structure associated with migraine. This narrative review summarizes key imaging findings and relates imaging findings with clinical features of migraine. METHODS We searched PubMed for English language articles using the key words "neuroimaging" AND/OR "MRI" combined with "migraine" through August 20, 2020. The titles and abstracts of resulting articles were reviewed for their possible inclusion in this manuscript, followed by examination of the full texts and reference lists of relevant articles. RESULTS Migraine is associated with structural brain aberrations within regions that participate in pain processing, the processing of other sensory stimuli, multisensory integration, and in white matter fiber tracts. Furthermore, migraine is associated with magnetic resonance imaging T2/fluid-attenuated inversion recovery white matter hyperintensities. Some structural aberrations are correlated with the severity and clinical features of migraine, whereas others are not. These findings suggest that some structural abnormalities are associated with or amplified by recurrent migraine attacks, whereas others are intrinsic to the migraine brain. CONCLUSIONS Migraine is associated with aberrant brain structure. Structural neuroimaging studies contribute to understanding migraine pathophysiology and identification of brain regions associated with migraine and its individual symptoms. Additional work is needed to determine the extent to which structural aberrations are a result of recurrent migraine attacks, and perhaps reversible with effective treatment or migraine resolution, versus being intrinsic traits of the migraine brain.
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Affiliation(s)
- Soo-Kyoung Kim
- Department of Neurology and Institute of Health Science, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, South Korea
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Eikermann-Haerter K, Huang SY. White Matter Lesions in Migraine. THE AMERICAN JOURNAL OF PATHOLOGY 2021; 191:1955-1962. [PMID: 33636178 DOI: 10.1016/j.ajpath.2021.02.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/16/2021] [Accepted: 02/12/2021] [Indexed: 12/20/2022]
Abstract
Migraine, the third most common disease worldwide, is a well-known independent risk factor for subclinical focal deep white matter lesions (WMLs), even in young and otherwise healthy individuals with no cardiovascular risk factors. These WMLs are more commonly seen in migraine patients with transient neurologic symptoms preceding their headaches, the so-called aura, and those with a high attack frequency. The pathophysiology of migraine-related deep white matter hyperintensities remains poorly understood despite their prevalence. Characteristic differences in their distribution related to chronic small vessel ischemic disease compared with that of common periventricular WMLs in the elderly suggest a different underlying mechanism. Both ischemic and inflammatory mechanisms have been proposed, as there is increased cerebral vulnerability to ischemia in migraineurs, whereas there is also evidence of blood-brain barrier disruption with associated release of proinflammatory substances during migraine attacks. An enhanced susceptibility to spreading depolarization, the electrophysiological event underlying migraine, may be the mechanism that causes repetitive episodes of cerebral hypoperfusion and neuroinflammation during migraine attacks. WMLs can negatively affect both physical and cognitive function, underscoring the public health importance of migraine, and suggesting that migraine is an important contributor to neurologic deficits in the general population.
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Affiliation(s)
| | - Susie Y Huang
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts; and the Harvard-MIT Division of Health Sciences and Technology, Massachusetts Institute of Technology, Cambridge, Massachusetts
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Kamtchum-Tatuene J, Kenteu B, Fogang YF, Zafack JG, Nyaga UF, Noubiap JJ. Neuroimaging findings in headache with normal neurologic examination: Systematic review and meta-analysis. J Neurol Sci 2020; 416:116997. [DOI: 10.1016/j.jns.2020.116997] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/25/2020] [Accepted: 06/15/2020] [Indexed: 01/16/2023]
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Abstract
This literature review provides an overview of the research using magnetic resonance imaging (MRI) in pediatric migraine and compares findings with the adult migraine literature. A literature search using PubMed was conducted using all relevant sources up to February 2019. Using MRI methods to categorize and explain pediatric migraine in comparison with adult migraine is important, in order to recognize and appreciate the differences between the two entities, both clinically and physiologically. We aim to demonstrate the differences and similarities between pediatric and adult migraine using data from white matter and gray matter structural studies, cerebral perfusion, metabolites, and functional MRI (fMRI) studies, including task-based and resting-state blood oxygen level-dependent studies. By doing this we identify areas that need further research, as well as possible areas where intervention could alter outcomes.
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Dangouloff-Ros V, Roux CJ, Boulouis G, Levy R, Nicolas N, Lozach C, Grevent D, Brunelle F, Boddaert N, Naggara O. Incidental Brain MRI Findings in Children: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol 2019; 40:1818-1823. [PMID: 31624116 DOI: 10.3174/ajnr.a6281] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/03/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND The detection of incidental findings on children's brain MR imaging poses various practical issues because the life-long implications of such findings may be profound. PURPOSE Our aim was to assess the prevalence and characteristics of incidental brain MR imaging findings in children. DATA SOURCES Electronic databases (PubMed, EMBASE, and Cochrane) were searched for articles published between 1985 to July 2018, with the following search terms: "incidental," "findings," "brain," "MR imaging." STUDY SELECTION Inclusion criteria were the following: 1) patients younger than 21 years of age, 2) healthy children without any clinical condition, 3) MR images obtained with at least a 1.5T magnet, 4) original articles, and 5) a methodologic quality score of ≥10. DATA ANALYSIS Two observers independently extracted data and assessed data quality and validity. The number and type of incidental findings were pooled. Heterogeneity was assessed using the Cochran Q statistic and the I2 statistic. DATA SYNTHESIS Seven studies were included, reporting 5938 children (mean age, 11.3 ± 2.8 years). Incidental findings were present in 16.4% (99% CI, 9.8-26.2; Q = 117.5, I2= 94.9%) of healthy children, intracranial cysts being the most frequent (10.2%, 99% CI, 3.1-28.5; Q = 306.4, I2 = 98.0%). Nonspecific white matter hyperintensities were reported in 1.9% (99% CI, 0.2-16.8; Q = 73.6, I2 = 94.6%), Chiari 1 malformation was found in 0.8% (99% CI, 0.5-1.3; Q = 7.6, I2 = 60.5%), and intracranial neoplasms were reported in 0.2% (99% CI, 0.1-0.6; Q = 3.4, I2 = 12.3%). In total, the prevalence of incidental findings needing follow-up was 2.6% (99% CI, 0.5-11.7; Q = 131.2, I2 = 95.4%). Incidental findings needing specific treatment were brain tumors (0.2%) and cavernomas (0.2%). LIMITATIONS Limitations were no age stratification or ethnicity data and variation in the design of included studies. CONCLUSIONS The prevalence of incidental findings is much more frequent in children than previously reported in adults, but clinically meaningfull incidental findings were present in <1 in 38 children.
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Affiliation(s)
- V Dangouloff-Ros
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- Institut National de l a Santé et de la Recherche Médicale U1000 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Paris, France
- Unité Mixte de Recherche 1163 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Institut Imagine, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
| | - C-J Roux
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- Institut National de l a Santé et de la Recherche Médicale U1000 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Paris, France
- Unité Mixte de Recherche 1163 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Institut Imagine, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
| | - G Boulouis
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
- Neuroradiology Department (G.B., O.N.), Centre Hospitalier Sainte-Anne, Paris, France
| | - R Levy
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- Institut National de l a Santé et de la Recherche Médicale U1000 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Paris, France
- Unité Mixte de Recherche 1163 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Institut Imagine, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
| | - N Nicolas
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- Institut National de l a Santé et de la Recherche Médicale U1000 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Paris, France
- Unité Mixte de Recherche 1163 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Institut Imagine, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
| | - C Lozach
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- Institut National de l a Santé et de la Recherche Médicale U1000 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Paris, France
- Unité Mixte de Recherche 1163 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Institut Imagine, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
| | - D Grevent
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- Institut National de l a Santé et de la Recherche Médicale U1000 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Paris, France
- Unité Mixte de Recherche 1163 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Institut Imagine, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
| | - F Brunelle
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- Institut National de l a Santé et de la Recherche Médicale U1000 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Paris, France
- Unité Mixte de Recherche 1163 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Institut Imagine, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
| | - N Boddaert
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- Institut National de l a Santé et de la Recherche Médicale U1000 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Paris, France
- Unité Mixte de Recherche 1163 (V.D.-R., C.-J.R., R.L., N.N., C.L., D.G., F.B., N.B.), Institut Imagine, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
| | - O Naggara
- From the Pediatric Radiology Department (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), Hôpital Necker-Enfants Malades, Paris, France
- University René Descartes (V.D.-R., C.-J.R., G.B., R.L., N.N., C.L., D.G., F.B., N.B., O.N.), PRES Sorbonne Paris Cité, Paris, France
- Neuroradiology Department (G.B., O.N.), Centre Hospitalier Sainte-Anne, Paris, France
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Komáromy H, He M, Perlaki G, Orsi G, Nagy SA, Bosnyák E, Kamson Olayinka D, John F, Trauninger A, Pfund Z. Influence of hemispheric white matter lesions and migraine characteristics on cortical thickness and volume. J Headache Pain 2019; 20:4. [PMID: 30630410 PMCID: PMC6734368 DOI: 10.1186/s10194-019-0959-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 01/02/2019] [Indexed: 01/03/2023] Open
Abstract
Background/Aim Migraine-related intracerebral white matter lesions (WMLs) are likely to be microvascular in nature and can be found in all hemispheric lobes. The aim of this study was to investigate migraine patients with or without WMLs to see the effects of these tissue damages on cortical thickness and volume. The role of migraine characteristics (duration of headache, attack frequency, estimated lifetime attack number, aura) was also tested. Methods As study participants, 161 female migraine patients (63 with aura; 52 with WMLs) and 40 age-matched healthy female subjects were enrolled in the study. None of the included migraine patients’ headache or aura (where present) was unilaterally side-locked. Patients and controls were all right handed. Except for migraine, patients were free of any medical comorbidity. Cortical reconstruction and segmentation were performed on the 3D T1-weighted images using Freesurfer 5.3 image analysis suite. The automatic cortical parcellation was based on Freesurfer’s Desikan–Killiany–Tourville atlas, which has 31 cortical regions per hemisphere. The segmented regions were divided into five lobes (frontal, parietal, temporal, occipital, insula). Since the left and right differences in lobar and insular volumes/thicknesses were not different among our groups, volume and cortical thickness were calculated for corresponding bilateral lobes. Results There was no significant difference in age between the whole migraine and the control groups. Migraineurs with WMLs (L+ patients) were significantly older than lesion-free (L-) patients (P = 0.0003) and controls (P = 0.018). Disease duration (P = 0.003), the total number of migraine attacks (P = 0.022) and the rate of aura (P = 0.0003) were significantly higher in L+ patients than in L- patients. Cortical thickness and volume measurements of lobes were not statistically different between the three groups (L+, L-, control). Age showed a significant negative association with both thickness and volume in each examined lobe (P < 0.001). Intracranial volume (ICV) showed a significant positive association with all regional volumes (P < 0.001). There were no significant group*age, group*ICV, or age*ICV interactions. None of the migraine characteristics were selected by stepwise linear regression as significant predictors of cortical thickness or volume. Only age (for both thickness and volume) and ICV (for volume) were identified as significant predictors (P < 0.001). When the L + group was divided into two subgroups by median split of total and lobar lesion number and volume, the cortical measures did not show any significant difference between the groups with low vs. high lesion number/volume by stepwise linear regression. Conclusions In a female migraine group, we found that the WMLs and clinical migraine characteristics have no effect on cortical thickness and volume of bilateral lobes. Lobar cortical thicknesses were equivalent within the range of ±0.1 mm. Only age and ICV proved to be significant predictors; the former for both cortical thickness and volume, while the latter for cortical volume.
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Affiliation(s)
| | - Mingchen He
- Department of Neurosurgery, Medical School, University of Pécs, Pécs, Hungary
| | - Gábor Perlaki
- Pécs Diagnostic Center, Pécs, Hungary.,Department of Neurosurgery, Medical School, University of Pécs, Pécs, Hungary.,MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary
| | - Gergely Orsi
- Pécs Diagnostic Center, Pécs, Hungary.,Department of Neurosurgery, Medical School, University of Pécs, Pécs, Hungary.,MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary
| | - Szilvia Anett Nagy
- Pécs Diagnostic Center, Pécs, Hungary.,Department of Neurosurgery, Medical School, University of Pécs, Pécs, Hungary.,MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary.,Neurobiology of Stress Research Group, Szentágothai Research Center, University of Pécs, Pécs, Hungary
| | - Edit Bosnyák
- Department of Neurology, Medical School, University of Pécs, Pécs, Hungary
| | | | - Flóra John
- Department of Neurology, Medical School, University of Pécs, Pécs, Hungary
| | - Anita Trauninger
- Department of Neurology, Medical School, University of Pécs, Pécs, Hungary
| | - Zoltán Pfund
- Department of Neurology, Medical School, University of Pécs, Pécs, Hungary.
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Hu B, Wang X, He JB, Dai YJ, Zhang J, Yu Y, Sun Q, Lin-FengYan, Hu YC, Nan HY, Yang Y, Kaye AD, Cui GB, Wang W. Structural and functional brain changes in perimenopausal women who are susceptible to migraine: a study protocol of multi-modal MRI trial. BMC Med Imaging 2018; 18:26. [PMID: 30189858 PMCID: PMC6127929 DOI: 10.1186/s12880-018-0272-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 08/29/2018] [Indexed: 01/01/2023] Open
Abstract
Background As a common clinical symptom that often bothers midlife females, migraine is closely associated with perimenopause. Previous studies suggest that one of the most prominent triggers is the sudden decline of estrogen during perimenopausal period. Hormone replacement therapy (HRT) is widely used to prevent this suffering in perimenopausal women, but effective diagnostic system is lacked for quantifying the severity of the diseaase. To avoid the abuse and overuse of HRT, we propose to conduct a diagnostic trial using multimodal MRI techniques to quantify the severity of these perimenopausal migraineurs who are susceptible to the decline of estrogen. Methods Perimenopausal women suffering from migraine will be recruited from the pain clinic of our hospital. Perimenopausal women not suffering from any kind of headache will be recruited from the local community. Clinical assessment and multi-modal MR imaging examination will be conducted. A follow up will be conducted once half year within 3 years. Pain behavior, neuropsychology scores, fMRI analysis combined with suitable statistical software will be used to reveal the potential association between these above traits and the susceptibility of migraine. Discussion Multi-modal imaging features of both healthy controls and perimenopausal women who are susceptible to estrogen decline will be acquired. Imaging features will include volumetric characteristics, white matter integrity, functional characteristics, topological properties, and perfusion properties. Clinical information, such as basic information, blood estrogen level, information of migraine, and a bunch of neurological scale will also be used for statistic assessment. This clinical trial would help to build an effective screen system for quantifying the severity of illness of those susceptible women during the perimenopausal period. Trial registration This study has already been registered at Clinical Trials. gov (ID: NCT02820974). Registration date: September 28th, 2014.
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Affiliation(s)
- Bo Hu
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - Xu Wang
- Student Brigade, Fourth Military Medical University (Air Force Medical University), 169 West Changle Road, Xi'an, 710032, Shaanxi Province, China
| | - Jie-Bing He
- Student Brigade, Fourth Military Medical University (Air Force Medical University), 169 West Changle Road, Xi'an, 710032, Shaanxi Province, China
| | - Yu-Jie Dai
- Department of Clinical Nutrition, Xijing Hospital, The Fourth Military Medical University, Xi'an, China
| | - Jin Zhang
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - Ying Yu
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - Qian Sun
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - Lin-FengYan
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - Yu-Chuan Hu
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - Hai-Yan Nan
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - Yang Yang
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China
| | - Alan D Kaye
- Departments of Anesthesiology and Pharmacology, Louisiana State University School of Medicine, New Orleans, Louisiana, USA
| | - Guang-Bin Cui
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China.
| | - Wen Wang
- Department of Radiology & Functional and Molecular Imaging Key Lab of Shaanxi Province, Tangdu Hospital, Fourth Military Medical University (Air Force Medical University), 569 Xinsi Road, Xi'an, 710038, Shaanxi, China.
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Barz H, Barz U, Schreiber A. Morphogenesis of the demyelinating lesions in Baló’s concentric sclerosis. Med Hypotheses 2016; 91:56-61. [DOI: 10.1016/j.mehy.2016.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 03/26/2016] [Indexed: 12/17/2022]
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Erdélyi-Bótor S, Komáromy H, Kamson DO, Kovács N, Perlaki G, Orsi G, Molnár T, Illes Z, Nagy L, Kéki S, Deli G, Bosnyák E, Trauninger A, Pfund Z. Serum L-arginine and dimethylarginine levels in migraine patients with brain white matter lesions. Cephalalgia 2016; 37:571-580. [DOI: 10.1177/0333102416651454] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background/Aim Migraine is a risk factor for the formation of silent brain white matter lesions (WMLs) that are possibly ischemic in nature. Although dysfunction of the L-arginine/nitric oxide (NO) pathway has been associated with oxidative stress and endothelial dysfunction in migraine, its role in WML development has not been specifically investigated. Thus, this prospective study aimed to measure the serum concentrations of the NO substrate L-arginine, the NO synthase inhibitor asymmetric dimethylarginine (ADMA), and the L-arginine transport regulator symmetric dimethylarginine (SDMA) in migraine patients in a headache-free period. Methods All participants underwent MR imaging to assess for the presence of WMLs on fluid-attenuated inversion recovery imaging. Altogether 109 migraine patients (43 with lesions, 66 without lesions) and 46 control individuals were studied. High-performance liquid chromatography was used to quantify L-arginine, ADMA and SDMA serum concentrations. Migraine characteristics were investigated, and participants were screened for risk factors that can lead to elevated serum ADMA levels independent of migraine. Results Migraine patients and controls did not differ in regard to vascular risk factors. Migraineurs with WMLs had a longer disease duration ( p < 0.001) and a higher number of lifetime headache attacks ( p = 0.005) than lesion-free patients. Higher L-arginine serum levels were found in both migraine subgroups compared to controls ( p < 0.001). Migraine patients with WMLs showed higher ADMA concentrations than lesion-free patients and controls ( p < 0.001, for both). In migraineurs, the presence of WMLs, aura and increasing age proved to be significant predictors of increased ADMA levels ( p = 0.008, 0.047 and 0.012, respectively). SDMA serum levels of lesional migraineurs were higher than in nonlesional patients ( p < 0.001). The presence of lesions and increasing age indicated an increased SDMA level ( p = 0.017 and 0.001, respectively). Binary logistic regression analysis showed that ADMA level ( p = 0.006), increasing age ( p = 0.017) and the total number of lifetime migraine attacks ( p = 0.026) were associated with an increased likelihood of exhibiting WMLs. There was no significant effect of age on ADMA and SDMA concentrations in controls. Conclusions Elevated ADMA levels may impact the pathogenesis of migraine-related WMLs by influencing cerebrovascular autoregulation and vasomotor reactivity. Higher SDMA concentrations may indirectly influence NO synthesis by reducing substrate availability. Elevated L-arginine serum levels might reflect an increased demand for NO synthesis.
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Affiliation(s)
| | | | | | - Norbert Kovács
- Department of Neurology, University of Pécs, Pécs, Hungary
| | - Gábor Perlaki
- Department of Neurology, University of Pécs, Pécs, Hungary
- Diagnostic Center of Pécs, Pécs, Hungary
- MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary
| | - Gergely Orsi
- Department of Neurology, University of Pécs, Pécs, Hungary
- Diagnostic Center of Pécs, Pécs, Hungary
- MTA-PTE Clinical Neuroscience MR Research Group, Pécs, Hungary
| | - Tihamér Molnár
- Department of Anesthesiology and Intensive Care, University of Pécs, Pécs, Hungary
| | - Zsolt Illes
- Department of Neurology, University of Pécs, Pécs, Hungary
| | - Lajos Nagy
- Department of Applied Chemistry, University of Debrecen, Debrecen, Hungary
| | - Sándor Kéki
- Department of Applied Chemistry, University of Debrecen, Debrecen, Hungary
| | - Gabriella Deli
- Department of Neurology, University of Pécs, Pécs, Hungary
| | - Edit Bosnyák
- Department of Neurology, University of Pécs, Pécs, Hungary
| | | | - Zoltán Pfund
- Department of Neurology, University of Pécs, Pécs, Hungary
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Sweeney ML, Kukreja M, Horn PS, Standridge SM. Diagnoses in Pediatric Patients With Magnetic Resonance Imaging (MRI) Lesions Suspicious for Demyelination. J Child Neurol 2015; 30:1651-7. [PMID: 25862736 DOI: 10.1177/0883073815578522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Accepted: 02/08/2015] [Indexed: 11/16/2022]
Abstract
Magnetic resonance imaging (MRI) studies of the brain in pediatric patients frequently show abnormal white matter lesions, which may be concerning for demyelinating disease. This study aimed to determine the proportion of pediatric patients who have MRI lesions concerning for demyelinating disease at presentation and ultimately are diagnosed with a primary central nervous system demyelinating disease. A retrospective chart review was performed on MRI reports of patients who underwent imaging evaluation at a single tertiary pediatric hospital. Of 299 patients identified, 192 presented with acute neurologic complaints. In this group, ≥ 5 discrete lesions, African American race, and having brain stem, thalamic, cerebellar, or optic nerve lesions was associated with the patient being diagnosed with a disease that required further treatment. The other 107 patients underwent MRI for other indications. Among these subjects, having lesions within the corpus callosum or cerebellum was associated with being diagnosed with a disease requiring further treatment.
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Affiliation(s)
- Michael L Sweeney
- Department of Child Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Marcia Kukreja
- Department of Radiology, Texas Children's Hospital, Houston, TX, USA
| | - Paul S Horn
- Department of Child Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA Division of Biostatistics & Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Shannon M Standridge
- Department of Child Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Tso AR, Goadsby PJ. Recent Neuroimaging Advances in the Study of Primary Headaches. Curr Pain Headache Rep 2015; 19:15. [DOI: 10.1007/s11916-015-0487-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Landy SH, Kaniecki RG, Taylor FR. Abstracts and Citations. Headache 2014. [DOI: 10.1111/head.12302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Candee MS, McCandless RT, Moore KR, Arrington CB, Minich LL, Bale JF. White matter lesions in children and adolescents with migraine. Pediatr Neurol 2013; 49:393-6. [PMID: 24095578 DOI: 10.1016/j.pediatrneurol.2013.08.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 08/13/2013] [Accepted: 08/21/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The etiology and clinical importance of white matter lesions in migraine remain poorly understood. To understand these issues more fully, we reviewed the brain magnetic resonance imaging scans of pediatric patients and assessed the relationships between white matter lesions, migraine type, patent foramen ovale, and right-to-left shunting. METHODS The magnetic resonance imaging scans of a cohort of children (n = 89) and adolescents, ages 6 to 18 years, who participated in a study of migraine and patent foramen ovale were reviewed. All children in the cohort had undergone saline contrast transthoracic echocardiography and transcranial Doppler studies. RESULTS White matter lesions were detected in 15 of the 89 patients (17%). White matter lesions were small (<5 mm) in the majority (10/15; 66%). We observed no relationship between the presence of white matter lesions and (1) migraine type (six patients with white matter lesions among 35 with migraine with aura [17%] vs. nine with white matter lesions among 54 without aura [17%]; P = 1.0); (2) patent foramen ovale (five with white matter lesions among 35 with patent foramen ovale [14%] vs. 10 with white matter lesions among 54 without patent foramen ovale [19%]; P = 0.77); or (3) shunt size (two large shunts in 15 with white matter lesions [13%] vs. nine large shunts among 72 without white matter lesions [13%]; P = 1.0). CONCLUSIONS These results indicate that small white matter lesions are not infrequent in children and adolescents with migraine. However, no relationships between white matter lesions and migraine type, patent foramen ovale, or degree of right-to-left shunting were observed.
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Affiliation(s)
- Meghan S Candee
- Division of Pediatric Neurology, Department of Pediatrics, Primary Children's Medical Center and the University of Utah, Salt Lake City, Utah; Division of Pediatric Neurology, Department of Neurology, Primary Children's Medical Center and the University of Utah, Salt Lake City, Utah.
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