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Gurgoglione FL, Vignali L, Cattabiani MA, Solinas E, Benatti G, Tadonio I, Barocelli F, Dizdari C, Tuttolomondo D, Ardissino D, Nicolini F, Niccoli G. Predictors of recurrent cerebral ischemia after patent foramen ovale closure: A single center observational study. J Stroke Cerebrovasc Dis 2024; 33:107448. [PMID: 37988831 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107448] [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: 06/30/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 11/23/2023] Open
Abstract
OBJECTIVES Transcatheter patent foramen ovale closure lowers recurrent stroke in patients with cryptogenic stroke or transient ischemic attack with an indication for closure. However, the incidence of recurrent stroke is not negligible and underlying pathophysiology remains largely unknown. We sought to evaluate the prevalence of recurrent ischemic neurological events and to assess its predictors after transcatheter patent foramen ovale closure. METHODS We enrolled consecutive patients who underwent patent foramen ovale closure for secondary prevention of neurological ischemic events at the University Hospital of Parma between 2006 and 2021. Clinical and procedure-related features were collected for each patient. The incidence of recurrent ischemic neurological events was assessed at follow-up. RESULTS We enrolled a total of 169 patients with mean Risk of Paradoxical Embolism score at hospital admission of 6.4 ± 1.5. The primary indication was previous cryptogenic stroke (94 [55.6 %] subjects), followed by transient ischemic attack (75 [44.4 %]). Among patients with complete outcome data (n= 154), after a median follow-up of 112 months, recurrent cerebral ischemia occurred in 13 [8.4 %], with an annualized rate of 0.92/100 patients. The presence of obesity [OR 5.268, p = 0.018], Risk of Paradoxical Embolism score < 7 [OR 5.991, p = 0.035] and migraine [OR = 5.932 p = 0.012] were independent positive predictors of recurrent stroke/ transient ischemic attack after patent foramen ovale closure. CONCLUSIONS The presence of obesity, Risk of Paradoxical Embolism score < 7 and migraine were independent positive predictors of recurrent ischemic neurological events after patent foramen ovale closure.
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Affiliation(s)
| | - Luigi Vignali
- Cardiology Department, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | | | - Emilia Solinas
- Cardiology Department, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Giorgio Benatti
- Cardiology Department, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Iacopo Tadonio
- Cardiology Department, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Federico Barocelli
- Cardiology Department, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Chiara Dizdari
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Diego Ardissino
- Cardiology Department, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Francesco Nicolini
- Department of Medicine and Surgery, University of Parma, Parma, Italy; Cardiac Surgery Unit, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy
| | - Giampaolo Niccoli
- Cardiology Department, Azienda Ospedaliero-Universitaria of Parma, Parma, Italy; Department of Medicine and Surgery, University of Parma, Parma, Italy.
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Gil Y, Lee MJ, Cho S, Chung C. Effect of caffeine and caffeine cessation on cerebrovascular reactivity in patients with migraine. Headache 2022; 62:169-175. [DOI: 10.1111/head.14263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 11/23/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Young‐Eun Gil
- Department of Neurology Ajou University School of Medicine, Ajou University Medical Center Suwon South Korea
| | - Mi Ji Lee
- Department of Neurology Neuroscience Center Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
| | - Soohyun Cho
- Department of Neurology Uijeongbu Eulji Medical Center Eulji University School of Medicine Uijeongbu Korea
| | - Chin‐Sang Chung
- Department of Neurology Neuroscience Center Samsung Medical Center Sungkyunkwan University School of Medicine Seoul Korea
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3
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Dzator JS, Howe PR, Wong RH. Profiling cerebrovascular function in migraine: A systematic review and meta-analysis. J Cereb Blood Flow Metab 2021; 41:919-944. [PMID: 33086920 PMCID: PMC8054723 DOI: 10.1177/0271678x20964344] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Previous studies have investigated whether migraine is a circulatory disorder, as migraineurs are at heightened risk of cerebrovascular disease. However, in most cases, systemic vascular function was evaluated, which may not reflect abnormalities in the cerebral circulation. Therefore, we aimed to determine whether cerebrovascular function differs between migraineurs and controls. A systematic literature search was conducted across three electronic databases to search for studies that compared cerebrovascular function in migraineurs to controls. Where applicable, meta-analyses were used to determine standardised mean differences (SMD) between migraineurs and controls. Seventy articles were identified, 40 of which contained quantitative data. Meta-analyses showed pulsatility index (PI) was higher (SMD = 0.23; 95%CI = 0.05 to 0.42, P = 0.01) and cerebrovascular responsiveness (CVR) to hypercapnia was lower (SMD=-0.34; 95%CI=-0.67 to -0.01, P = 0.04) in the posterior circulation of migraineurs, particularly those without aura. The meta-analyses also indicated that migraineurs have higher resting mean blood flow velocity in both anterior (SMD = 0.14; 95%CI = 0.05 to 0.23, P = 0.003) and posterior circulations (SMD = 0.20; 95%CI = 0.05 to 0.34, P = 0.007). Compared to healthy controls, migraineurs have altered cerebrovascular function, evidenced by elevated PI (representing arterial stiffness) and impaired CVR to hypercapnia (representing cerebral vasodilator function). Future studies should investigate whether improvement of cerebrovascular function is able to alleviate migraine.
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Affiliation(s)
- Jemima Sa Dzator
- Clinical Nutrition Research Centre, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Australia
| | - Peter Rc Howe
- Clinical Nutrition Research Centre, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Australia.,Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Queensland, Australia.,UniSA Allied Health & Human Performance, University of South Australia, Adelaide, Australia
| | - Rachel Hx Wong
- Clinical Nutrition Research Centre, School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, Australia.,Centre for Health Research, Institute for Resilient Regions, University of Southern Queensland, Springfield Central, Queensland, Australia
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Paolucci M, Altamura C, Vernieri F. The Role of Endothelial Dysfunction in the Pathophysiology and Cerebrovascular Effects of Migraine: A Narrative Review. J Clin Neurol 2021; 17:164-175. [PMID: 33835736 PMCID: PMC8053543 DOI: 10.3988/jcn.2021.17.2.164] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 12/07/2020] [Accepted: 12/08/2020] [Indexed: 12/17/2022] Open
Abstract
Background and Purpose Migraine is a complex neurovascular disorder whose triggers are not entirely understood. Endothelial dysfunction might play a role in migraine, and there have been numerous reports on endothelium dysfunction and migraine pathophysiology, but their reciprocal cause–effect relationship remains unclear. This review reports the current evidence on endothelium dysfunction, its link with migraine, and its possible consequences for cerebral hemodynamics. Methods We performed a systematic literature search of PubMed up to March 2020. We included 115 articles in a narrative review. Results Several studies have demonstrated that endothelium dysfunction may play an important role in migraine. Despite the lack of specific biomarkers, there is evidence of oxidative stress and inflammation—two of the primary causes of endothelial damage—in migraine. The main consequences of endothelial dysfunction are increased vascular tone, thrombosis, inflammation, and increased vascular permeability. As a consequence of oxidative stress, the activity of endothelin-1 is not counterbalanced by nitric oxide (NO), whose levels decrease to lead to vasoconstriction and a possible contribution to cortical spreading depression. NO is involved in pain perception via the cyclic guanosine monophosphate (cGMP) pathway and the induction of calcitonin gene-related peptide. Oxidative stress may induce a hypercoagulable state that mainly affects platelet function through different mechanisms. Endothelial dysfunction seems to be particularly pronounced in migraine with aura (MA). Endothelial dysfunction in migraine particularly involves intracranial vessels, since flow-mediated dilation cannot detect overt peripheral vascular dysfunction. Conclusions Endothelial dysfunction is a vascular risk marker. How it impacts migraine, and particularly MA, needs to be understood better by defining its possible role in increasing the stroke risk in migraine patients.
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Affiliation(s)
- Matteo Paolucci
- Headache and Neurosonology Unit, Neurology, Campus Bio-Medico University of Rome, Rome, Italy.,Neurology Unit, M. Bufalini Hospital, Cesena, AUSL Romagna, Italy.
| | - Claudia Altamura
- Headache and Neurosonology Unit, Neurology, Campus Bio-Medico University of Rome, Rome, Italy
| | - Fabrizio Vernieri
- Headache and Neurosonology Unit, Neurology, Campus Bio-Medico University of Rome, Rome, Italy
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Ornello R, Tiseo C, Pistoia F, Sacco S. Cerebrovascular reactivity in subjects with migraine: Age paradox? J Neurol Sci 2019; 398:202-203. [DOI: 10.1016/j.jns.2019.01.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 01/23/2019] [Indexed: 11/28/2022]
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Lee MJ, Park BY, Cho S, Park H, Chung CS. Cerebrovascular reactivity as a determinant of deep white matter hyperintensities in migraine. Neurology 2019; 92:e342-e350. [PMID: 30610094 DOI: 10.1212/wnl.0000000000006822] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 09/27/2018] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To evaluate the association between the cerebrovascular reactivity to carbon dioxide (CO2-CVR) and the deep white matter hyperintensity (WMH) burden in patients with migraine. METHODS A total of 86 nonelderly patients with episodic migraine without vascular risk factors and 35 headache-free controls underwent 3T MRI. Deep WMHs were quantified with a segmentation method developed for nonelderly migraineurs. The interictal CO2-CVR was measured with transcranial Doppler with the breath-holding method. The mean breath-holding index of the bilateral middle cerebral arteries (MCA-BHI) was square root transformed and analyzed with univariate and multivariate logistic regression models to determine its association with the highest tertiles of deep WMH burden (number and volume). RESULTS A low MCA-BHI was independently associated with the highest tertile of deep WMH number in patients with migraine (adjusted odds ratio [OR] 0.02, 95% confidence interval [CI] 0.0007-0.63, p = 0.026). In controls, the MCA-BHI was not associated with deep WMH number. Interaction analysis revealed that migraine modified the effect of MCA-BHI on deep WMH number (p for interaction = 0.029). The MCA-BHI was not associated with increased deep WMH volume in both patients and controls. Age was independently associated with deep WMH volume in patients (adjusted OR 1.07, 95% CI 1.004-1.15, p = 0.037). CONCLUSIONS In this study, we found a migraine-specific association between a reduced CVR to apnea and increased number of deep WMHs in healthy, nonelderly patients with migraine. A dysfunctional vascular response to apnea may predispose migraineurs to an increased risk of WMHs.
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Affiliation(s)
- Mi Ji Lee
- From the Department of Neurology (M.J.L., S.C., C.-S.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Neuroscience Center (M.J.L., C.-S.C.), Samsung Medical Center, Seoul; Department of Electrical and Computer Engineering (B.-Y.P.) and School of Electronic and Electrical Engineering (H.P.), Sungkyunkwan University; and Center for Neuroscience Imaging Research (B.-Y.P., H.P.), Institute for Basic Science, Suwon, Korea
| | - Bo-Yong Park
- From the Department of Neurology (M.J.L., S.C., C.-S.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Neuroscience Center (M.J.L., C.-S.C.), Samsung Medical Center, Seoul; Department of Electrical and Computer Engineering (B.-Y.P.) and School of Electronic and Electrical Engineering (H.P.), Sungkyunkwan University; and Center for Neuroscience Imaging Research (B.-Y.P., H.P.), Institute for Basic Science, Suwon, Korea
| | - Soohyun Cho
- From the Department of Neurology (M.J.L., S.C., C.-S.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Neuroscience Center (M.J.L., C.-S.C.), Samsung Medical Center, Seoul; Department of Electrical and Computer Engineering (B.-Y.P.) and School of Electronic and Electrical Engineering (H.P.), Sungkyunkwan University; and Center for Neuroscience Imaging Research (B.-Y.P., H.P.), Institute for Basic Science, Suwon, Korea
| | - Hyunjin Park
- From the Department of Neurology (M.J.L., S.C., C.-S.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Neuroscience Center (M.J.L., C.-S.C.), Samsung Medical Center, Seoul; Department of Electrical and Computer Engineering (B.-Y.P.) and School of Electronic and Electrical Engineering (H.P.), Sungkyunkwan University; and Center for Neuroscience Imaging Research (B.-Y.P., H.P.), Institute for Basic Science, Suwon, Korea.
| | - Chin-Sang Chung
- From the Department of Neurology (M.J.L., S.C., C.-S.C.), Samsung Medical Center, Sungkyunkwan University School of Medicine; Neuroscience Center (M.J.L., C.-S.C.), Samsung Medical Center, Seoul; Department of Electrical and Computer Engineering (B.-Y.P.) and School of Electronic and Electrical Engineering (H.P.), Sungkyunkwan University; and Center for Neuroscience Imaging Research (B.-Y.P., H.P.), Institute for Basic Science, Suwon, Korea.
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Ascaso FJ, Marco S, Mateo J, Martínez M, Esteban O, Grzybowski A. Optical Coherence Tomography in Patients with Chronic Migraine: Literature Review and Update. Front Neurol 2017; 8:684. [PMID: 29321760 PMCID: PMC5733482 DOI: 10.3389/fneur.2017.00684] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2017] [Accepted: 11/30/2017] [Indexed: 01/27/2023] Open
Abstract
Migraine is a chronic disease characterized by unilateral, pulsating, and often moderate-to-severe recurrent episodes of headache with nausea and vomiting. It affects approximately 15% of the general population, yet the underlying pathophysiological mechanisms are not fully understood. Optical coherence tomography (OCT) is a safe and reproducible diagnostic technique that utilizes infrared wavelengths and has a sensitivity of 8–10 μm. It can be used to measure thinning of the retinal nerve fiber layer (RNFL) in some neurological disorders. Although ophthalmologists are often the first specialists to examine patients with migraine, few studies have addressed the involvement of the optic nerve and retino-choroidal structures in this group. We reviewed the literature on the etiological and pathological mechanisms of migraine and the relationship between recurrent constriction of cerebral and retrobulbar vessels and ischemic damage to the optic nerve, retina, and choroid. We also assessed the role of OCT for measuring peripapillary RNFL thickness and macular and choroidal changes in migraine patients. There is considerable evidence of cerebral and retrobulbar vascular involvement in the etiology of migraine. Transitory and recurrent constriction of the retinal and ciliary arteries may cause ischemic damage to the optic nerve, retina, and choroid in patients with migraine. OCT to assess the thickness of the peripapillary RNFL, macula, and choroid might increase our understanding of the pathophysiology of migraine and facilitate diagnosis of retino-choroidal compromise and follow-up of therapy in migraine patients. Future studies should determine the usefulness of OCT findings as a biomarker of migraine.
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Affiliation(s)
- Francisco J Ascaso
- Department of Ophthalmology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.,Instituto de Investigación Sanitaria de Aragón (IIS Aragon), Zaragoza, Spain
| | - Sara Marco
- Department of Ophthalmology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Javier Mateo
- Department of Ophthalmology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Mireya Martínez
- Department of Ophthalmology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Olivia Esteban
- Department of Ophthalmology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Andrzej Grzybowski
- Department of Ophthalmology, Poznan City Hospital, Poznan, Poland.,University of Warmia and Mazury, Olsztyn, Poland
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Cerebral endothelial dysfunction in reversible cerebral vasoconstriction syndrome: a case-control study. J Headache Pain 2017; 18:29. [PMID: 28229321 PMCID: PMC5321640 DOI: 10.1186/s10194-017-0738-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 02/15/2017] [Indexed: 01/03/2023] Open
Abstract
Background The aim of this study is to investigate cerebral endothelial dysfunction in patients with reversible cerebral vasoconstriction syndrome (RCVS). Methods We prospectively recruited patients with RCVS, age-matched controls with episodic migraine, and age-matched healthy controls at Samsung Medical Center from Apr 2015 to Jul 2016. All participants underwent transcranial Doppler evaluation, with a breath-holding maneuver, for the evaluation of bilateral middle cerebral arteries (MCAs), posterior cerebral arteries (PCAs), and the basilar artery (BA). The breath-holding index (BHI) was used to measure cerebral endothelium-dependent vasodilation. Follow-up BHIs were recorded in selected patients with RCVS after 3 months. Results A total of 84 subjects were recruited for this study (n = 28 in each group of RCVS, episodic migraine, and healthy control; mean age, 49.8 years). The RCVS group showed lower BHIs in all basal arteries, in comparison to healthy controls (p < 0.001, 0.009 for bilateral MCAs, p < 0.001 and 0.028 for bilateral PCAs, and p = 0.060 for the BA). Compared to migraineurs, RCVS patients had lower BHIs only in the anterior circulation (p = 0.002 and 0.038 for bilateral MCAs; p = 0.069 and 0.247 for bilateral PCAs; p = 0.120 for the BA). Of the 10 patients who had follow-up BHIs at 3 months, 7 showed complete normalization, while three did not. Conclusions Cerebral endothelial function is impaired in a widespread distribution in RCVS. Its role in the pathogenesis and clinical outcome of RCVS should be determined in further studies. Electronic supplementary material The online version of this article (doi:10.1186/s10194-017-0738-x) contains supplementary material, which is available to authorized users.
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Letra L, Sena C. Cerebrovascular Disease: Consequences of Obesity-Induced Endothelial Dysfunction. ADVANCES IN NEUROBIOLOGY 2017; 19:163-189. [PMID: 28933065 DOI: 10.1007/978-3-319-63260-5_7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Despite the well-known global impact of overweight and obesity in the incidence of cerebrovascular disease, many aspects of this association are still inconsistently defined. In this chapter we aim to present a critical review on the links between obesity and both ischemic and hemorrhagic stroke and discuss its influence on functional outcomes, survival, and current treatments to acute and chronic stroke. The role of cerebrovascular endothelial function and respective modulation is also described as well as its laboratory and clinical assessment. In this context, the major contributing mechanisms underlying obesity-induced cerebral endothelial function (adipokine secretion, insulin resistance, inflammation, and hypertension) are discussed. A special emphasis is given to the participation of adipokines in the pathophysiology of stroke, namely adiponectin, leptin, resistin, apelin, and visfatin.
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Affiliation(s)
- Liliana Letra
- Institute of Physiology, Institute for Biomedical Imaging and Life Sciences-IBILI, Faculty of Medicine, University of Coimbra, Coimbra, Portugal. .,Neurology Department, Centro Hospitalar do Baixo Vouga, Aveiro, Portugal.
| | - Cristina Sena
- Institute of Physiology, Institute for Biomedical Imaging and Life Sciences-IBILI, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
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Larsen JS, Skaug EA, Wisløff U, Ellingsen Ø, Stovner LJ, Linde M, Hagen K. Migraine and endothelial function: The HUNT3 Study. Cephalalgia 2016; 36:1341-1349. [DOI: 10.1177/0333102416631961] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 01/08/2016] [Accepted: 01/17/2016] [Indexed: 11/17/2022]
Abstract
Background Reduced endothelial function is associated with elevated risk of cardiovascular disease, but evidence on the association between migraine and endothelial function is conflicting. The aim of this population-based study was to examine the relationship between flow-mediated dilatation (FMD) and migraine with aura, migraine without aura and tension-type headache. Methods In the third Nord-Trøndelag Healthy Study (HUNT3) FMD was measured by ultrasound during reactive hyperaemia of the brachial artery in a sample of 4739 healthy adult participants, 3929 of whom answered headache questions. The cross-sectional association between different headache diagnoses and FMD was evaluated by logistic regression, using a categorical approach. Results Mean FMD did not differ between the headache groups and headache-free controls. In multi-adjusted analyses, no consistent association was found between FMD quintiles and headache groups. Conclusions There was no relationship between FMD and migraine or other headache diagnoses in this large cross-sectional study of otherwise healthy respondents including freedom from pulmonary and cardiovascular diseases.
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Affiliation(s)
| | - Eli-Anne Skaug
- K.G. Jebsen Center of Exercise in Medicine, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Norway
| | - Ulrik Wisløff
- K.G. Jebsen Center of Exercise in Medicine, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Norway
- Department of Cardiology, St. Olavs Hospital, Norway
| | - Øyvind Ellingsen
- K.G. Jebsen Center of Exercise in Medicine, Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Norway
- Department of Cardiology, St. Olavs Hospital, Norway
| | - Lars Jacob Stovner
- Department of Neuroscience, Norwegian University of Science and Technology, Norway
- Norwegian Advisory Unit on Headaches, St Olavs Hospital, Norway
| | - Mattias Linde
- Department of Neuroscience, Norwegian University of Science and Technology, Norway
- Norwegian Advisory Unit on Headaches, St Olavs Hospital, Norway
| | - Knut Hagen
- Department of Neuroscience, Norwegian University of Science and Technology, Norway
- Norwegian Advisory Unit on Headaches, St Olavs Hospital, Norway
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Koban Y, Ozlece HK, Bilgin G, Koc M, Cagatay HH, Durgunlu EI, Burcu A. Intraocular pressure and ocular biometric parameters changes in migraine. BMC Ophthalmol 2016; 16:70. [PMID: 27245325 PMCID: PMC4886420 DOI: 10.1186/s12886-016-0258-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Accepted: 05/27/2016] [Indexed: 01/03/2023] Open
Abstract
Background The aim of this study was to assess the intraocular pressure and ocular biometric parameters in migraine patients during acute migraine attacks and compare them with painless period and healthy controls using a new optical biometer AL-Scan. Methods In this prospective, case–control study, the axial length, corneal curvature radius, anterior chamber depth, central corneal thickness, and pupil size of 40 migraine patients during acute migraine attacks and painless period and 40 age- and sex-matched healthy subjects were measured using a AL-Scan optical biometer (Nidek Co., Gamagori, Japan). All patients underwent a complete ophthalmic examination before the measurements. IOP and biometer measurements were taken at the same time of day (10:00–12:00) in order to minimize the effects of diurnal variation. Results There was not a statistically significant difference in intraocular pressure between the migraine patients during acute migraine attacks (15.07 mmHg), painless period (14.10 mmHg), and the controls (15,73 ± 0,81). Also, the ocular biometric parameters did not significantly vary during the acute migraine attacks. Conclusions Further studies are needed to evaluate the etiopathologic relationship between intraocular pressure and ocular biometric parameters and acute migraine attack.
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Affiliation(s)
- Yaran Koban
- Department of Ophthalmology, Faculty of Medicine, University of Kafkas, Kars, Turkey. .,Kafkas University Medical School, Merkez, 36100, Kars, Turkey.
| | | | - Gorkem Bilgin
- Department of Ophthalmology, Hacettepe University Beytepe Health Center, Ankara, Turkey
| | - Mustafa Koc
- Ophthalmology Department, Ulucanlar Eye Training and Research Hospital, Ankara, Turkey
| | - Halil Huseyin Cagatay
- Department of Ophthalmology, Faculty of Medicine, University of Kafkas, Kars, Turkey
| | - Emre I Durgunlu
- Department of Ophthalmology, Faculty of Medicine, University of Kafkas, Kars, Turkey
| | - Ayse Burcu
- Department of Ophthalmology, Faculty of Medicine, University of Kafkas, Kars, Turkey
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Lee MJ, Lee C, Chung CS. The Migraine-Stroke Connection. J Stroke 2016; 18:146-56. [PMID: 27283278 PMCID: PMC4901947 DOI: 10.5853/jos.2015.01683] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/12/2016] [Accepted: 02/11/2016] [Indexed: 01/03/2023] Open
Abstract
Migraine and stroke are common neurovascular disorders which share underlying physiological processes. Increased risks of ischemic stroke, hemorrhagic stroke, and subclinical ischemic lesions have been consistently found in migraineurs. Three possible associations are suggested. One is that underlying pathophysiology of migraine can lead to ischemic stroke. Second, common comorbidities between migraine and stroke can be present. Lastly, some syndromes can manifest with both migraine-like headache and cerebrovascular disease. Future studies should be targeted on bidirectional influence of migraine on different stroke mechanisms and optimal prevention of stroke in migraine patients.
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Affiliation(s)
- Mi Ji Lee
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Stroke Center, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Korea
| | - Chungbin Lee
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chin-Sang Chung
- Department of Neurology, Neuroscience Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Stroke Center, Heart Vascular Stroke Institute, Samsung Medical Center, Seoul, Korea
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13
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Prakash K, Chandran DS, Khadgawat R, Jaryal AK, Deepak KK. Correlations between endothelial function in the systemic and cerebral circulation and insulin resistance in type 2 diabetes mellitus. Diab Vasc Dis Res 2016; 13:49-55. [PMID: 26408643 DOI: 10.1177/1479164115604120] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Insulin resistance is associated with endothelial dysfunction in type 2 diabetes mellitus, which can lead to impaired vascular reactivities of both systemic and cerebral circulations. Appropriate 'correction' of vascular reactivity results for non-endothelium-dependent systemic effects avoids misinterpretation of endothelial function. Therefore, we 'corrected' vascular reactivity results and explored the potential correlations between systemic vascular reactivity, cerebrovascular reactivity and insulin resistance. In 34 patients, 'systemic vascular reactivity' was assessed by quantifying reactive hyperaemia. Cerebrovascular reactivity was assessed by quantifying changes in cerebral blood flow velocity during hypercapnia. To minimize the influence of non-endothelium-dependent systemic effects on vascular reactivity results, 'corrected systemic vascular reactivity' was calculated by normalizing systemic vascular reactivity using the measurements from the contralateral side; and cerebrovascular reactivity results were corrected by calculating percentage and absolute changes in cerebrovascular conductance index ('percent cerebrovascular conductance index' and 'delta cerebrovascular conductance index', respectively). Insulin resistance was estimated by homeostatic model assessment. Correlation between conventional cerebrovascular reactivity and systemic vascular reactivity was not significant. But correlations between 'corrected systemic vascular reactivity' and 'percent cerebrovascular conductance index' (r = 0.51; p = 0.002) and 'corrected systemic vascular reactivity' and 'delta cerebrovascular conductance index' (r = 0.50; p = 0.003) were significant. Among all vascular reactivity parameters, only 'delta cerebrovascular conductance index' was significantly correlated with homeostatic model assessment of insulin resistance (r = -0.38; p = 0.029). In conclusion, endothelial function in the systemic and cerebral circulations is moderately correlated, provided that vascular reactivity estimates are corrected for non-endothelium-dependent influences.
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Affiliation(s)
- Kiran Prakash
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India Department of Physiology, Government Medical College & Hospital, Chandigarh, India
| | - Dinu S Chandran
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Khadgawat
- Department of Endocrinology & Metabolism, All India Institute of Medical Sciences, New Delhi, India
| | - Ashok Kumar Jaryal
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
| | - Kishore K Deepak
- Department of Physiology, All India Institute of Medical Sciences, New Delhi, India
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Rajan R, Khurana D, Lal V. Interictal cerebral and systemic endothelial dysfunction in patients with migraine: a case-control study. J Neurol Neurosurg Psychiatry 2015; 86:1253-7. [PMID: 25550413 DOI: 10.1136/jnnp-2014-309571] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 12/01/2014] [Indexed: 11/04/2022]
Abstract
BACKGROUND Although systemic endothelial function is unimpaired in migraine, it is unknown whether cerebral endothelial function impairment exists in migraineurs. MATERIALS AND METHODS We conducted a prospective study to assess endothelial function in migraineurs (n=45) and healthy volunteers (n=44). Cerebral endothelial function was assessed by Breath Holding Index (BHI) on transcranial Doppler in bilateral middle cerebral artery (MCA at 30-60 mm), posterior cerebral artery (PCA at 60-80 mm) and basilar artery (BA at 80-120 mm) using bilateral monitoring probes fixed on headband. Brachial artery flow-mediated dilation (FMD) was used as measure of systemic endothelial function. RESULTS There was no difference in baseline mean velocities of MCA, PCA, BA among migraineurs and controls. Mean BHI was significantly lower in PCA (p<0.001) and BA (p<0.001) in patients with migraine with no difference in MCA (p=0.909, 0.450). Cerebral endothelial dysfunction (BHI<1.15) was present in 62.2% of migraineurs in the right PCA (p<0.001), 57.8% in left PCA (p<0.001) and 77.8% in BA (BHI <0.83, p<0.001). There was no difference in BHI among migraineurs without and with aura (n=15). Cerebral and systemic endothelial function had no correlation in migraineurs. Increasing BMI was identified as a predictor of impaired BHI in the BA in migraineurs (p=0.020). Age, sex, presence of aura, lateralisation of headache, headache frequency, time to last attack and impaired FMD were not associated with impaired PCA and BA BHI in migraineurs. CONCLUSIONS Migraineurs may have isolated cerebral endothelial dysfunction restricted to the posterior circulation in the absence of systemic endothelial dysfunction.
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Affiliation(s)
- Roopa Rajan
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dheeraj Khurana
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivek Lal
- Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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15
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González-Quintanilla V, Toriello M, Palacio E, González-Gay MA, Castillo J, Montes S, Martínez-Nieto R, Fernandez J, Rojo A, Gutiérrez S, Pons E, Oterino A. Systemic and cerebral endothelial dysfunction in chronic migraine. A case-control study with an active comparator. Cephalalgia 2015; 36:552-60. [PMID: 26395894 DOI: 10.1177/0333102415607857] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 08/30/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND OBJECTIVE Unlike migraine and migraine with aura, little information exists regarding chronic migraine (CM) as a risk factor for cardiovascular disease. In this study we aim to determine whether an association between CM and endothelial dysfunction exists. METHODS Individuals 18 years and older diagnosed with episodic migraine (EM) and CM according to ICHD criteria were studied. After an overnight fast and abstinence from vasoactive drugs, ultrasound studies were performed and blood samples taken from patients and matched controls according to internationally agreed on protocols. RESULTS A total of 113 individuals were enrolled (35 CM, 37 EM, 41 controls). CM patients had a lower percentage of flow-mediated vasodilation (FMD; difference of means = 5.03%; p = 1.0E-6) and breath-holding index (BHI; difference of means 0.754; p = 2.0E-6), as well as increased carotid intima media thickness (cIMT; difference of means = 0.128 mm; p = 7.0E-5) than controls. The EM patients and controls comparison found similar, but less pronounced, differences: decreased BHI (p = 0.031), and increased cIMT (p = 0.028). Fibrinogen (r = 0.277; p = 0.006), C-reactive protein (r = 0.288; p = 0.003), and erythrocyte rate sedimentation (r = 0.298; p = 0.002) also correlated with cIMT, and inversely with BHImV and FMD. CONCLUSIONS Migraine is associated with systemic and cerebral endothelial dysfunction demonstrated by ultrasound studies and biological markers. The degree of these changes was strongly associated with the severity of migraine. Our data indicate that migraine may be a cerebral disorder with systemic endothelial damage.
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Affiliation(s)
| | - María Toriello
- Service of Neurology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Spain
| | - Enrique Palacio
- Service of Neurology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Spain
| | - Miguel A González-Gay
- Service of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Spain
| | - Jesús Castillo
- Health Service of Camargo Costa, Servicio Cántabro de Salud, Spain
| | - Silvia Montes
- Health Service of Camargo Costa, Servicio Cántabro de Salud, Spain
| | | | - Jenifer Fernandez
- Service of Neurology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Spain
| | - Alvaro Rojo
- Service of Neurology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Spain
| | - Silvia Gutiérrez
- Service of Neurology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Spain
| | - Enar Pons
- Service of Neurology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Spain
| | - Agustín Oterino
- Service of Neurology, Hospital Universitario Marqués de Valdecilla, IDIVAL, Spain
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Fabjan A, Zaletel M, Žvan B. Is there a persistent dysfunction of neurovascular coupling in migraine? BIOMED RESEARCH INTERNATIONAL 2015; 2015:574186. [PMID: 25705673 PMCID: PMC4331400 DOI: 10.1155/2015/574186] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 12/02/2014] [Indexed: 12/21/2022]
Abstract
Changes in cerebral blood flow are one of the main features of migraine attack and have inspired the vascular theory of migraine. This traditional view has been reshaped with recent experimental data, which gave rise to the neural theory of migraine. In this review, we speculate that there might be an important link between the two theories, that is, the dysfunction of neurovascular coupling.
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Affiliation(s)
- Andrej Fabjan
- Institute of Physiology, Medical Faculty, University of Ljubljana, Zaloška Cesta 4, 1000 Ljubljana, Slovenia
| | - Marjan Zaletel
- Department of Vascular Neurology, University Clinical Centre, Zaloška Cesta 2, 1000 Ljubljana, Slovenia
| | - Bojana Žvan
- Department of Vascular Neurology, University Clinical Centre, Zaloška Cesta 2, 1000 Ljubljana, Slovenia
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Fischer M, Gaul C, Shanib H, Holle D, Loacker L, Griesmacher A, Lackner P, Broessner G. Markers of endothelial function in migraine patients: Results from a bi-center prospective study. Cephalalgia 2014; 35:877-85. [DOI: 10.1177/0333102414564890] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 11/27/2014] [Indexed: 11/16/2022]
Abstract
Background Numerous studies suggest an increased vascular risk in patients with migraine, in particular in those with aura. A possible link between both conditions might be a dysfunction of the vascular endothelium. This observational study analyzed the endothelial markers angiopoietin-1, angiopoietin-2, Tie-2, sFlt-1 and NT-proBNP for the first time in migraineurs, patients with other primary headache disorders and healthy controls. Methods Patients with episodic migraine with and without aura, episodic cluster headache, tension-type headache and healthy controls were included. Blood samples were obtained during migraine attacks and headache-free periods in migraineurs, in and out of bout in cluster headache and during headache-free periods in tension-type headache and healthy individuals to analyze markers of endothelial function. Results No significant difference in endothelial markers between migraine, other headache disorders and healthy controls was detected. There was no significant difference between migraine attacks and headache-free intervals. Additionally, no distinction could be found between migraine with and without aura. Discussion The endothelial markers analyzed do not display a characteristic pattern in different headache disorders especially migraine compared to healthy controls. The novel findings of our study indicate that factors other than endothelial dysfunction seem to be responsible for the at least statistical association of migraine with vascular disease.
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Affiliation(s)
- Marlene Fischer
- Department of Neurology, Headache Outpatient Clinic, Medical University of Innsbruck, Austria
| | - Charly Gaul
- Department of Neurology, University of Duisburg-Essen, Germany
- Migräne und Kopfschmerzklinik Königstein, Germany
| | - Hind Shanib
- Department of Neurology, University of Duisburg-Essen, Germany
| | - Dagny Holle
- Department of Neurology, University of Duisburg-Essen, Germany
| | - Lorin Loacker
- Central Institute of Medicinal and Chemical Laboratory Diagnostics, University Hospital, Austria
| | - Andrea Griesmacher
- Central Institute of Medicinal and Chemical Laboratory Diagnostics, University Hospital, Austria
| | - Peter Lackner
- Department of Neurology, Headache Outpatient Clinic, Medical University of Innsbruck, Austria
| | - Gregor Broessner
- Department of Neurology, Headache Outpatient Clinic, Medical University of Innsbruck, Austria
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Abstract
BACKGROUND Migraine, particularly with aura, increases the risk for ischemic stroke, at least in a subset of patients. The underlying mechanisms are poorly understood and probably multifactorial. METHODS We carried out an extended literature review of experimental and clinical evidence supporting the association between migraine and ischemic stroke to identify potential mechanisms that can explain the association. RESULTS Observational, imaging and genetic evidence support a link between migraine and ischemic stroke. Based on clinical and experimental data, we propose mechanistic hypotheses to explain the link, such as microembolic triggers of migraine and enhanced sensitivity to ischemic injury in migraineurs. DISCUSSION We discuss the possible practical implications of clinical and experimental data, such as aggressive risk factor screening and management, stroke prophylaxis and specific acute stroke management in migraineurs. However, evidence from prospective clinical trials is required before modifying the practice in this patient population.
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Affiliation(s)
- Jerome Mawet
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, MA, USA Emergency Headache Center, Lariboisiere Hospital, Assistance Publique-Hopitaux de Paris, France DHU NeuroVasc, France
| | - Tobias Kurth
- Inserm Research Center for Epidemiology and Biostatistics (U897), Team Neuroepidemiology, France University of Bordeaux, College of Health Sciences, France Division of Preventive Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, MA, USA
| | - Cenk Ayata
- Neurovascular Research Laboratory, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, MA, USA Stroke Service and Neuroscience Intensive Care Unit, Department of Neurology, Massachusetts General Hospital, Harvard Medical School, MA, USA
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Borgdorff P, Tangelder GJ. Incomplete circle of willis and migraine: role for shear-induced platelet aggregation? Headache 2014; 54:1054-6. [PMID: 24916591 DOI: 10.1111/head.12348] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Piet Borgdorff
- Institute for Cardiovascular Research, VU University Medical Center, Amsterdam, The Netherlands
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20
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Sacco S, Ripa P, Grassi D, Pistoia F, Ornello R, Carolei A, Kurth T. Peripheral vascular dysfunction in migraine: a review. J Headache Pain 2013; 14:80. [PMID: 24083826 PMCID: PMC3849862 DOI: 10.1186/1129-2377-14-80] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 09/20/2013] [Indexed: 12/13/2022] Open
Abstract
Numerous studies have indicated an increased risk of vascular disease among migraineurs. Alterations in endothelial and arterial function, which predispose to atherosclerosis and cardiovascular diseases, have been suggested as an important link between migraine and vascular disease. However, the available evidence is inconsistent. We aimed to review and summarize the published evidence about the peripheral vascular dysfunction of migraineurs.We systematically searched in BIOSIS, the Cochrane database, Embase, Google scholar, ISI Web of Science, and Medline to identify articles, published up to April 2013, evaluating the endothelial and arterial function of migraineurs.Several lines of evidence for vascular dysfunction were reported in migraineurs. Findings regarding endothelial function are particularly controversial since studies variously indicated the presence of endothelial dysfunction in migraineurs, the absence of any difference in endothelial function between migraineurs and non-migraineurs, and even an enhanced endothelial function in migraineurs. Reports on arterial function are more consistent and suggest that functional properties of large arteries are altered in migraineurs.Peripheral vascular function, particularly arterial function, is a promising non-invasive indicator of the vascular health of subjects with migraine. However, further targeted research is needed to understand whether altered arterial function explains the increased risk of vascular disease among patients with migraine.
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Affiliation(s)
- Simona Sacco
- Department of Neurology and Regional Headache Center, University of L'Aquila, Piazzale Salvatore Tommasi 1, L'Aquila, 67100, Italy.
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Chronic consumption of a wild green oat extract (Neuravena) improves brachial flow-mediated dilatation and cerebrovascular responsiveness in older adults. J Hypertens 2013; 31:192-200. [PMID: 23221935 DOI: 10.1097/hjh.0b013e32835b04d4] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Heart health benefits have been attributed to regular consumption of oats. Preclinical evidence suggests that a wild green oat extract (WGOE) may improve vasodilator function, but this is yet to be evaluated in humans. OBJECTIVE To determine whether regular daily consumption of WGOE can influence vasodilator function in systemic and cerebral arteries. METHODS Thirty-seven healthy older adults (>60 years) completed a 24-week randomized, double-blind, placebo-controlled two-way crossover dietary intervention with 1500 mg/day of encapsulated WGOE or placebo. All assessments were conducted at the end of each 12-week intervention arm, after participants had fasted for at least 4 h and at least 18 h after they had taken their last dose of supplement. Flow-mediated dilatation (FMD) of the brachial artery and hypercapnia-induced increases of blood flow in the middle cerebral artery were used to measure systemic and cerebral vasodilator responsiveness (CVR), respectively. RESULTS Compared with placebo, WGOE supplementation increased CVR and FMD to a similar extent (42 and 41%, respectively, P < 0.01 for both). The improvements in CVR and FMD were not correlated. Resting blood pressure did not alter with supplementation. Dose and treatment duration were well tolerated by participants. CONCLUSION WGOE supplementation can improve vasodilator function in systemic and cerebral arteries, suggesting a potential role in the maintenance of cardiovascular health.
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Lantz M, Kostulas K, Sjöstrand C. Migraine-related ischemic stroke? Acta Neurol Scand 2013; 127:e18-23. [PMID: 23278955 DOI: 10.1111/ane.12069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2012] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Migraine, especially migraine with aura, has been described to be associated with an increased risk for ischemic stroke. An increased incidence of silent lesions in the posterior circulation has also been described. METHOD Six cases with migraine and stroke in close relation over time were retrospectively reviewed. RESULTS All patients had previously known MA or MO and suffered from a stroke within the first 24-hour period after an acute migraine attack. None of the patients fulfilled the IHS criteria for migrainous infarction. Four out of these six patients had a patent foramen ovale (PFO) or an atrial septal defect (ASD). DISCUSSION None of these cases can be categorized as migrainous infarctions according to IHS. However, the migraine attack might have been involved in the mechanisms for the development of the infarctions.
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Affiliation(s)
- M. Lantz
- Department of Neurology; Karolinska Institute; Karolinska University Hospital; Stockholm; Sweden
| | - K. Kostulas
- Department of Neurology; Karolinska Institute; Karolinska University Hospital; Stockholm; Sweden
| | - C. Sjöstrand
- Department of Neurology; Karolinska Institute; Karolinska University Hospital; Stockholm; Sweden
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Miao J, Wang F, Fang Y. Association of 231G>A polymorphism of endothelin type A receptor gene with migraine: a meta-analysis. J Neurol Sci 2012; 323:232-5. [PMID: 23058564 DOI: 10.1016/j.jns.2012.09.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Revised: 09/20/2012] [Accepted: 09/25/2012] [Indexed: 11/08/2022]
Abstract
BACKGROUND/AIMS Vascular dysfunction is implied in migraine. Endothelin type A receptor (EDNRA) is a receptor for endothelin-1, a potent vasoconstrictor. Several studies have investigated the association between EDNRA -231G>A SNP and migraine, but showed conflicting results. This study aimed to evaluate the association between EDNRA -231A allele and migraine by meta-analysis. METHODS Relevant databases were searched to identify eligible studies published in English from 2000 to 2012. Data were extracted using standardized forms. The association was assessed by relative risk (RR) with 95% confidence intervals (CIs) using a fixed or random effects model to determine the strength of the genetic association. RESULTS Three studies comprising 440 migraineurs, 222 subjects with tension-type headaches (TTHs) and 1323 controls were included in the meta-analysis. A significant difference was found between migraineurs and controls with AA genotype vs. AG+GG, and pooled RR with fixed effect was 4.04 (95% CI 1.173, 1.585; p=0.000, I(2)=15.1%). However, there was no statistically significant difference between TTH and controls (p=0.774). CONCLUSIONS This meta-analysis provides evidence suggesting a significant association between EDNRA -231G>A polymorphism and migraine.
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Affiliation(s)
- Jiayin Miao
- Department of Neurology, Zhongshan Hospital, Xiamen University, 201 Hubinnan Road, Xiamen 361004, China
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Liman TG, Neeb L, Rosinski J, Wellwood I, Reuter U, Doehner W, Heuschmann PU, Endres M. Peripheral endothelial function and arterial stiffness in women with migraine with aura: a case-control study. Cephalalgia 2012; 32:459-66. [PMID: 22523187 DOI: 10.1177/0333102412444014] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Vascular dysfunction may be involved in migraine pathophysiology and contribute to the increased risk of ischemic stroke in migraine, particularly in women with migraine with aura (MA). However, data on endothelial function in MA are controversial. Here, we investigated whether systemic endothelial function and arterial stiffness are altered in women with MA, using a novel peripheral arterial tonometry device for the first time. METHODS Twenty-nine female MA patients without comorbidities and 30 healthy women were included, and carotid intima-media thickness was assessed by a standardized procedure. Endothelial function was assessed using peripheral arterial tonometry. Reactive hyperaemic response of digital pulse amplitude was measured following 5 minutes of forearm occlusion of the brachial artery. Arterial stiffness was assessed by fingertip tonometry derived and heart-rate-adjusted augmentation index. RESULTS No differences were found in peripheral arterial tonometry ratio (2.3 ± 0.6 vs 2.2 ± 0.8; p = 0.58) and left carotid intima-media thickness (in µm: 484 ± 119 vs 508 ± 60; p = 0.37). Women with MA had higher heart-rate-averaged augmentation index [median (interquartile range, IQR) of 5 (IQR 0.5 to 18) vs -5 (IQR -16.8 to 8.3), p = 0.005] and heart-rate-adjusted augmentation index [1 (IQR -6 to 12.5) vs -8 (IQR -20.3 to 2.5), p = 0.008] than healthy controls. CONCLUSION Peripheral endothelial function is not impaired in women with MA, but they have greater arterial stiffness. This may contribute to the increased stroke risk in women with MA.
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Affiliation(s)
- T G Liman
- Charité-Universitätsmedizin Berlin, Germany.
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