1
|
Li P, Li J, Zhu H, Sheng D, Xiao Z, Liu W, Xiao B, Zhou L. Causal effects of sedentary behaviours on the risk of migraine: A univariable and multivariable Mendelian randomization study. Eur J Pain 2024. [PMID: 38837486 DOI: 10.1002/ejp.2296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Revised: 05/02/2024] [Accepted: 05/20/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Migraine is a common and burdensome neurological disorder. The causal relationship between sedentary behaviours (SBs) and migraine remains instinct. We aimed to evaluate the roles of SBs including watching TV, using computer and driving in the risk of migraine. METHODS We conducted a univariable and multivariable Mendelian randomization (MR) study based on summary datasets of large genome-wide association studies. The inverse variance weighted method was utilized as the primary analytical tool. Cochran's Q, MR-Egger intercept test, MR pleiotropy residual sum and outlier and leave-one-out were conducted as sensitivity analysis. Additionally, we performed a meta-analysis to combine the causal estimates. RESULTS In the discovery analysis, we identified causal associations between time spent watching TV and an increased risk of migraine (p = 0.015) and migraine without aura (MO) (p = 0.002). Such causalities with increasing risk of migraine (p = 0.005), and MO (p = 0.006) were further verified using summary datasets from another study in the replication analysis. There was no significant causal association found between time spent using computer, driving and migraine or its two subtypes. The meta-analysis and multivariable MR analysis also strongly supported the causal relationships between time spent watching TV and an increased risk of migraine (p = 0.0003 and p = 0.034), as well as MO (p < 0.0001 and p = 0.0004), respectively. These findings were robust under all sensitivity analysis. CONCLUSIONS Our study suggested that time spent watching TV may be causally associated with an increased risk of migraine, particularly MO. Large-scale and well-designed cohort studies may be warranted for further validation. SIGNIFICANCE STATEMENT This study represents the first attempt to investigate whether a causal relationship exists between SBs and migraine. Utilizing MR analysis helps mitigate reverse causation bias and confounding factors commonly encountered in observational cohorts, thereby enhancing the robustness of derived causal associations. Our MR analysis revealed that time spent watching TV may serve as a potential risk factor for migraine, particularly MO.
Collapse
Affiliation(s)
- Peihong Li
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Medical Research Center for Geriatric Diseases (Xiangya Hospital), Central South University, Changsha, Hunan, China
| | - Jiaxin Li
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Medical Research Center for Geriatric Diseases (Xiangya Hospital), Central South University, Changsha, Hunan, China
| | - Haoyue Zhu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Medical Research Center for Geriatric Diseases (Xiangya Hospital), Central South University, Changsha, Hunan, China
| | - Dandan Sheng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Medical Research Center for Geriatric Diseases (Xiangya Hospital), Central South University, Changsha, Hunan, China
| | - Zheng Xiao
- Department of Pathology, First Hospital of Changsha, Changsha, Hunan, China
| | - Weiping Liu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Medical Research Center for Geriatric Diseases (Xiangya Hospital), Central South University, Changsha, Hunan, China
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Medical Research Center for Geriatric Diseases (Xiangya Hospital), Central South University, Changsha, Hunan, China
| | - Luo Zhou
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, Hunan, China
- National Clinical Medical Research Center for Geriatric Diseases (Xiangya Hospital), Central South University, Changsha, Hunan, China
| |
Collapse
|
2
|
Fan XX, Ye L, Yang YH, Huang WJ, Ko CY. Migraine Duration as a Potential Amplifier of Obesity. Diabetes Metab Syndr Obes 2024; 17:1025-1037. [PMID: 38476349 PMCID: PMC10928920 DOI: 10.2147/dmso.s447781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 02/15/2024] [Indexed: 03/14/2024] Open
Abstract
Purpose Migraine is a complex neurovascular disorder with obesity as a notable risk factor. This study aimed to investigate an under-researched area of the association between migraine duration and body composition. Patients and Methods Patients with migraine from a neurology outpatient department were enrolled and were categorized into four groups based on illness duration: 1 year, 1-5 years, 5-10 years, and >10 years. Patient demographics, blood biochemistry, and body composition data were collected and analyzed statistically. Results Patients with migraine were predominantly female, with lower education levels, significant work stress, poor sleep, and limited exercise. Longer migraine duration corresponded to increased obesity metrics. Notably, those patients with under 1 year of illness showed elevated blood lipid and liver function levels, whereas those with >10 years showed increased weight, waist circumference, body mass index, and fat content, despite higher physical activity. Significant positive correlation between obesity metrics and migraine duration was seen in patients who had migraine for >1 year. Conclusion Our findings indicate that protracted episodes of migraine could amplify obesity tendencies, underscoring the imperative of weight regulation in migraine intervention to diminish ensuing adiposity-associated hazards.
Collapse
Affiliation(s)
- Xi-Xin Fan
- The School of Public Health, Fujian Medical University, Fuzhou, People’s Republic of China
- Department of Clinical Nutrition, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, People’s Republic of China
| | - Lichao Ye
- Department of Neurology, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, People’s Republic of China
| | - Ya-Hui Yang
- The School of Public Health, Fujian Medical University, Fuzhou, People’s Republic of China
- Department of Clinical Nutrition, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, People’s Republic of China
| | - Wen-Jian Huang
- Department of Clinical Nutrition, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, People’s Republic of China
- Huidong Center for Chronic Disease Control, Huizhou, People’s Republic of China
| | - Chih-Yuan Ko
- Department of Clinical Nutrition, the Second Affiliated Hospital of Fujian Medical University, Quanzhou, People’s Republic of China
| |
Collapse
|
3
|
Bu XX, Zhu LH, Wang ZM, Lu C, Chen H, Yu D. Association of obesity with headache among US children and adolescents: Evidence from NHANES 1999-2004. Front Endocrinol (Lausanne) 2023; 13:1072419. [PMID: 36686472 PMCID: PMC9849580 DOI: 10.3389/fendo.2022.1072419] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 12/15/2022] [Indexed: 01/06/2023] Open
Abstract
Background Children and adolescents increasingly commonly suffer from obesity and headache. It has been confirmed that there is an association between obesity and headache in adults; however, evidence of such an association in paediatric populations is still controversial. Therefore, this study examined the relationship between obesity and headache among children and adolescents in the US. Methods The cross-sectional data of 3948 participants were obtained from the National Health and Nutrition Examination Survey 1999-2004. Weighted logistic regression models were applied to investigate the association between obesity and headache. Subgroup analysis stratified by sex and age was performed to explore the potential difference in the association of paediatric obesity with headache. The performance of paediatric obesity on headache was assessed by receiver operating characteristic (ROC) curve. Results The present study involved 3948 participants, of whom 713 (18.1%) had headache. Compared to those without headache, participants with headache tended to be girls and adolescents, have less calcium intake, and have higher levels of body mass index (BMI), C-reactive protein (CRP), serum ferritin and triglycerides (TGs) (all P < 0.05). After fully adjusting for potential confounders, the ORs with 95% CIs for headache were 1.03 (0.58-1.54) and 1.25 (0.68-2.30) for overweight and obese participants in comparison with normal-weight controls, respectively, implying no association of paediatric obesity with headache independent of other potential confounding factors. In addition, although higher odds of headache were noted in girls and adolescents (aged 10-17 years), no statistically significant difference was found across any subgroups. The area under the ROC (AUC) of paediatric obesity on headache was 0.634. Conclusions In summary, our study indicated that obesity is not associated with headache among US children and adolescents. Further prospective studies with larger sample size are needed to validate our findings.
Collapse
Affiliation(s)
- Xin-Xin Bu
- Department of Paediatric, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Liang-Hua Zhu
- Department of Paediatric, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ze-Mu Wang
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chao Lu
- Department of Paediatric, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hui Chen
- Department of Paediatric, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Di Yu
- Department of Cardiothoracic Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China
| |
Collapse
|
4
|
Almusalam AA, Abdullah NHH, Alshammari MMM. Updates on the Association between Obesity and Migraine: Systematic Review of Observational Studies. INTERNATIONAL JOURNAL OF PHARMACEUTICAL RESEARCH AND ALLIED SCIENCES 2023. [DOI: 10.51847/r9e9inze8d] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2023]
|
5
|
Martami F, Jayedi A, Shab‐Bidar S. Primary headache disorders and body mass index categories: A systematic review and dose–response meta‐analysis. Headache 2022; 62:801-810. [DOI: 10.1111/head.14356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 05/10/2022] [Accepted: 05/10/2022] [Indexed: 11/27/2022]
Affiliation(s)
- Fahimeh Martami
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics Tehran University of Medical Sciences Tehran Iran
| | - Ahmad Jayedi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics Tehran University of Medical Sciences Tehran Iran
- Food Safety Research Center (Salt) Semnan University of Medical Sciences Semnan Iran
| | - Sakineh Shab‐Bidar
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics Tehran University of Medical Sciences Tehran Iran
| |
Collapse
|
6
|
Halaiko DA, Faro P, Levis AA, Netto BDM. The association between obesity and migraine and possible mechanisms of action: an integrative literature review. HEADACHE MEDICINE 2021. [DOI: 10.48208/headachemed.2021.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
IntroductionObesity is a multifactorial disease and is defined by the excessive accumulation of adipose tissue that can cause harm to human health. The presence of obesity is an important risk factor for migraine chronification. However, not much is known about the link between the two diseases.
MethodsIn this study, an integrative literature review was conducted to better understand the mechanisms of interaction between migraine and obesity. Therefore, a search of PubMed and the Virtual Health Library (VHL) was performed with the following keywords: enxaqueca e obesidade; enxaqueca e obesidade e inflamação; enxaqueca e obesidade e neuropeptídeos; migraine and obesity; migraine and obesity and inflammation; migraine and obesity and neuropeptides.
ResultsThe search identified 22 articles. After reading and analyzing the articles, three thematic categories emerged: 1) Obesity as an Aggravating Factor for Migraine 2) Mechanisms Studied between Obesity and Migraine 3) The Effect of Weight Loss on Migraine Symptoms.
ConclusionsThe chronic low-grade inflammation associated with obesity can cause a predisposition to migraine chronification. The abnormal secretion of adipokines, dysregulation of the sympathetic nervous system, and hypothalamic dysfunction have been suggested to be the main shared mechanisms between both diseases.
Collapse
|
7
|
Kristoffersen ES, Børte S, Hagen K, Zwart JA, Winsvold BS. Migraine, obesity and body fat distribution - a population-based study. J Headache Pain 2020; 21:97. [PMID: 32762643 PMCID: PMC7409451 DOI: 10.1186/s10194-020-01163-w] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 07/21/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Obesity has been linked to an increased prevalence of migraine, and to increased migraine attack frequency, but several questions are left unanswered by previous studies. We examined the relationship between obesity and headache in a large, population-based study where we could take into account body fat distribution, migraine subtypes and tension-type headache. METHODS The third population-based Nord-Trøndelag Health Study (HUNT3) included validated headache questionnaires and objective anthropometric measurements. Using a cross-sectional design, our sample consisted of 18,191 women and 14,985 men, aged 19 to 96 years. Of these 4290 (12.9%) had migraine, 4447 (13.4%) had frequent tension-type headache (TTH), and 24,439 were headache-free controls. A total of 5049 individuals with unclassified headache were excluded from the analyses. Using logistic regression, we modeled the association between obesity and headache prevalence, adjusting for relevant confounders. RESULTS Both total body obesity (TBO) and abdominal obesity (AO) were associated with a higher prevalence of migraine when compared to headache-free controls (OR 1.45 95% CI 1.32-1.59 and OR 1.29 95% CI 1.18-1.41, respectively), in particular for individuals < 50 years of age (OR 1.74 95% CI 1.54-1.98 and OR 1.89 95% CI 1.69-2.11). Similar results were seen for migraine with and without aura. Similar Overall, a weaker associations were as observed between obesity and TTH. There was a dose-response relationship between obesity categories and increased headache frequency in subjects with migraine. TBO was associated with migraine prevalence and attack frequency independent of AO. CONCLUSION Both TBO and AO were associated with migraine prevalence and attack frequency. This association was largely limited to individuals < 50 years of age. TBO, rather than AO, may be a better measure of obesity in relation to migraine.
Collapse
Affiliation(s)
- Espen Saxhaug Kristoffersen
- Research and Communication Unit for Musculoskeletal Health, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway. .,Department of General Practice, HELSAM, University of Oslo, PO Box 1130, Blindern, 0318, Oslo, Norway. .,Department of Neurology, Akershus University Hospital, Lørenskog, Norway.
| | - Sigrid Børte
- Research and Communication Unit for Musculoskeletal Health, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Knut Hagen
- Department of Neuromedicine and Movement science, Norwegian University of Science and Technology, Trondheim, Norway.,Clinical Research Unit Central Norway, St. Olavs University Hospital, Trondheim, Norway
| | - John-Anker Zwart
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| | - Bendik Slagsvold Winsvold
- Department of Research, Innovation and Education, Division of Clinical Neuroscience, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
8
|
Torres-Ferrús M, Ursitti F, Alpuente-Ruiz A, Brunello F, Chiappino D, de Vries T, Di Marco S, Ferlisi S, Guerritore L, Gonzalez-Garcia N, Gonzalez-Martinez A, Khutorov D, Kritsilis M, Kyrou A, Makeeva T, Minguez-Olaondo A, Pilati L, Serrien A, Tsurkalenko O, Van den Abbeele D, van Hoogstraten WS, Lampl C. From transformation to chronification of migraine: pathophysiological and clinical aspects. J Headache Pain 2020; 21:42. [PMID: 32349653 PMCID: PMC7189559 DOI: 10.1186/s10194-020-01111-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 04/15/2020] [Indexed: 02/06/2023] Open
Abstract
Chronic migraine is a neurological disorder characterized by 15 or more headache days per month of which at least 8 days show typical migraine features. The process that describes the development from episodic migraine into chronic migraine is commonly referred to as migraine transformation or chronification. Ample studies have attempted to identify factors associated with migraine transformation from different perspectives. Understanding CM as a pathological brain state with trigeminovascular participation where biological changes occur, we have completed a comprehensive review on the clinical, epidemiological, genetic, molecular, structural, functional, physiological and preclinical evidence available.
Collapse
Affiliation(s)
- M. Torres-Ferrús
- Headache and Craniofacial Pain Unit, Neurology Department, Hospital Universitari Vall d’Hebron, Headache and Neurological Pain Research Group, Vall d’Hebron Research Institute (VHIR), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - F. Ursitti
- Headache Center, Child Neurology Unit, Bambino Gesu’ Children’s Hospital, Rome, Italy
| | - A. Alpuente-Ruiz
- Headache and Craniofacial Pain Unit, Neurology Department, Hospital Universitari Vall d’Hebron, Headache and Neurological Pain Research Group, Vall d’Hebron Research Institute (VHIR), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - F. Brunello
- Juvenile Headache Centre, Department of Woman’s and Child’s Health, University Hospital of Padua, Padua, Italy
| | - D. Chiappino
- Department of Internal medicine, Sant’Andrea Hospital, University of Rome, Sapienza, Italy
| | - T. de Vries
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - S. Di Marco
- Department of Biomedicine Neuroscience and Advanced Diagnostics, Policlinico Paolo Giaccone Hospital, University of Palermo, Palermo, Italy
| | - S. Ferlisi
- Department of Biomedicine Neuroscience and Advanced Diagnostics, Policlinico Paolo Giaccone Hospital, University of Palermo, Palermo, Italy
| | - L. Guerritore
- Department of Internal medicine, Sant’Andrea Hospital, University of Rome, Sapienza, Italy
| | - N. Gonzalez-Garcia
- Headache and Craniofacial Pain Unit, Neurology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - A. Gonzalez-Martinez
- Neurology Department, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - D. Khutorov
- Department of Clinical Neurology and Sleep Medicine, The Nikiforov Russian Center of Emergency and Radiation Medicine of EMERCOM of Russia, Saint-Petersburg, Russia
| | | | - A. Kyrou
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland University Hospital of Psychiatry, Bern, Switzerland
| | - T. Makeeva
- Headache Unit, Department of Neurology, Medical center “New Medical Technologies”, Voronezh, Russia
| | - A. Minguez-Olaondo
- Department of Neurology, Universitary Hospital of Donostia, San Sebastian, Spain
- Department of Neurology, Clínica Universidad de Navarra, Pamplona, Spain
- Department of Neurology, Hospital Quironsalud Donostia, San Sebastian, Spain
| | - L. Pilati
- Department of Biomedicine Neuroscience and Advanced Diagnostics, Policlinico Paolo Giaccone Hospital, University of Palermo, Palermo, Italy
| | - A. Serrien
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
| | - O. Tsurkalenko
- Department of Neurology and Neurosurgery, State Institution “Dnipropetrovsk medical akademy MOH Ukraine”, Dnipro, Ukraine
| | | | - W. S. van Hoogstraten
- Department of Neuroscience, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - C. Lampl
- Headache Medical Center Linz, Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria
| | - On behalf of School of Advanced Studies of European Headache Federation (EHF-SAS)
- Headache and Craniofacial Pain Unit, Neurology Department, Hospital Universitari Vall d’Hebron, Headache and Neurological Pain Research Group, Vall d’Hebron Research Institute (VHIR), Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
- Headache Center, Child Neurology Unit, Bambino Gesu’ Children’s Hospital, Rome, Italy
- Juvenile Headache Centre, Department of Woman’s and Child’s Health, University Hospital of Padua, Padua, Italy
- Department of Internal medicine, Sant’Andrea Hospital, University of Rome, Sapienza, Italy
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
- Department of Biomedicine Neuroscience and Advanced Diagnostics, Policlinico Paolo Giaccone Hospital, University of Palermo, Palermo, Italy
- Headache and Craniofacial Pain Unit, Neurology Department, Hospital Universitario Clínico San Carlos, Madrid, Spain
- Neurology Department, Hospital Universitario de La Princesa & Instituto de Investigación Sanitaria de La Princesa, Universidad Autónoma de Madrid (UAM), Madrid, Spain
- Department of Clinical Neurology and Sleep Medicine, The Nikiforov Russian Center of Emergency and Radiation Medicine of EMERCOM of Russia, Saint-Petersburg, Russia
- Grevena General Hospital, Grevena, Greece
- University Hospital of Psychiatry and Psychotherapy, University of Bern, Switzerland University Hospital of Psychiatry, Bern, Switzerland
- Headache Unit, Department of Neurology, Medical center “New Medical Technologies”, Voronezh, Russia
- Department of Neurology, Universitary Hospital of Donostia, San Sebastian, Spain
- Department of Neurology, Clínica Universidad de Navarra, Pamplona, Spain
- Department of Neurology, Hospital Quironsalud Donostia, San Sebastian, Spain
- Department of Neurology, University Hospitals Leuven, Leuven, Belgium
- Department of Neurology and Neurosurgery, State Institution “Dnipropetrovsk medical akademy MOH Ukraine”, Dnipro, Ukraine
- Department of Neurology, Ghent University Hospital, Ghent, Belgium
- Department of Neuroscience, Erasmus University Medical Centre, Rotterdam, The Netherlands
- Headache Medical Center Linz, Ordensklinikum Linz Barmherzige Schwestern, Linz, Austria
| |
Collapse
|
9
|
Mínguez-Olaondo A, Martínez-Valbuena I, Romero S, Frühbeck G, Luquin MR, Martínez-Vila E, Irimia P. Excess abdominal fat is associated with cutaneous allodynia in individuals with migraine: a prospective cohort study. J Headache Pain 2020; 21:9. [PMID: 32019484 PMCID: PMC7001192 DOI: 10.1186/s10194-020-1082-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 01/29/2020] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To investigate the specific relationship between cutaneous allodynia (CA) and the percentages of body fat (BF) and abdominal fat in migraineurs. Additionally, we compared serum levels of inflammatory biomarkers in patients with and without CA. BACKGROUND Excess abdominal fat might facilitate progressive changes in nociceptive thresholds causing central sensitization, clinically reflected as CA, which could drive migraine progression. METHODS This prospective cohort study included 80 patients with migraine (mean age 39 years, 81.2% female) and 39 non-migraine controls. We analysed each participant's height, body weight, and body mass index (BMI). The amount and distribution of BF was also assessed by air displacement plethysmography (ADP) and ViScan, respectively. We analysed serum levels of markers of inflammation, during interictal periods. RESULTS We studied 52 patients with episodic migraine (EM) and 28 with chronic migraine (CM). Of the 80 patients, 53 (53.8%) had CA. Migraineurs with CA had a higher proportion of abdominal fat values than patients without CA (p = 0.04). The independent risk factors for CA were the use of migraine prophylaxis (OR 3.26, 95% CI [1.14 to 9.32]; p = 0.03), proportion of abdominal fat (OR 1.13, 95% CI [1.01 to 1.27]; p = 0.04), and presence of sleep disorders (OR 1.13, 95% CI [00.01 to 1.27]; p = 0.04). The concordance correlation coefficient between the ADP and BMI measurements was 0.51 (0.3681 to 0.6247). CA was not correlated with the mean plasma levels of inflammatory biomarkers. CONCLUSIONS There is a relation between excess abdominal fat and CA. Abdominal obesity might contribute to the development of central sensitization in migraineurs, leading to migraine chronification.
Collapse
Affiliation(s)
- Ane Mínguez-Olaondo
- Department of Neurology, Clínica Universidad de Navarra, Pío XII 36, 31008, Pamplona, Spain.,Department of Neurology, Hospital Universitario Donostia, San Sebastián, Spain
| | - Iván Martínez-Valbuena
- Department of Neurology, Clínica Universidad de Navarra, Pío XII 36, 31008, Pamplona, Spain.,Regenerative Therapy Laboratory, Neurosciences Division, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain.,Navarra's Health Research Institute (IDISNA), Pamplona, Spain
| | - Sonia Romero
- Endocrinology and Nutrition Department, Clínica Universidad de Navarra, Pamplona, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - Gema Frühbeck
- Navarra's Health Research Institute (IDISNA), Pamplona, Spain.,Endocrinology and Nutrition Department, Clínica Universidad de Navarra, Pamplona, Spain.,CIBER Fisiopatología de la Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Madrid, Spain
| | - María Rosario Luquin
- Department of Neurology, Clínica Universidad de Navarra, Pío XII 36, 31008, Pamplona, Spain.,Regenerative Therapy Laboratory, Neurosciences Division, Center for Applied Medical Research (CIMA), University of Navarra, Pamplona, Spain.,Navarra's Health Research Institute (IDISNA), Pamplona, Spain
| | - Eduardo Martínez-Vila
- Department of Neurology, Clínica Universidad de Navarra, Pío XII 36, 31008, Pamplona, Spain.,Navarra's Health Research Institute (IDISNA), Pamplona, Spain
| | - Pablo Irimia
- Department of Neurology, Clínica Universidad de Navarra, Pío XII 36, 31008, Pamplona, Spain. .,Navarra's Health Research Institute (IDISNA), Pamplona, Spain.
| |
Collapse
|
10
|
Goulart AC, de Almeida-Pititto B, Lotufo PA, Santos IS, Ferreira SRG, Benseñor IM. Adiponectin and leptin levels in migraineurs: Results from the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). CEPHALALGIA REPORTS 2020. [DOI: 10.1177/2515816320966965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Relationships of adipokines (ADP) with migraine are not well-established. We examined the relationship of adiponectin and leptin with migraine by aura symptoms. Methods: In a baseline cross-sectional data of Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), associations of ADP levels and migraine were assessed in a sample of 257 nondiabetic subjects, free from cardiovascular disease. Associations of ADP tertiles (dependent variable) and migraine status were tested using logistic regression models. Categories of migraine were created as follows: no headache (reference), migraine with aura (MA), and migraine without aura (MO) in all sample and by sex. Odds ratio (OR) with respective 95% confidence interval (CI) adjusted for age, sex, body mass index, and metabolic syndrome. Results: Among participants (46 years ± SD: 4.8), 47.5% were women and 36.2% had migraine (16.7% MA). Median values of leptin (ng/mL) increased gradually across subgroup: no headache: 9.5 (interquartile range (IQR): 5.5–15.7) versus MO: 17.0 (IQR: 10.9–34.2) versus MA: 20.9 (IQR: 11.7–29.3), overall p value <0.0001, but not for adiponectin levels. After full adjustment, the third of leptin was positively associated with MA (OR 2.89 (1.00–8.4)) and the second of adiponectin was associated with MO (OR 2.76; 95% CI: 1.09–6.96, p = 0.03). Positive associations with MA, second (OR 3.81; 95% CI: 1.07–13.59; p = 0.04) and third tertile of leptin (6.54; 95% CI: 1.74–24.57, p = 0.005), were also observed in women, but not in men. Conclusions: Positive associations between ADP and migraine, particularly between MA and leptin levels in women, raise the possibility of adipocytokines and play a role in migraine pathophysiology.
Collapse
Affiliation(s)
- Alessandra C Goulart
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Paulo A Lotufo
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de Sao Paulo, Sao Paulo, Brazil
- School of Medicine, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Itamar S Santos
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de Sao Paulo, Sao Paulo, Brazil
- School of Medicine, Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | - Isabela M Benseñor
- Center for Clinical and Epidemiological Research, Hospital Universitário, Universidade de Sao Paulo, Sao Paulo, Brazil
- School of Medicine, Universidade de Sao Paulo, Sao Paulo, Brazil
| |
Collapse
|
11
|
Abbasi M, Noori-Zadeh A, Seidkhani-Nahal A, Kaffashian M, Bakhtiyari S, Panahi S. Leptin, adiponectin, and resistin blood adipokine levels in migraineurs: Systematic reviews and meta-analyses. Cephalalgia 2019; 39:1010-1021. [PMID: 30798617 DOI: 10.1177/0333102418807182] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Migraine comorbidity with obesity is not new and studies have focused on how adipose tissue-derived substances such as adipokines might be involved in the migraine pathophysiology. Quantification of the nature and magnitude of the association between each adipokine including leptin, adiponectin and resistin with migraine pathophysiology is the objective of the current study. METHODS Using systematic reviews and meta-analyses and standardized mean difference as effect size, the levels of three adipokines, leptin, adiponectin and resistin, have been investigated in migraineur subjects in the case-control studies. RESULTS Using random-effects models, the final analyses demonstrated the standardized mean differences of leptin, adiponectin and resistin as 0.534 (95% confidence interval, 0.169-0.898), 0.439 (95% confidence interval, 0.132-0.746) and 0.194 (95% confidence interval, -0.158-0.546), respectively. The p-value for test of significance for each pooled standardized mean difference was examined by the z-test and calculated as 0.004, 0.005 and 0.281 for leptin, adiponectin and resistin (clearly considered as statistically significant, significant and non-significant), respectively. CONCLUSION Based on the findings, the blood levels of leptin and adiponectin, but not resistin, of the migraineurs are associated with disease pathogenesis.
Collapse
Affiliation(s)
- Milad Abbasi
- 1 Department of Clinical Biochemistry, Faculty of Allied Medical Sciences, Ilam University of Medical Sciences, Ilam, Iran
| | - Ali Noori-Zadeh
- 1 Department of Clinical Biochemistry, Faculty of Allied Medical Sciences, Ilam University of Medical Sciences, Ilam, Iran
| | - Ali Seidkhani-Nahal
- 2 Department of Clinical Biochemistry, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Mohammadreza Kaffashian
- 3 Department of Physiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Salar Bakhtiyari
- 2 Department of Clinical Biochemistry, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
| | - Sajjad Panahi
- 1 Department of Clinical Biochemistry, Faculty of Allied Medical Sciences, Ilam University of Medical Sciences, Ilam, Iran
| |
Collapse
|
12
|
Miri A, Nasiri M, Zonoori S, Yarahmad F, Dabbagh-Moghadam A, Askari G, Sadeghi O, Asadi M. The association between obesity and migraine in a population of Iranian adults: a case-control study. Diabetes Metab Syndr 2018; 12:733-736. [PMID: 29706311 DOI: 10.1016/j.dsx.2018.04.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 04/09/2018] [Indexed: 12/21/2022]
Abstract
AIM To assess the association between obesity and risk of migraine with aura and features of migraine attacks among a population of Iranian adults. METHODS In this case-control study, 102 confirmed cases of migraine with aura were matched based on age and gender with 102 healthy subjects. Data on demographic characteristics and anthropometric measurements were collected from all cases and controls by the same methods. Overweight and obesity were considered as body mass index ≥25-30 kg/m2 and ≥ 30 kg/m2, respectively. Features of migraine attacks including frequency, duration and headache daily result were determined for patients based on international headache society criteria. RESULTS Mean age of subjects was 34.5 ± 7.4 years and 77.9% of them were female. Compared with subjects with normal body mass index, those with obesity had greater odds for having migraine with aura (OR: 3.06, 95% CI: 1.11-8.43). Such finding was also seen even after adjusting for confounding variables; in a way that subjects with obesity were 2.92 times more likely for having migraine with aura compared with those with normal weight (OR: 2.92, 95% CI: 1.03-8.33). Among migraine with aura patients, we found that those with obesity had higher headache daily result compared with subjects with normal weight. However, obesity was not associated with frequency and duration of migraine attacks. CONCLUSIONS We found that obesity was positively associated with risk of migraine with aura. In addition, subjects with obesity had higher headache daily result compared with those with normal weight.
Collapse
Affiliation(s)
- Ali Miri
- Department of Nutrition, School of Health, Zabol University of Medical Sciences, Zabol, Iran
| | - Morteza Nasiri
- Department of Operation Room Technology, School of Paramedicine, Qom University of Medical Sciences, Qom, Iran
| | - Sahar Zonoori
- Department of Nursing, Brojerd School of Nursing, Lorestan University of Medical Sciences, Lorestan, Iran
| | - Fatemeh Yarahmad
- Department of Nursing, Brojerd School of Nursing, Lorestan University of Medical Sciences, Lorestan, Iran
| | - Arasb Dabbagh-Moghadam
- Department of Health, School of Health, AJA University of Medical Sciences, Tehran, Iran
| | - Gholamreza Askari
- Food Security Research Center and Department of Community Nutrition, School of Nutrition and Food Sciences, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Omid Sadeghi
- Department of Community Nutrition, School of Nutritional Sciences and Dietetics, Tehran University of Medical Sciences, Tehran, Iran.
| | - Masoumeh Asadi
- Department of Nursing and Midwifery, Abadan School of Medical Sciences, Abadan, Iran
| |
Collapse
|
13
|
Abstract
PURPOSE OF REVIEW Migraine is a common and highly disabling condition that is particularly prevalent among women and especially women of reproductive age. The tremendous rise in adiposity in the Western world has led to an epidemic of obesity in women. The particular effects of obesity on women with migraine of various ages are the focus of this review. RECENT FINDINGS Conflicting findings from various studies with different approaches and populations have made challenging definitive conclusions about associations between migraine and obesity. While the association between obesity and migraine frequency has been consistently demonstrated and obesity is considered a risk factor for progression from episodic to chronic migraine, the association between obesity and migraine prevalence is still somewhat debated and appears to be dependent on gender and age, with the most consistent effects observed in women younger than 55 years of age. Association between migraine and obesity is most commonly observed in women of reproductive age. The multimodal changes associated with age and hormonal change in women likely play a role in this relationship, as obesity does not appear to be related to migraine in women over 55 years of age. Future studies focusing on the migraine-obesity relationship in women should examine the effects of age, endogenous hormonal state, and exogenous hormones on migraine and obesity.
Collapse
Affiliation(s)
- Jelena M Pavlovic
- Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Van Etten 3C9B, Bronx, NY, 10461, USA.
- Montefiore Headache Center, Bronx, NY, USA.
| | - Julio R Vieira
- Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Van Etten 3C9B, Bronx, NY, 10461, USA
- Health Quest Neurology, Kingston, NY, USA
| | - Richard B Lipton
- Department of Neurology, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Van Etten 3C9B, Bronx, NY, 10461, USA
- Montefiore Headache Center, Bronx, NY, USA
| | - Dale S Bond
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, The Miriam Hospital/Weight Control and Diabetes Research Center, Providence, RI, USA
| |
Collapse
|
14
|
Gelaye B, Sacco S, Brown WJ, Nitchie HL, Ornello R, Peterlin BL. Body composition status and the risk of migraine: A meta-analysis. Neurology 2017; 88:1795-1804. [PMID: 28404807 DOI: 10.1212/wnl.0000000000003919] [Citation(s) in RCA: 70] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 02/14/2017] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To evaluate the association between migraine and body composition status as estimated based on body mass index and WHO physical status categories. METHODS Systematic electronic database searches were conducted for relevant studies. Two independent reviewers performed data extraction and quality appraisal. Odds ratios (OR) and confidence intervals (CI) were pooled using a random effects model. Significant values, weighted effect sizes, and tests of homogeneity of variance were calculated. RESULTS A total of 12 studies, encompassing data from 288,981 unique participants, were included. The age- and sex-adjusted pooled risk of migraine in those with obesity was increased by 27% compared with those of normal weight (odds ratio [OR] 1.27; 95% confidence interval [CI] 1.16-1.37, p < 0.001) and remained increased after multivariate adjustments. Although the age- and sex-adjusted pooled migraine risk was increased in overweight individuals (OR 1.08; 95% CI 1.04, 1.12, p < 0.001), significance was lost after multivariate adjustments. The age- and sex-adjusted pooled risk of migraine in underweight individuals was marginally increased by 13% compared with those of normal weight (OR 1.13; 95% CI 1.02, 1.24, p < 0.001) and remained increased after multivariate adjustments. CONCLUSIONS The current body of evidence shows that the risk of migraine is increased in obese and underweight individuals. Studies are needed to confirm whether interventions that modify obesity status decrease the risk of migraine.
Collapse
Affiliation(s)
- Bizu Gelaye
- From the Harvard T.H. Chan School of Public Health (B.G.), Department of Epidemiology, Boston, MA; Department of Neurology (S.S., R.O.), University of L'Aquila, Italy; School of Human Movement and Nutrition Sciences (W.J.B.), University of Queensland, Brisbane, Australia; and Department of Neurology (H.L.N., B.L.P.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Simona Sacco
- From the Harvard T.H. Chan School of Public Health (B.G.), Department of Epidemiology, Boston, MA; Department of Neurology (S.S., R.O.), University of L'Aquila, Italy; School of Human Movement and Nutrition Sciences (W.J.B.), University of Queensland, Brisbane, Australia; and Department of Neurology (H.L.N., B.L.P.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Wendy J Brown
- From the Harvard T.H. Chan School of Public Health (B.G.), Department of Epidemiology, Boston, MA; Department of Neurology (S.S., R.O.), University of L'Aquila, Italy; School of Human Movement and Nutrition Sciences (W.J.B.), University of Queensland, Brisbane, Australia; and Department of Neurology (H.L.N., B.L.P.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Haley L Nitchie
- From the Harvard T.H. Chan School of Public Health (B.G.), Department of Epidemiology, Boston, MA; Department of Neurology (S.S., R.O.), University of L'Aquila, Italy; School of Human Movement and Nutrition Sciences (W.J.B.), University of Queensland, Brisbane, Australia; and Department of Neurology (H.L.N., B.L.P.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - Raffaele Ornello
- From the Harvard T.H. Chan School of Public Health (B.G.), Department of Epidemiology, Boston, MA; Department of Neurology (S.S., R.O.), University of L'Aquila, Italy; School of Human Movement and Nutrition Sciences (W.J.B.), University of Queensland, Brisbane, Australia; and Department of Neurology (H.L.N., B.L.P.), Johns Hopkins University School of Medicine, Baltimore, MD
| | - B Lee Peterlin
- From the Harvard T.H. Chan School of Public Health (B.G.), Department of Epidemiology, Boston, MA; Department of Neurology (S.S., R.O.), University of L'Aquila, Italy; School of Human Movement and Nutrition Sciences (W.J.B.), University of Queensland, Brisbane, Australia; and Department of Neurology (H.L.N., B.L.P.), Johns Hopkins University School of Medicine, Baltimore, MD.
| |
Collapse
|
15
|
Berger A, Findler M, Korach T, Yativ OF, Gronovich Y, Hassidim A. Is Male Migraine Associated With Color Vision Deficiency? Findings Among Israeli Adolescents Between 2007 and 2013. J Child Neurol 2016; 31:593-6. [PMID: 26385974 DOI: 10.1177/0883073815604226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Accepted: 08/03/2015] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Accumulating clinical and experimental evidence has shown that migraine patients tend to suffer from color vision abnormalities. The aim of this study was to examine whether color vision deficiency is associated with male migraine in a large population of adolescents. METHODS The study population included all Israeli male adolescents who underwent medical and cognitive examinations as part of their recruiting process between the years 2007 and 2013. Migraine prevalence among patients with color vision deficiency was compared to that of males without substantial color vision abnormalities. RESULTS The study population included 305 964 male adolescents at the age of 17 ± 0.6, of whom 7584 (2.5%) had color vision deficiency, as determined by the Farnsworth Panel D-15 color blindness test. Males with color vision deficiency had a 32% increased prevalence of migraine as compared with the control group (odds ratio 1.32, 95% confidence interval 1.18-1.48, P < .001), after adjusting for multiple variables. CONCLUSIONS The authors found an association between color vision deficiency and migraine in male adolescents. The study results lay the basis for further research into male migraine, as well as the visual aspects of migraine.
Collapse
Affiliation(s)
- Assaf Berger
- Israel Defense Forces Medical Corps, Tel Aviv, Israel Neurosurgery Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Michael Findler
- Israel Defense Forces Medical Corps, Tel Aviv, Israel Neurology Department, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | | | - Yoav Gronovich
- Plastic Surgery Department, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Ayal Hassidim
- Israel Defense Forces Medical Corps, Tel Aviv, Israel
| |
Collapse
|
16
|
Tiseo C, Degan D, Ornello R, Gabriele A, Pistoia F, Carolei A, Sacco S. O050. Chronic daily headache and body mass index: a meta-analysis of observational studies. J Headache Pain 2015; 16:A64. [PMID: 28132324 PMCID: PMC4715189 DOI: 10.1186/1129-2377-16-s1-a64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
17
|
Ornello R, Ripa P, Pistoia F, Degan D, Tiseo C, Carolei A, Sacco S. Migraine and body mass index categories: a systematic review and meta-analysis of observational studies. J Headache Pain 2015; 16:27. [PMID: 25903159 PMCID: PMC4385329 DOI: 10.1186/s10194-015-0510-z] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 03/03/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Several studies have assessed the associations between migraine and underweight, pre-obesity or obesity, with conflicting results. To assess the consistency of the data on the topic, we performed a systematic review and meta-analysis of the available observational studies. METHODS Multiple electronic databases were systematically searched up to October 2014 for studies assessing the association between migraine and body mass index categories (underweight, pre-obesity, or obesity). RESULTS Out of 2,022 records, we included 15 studies. When considering the 11 studies following the World Health Organization BMI cutoffs, we found an increased risk of having migraine in underweight subjects (pooled adjusted effect estimate [PAEE] 1.21; 95% CI, 1.07-1.37; P = 0.002) and in obese women (PAEE 1.44; 95% CI, 1.05-1.97; P = 0.023) as compared with normal weight subjects; additionally, pre-obese subjects had an increased risk of having chronic migraine (PAEE 1.39; 95% CI, 1.13-1.71; P = 0.002). When considering all the 15 studies, we additionally found an increased risk of having migraine in obese as compared with normal weight subjects (PAEE 1.14; 95% CI, 1.02-1.27; P = 0.017); additionally, obese subjects had an increased risk of having chronic migraine (PAEE 1.75; 95% CI, 1.33-2.29; P < 0.001). The pooled analysis did not indicate an increased risk of having migraine in pre-obese subjects. CONCLUSIONS The meta-analysis of the available observational studies suggested an association between migraine and obesity likely mediated by gender and migraine frequency. Further studies taking into account gender, migraine type, frequency, activity, and duration could provide more robust evidence.
Collapse
Affiliation(s)
- Raffaele Ornello
- Department of Applied Clinical Sciences and Biotechnology, Institute of Neurology, University of L'Aquila, 67100, L'Aquila, Italy.
| | - Patrizia Ripa
- Department of Applied Clinical Sciences and Biotechnology, Institute of Neurology, University of L'Aquila, 67100, L'Aquila, Italy.
| | - Francesca Pistoia
- Department of Applied Clinical Sciences and Biotechnology, Institute of Neurology, University of L'Aquila, 67100, L'Aquila, Italy.
| | - Diana Degan
- Department of Applied Clinical Sciences and Biotechnology, Institute of Neurology, University of L'Aquila, 67100, L'Aquila, Italy.
| | - Cindy Tiseo
- Department of Applied Clinical Sciences and Biotechnology, Institute of Neurology, University of L'Aquila, 67100, L'Aquila, Italy.
| | - Antonio Carolei
- Department of Applied Clinical Sciences and Biotechnology, Institute of Neurology, University of L'Aquila, 67100, L'Aquila, Italy.
| | - Simona Sacco
- Department of Applied Clinical Sciences and Biotechnology, Institute of Neurology, University of L'Aquila, 67100, L'Aquila, Italy.
| |
Collapse
|