1
|
Kalita J, Laskar S, Sachan A. Topographic localization of migraine triggers and its association with headache frequency and severity. Clin Neurol Neurosurg 2023; 230:107794. [PMID: 37229952 DOI: 10.1016/j.clineuro.2023.107794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/10/2023] [Accepted: 05/13/2023] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Internal biological rhythm with or without external trigger may precipitate migraine. Classifying exogenous and endogenous triggers to a topographic localization may help in understanding the migraine. We report topographic localization of migraine triggers and its influence on headache frequency and severity. METHODS 588 migraineurs, aged 16-69 years were included. Various endogenous and exogenous triggers were categorized to topographic localization- hypothalamic, pituitary, auditory, visual, somato-sensory, olfactory and gustatory. The relationship of topographic localization of triggers with episodic versus chronic migraine, and moderate versus severe headache were analyzed using univariate followed by multivariate analysis. RESULTS All migraineurs had triggers 584(99.9%) except 4(0.1%) patients. Presence of multiple triggers (99.4%), and combination of both endogenous and exogenous triggers (97.7%) was the rule. On topographic localization, hypothalamic trigger was the commonest (98.1%) followed by visual (84.1%), auditory (82.1%), somatosensory (76.1%), olfactory (26.2%), pituitary (24.1%), and gustatory (6.6%). 98.6% patients had combination of hypothalamic with pituitary triggers. Hypothalamic [Adjusted odds ratio (AOR) 4.50] and auditory triggers (AOR 0.34) independently predicted chronic migraine, and auditory (AOR 0.55) and gustatory (AOR 2.41) triggers predicted severity of headache. CONCLUSION Hypothalamic triggers are the commonest suggesting an innate susceptibility of migraine. Auditory trigger may precipitate frequent and severe headache.
Collapse
Affiliation(s)
- Jayantee Kalita
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh 226014, India.
| | - Sanghamitra Laskar
- Department of Neurology, Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi 110 029, India
| | - Abhishek Sachan
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raebareli Road, Lucknow, Uttar Pradesh 226014, India
| |
Collapse
|
2
|
Iba C, Ohtani S, Lee MJ, Huh S, Watanabe N, Nakahara J, Peng KP, Takizawa T. Migraine triggers in Asian countries: a narrative review. Front Neurol 2023; 14:1169795. [PMID: 37206912 PMCID: PMC10189151 DOI: 10.3389/fneur.2023.1169795] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/03/2023] [Indexed: 05/21/2023] Open
Abstract
Background Migraine is one of the most common neurological disorders worldwide. Clinical characteristics of migraine may be somewhat different across ethnic groups. Although factors such as stress, lack of sleep, and fasting are known as migraine triggers, the discussion about geographical differences of migraine triggers in Asia is lacking. Methods In this study, we performed a narrative review on migraine triggers in Asia. We searched PubMed for relevant papers published between January 2000 and February 2022. Results Forty-two papers from 13 Asian countries were included. Stress and sleep are the most frequently reported migraine triggers in Asia. There were some differences in migraine triggers in Asian countries: fatigue and weather common in Eastern Asia and fasting common in Western Asia. Conclusion Majority of the common triggers reported by patients with migraine in Asia were stress and sleep, similar to those reported globally, thus showing they are universally important. Some triggers linked to internal homeostasis are influenced by culture (e.g., alcohol, food/eating habit), and triggers related to environmental homeostasis, such as weather, are highly heterogenous between regions.
Collapse
Affiliation(s)
- Chisato Iba
- Department of Neurology, School of Medicine, Keio University, Tokyo, Japan
| | - Seiya Ohtani
- Department of Neurology, School of Medicine, Keio University, Tokyo, Japan
| | - Mi Ji Lee
- Department of Neurology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sunjun Huh
- Department of Neurology, School of Medicine, Keio University, Tokyo, Japan
| | - Narumi Watanabe
- Department of Neurology, School of Medicine, Keio University, Tokyo, Japan
| | - Jin Nakahara
- Department of Neurology, School of Medicine, Keio University, Tokyo, Japan
| | - Kuan-Po Peng
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tsubasa Takizawa
- Department of Neurology, School of Medicine, Keio University, Tokyo, Japan
- *Correspondence: Tsubasa Takizawa
| |
Collapse
|
3
|
Uniyal R, Pandey S, Kumar N, Garg RK, Malhotra HS, Rizvi I, Tripathi A. Impact of comorbid psychogenic non-epileptic seizures on migraine: An observational study. J Neurosci Rural Pract 2023; 14:84-90. [PMID: 36891112 PMCID: PMC9944316 DOI: 10.25259/jnrp-2022-3-18] [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: 03/10/2022] [Accepted: 08/09/2022] [Indexed: 12/23/2022] Open
Abstract
Objectives There is a bidirectional and complex interplay between psychiatric comorbidities and migraine. Migraine has been observed in 50-60% of patients with psychogenic non-epileptic seizures (PNES). Studies describe migraine as a medical comorbidity in PNES. However, there are limited studies on impact of PNES on migraine. We aim to see the impact of PNES on migraine. Materials and Methods This cross-sectional and observational study was conducted at a tertiary-care center from June 2017 to May 2019. Fifty-two patients with migraine with PNES and 48 patients with migraine without PNES were included on the study. Migraine and PNES were diagnosed based on International Classification of Headache Disorders-3 (ICHD-3) and International League Against Epilepsy (ILAE) criteria, respectively. Headache intensity was assessed using visual analog scale. Comorbid depression, anxiety, and somatoform-symptom-disease were assessed using the Generalized Anxiety Disorder-7 Scale, Patient Health Questionnaire-9, and DSM-5 criteria, respectively. Results Females were common in both groups and the difference was statistically insignificant. Headache frequency was significantly more in patients with migraine with PNES (P < 0.05). However, headache intensity was similar in both groups. Patients with headaches and PNES identified triggers less commonly except for stress. Depression and somatoform symptom disorder were significantly more common in patients with migraine with PNES. Abnormal neurocircuitry involving frontal, limbic, and thalamic regions due to comorbid PNES may cause central sensitization, resulting in frequent migraine headaches which is further augmented by coexisting depression and somatoform-symptom-disease. Conclusion Migraine with PNES patients suffers more frequent headaches than patients with migraine without PNES. They differ in various headache triggers, with mental stress being the predominant trigger.
Collapse
Affiliation(s)
- Ravi Uniyal
- Department of Neurology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Shweta Pandey
- Department of Neurology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Neeraj Kumar
- Department of Neurology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Ravindra Kumar Garg
- Department of Neurology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Hardeep Singh Malhotra
- Department of Neurology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Imran Rizvi
- Department of Neurology, King George’s Medical University, Lucknow, Uttar Pradesh, India
| | - Adarsh Tripathi
- Department of Psychiatry, King George’s Medical University, Lucknow, Uttar Pradesh, India
| |
Collapse
|
4
|
Kalita J, Misra UK, Kumar M, Bansal R, Uniyal R. Is Palinopsia in Migraineurs a Phenomenon of Impaired Habituation of Visual Cortical Neurons? Clin EEG Neurosci 2022; 53:196-203. [PMID: 33646059 DOI: 10.1177/1550059421991707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Palinopsia in migraine has been reported recently, which may be due to the dysexcitability of visual cortical neurons. In this cross-sectional study, we report the correlation of neuronal dysexcitability with palinopsia using pattern shift visual evoked potential (PSVEP) in 91 migraineurs and 25 healthy controls. The presence of palinopsia was evaluated using a novel objective method, and revealed more frequent palinopsia in the migraineurs compared to the controls (53 of 91 [58.2%] vs 3 of 25 [12%]; P < .001). Five consecutive blocks of PSVEP were recorded for the evaluation of sensitization and impaired habituation. Amplitudes of N75 and P100 in block 1 were considered for sensitization. Impaired habituation of N75 and P100 was considered if any amplitudes in blocks 2 to 5 were higher than block 1. Impaired habituation was more frequent in migraineurs compared with the controls, and was more marked in wave N75 (81.3% vs 32%; P < .001) than wave P100 (63.7% vs 44%; P = .12). Impaired habituations of wave N75 (81.7% vs 58.9%; P = .008) and wave P100 (71.7% vs 46.4%; P = .008) were more frequent in those with palinopsia compared with those without. There was a lack of suppression of P100 amplitude in block 3 in the palinopsia group compared to the controls. The duration of palinopsia correlated with the extent of impaired habituation of N75. It can be concluded that the impaired habituation of PSVEP waveforms is a biomarker of palinopsia in migraine.
Collapse
Affiliation(s)
- Jayantee Kalita
- 30093Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Usha K Misra
- 30093Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | | | - Robin Bansal
- 30093Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Ravi Uniyal
- 30093Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| |
Collapse
|
5
|
Abstract
Purpose of Review Until the last 5 years, there was very little in the literature about the phenomenon now known as visual snow syndrome. This review will examine the current thinking on the pathology of visual snow and how that thinking has evolved. Recent Findings While migraine is a common comorbidity to visual snow syndrome, evidence points to these conditions being distinct clinical entities, with some overlapping pathophysiological processes. There is increasing structural and functional evidence that visual snow syndrome is due to a widespread cortical dysfunction. Cortical hyperexcitability coupled with changes in thalamocortical pathways and higher-level salience network controls have all shown differences in patients with visual snow syndrome compared to controls. Summary Further work is needed to clarify the exact mechanisms of visual snow syndrome. Until that time, treatment options will remain limited. Clinicians having a clearer understanding of the basis for visual snow syndrome can appropriately discuss the diagnosis with their patients and steer them towards appropriate management options.
Collapse
Affiliation(s)
- Clare L Fraser
- Faculty of Health and Medicine, Save Sight Institute, The University of Sydney, 8 Macquarie Street, Sydney, NSW, 2000, Australia. .,Macquarie Ophthalmology, School of Clinical Medicine, Macquarie University, Sydney, Australia.
| |
Collapse
|
6
|
Abstract
Illusions and hallucinations are commonly encountered in both daily life and clinical practice. In this chapter, we review definitions and possible underlying mechanisms of these phenomena and then review what is known about specific conditions that are associated with them, including ophthalmic causes, migraine, epilepsy, Parkinson's disease, and schizophrenia. We then discuss specific syndromes including the Charles Bonnet syndrome, visual snow syndrome, Alice in Wonderland syndrome, and peduncular hallucinosis. The scientific study of illusions and hallucinations has contributed significantly to our understanding of how eye and brain process vision and contribute to perception. Important concepts are the distinction between topologic and hodologic mechanisms underlying hallucinations and the involvement of attentional networks. This chapter examines the various ways in which pathological illusions and hallucinations might arise in relation to the phenomenology and known pathology of the various conditions associated with them.
Collapse
Affiliation(s)
- Clare L Fraser
- Department of Ophthalmology, Save Sight Institute, Faculty of Health and Medicine, University of Sydney, Sydney, Australia.
| | - Christian J Lueck
- Department of Neurology, Canberra Hospital, and Australian National University Medical School, Canberra, Australia
| |
Collapse
|
7
|
Abstract
Migraine is a common headache disorder characterized by often-severe headaches that may be preceded or accompanied by a variety of visual symptoms. Although a typical migraine aura is not difficult to diagnose, patients with migraine may report several other visual symptoms, such as prolonged or otherwise atypical auras, "visual blurring", "retinal migraine", "ophthalmoplegic migraine", photophobia, palinopsia, and "visual snow". Here, we provide a short overview of these symptoms and what is known about the relationship with migraine pathophysiology. For some symptoms, the association with migraine is still debated; for other symptoms, recent studies indicate that migraine mechanisms play a role.
Collapse
Affiliation(s)
- Robin M. van Dongen
- Department of Neurology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Joost Haan
- Department of Neurology, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
- Department of Neurology, Alrijne Ziekenhuis, Simon Smitweg 1, 2353 GA, Leiderdorp, The Netherlands
| |
Collapse
|
8
|
Laskar S, Kalita J, Misra UK. Comparison of chronic daily headache with and without medication overuse headache using ICHD II R and ICHD 3 beta criteria. Clin Neurol Neurosurg 2019; 183:105382. [PMID: 31226669 DOI: 10.1016/j.clineuro.2019.105382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 05/08/2019] [Accepted: 06/04/2019] [Indexed: 01/03/2023]
Abstract
OBJECTIVE To evaluate the frequency of Medication Overuse Headache (MOH) in the patients with Chronic Daily Headache (CDH) using International Classification of Headache Disorder II Revision (ICHD II R) and International Classification of Headache Disorder 3 Beta (ICHD-3 beta) criteria. We also compare the CHD patients with and without MOH using both the criteria. PATIENTS AND METHODS Consecutive CDH patients from neurology service between 2014 and 2015 were included. The patients with CDH was categorised to MOH was based on ICHDIIR and ICHD-3 beta criteria. Their demographic and headache characteristics including frequency, duration, severity and disability were noted. Severity of headache was assessed using Visual Analogue Scale (VAS). Predictors of MOH were evaluated by multivariate analysis. Demographic and headache characteristics of CDH patients without MOH were compared with those with MOH. RESULTS 202 patients were included whose median age was 32 (range 18-65) years, and 151(74.8%) were females. 12.3% patients fulfilled ICHDIIR criteria for MOH and 46.5% fulfilled ICHD-3 beta criteria. The predictors of MOH were female gender (OR = 3.72; 95% CI 1.72-8.02, p = 0.001), low education level (OR = 1.07, 95%CI 1.02-1.13; p = 0.007) and higher VAS score (OR = 0.67, 95%CI 0.51-0.88; p = 0.004). MOH patients as per ICHD-3 beta criteria had higher education (p = 0.02) and consumed lesser abortive drugs (p = 0.03) as compared with ICHDIIR criteria. CONCLUSION The frequency of MOH increases by four-fold when using ICHD-3 beta criteria instead of ICHDIIR criteria. Females with lower education level predispose to MOH.
Collapse
Affiliation(s)
- Sanghamitra Laskar
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Jayantee Kalita
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India.
| | - Usha K Misra
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| |
Collapse
|
9
|
Misra UK, Kalita J, Tripathi G, Bhoi SK. Role of β endorphin in pain relief following high rate repetitive transcranial magnetic stimulation in migraine. Brain Stimul 2017; 10:618-623. [DOI: 10.1016/j.brs.2017.02.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 02/21/2017] [Accepted: 02/22/2017] [Indexed: 01/03/2023] Open
|
10
|
Misra UK, Kalita J. Neurology at Sanjay Gandhi PGI: Beginning, progress and hope. Neurol India 2016; 64:1010-5. [PMID: 27625247 DOI: 10.4103/0028-3886.190247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
High quality publications, patient care and educational standard have made Sanjay Gandhi Postgraduate Institute of Medical Sciences (SGPGIMS), Lucknow, India a favored destination for the patients and medical students, for getting treatment and education, respectively. The current article traces the history and milestone of the Department of Neurology, SGPGIMS, Lucknow and summarizes its achievements and facilities. The uniqueness of the department lies in being sensitive to the expectation of the patients, students and its faculty's own aspirations in research, keeping the patient as the center of focus.
Collapse
Affiliation(s)
- Usha Kant Misra
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Jayantee Kalita
- Department of Neurology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| |
Collapse
|