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Nathan N, Ngo A, Khoromi S. Migraine and Stroke: A Scoping Review. J Clin Med 2024; 13:5380. [PMID: 39336867 PMCID: PMC11432473 DOI: 10.3390/jcm13185380] [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: 07/31/2024] [Revised: 09/09/2024] [Accepted: 09/09/2024] [Indexed: 09/30/2024] Open
Abstract
An increased risk of ischemic stroke in migraine with aura (MA) has been consistently demonstrated. The pathophysiology of risk factors is not yet well understood. Several mechanisms have been proposed to explain the association between MA and ischemic stroke including decreased focal cerebral blood flow and other phenomena linked with cortical spreading depression (CSD) as well as neurovascular pathology, which appear to play a key role in MA. In addition to genetic predisposition, other classic stroke risk factors such as atrial fibrillation, emboli, migraine-associated vasculopathy, endothelial dysfunction, platelet dysfunction, coagulation pathway abnormalities, and inflammatory factors have been examined and investigated. For further clarification, distinctions have been made between features of migrainous infarctions and non-migrainous infarctions among migraineurs. Furthermore, the association is less clear when considering the mixed results studying the risk of ischemic stroke in migraines without aura (MO) and the risk of hemorrhagic stroke in people with all types of migraine. Translational research is investigating the role of biomarkers which can help identify vascular links between stroke and migraine and lead to further treatment developments. We performed a scoping review of the PubMed database to further characterize and update the clinical connections between migraine and stroke.
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Affiliation(s)
| | | | - Suzan Khoromi
- Department of Neurosciences, University of California-San Diego, 200 W Arbor Drive, San Diego, CA 92103, USA; (N.N.)
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Ravi V, Osouli Meinagh S, Bavarsad Shahripour R. Reviewing migraine-associated pathophysiology and its impact on elevated stroke risk. Front Neurol 2024; 15:1435208. [PMID: 39148704 PMCID: PMC11324503 DOI: 10.3389/fneur.2024.1435208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2024] [Accepted: 07/03/2024] [Indexed: 08/17/2024] Open
Abstract
Migraine affects up to 20 percent of the global population and ranks as the second leading cause of disability worldwide. In parallel, ischemic stroke stands as the second leading cause of mortality and the third leading cause of disability worldwide. This review aims to elucidate the intricate relationship between migraine and stroke, highlighting the role of genetic, vascular, and hormonal factors. Epidemiological evidence shows a positive association between migraine, particularly with aura, and ischemic stroke (IS), though the link to hemorrhagic stroke (HS) remains inconclusive. The shared pathophysiology between migraine and stroke includes cortical spreading depression, endothelial dysfunction, and genetic predispositions, such as mutations linked to conditions like CADASIL and MELAS. Genetic studies indicate that common loci may predispose individuals to both migraine and stroke, while biomarkers such as endothelial microparticles and inflammatory cytokines offer insights into the underlying mechanisms. Additionally, hormonal influences, particularly fluctuations in estrogen levels, significantly impact migraine pathogenesis and stroke risk, highlighting the need for tailored interventions for women. The presence of a patent foramen ovale (PFO) in migraineurs further complicates their risk profile, with device closure showing promise in reducing stroke occurrence. Furthermore, white matter lesions (WMLs) are frequently observed in migraine patients, suggesting potential cognitive and stroke risks. This review hopes to summarize the links between migraine and its associated conditions and ischemic stroke, recognizing the profound implications for clinical management strategies for both disorders. Understanding the complex relationship between migraine and ischemic stroke holds the key to navigating treatment options and preventive interventions to enhance overall patient outcomes.
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Affiliation(s)
- Vikas Ravi
- Department of Neurosciences, University of California, San Diego, San Diego, CA, United States
| | - Sima Osouli Meinagh
- Department of Neurology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Yuan L, Chen X, Jankovic J, Deng H. CADASIL: A NOTCH3-associated cerebral small vessel disease. J Adv Res 2024:S2090-1232(24)00001-8. [PMID: 38176524 DOI: 10.1016/j.jare.2024.01.001] [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: 10/18/2023] [Revised: 12/16/2023] [Accepted: 01/01/2024] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is the most common hereditary cerebral small vessel disease (CSVD), pathologically characterized by a non-atherosclerotic and non-amyloid diffuse angiopathy primarily involving small to medium-sized penetrating arteries and leptomeningeal arteries. In 1996, mutation in the notch receptor 3 gene (NOTCH3) was identified as the cause of CADASIL. However, since that time other genetic CSVDs have been described, including the HtrA serine peptidase 1 gene-associated CSVD and the cathepsin A gene-associated CSVD, that clinically mimic the original phenotype. Though NOTCH3-associated CSVD is now a well-recognized hereditary disorder and the number of studies investigating this disease is increasing, the role of NOTCH3 in the pathogenesis of CADASIL remains elusive. AIM OF REVIEW This review aims to provide insights into the pathogenesis and the diagnosis of hereditary CSVDs, as well as personalized therapy, predictive approach, and targeted prevention. In this review, we summarize the current progress in CADASIL, including the clinical, neuroimaging, pathological, genetic, diagnostic, and therapeutic aspects, as well as differential diagnosis, in which the role of NOTCH3 mutations is highlighted. KEY SCIENTIFIC CONCEPTS OF REVIEW In this review, CADASIL is revisited as a NOTCH3-associated CSVD along with other hereditary CSVDs.
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Affiliation(s)
- Lamei Yuan
- Health Management Center, the Third Xiangya Hospital, Central South University, Changsha, China; Center for Experimental Medicine, the Third Xiangya Hospital, Central South University, Changsha, China; Disease Genome Research Center, Central South University, Changsha, China; Department of Neurology, the Third Xiangya Hospital, Central South University, Changsha, China
| | - Xiangyu Chen
- Center for Experimental Medicine, the Third Xiangya Hospital, Central South University, Changsha, China; Disease Genome Research Center, Central South University, Changsha, China; Department of Pathology, Changsha Maternal and Child Health Care Hospital, Changsha, China
| | - Joseph Jankovic
- Parkinson's Disease Center and Movement Disorders Clinic, Department of Neurology, Baylor College of Medicine, Houston, TX, USA
| | - Hao Deng
- Health Management Center, the Third Xiangya Hospital, Central South University, Changsha, China; Center for Experimental Medicine, the Third Xiangya Hospital, Central South University, Changsha, China; Disease Genome Research Center, Central South University, Changsha, China; Department of Neurology, the Third Xiangya Hospital, Central South University, Changsha, China.
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4
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Brunelli N, Altamura C, Mallio CA, Lo Vullo G, Marcosano M, Bach-Pages M, Beomonte Zobel B, Quattrocchi CC, Vernieri F. Cerebral Hemodynamics, Right-to-Left Shunt and White Matter Hyperintensities in Patients with Migraine with Aura, Young Stroke Patients and Controls. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148575. [PMID: 35886428 PMCID: PMC9318654 DOI: 10.3390/ijerph19148575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/05/2022] [Accepted: 07/09/2022] [Indexed: 12/10/2022]
Abstract
Background: Migraine with aura (MA) patients present an increased risk of cerebrovascular events. However, whether these patients present an increased white matter hyperintensities (WMHs) load compared to the general population is still under debate. Our study aimed to evaluate the relationship between cerebral hemodynamics, right-to-left shunt (RLS) and WMHs in MA patients, young patients with cryptogenic stroke or motor transient ischemic attack (TIA) and controls. Methods: We enrolled 30 MA patients, 20 young (<60 years) patients with cryptogenic stroke/motor TIA, and 10 controls. All the subjects underwent a transcranial Doppler bubble test to detect RLS and cerebral hemodynamics assessed by the breath holding index (BHI) for the middle (MCA) and posterior (PCA) cerebral arteries. Vascular risk factors were collected. The WMHs load on FLAIR MRI sequences was quantitatively assessed. Results: The stroke/TIA patients presented a higher prevalence of RLS (100%) compared with the other groups (p < 0.001). The MA patients presented a higher BHI compared with the other groups in the PCA (p = 0.010) and higher RLS prevalence (60%) than controls (30%) (p < 0.001). The WMHs load did not differ across groups. BHI and RLS were not correlated to the WMHs load in the groups. Conclusions: A preserved or more reactive cerebral hemodynamics and the presence of a RLS are likely not involved in the genesis of WMHs in MA patients. A higher BHI may counteract the risk related to their higher prevalence of RLS. These results need to be confirmed by further studies to be able to effectively identify the protective role of cerebral hemodynamics in the increased RLS frequency in MA patients.
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Affiliation(s)
- Nicoletta Brunelli
- Headache and Neurosonology Unit, Neurology Unit, Campus Bio-Medico University Hospital Foundation, 00128 Rome, Italy; (C.A.); (M.M.); (F.V.)
- Correspondence:
| | - Claudia Altamura
- Headache and Neurosonology Unit, Neurology Unit, Campus Bio-Medico University Hospital Foundation, 00128 Rome, Italy; (C.A.); (M.M.); (F.V.)
| | - Carlo A. Mallio
- Radiology Unit, Campus Bio-Medico University Hospital Foundation, 00128 Rome, Italy; (C.A.M.); (G.L.V.); (B.B.Z.); (C.C.Q.)
| | - Gianguido Lo Vullo
- Radiology Unit, Campus Bio-Medico University Hospital Foundation, 00128 Rome, Italy; (C.A.M.); (G.L.V.); (B.B.Z.); (C.C.Q.)
| | - Marilena Marcosano
- Headache and Neurosonology Unit, Neurology Unit, Campus Bio-Medico University Hospital Foundation, 00128 Rome, Italy; (C.A.); (M.M.); (F.V.)
| | - Marcel Bach-Pages
- Department of Plant Sciences, University of Oxford, Oxford OX1 3RB, UK;
- FENIX Group International, LLC, Reading, PA 19601, USA
| | - Bruno Beomonte Zobel
- Radiology Unit, Campus Bio-Medico University Hospital Foundation, 00128 Rome, Italy; (C.A.M.); (G.L.V.); (B.B.Z.); (C.C.Q.)
| | - Carlo Cosimo Quattrocchi
- Radiology Unit, Campus Bio-Medico University Hospital Foundation, 00128 Rome, Italy; (C.A.M.); (G.L.V.); (B.B.Z.); (C.C.Q.)
| | - Fabrizio Vernieri
- Headache and Neurosonology Unit, Neurology Unit, Campus Bio-Medico University Hospital Foundation, 00128 Rome, Italy; (C.A.); (M.M.); (F.V.)
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Daghals I, Sargurupremraj M, Danning R, Gormley P, Malik R, Amouyel P, Metso T, Pezzini A, Kurth T, Debette S, Chasman D. Migraine, Stroke, and Cervical Arterial Dissection: Shared Genetics for a Triad of Brain Disorders With Vascular Involvement. Neurol Genet 2022; 8:e653. [PMID: 35128049 PMCID: PMC8808356 DOI: 10.1212/nxg.0000000000000653] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 12/07/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Migraine, stroke, and cervical artery dissection (CeAD) represent a triad of cerebrovascular disorders with pairwise comorbid relationships and vascular involvement. Larger samples and recent advances in methodology invite systematic exploration of their shared genetics. METHODS Genetic analyses leveraged summary statistics from genome-wide association studies of the largest available samples of each disorder, including subtypes of stroke (ischemic stroke, large artery stroke, small vessel stroke, and cardioembolic stroke) and migraine (with aura and without aura). For each pair of disorders, genetic correlation was assessed both on a genome-wide basis and within independent segments across the genome including known specific loci for each disorder. A cross-trait meta-analysis was used to identify novel candidate loci. Finally, potential causality of migraine susceptibility on stroke and CeAD was assessed by Mendelian randomization. RESULTS Among all pairs of disorders, genome-wide genetic correlation was observed only between CeAD and migraine, particularly MO. Local genetic correlations were more extensive between migraine and CeAD than those between migraine and stroke or CeAD and stroke and revealed evidence for novel CeAD associations at rs6693567 (ADAMTSL4/ECM1), rs11187838 (PLCE1), and rs7940646 (MRVI1) while strengthening prior subthreshold evidence at rs9486725 (FHL5) and rs650724 (LRP1). At known migraine loci, novel associations with stroke had concordant risk alleles for small vessel stroke at rs191602009 (CARF) and for cardioembolic stroke at rs55884259 (NKX2-5). Known migraine loci also revealed novel associations but with opposite risk alleles for all stroke, ischemic stroke, and small vessel stroke at rs55928386 (HTRA1), for large artery stroke at rs11172113 (LRP1), and for all stroke and ischemic stroke at rs1535791 and rs4942561 (both LRCH1), respectively. rs182923402 (near PTCH1) was a novel concordant locus for migraine and cardioembolic stroke. Mendelian randomization supported potential causal influences of migraine on CeAD (odds ratio [95% confidence interval] per doubling migraine prevalence = 1.69 [1.24-2.3], p = 0.0009) with concordant risk, but with opposite risk on large artery stroke (0.86 [0.76-0.96], p = 0.0067). DISCUSSION The findings emphasize shared genetic risk between migraine and CeAD while identifying loci with likely vascular function in migraine and shared but opposite genetic risk between migraine and stroke subtypes, and a central role of LRP1 in all 3 cerebrovascular disorders.
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Affiliation(s)
| | | | - Rebecca Danning
- From the Harvard Medical School (I.D., D.C.), Boston, MA; Division of Preventive Medicine (I.D., R.D., D.C.), Brigham and Women's Hospital, Boston, MA; University of Bordeaux (M.S., S.D.), Inserm, Bordeaux Population Health Research Center, Team VINTAGE, UMR 1219, France; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (M.S.), University of Texas Health, San Antonio; Massachusetts General Hospital (P.G.), Boston; Institute for Stroke and Dementia Research (R.M.), Klinikum der Universität München, Ludwig-Maximilians-University, Germany; LabEx DISTALZ-U1167 (P.A.), RID-AGE-Risk Factors and Molecular Determinants of Aging-Related Diseases, University of Lille; Inserm U1167 (P.A.), Lille; Centre Hospitalier Universitaire Lille (P.A.); Institut Pasteur de Lille (P.A.), France; Department of Neurology (T.M.), Helsinki University Central Hospital, Finland; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, Brescia University Hospital, Italy; Institute of Public Health (T.K.), Charité—Universitätsmedizin Berlin, Germany; and Department of Neurology (S.D.), CHU de Bordeaux, France
| | - Padhraig Gormley
- From the Harvard Medical School (I.D., D.C.), Boston, MA; Division of Preventive Medicine (I.D., R.D., D.C.), Brigham and Women's Hospital, Boston, MA; University of Bordeaux (M.S., S.D.), Inserm, Bordeaux Population Health Research Center, Team VINTAGE, UMR 1219, France; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (M.S.), University of Texas Health, San Antonio; Massachusetts General Hospital (P.G.), Boston; Institute for Stroke and Dementia Research (R.M.), Klinikum der Universität München, Ludwig-Maximilians-University, Germany; LabEx DISTALZ-U1167 (P.A.), RID-AGE-Risk Factors and Molecular Determinants of Aging-Related Diseases, University of Lille; Inserm U1167 (P.A.), Lille; Centre Hospitalier Universitaire Lille (P.A.); Institut Pasteur de Lille (P.A.), France; Department of Neurology (T.M.), Helsinki University Central Hospital, Finland; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, Brescia University Hospital, Italy; Institute of Public Health (T.K.), Charité—Universitätsmedizin Berlin, Germany; and Department of Neurology (S.D.), CHU de Bordeaux, France
| | - Rainer Malik
- From the Harvard Medical School (I.D., D.C.), Boston, MA; Division of Preventive Medicine (I.D., R.D., D.C.), Brigham and Women's Hospital, Boston, MA; University of Bordeaux (M.S., S.D.), Inserm, Bordeaux Population Health Research Center, Team VINTAGE, UMR 1219, France; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (M.S.), University of Texas Health, San Antonio; Massachusetts General Hospital (P.G.), Boston; Institute for Stroke and Dementia Research (R.M.), Klinikum der Universität München, Ludwig-Maximilians-University, Germany; LabEx DISTALZ-U1167 (P.A.), RID-AGE-Risk Factors and Molecular Determinants of Aging-Related Diseases, University of Lille; Inserm U1167 (P.A.), Lille; Centre Hospitalier Universitaire Lille (P.A.); Institut Pasteur de Lille (P.A.), France; Department of Neurology (T.M.), Helsinki University Central Hospital, Finland; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, Brescia University Hospital, Italy; Institute of Public Health (T.K.), Charité—Universitätsmedizin Berlin, Germany; and Department of Neurology (S.D.), CHU de Bordeaux, France
| | - Philippe Amouyel
- From the Harvard Medical School (I.D., D.C.), Boston, MA; Division of Preventive Medicine (I.D., R.D., D.C.), Brigham and Women's Hospital, Boston, MA; University of Bordeaux (M.S., S.D.), Inserm, Bordeaux Population Health Research Center, Team VINTAGE, UMR 1219, France; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (M.S.), University of Texas Health, San Antonio; Massachusetts General Hospital (P.G.), Boston; Institute for Stroke and Dementia Research (R.M.), Klinikum der Universität München, Ludwig-Maximilians-University, Germany; LabEx DISTALZ-U1167 (P.A.), RID-AGE-Risk Factors and Molecular Determinants of Aging-Related Diseases, University of Lille; Inserm U1167 (P.A.), Lille; Centre Hospitalier Universitaire Lille (P.A.); Institut Pasteur de Lille (P.A.), France; Department of Neurology (T.M.), Helsinki University Central Hospital, Finland; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, Brescia University Hospital, Italy; Institute of Public Health (T.K.), Charité—Universitätsmedizin Berlin, Germany; and Department of Neurology (S.D.), CHU de Bordeaux, France
| | - Tiina Metso
- From the Harvard Medical School (I.D., D.C.), Boston, MA; Division of Preventive Medicine (I.D., R.D., D.C.), Brigham and Women's Hospital, Boston, MA; University of Bordeaux (M.S., S.D.), Inserm, Bordeaux Population Health Research Center, Team VINTAGE, UMR 1219, France; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (M.S.), University of Texas Health, San Antonio; Massachusetts General Hospital (P.G.), Boston; Institute for Stroke and Dementia Research (R.M.), Klinikum der Universität München, Ludwig-Maximilians-University, Germany; LabEx DISTALZ-U1167 (P.A.), RID-AGE-Risk Factors and Molecular Determinants of Aging-Related Diseases, University of Lille; Inserm U1167 (P.A.), Lille; Centre Hospitalier Universitaire Lille (P.A.); Institut Pasteur de Lille (P.A.), France; Department of Neurology (T.M.), Helsinki University Central Hospital, Finland; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, Brescia University Hospital, Italy; Institute of Public Health (T.K.), Charité—Universitätsmedizin Berlin, Germany; and Department of Neurology (S.D.), CHU de Bordeaux, France
| | - Alessandro Pezzini
- From the Harvard Medical School (I.D., D.C.), Boston, MA; Division of Preventive Medicine (I.D., R.D., D.C.), Brigham and Women's Hospital, Boston, MA; University of Bordeaux (M.S., S.D.), Inserm, Bordeaux Population Health Research Center, Team VINTAGE, UMR 1219, France; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (M.S.), University of Texas Health, San Antonio; Massachusetts General Hospital (P.G.), Boston; Institute for Stroke and Dementia Research (R.M.), Klinikum der Universität München, Ludwig-Maximilians-University, Germany; LabEx DISTALZ-U1167 (P.A.), RID-AGE-Risk Factors and Molecular Determinants of Aging-Related Diseases, University of Lille; Inserm U1167 (P.A.), Lille; Centre Hospitalier Universitaire Lille (P.A.); Institut Pasteur de Lille (P.A.), France; Department of Neurology (T.M.), Helsinki University Central Hospital, Finland; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, Brescia University Hospital, Italy; Institute of Public Health (T.K.), Charité—Universitätsmedizin Berlin, Germany; and Department of Neurology (S.D.), CHU de Bordeaux, France
| | - Tobias Kurth
- From the Harvard Medical School (I.D., D.C.), Boston, MA; Division of Preventive Medicine (I.D., R.D., D.C.), Brigham and Women's Hospital, Boston, MA; University of Bordeaux (M.S., S.D.), Inserm, Bordeaux Population Health Research Center, Team VINTAGE, UMR 1219, France; Glenn Biggs Institute for Alzheimer's and Neurodegenerative Diseases (M.S.), University of Texas Health, San Antonio; Massachusetts General Hospital (P.G.), Boston; Institute for Stroke and Dementia Research (R.M.), Klinikum der Universität München, Ludwig-Maximilians-University, Germany; LabEx DISTALZ-U1167 (P.A.), RID-AGE-Risk Factors and Molecular Determinants of Aging-Related Diseases, University of Lille; Inserm U1167 (P.A.), Lille; Centre Hospitalier Universitaire Lille (P.A.); Institut Pasteur de Lille (P.A.), France; Department of Neurology (T.M.), Helsinki University Central Hospital, Finland; Department of Clinical and Experimental Sciences (A.P.), Neurology Clinic, Brescia University Hospital, Italy; Institute of Public Health (T.K.), Charité—Universitätsmedizin Berlin, Germany; and Department of Neurology (S.D.), CHU de Bordeaux, France
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Myocardial infarction, stroke and cardiovascular mortality among migraine patients: a systematic review and meta-analysis. J Neurol 2022; 269:2346-2358. [PMID: 34997286 DOI: 10.1007/s00415-021-10930-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND An increasing number of studies have shown an association between migraine and cardiovascular disease, in particular cardio- and cerebro-vascular events. METHODS Three electronic databases (PubMed, Embase and Scopus) were searched from inception to May 22, 2021 for prospective cohort studies evaluating the risk of myocardial infarction, stroke and cardiovascular mortality in migraine patients. A random effects meta-analysis model was used to summarize the included studies. RESULTS A total of 18 prospective cohort studies were included consisting of 370,050 migraine patients and 1,387,539 controls. Migraine was associated with myocardial infarction (hazard ratio, 1.36; 95% CI, 1.23-1.51; p = < 0.001), unspecified stroke (hazard ratio, 1.30; 95% CI, 1.07-1.60; p = 0.01), ischemic stroke (hazard ratio, 1.35; 95% CI, 1.03-1.78; p = 0.03) and hemorrhagic stroke (hazard ratio, 1.43; 95% CI, 1.07-1.92; p = 0.02). Subgroup analysis of migraine with aura found a further increase in risk of myocardial infarction and both ischemic and hemorrhagic stroke, as well as improved substantial statistical heterogeneity. Migraine with aura was also associated with an increased risk of cardiovascular mortality (hazard ratio, 1.27; 95% CI, 1.14-1.42; p = < 0.001). CONCLUSION Migraine, especially migraine with aura, is associated with myocardial infarction and stroke. Migraine with aura increases the risk of overall cardiovascular mortality.
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7
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Altamura C, Corbelli I, de Tommaso M, Di Lorenzo C, Di Lorenzo G, Di Renzo A, Filippi M, Jannini TB, Messina R, Parisi P, Parisi V, Pierelli F, Rainero I, Raucci U, Rubino E, Sarchielli P, Li L, Vernieri F, Vollono C, Coppola G. Pathophysiological Bases of Comorbidity in Migraine. Front Hum Neurosci 2021; 15:640574. [PMID: 33958992 PMCID: PMC8093831 DOI: 10.3389/fnhum.2021.640574] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 02/23/2021] [Indexed: 12/12/2022] Open
Abstract
Despite that it is commonly accepted that migraine is a disorder of the nervous system with a prominent genetic basis, it is comorbid with a plethora of medical conditions. Several studies have found bidirectional comorbidity between migraine and different disorders including neurological, psychiatric, cardio- and cerebrovascular, gastrointestinal, metaboloendocrine, and immunological conditions. Each of these has its own genetic load and shares some common characteristics with migraine. The bidirectional mechanisms that are likely to underlie this extensive comorbidity between migraine and other diseases are manifold. Comorbid pathologies can induce and promote thalamocortical network dysexcitability, multi-organ transient or persistent pro-inflammatory state, and disproportionate energetic needs in a variable combination, which in turn may be causative mechanisms of the activation of an ample defensive system with includes the trigeminovascular system in conjunction with the neuroendocrine hypothalamic system. This strategy is designed to maintain brain homeostasis by regulating homeostatic needs, such as normal subcortico-cortical excitability, energy balance, osmoregulation, and emotional response. In this light, the treatment of migraine should always involves a multidisciplinary approach, aimed at identifying and, if necessary, eliminating possible risk and comorbidity factors.
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Affiliation(s)
- Claudia Altamura
- Headache and Neurosonology Unit, Neurology, Campus Bio-Medico University Hospital, Rome, Italy
| | - Ilenia Corbelli
- Clinica Neurologica, Dipartimento di Medicina, Ospedale S.M. Misericordia, Università degli Studi di Perugia, Perugia, Italy
| | - Marina de Tommaso
- Applied Neurophysiology and Pain Unit, SMBNOS Department, Bari Aldo Moro University, Policlinico General Hospital, Bari, Italy
| | - Cherubino Di Lorenzo
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy
| | - Giorgio Di Lorenzo
- Laboratory of Psychophysiology and Cognitive Neuroscience, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.,IRCCS-Fondazione Santa Lucia, Rome, Italy
| | | | - Massimo Filippi
- Neuroimaging Research Unit, Division of Neuroscience, Institute of Experimental Neurology, Milan, Italy.,Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Tommaso B Jannini
- Laboratory of Psychophysiology and Cognitive Neuroscience, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Roberta Messina
- Neurology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Vita-Salute San Raffaele University, Milan, Italy
| | - Pasquale Parisi
- Child Neurology, Department of Neuroscience, Mental Health and Sense Organs (NESMOS), Faculty of Medicine & Psychology, c/o Sant'Andrea Hospital, Sapienza University, Rome, Italy
| | | | - Francesco Pierelli
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy.,Headache Clinic, IRCCS-Neuromed, Pozzilli, Italy
| | - Innocenzo Rainero
- Neurology I, Department of Neuroscience "Rita Levi Montalcini," University of Torino, Torino, Italy
| | - Umberto Raucci
- Department of Emergency, Acceptance and General Pediatrics, Bambino Gesù Children's Hospital, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Rome, Italy
| | - Elisa Rubino
- Neurology I, Department of Neuroscience "Rita Levi Montalcini," University of Torino, Torino, Italy
| | - Paola Sarchielli
- Clinica Neurologica, Dipartimento di Medicina, Ospedale S.M. Misericordia, Università degli Studi di Perugia, Perugia, Italy
| | - Linxin Li
- Nuffield Department of Clinical Neurosciences, Centre for Prevention of Stroke and Dementia, John Radcliffe Hospital, University of Oxford, Oxford, United Kingdom
| | - Fabrizio Vernieri
- Headache and Neurosonology Unit, Neurology, Campus Bio-Medico University Hospital, Rome, Italy
| | - Catello Vollono
- Department of Neurology, Fondazione Policlinico Universitario "Agostino Gemelli" IRCCS, Catholic University, Rome, Italy
| | - Gianluca Coppola
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome Polo Pontino, Latina, Italy
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8
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Putaala J, Artto V, Martinez-Majander N. Reply to "Migraine and Cryptogenic Ischemic Stroke". Ann Neurol 2021; 89:629. [PMID: 33368554 DOI: 10.1002/ana.25997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 12/21/2020] [Accepted: 12/21/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Jukka Putaala
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ville Artto
- Department of Neurology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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9
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Martinez-Majander N, Artto V, Ylikotila P, von Sarnowski B, Waje-Andreassen U, Yesilot N, Zedde M, Huhtakangas J, Numminen H, Jäkälä P, Fonseca AC, Redfors P, Wermer MJH, Pezzini A, Putaala J. Association between Migraine and Cryptogenic Ischemic Stroke in Young Adults. Ann Neurol 2020; 89:242-253. [PMID: 33078475 DOI: 10.1002/ana.25937] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/26/2020] [Accepted: 10/11/2020] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To assess the association between migraine and cryptogenic ischemic stroke (CIS) in young adults, with subgroup analyses stratified by sex and presence of patent foramen ovale (PFO). METHODS We prospectively enrolled 347 consecutive patients aged 18 to 49 years with a recent CIS and 347 age- and sex-matched (±5 years) stroke-free controls. Any migraine and migraine with (MA) and migraine without aura (MO) were identified by a screener, which we validated against a headache neurologist. We used conditional logistic regression adjusting for age, education, hypertension, diabetes, waist-to-hip ratio, physical inactivity, current smoking, heavy drinking, and oral estrogen use to assess independent association between migraine and CIS. The effect of PFO on the association between migraine and CIS was analyzed with logistic regression in a subgroup investigated with transcranial Doppler bubble screen. RESULTS The screener performance was excellent (Cohen kappa > 0.75) in patients and controls. Compared with nonmigraineurs, any migraine (odds ratio [OR] = 2.48, 95% confidence interval [CI] = 1.63-3.76) and MA (OR = 3.50, 95% CI = 2.19-5.61) were associated with CIS, whereas MO was not. The association emerged in both women (OR = 2.97 for any migraine, 95% CI = 1.61-5.47; OR = 4.32 for MA, 95% CI = 2.16-8.65) and men (OR = 2.47 for any migraine, 95% CI = 1.32-4.61; OR = 3.61 for MA, 95% CI = 1.75-7.45). Specifically for MA, the association with CIS remained significant irrespective of PFO. MA prevalence increased with increasing magnitude of the right-to-left shunt in patients with PFO. INTERPRETATION MA has a strong association with CIS in young patients, independent of vascular risk factors and presence of PFO. ANN NEUROL 2021;89:242-253.
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Affiliation(s)
| | - Ville Artto
- Neurology, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
| | - Pauli Ylikotila
- Neurocenter, Turku University Hospital, Clinical Neurosciences, Turku University, Turku, Finland
| | | | | | - Nilufer Yesilot
- Istanbul Faculty of Medicine, Department of Neurology, Istanbul University, Istanbul, Turkey
| | - Marialuisa Zedde
- Neurology Unit, Company Local Health Unit-Reggio Emilia National Institute for Research and Treatment, Reggio Emilia, Italy
| | - Juha Huhtakangas
- Department of Neurology, Oulu University Hospital, Oulu, Finland
| | - Heikki Numminen
- Department of Neuroscience and Rehabilitation, Tampere University Hospital, Tampere, Finland
| | - Pekka Jäkälä
- Kuopio University Hospital, Neurocenter Neurology, Finland and University of Eastern Finland, Kuopio, Finland
| | - Ana C Fonseca
- Department of Neurosciences (Neurology), Hospital de Santa Maria, University of Lisbon, Lisbon, Portugal
| | - Petra Redfors
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.,Department of Neurology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Alessandro Pezzini
- Department of Clinical and Experimental Sciences, Neurology Clinic, University of Brescia, Brescia, Italy
| | - Jukka Putaala
- Neurology, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
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10
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De Giuli V, Grassi M, Locatelli M, Gamba M, Morotti A, Bonacina S, Mazzoleni V, Pezzini D, Magoni M, Monastero R, Padovani A, Pezzini A. Cardiac sources of cerebral embolism in people with migraine. Eur J Neurol 2020; 28:516-524. [PMID: 32979886 DOI: 10.1111/ene.14556] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 09/14/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND AND PURPOSE Whether the reported association between migraine with aura (MA) and cardioembolic stroke may be explained by a higher rate of atrial fibrillation (AF) or by other potential cardiac sources of cerebral embolism remains to be determined. METHODS In the setting of a single centre cohort study of consecutive patients with acute brain ischaemia stratified by migraine status, the association between AF as well as patent foramen ovale (PFO) and migraine was explored. RESULTS In all, 1738 patients (1017 [58.5%] men, mean age 67.9 ± 14.9 years) qualified for the analysis. Aging was inversely associated with migraine, whilst women had a >3-fold increased disease risk (odds ratio [OR] 3.82, 95% confidence interval [CI] 2.58-5.66). No association between AF and history of migraine or its pathogenic subtypes was detected. Conversely, migraine was associated with PFO, both in the entire cohort (OR 1.84, 95% CI 1.07-3.16) and in patients aged ≤55 years (OR 2.21, 95% CI 1.16-4.22). This association was significant for MA (OR 2.92, 95% CI 1.32-6.45 in the entire cohort; OR 2.92, 95% CI 1.15-7.41 in patients aged ≤55 years) and in women (OR 8.23, 95% CI 2.06-32.77), but not for migraine without aura. CONCLUSIONS In patients with brain ischaemia migraine is not associated with AF. Conversely, there is a probable relation between migraine, especially MA, and PFO in patients who are younger and have a more favourable vascular risk factor profile, and in women.
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Affiliation(s)
- V De Giuli
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy
| | - M Grassi
- Dipartimento di Scienze del Sistema Nervoso e del Comportamento, Unità di Statistica Medica e Genomica, Università di Pavia, Pavia, Italy
| | - M Locatelli
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy
| | - M Gamba
- Neurologia Vascolare, Stroke Unit, Spedali Civili di Brescia, Brescia, Italy
| | - A Morotti
- UO Neurologia, Ospedale di Esine, ASST della Vallecamonica, Esine, Italy
| | - S Bonacina
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy
| | - V Mazzoleni
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy
| | - D Pezzini
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy
| | - M Magoni
- Neurologia Vascolare, Stroke Unit, Spedali Civili di Brescia, Brescia, Italy
| | - R Monastero
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università di Palermo, Palermo, Italy
| | - A Padovani
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy
| | - A Pezzini
- Dipartimento di Scienze Cliniche e Sperimentali, Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italy
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11
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Magalhães JE, Sampaio Rocha-Filho PA. Migraine and cerebrovascular diseases: Epidemiology, pathophysiological, and clinical considerations. Headache 2018; 58:1277-1286. [DOI: 10.1111/head.13378] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2018] [Indexed: 01/24/2023]
Affiliation(s)
- João Eudes Magalhães
- Postgraduate program in Neuropsychiatry and Behavioral Sciences, Universidade Federal de Pernambuco (UFPE); Pernambuco Brazil
- Stroke Clinic, Hospital Universitario Oswaldo Cruz, Universidade de Pernambuco (UPE); Recife Brazil
| | - Pedro Augusto Sampaio Rocha-Filho
- Department of Neuropsychiatry; Universidade Federal de Pernambuco (UFPE); Recife Brazil
- Headache Clinic, Hospital Universitario Oswaldo Cruz, Universidade de Pernambuco (UPE); Recife Brazil
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12
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Rubino E, Rainero I, Garino F, Vicentini C, Govone F, Vacca A, Gai A, Gentile S, Govone G, Ragazzoni F, Pinessi L, Giordana MT, Limone P. Subclinical hypothyroidism is associated with migraine: A case-control study. Cephalalgia 2018; 39:15-20. [PMID: 29682977 DOI: 10.1177/0333102418769917] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Recent studies suggested a potential association between both overt and subclinical hypothyroidism and migraine. Aims of this study were to estimate the comorbidity of migraine in patients with subclinical hypothyroidism and to evaluate associated clinical characteristics. METHODS Using a case-control strategy, 151 consecutive subclinical hypothyroidism patients (mean age 48.36 ± 15.86 years) and 150 controls (mean age 50.86 ± 9.19 years) were recruited. In all subjects, migraine characteristics were collected through a direct interview. Clinical and biochemical parameters (thyroid-stimulating hormone, free triiodothyronine, free thyroxine, and anti-thyroid antibodies) were compared between subclinical hypothyroidism patients in comorbidity with migraine and subclinical hypothyroidism patients without migraine. RESULTS The prevalence of lifetime migraine was significantly higher in subclinical hypothyroidism patients in comparison with controls (46% vs. 13%, p < 0.001; OR 5.80; 95% CI = 3.35-10.34). Both migraine without and with aura were significantly higher in subclinical hypothyroidism patients than controls ( p < 0.001 and p = 0.010, respectively). Thyroid hormones and concentrations of antibodies did not differ between subclinical hypothyroidism patients with and without migraine. Interestingly, a comorbidity for autoimmune diseases was observed in subclinical hypothyroidism patients with migraine in respect to those without migraine ( p = 0.005). CONCLUSIONS Our data suggest that migraine is more frequent in patients with subclinical hypothyroidism in respect to controls. Further studies are needed in order to confirm this association.
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Affiliation(s)
- Elisa Rubino
- 1 Neurology I - Headache Center, Department of Neuroscience "Rita Levi Montalcini", University of Torino, Italy
| | - Innocenzo Rainero
- 1 Neurology I - Headache Center, Department of Neuroscience "Rita Levi Montalcini", University of Torino, Italy
| | - Francesca Garino
- 2 Endocrinology, Diabetes and Metabolic Disease Unit, A.O. Ordine Mauriziano di Torino, Torino, Italy
| | - Costanza Vicentini
- 1 Neurology I - Headache Center, Department of Neuroscience "Rita Levi Montalcini", University of Torino, Italy
| | - Flora Govone
- 1 Neurology I - Headache Center, Department of Neuroscience "Rita Levi Montalcini", University of Torino, Italy
| | - Alessandro Vacca
- 1 Neurology I - Headache Center, Department of Neuroscience "Rita Levi Montalcini", University of Torino, Italy
| | - Annalisa Gai
- 1 Neurology I - Headache Center, Department of Neuroscience "Rita Levi Montalcini", University of Torino, Italy
| | - Salvatore Gentile
- 3 Department of Neuroscience and Mental Health, A.O.U. Città della Salute e della Scienza, Torino, Italy
| | - Guido Govone
- 1 Neurology I - Headache Center, Department of Neuroscience "Rita Levi Montalcini", University of Torino, Italy
| | - Federico Ragazzoni
- 2 Endocrinology, Diabetes and Metabolic Disease Unit, A.O. Ordine Mauriziano di Torino, Torino, Italy
| | - Lorenzo Pinessi
- 1 Neurology I - Headache Center, Department of Neuroscience "Rita Levi Montalcini", University of Torino, Italy
| | - Maria Teresa Giordana
- 1 Neurology I - Headache Center, Department of Neuroscience "Rita Levi Montalcini", University of Torino, Italy
| | - Paolo Limone
- 2 Endocrinology, Diabetes and Metabolic Disease Unit, A.O. Ordine Mauriziano di Torino, Torino, Italy
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13
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Zhang Y, Parikh A, Qian S. Migraine and stroke. Stroke Vasc Neurol 2017; 2:160-167. [PMID: 28989805 PMCID: PMC5628377 DOI: 10.1136/svn-2017-000077] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/06/2017] [Accepted: 04/09/2017] [Indexed: 12/23/2022] Open
Abstract
Migraines are generally considered a relatively benign neurological condition. However, research has shown an association between migraines and stroke, and especially between migraine with aura and ischaemic stroke. Patients can also suffer from migrainous infarction, a subset of ischaemic stroke that often occurs in the posterior circulation of younger women. The exact pathogenesis of migrainous infarct is not known, but it is theorised that the duration and local neuronal energy level from cortical spreading depression may be a key factor. Other factors contributing to migrainous infarct may include vascular, inflammatory, endothelial structure, patent foramen ovale, gender, oral contraceptive pill use and smoking. Vasoconstrictors such as the triptan and ergot class are commonly used to treat migraines and may also play a role. Migraine is also shown to be correlated to haemorrhagic stroke, although studies do not demonstrate causation versus association, and further studies are warranted. There are also some rare genetic diseases such as cerebral autosomal-dominant arteriopathy with subcortical infarcts and leukoencephalopathy, retinal vasculopathy with cerebral leukodystrophy and others, which can cause both migraines and infarcts. On imaging, many migraineurs are found to have white matter changes similar to those seen in patients with stroke. These may be caused in part by alterations in resting cerebral blood flow and vasoconstrictor use. In treating patients with migraines, it is important to identify and modify any vascular risk factors such as hypertension, smoking, oral contraceptive pill use and lifestyle factors. Further studies will determine if more aggressive treatment of migraines can ultimately lead to fewer strokes in this population.
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Affiliation(s)
- Yonghua Zhang
- Edward Neurosciences Institute in affiliation with Northwestern Medicine, Naperville, Illinois, USA
| | - Aasheeta Parikh
- Edward Neurosciences Institute in affiliation with Northwestern Medicine, Naperville, Illinois, USA
| | - Shuo Qian
- Department of Neurology & Rehabilitation, University of Illinois, Chicago, Illinois, USA
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14
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Abstract
Background Metabolic syndrome (MetS) and migraine are known to be associated. This study assessed the risk of MetS and its clinical characteristics in migraine with aura (MA) and without aura (MO) based on a large-scale cross-sectional survey. Methods The study material consisted of 751 participants in the Nutrition, Environment and CardioVascular Health (NESCaV) survey. Diagnosis of migraine was based on the ef-ID migraine questionnaire and MetS was defined according to the Revised-Adult Treatment Panel III criteria. Sociodemographic and risk factors were also recorded. Weighted logistic regression was used to assess the risk of MetS. Results After adjusting for stratification (gender, age, district) and other factors (smoking status, sedentary lifestyle, family history of stroke, myocardial infarction and hypertension), MA subjects were at higher risk of MetS (OR 3.45; 95% CI: 1.63–7.29) while MO individuals were not, when compared to non-migraineurs. When considering MetS components, MA was positively associated with low HDL-cholesterol (OR 2.26; 95% CI: 1.08–4.74), hyperglycemia (OR 2.77; 95% CI: 1.30–5.88) and abdominal obesity (OR 2.03; 95% CI: 1.07–3.86). Conclusion Migraineurs with aura are at higher risk of MetS, suggesting that these subjects, already more exposed to stroke, may benefit from a systematic screening for the metabolic syndrome.
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15
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Affiliation(s)
- Arn MJM van den Maagdenberg
- Department of Human Genetics, Leiden University Medical Centre, the Netherlands
- Department of Neurology, Leiden University Medical Centre, the Netherlands
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16
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Geyik S, Ergun S, Kuzudişli S, Şensoy F, Temiz E, Altunışık E, Korkmaz M, Dağlı H, Kul S, Akçalı A, Neyal AM. Plasma urotensin-2 level and Thr21Met but not Ser89Asn polymorphisms of the urotensin-2 gene are associated with migraines. J Headache Pain 2016; 17:36. [PMID: 27090416 PMCID: PMC4835397 DOI: 10.1186/s10194-016-0623-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 04/07/2016] [Indexed: 02/07/2023] Open
Abstract
Background Urotensin-II (U-II) is a peptide recognized by its potent vasoconstrictor activity in many vascular events, however the role of urotensin-II in migraine has not been considered yet. The molecular mechanisms and genetics of migraine have not been fully clarified yet, but it is well-known that vascular changes considerably contribute in pathophysiology of migraine and also its complications. The aim of this study was to analyze the plasma U-II levels along with genotype distributions and allele frequencies for UTS2 Thr21Met and Ser89Asn polymorphisms among the patients with migraine without aura (MWoA). Methods One hundred eighty-six patients with MWoA and 171 healthy individuals were included in this study. Plasma U-II levels were measured in attack free period. The genotype and allele frequencies for the Thr21Met (T21M) and Ser89Asn (S89N) polymorphisms in the UTS2 gene were analyzed. Results Plasma U-II levels were significantly higher in MWoA patients (p = 0.002). We detected a significant association between the T21M polymorphism in the UTS2 gene and migraine (53.8 % in patients, 40.4 % in controls, p = 0.035), but not with S89N polymorphism (p = 0.620). A significant relationship was found between U-II levels and MIDAS score (β = 0.508, p = 0.001). Conclusion Our study suggests that U-II may play a role in migraine pathogenesis; also Thr21Met polymorphism was associated with the risk of migraine disease. Further studies are needed for considering the role of U-II in migraine pathophysiology and for deciding if UTS2 gene may be a novel candidate gene in migraine cases.
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Affiliation(s)
- Sırma Geyik
- Department of Neurology, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey.
| | - Sercan Ergun
- Ulubey Vocational Higher School, Ordu University, Ordu, Turkey
| | - Samiye Kuzudişli
- Department of Neurology, Emine-Bahaeddin Nakiboglu Medical Faculty, Zirve University, Gaziantep, Turkey
| | - Figen Şensoy
- Neurology Clinics, Medical Park Hospital, Gaziantep, Turkey
| | - Ebru Temiz
- Department of Medical Biology, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey
| | - Erman Altunışık
- Division Of Neurology, Turkish Ministry Of Health Siirt State Hospital, Siirt, Turkey
| | - Murat Korkmaz
- Department of Medical Biology, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey
| | - Hasan Dağlı
- Department of Medical Biology, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey
| | - Seval Kul
- Department of Biostatistics, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey
| | - Aylin Akçalı
- Department of Neurology, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey
| | - Ayşe Münife Neyal
- Department of Neurology, Faculty of Medicine, University of Gaziantep, Gaziantep, Turkey
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