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Al-Nimry SS, Alkilani AZ, Alda'ajeh NA. Transdermal drug delivery of rizatriptan using microneedles array patch: preparation, characterization and ex-vivo/in-vivo study. Pharm Dev Technol 2024:1-14. [PMID: 39159078 DOI: 10.1080/10837450.2024.2393218] [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: 05/31/2024] [Revised: 08/11/2024] [Accepted: 08/12/2024] [Indexed: 08/21/2024]
Abstract
Given the extensive first pass metabolism of rizatriptan in oral administration and its delayed absorption during a migraine attack as a result of gastric stasis, focus has been on transdermal delivery. The main purpose of this study is to prepare and assess transdermal formulation of rizatriptan, loaded on hydrogel microneedles delivery system, to avoid first pass metabolism and also improve its percutaneous permeation rate. Rizatriptan hydrogel microneedles were prepared using micromolding method and evaluated in terms of mechanical strength, encapsulation efficiency, permeation and in-vivo skin absorption. Different formulations of rizatriptan microneedles (F1-F5) were successfully prepared using different concentrations of carboxymethyl cellulose and gelatin type A. Rizatriptan hydrogel microneedles demonstrated favorable mechanical properties, including withstanding insertion forces, thereby enhancing its skin insertion ability. In permeation study, the percent cumulative drug released after 24 h ranged between 93.1-100% which means that microneedles were able to deliver the drug effectively. For in-vivo study, F3 formulation was selected due to its superior characteristics over other formulations as it exhibited the highest swelling capacity, and demonstrated favorable mechanical properties. Furthermore, F3 showcased the most controlled drug release over a 24-hour period. Relative bioavailability of F3 microneedles was 179.59% compared to oral administration based on the AUC0-24. The observed AUC0-24 in F3 microneedles was statistically significant and 1.80 times greater than that in oral administration. The higher rizatriptan level in the microneedle demonstrated adequate drug permeability through the rat skin, suggesting the potential of microneedles for enhanced therapeutic effectiveness.
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Affiliation(s)
- Suhair S Al-Nimry
- Department of Pharmaceutical Technology, Jordan University of Science and Technology, Irbid, Jordan
| | | | - Nareman A Alda'ajeh
- Department of Pharmaceutical Technology, Jordan University of Science and Technology, Irbid, Jordan
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Alshamrani FJ, AlSheikh MH, Almuslim N, Al Azman H, Alkhamis F, Nazish S, Alnajashi H, Alsulaiman A. Prospective Matched Case-Control Study of Over-Early P100 Wave Latency in Migraine with Aura. Biomedicines 2023; 11:2979. [PMID: 38001979 PMCID: PMC10669729 DOI: 10.3390/biomedicines11112979] [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: 09/25/2023] [Revised: 10/19/2023] [Accepted: 10/28/2023] [Indexed: 11/26/2023] Open
Abstract
A sizable portion of the world's population suffers from migraines with aura. The purpose of this research is to describe the findings of a case-control study that was carried out to gain a better understanding of how migraine with aura manifests. The research looked at the P100 delay of the visual-evoked potential in both eyes of 92 healthy people and 44 patients who suffered from migraines with visual aura. All of the participants in the study were recruited from King Fahad University Hospital in Saudi Arabia. Both sets of people had the same ancestry and originated from the same location. Patients who suffered from migraines with aura exhibited a significantly shorter P100 delay in both eyes compared to healthy controls (p = 0.001), which is evidence that their early visual processing was distinct. In order to arrive at these findings, we compared people who suffer from migraines with aura to people who do not suffer from migraines and used them as subjects. These findings contribute to the ongoing attempts to bring the disease under control and provide vitally significant new information regarding the functioning of headaches with auras. The primary focus of study in the future should be on determining the nature of the connection between issues with early visual processing and headaches with aura.
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Affiliation(s)
- Foziah J. Alshamrani
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia (S.N.)
| | - Mona Hmoud AlSheikh
- Physiology Department, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia;
| | - Noora Almuslim
- Neurology Department, King Fahad University Hospital, Dammam, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Hatem Al Azman
- Neurology Department, King Fahad University Hospital, Dammam, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia
| | - Fahad Alkhamis
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia (S.N.)
| | - Saima Nazish
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia (S.N.)
| | - Hind Alnajashi
- Neurology Division, Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
| | - Abdulla Alsulaiman
- Department of Neurology, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam 34212, Saudi Arabia (S.N.)
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Basappa P, MS US, Dama VR. Isolation and characterization of major degradants in dihydroergotamine injection. ACTA CHROMATOGR 2022. [DOI: 10.1556/1326.2022.01095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AbstractIn this study, we report the systematic approach for characterization of two major degradant impurities, which are not listed in any compendia and were formed during the stability studies of Dihydroergotamine mesylate injection (DHE). An ion-pair UPLC chromatographic method was developed to quantify the related substances present in the DHE injection drug product. The same was used to monitor the impurity profiling during its stability. The two unknown impurities were observed at RRT about 0.08 (Impurity-1) and RRT about 0.80 (Impurity-5) and found to be significantly increasing on stability. Forced degradation studies revealed the nature of the impurity and conditions required for enriching them. A Mass compatible HPLC method was developed to quantify only these two impurities using 25% ammonia and formic acid in water. Their mass numbers were identified using LC MS/MS with triple quadruple mass spectrometer coupled with a HPLC. These two impurities were then isolated from enriched products using preparative HPLC. These impurities were then characterized using Mass and NMR analysis along with Q-TOF elemental analysis.
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Affiliation(s)
- Praveen Basappa
- Integrated Product Development, Dr Reddys Laboratory, Bachupally, Hyderabad, Telangana-500049, India
| | - Uma Shankar MS
- Department of Pharmaceutics, SRM University, Kattankulathur, Chengalpattu District, Tamil Nadu–603203, India
| | - Venugopala Rao Dama
- Integrated Product Development, Dr Reddys Laboratory, Bachupally, Hyderabad, Telangana-500049, India
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Nguyen JL, Munshi K, Peasah SK, Swart ECS, Kohli M, Henderson R, Good CB. Trends in utilization and costs of migraine medications, 2017–2020. J Headache Pain 2022; 23:111. [PMID: 36031609 PMCID: PMC9420279 DOI: 10.1186/s10194-022-01476-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 08/04/2022] [Indexed: 11/16/2022] Open
Abstract
Objective This study examines changes in utilization and costs trends associated with migraine medications. Background Migraine attacks are a burden to many patients. There are many pharmacotherapy options available with newer migraine drug classes entering the market in the past decade. Little is known about the use, associated costs, and the impact of the newer agents. Methods This retrospective, cross-sectional study examined 2017–2020 administrative claims from a large national pharmacy benefits manager. Patients aged ≥ 18 years enrolled in commercial, Medicare, Medicaid, or health insurance exchange insurance plans who filled ≥ 2 prescription claims for triptans, ergotamines, isometheptenes, gepants, ditans, and CGRP mABs were included. A two-sample t-test was conducted to estimate whether differences in mean utilization and costs between 2017 and 2020 were statistically significant for migraine drug classes, except for CGRP mABs, which were estimated between 2018 and 2020. Results The sample ranged from 161,369 (2017) to 240,330 (2020) patients. 84.5% (n = 203,110; 2020) of patients were women. The number of 30-day adjusted prescription fills for prophylaxis remained stable over the four-year period, except for CGRP mABs, which increased from 0.5% (n = 0.007; 2018) to 5.3% (n = 0.075; 2020). Antiepileptics, antidepressants and beta blockers were the most common prophylaxes, while triptans, non-steroidal anti-inflammatory drugs/non-narcotic analgesics and opioids were the most common treatments utilized. CGRP mABs were the most expensive, while utilization of triptans were the highest. CGRP mABs had the largest increase in utilization (177.5%) and costs (166.3%) PPPM in 2020 ($291.17) compared to 2018 ($109.35), the year they were first available (p < 0.001). Between 2018 and 2020, costs increased overall and for commercial and Medicare enrollees, but remained unchanged for Medicaid and HIX members. Conclusion Our study demonstrates a shift in migraine medication utilization from 2017–2020, where increased use of CGRP mABs had a significant contribution to increased costs. These increased pharmacy costs must be weighed against the improved tolerability of these agents likely resulting in other healthcare and indirect cost savings. Supplementary Information The online version contains supplementary material available at 10.1186/s10194-022-01476-y.
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Ly-Yang F, Gómez-Calleja V, Pérez-García P, González-Gómez N, Porta-Etessam J, Santos-Bueso E. Intercritical photophobia in the migrainous patient. Proposal for diagnostic criteria. NEUROLOGÍA (ENGLISH EDITION) 2022:S2173-5808(22)00077-3. [PMID: 35842130 DOI: 10.1016/j.nrleng.2020.12.004] [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: 05/12/2020] [Accepted: 12/17/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Photophobia is a symptom of abnormal light intolerance without pain sensation that requires an anamnesis and an examination to diagnose an underlying etiology. BASIC PROCEDURE This article focuses on 30 clinical cases with isolated intense photophobia and on the review of the literature. OBJECTIVE The purpose of this article is to establish diagnostic criteria for photophobia. RESULTS The etiology of photophobia appears to be at the level of the intrinsically photosensitive retinal ganglion cells known as melanopsin cells and at a neurochemical level mediated by calcitonin-related peptide and the pituitary activating peptide cyclase. CONCLUSION The treatment of photophobia could consist of monoclonal antibodies against calcitonin-related peptide and/or pituitary activating peptide cyclase.
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Affiliation(s)
- F Ly-Yang
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain.
| | - V Gómez-Calleja
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - P Pérez-García
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - N González-Gómez
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - J Porta-Etessam
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
| | - E Santos-Bueso
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, Spain
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Wang L, Tan HP, Han R. The Association Between Blood Pressure and Headache in Postmenopausal Women: A Prospective Hospital-Based Study. Int J Gen Med 2021; 14:2563-2568. [PMID: 34163225 PMCID: PMC8216200 DOI: 10.2147/ijgm.s317780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 06/03/2021] [Indexed: 12/01/2022] Open
Abstract
Background Headache is the most frequent condition for outpatient patients because of neurological problems, but little is known about predisposing and enabling factors for headache patients. Aim To investigate the association between blood pressure (BP) and headache in postmenopausal women. Methods The postmenopausal women who were admitted to our hospital from January 2015 to December 2019 were screening according to the criteria. Their systolic BP (SBP), diastolic BP (DBP), pulse pressure (PP) were assessed and the information of age, body mass index, smoking status, caffeine consumption, cholesterol levels, and daily alcohol use were collected. Multiple logistic regression model was established to evaluate the association between BP and headache. Results A total of 1571 postmenopausal women were included in the analysis, including 953 headache-free population and 618 headache participants during the studied periods. We found that increasing SBP and PP were associated with the lower occurrence of migraine, tension-type headache (TTH), probable migraine, and unclassified headache (P < 0.05). However, there was a negative association between DBP levels and the new occurrence of overall headache, but we did not find any relations of DBP with any subtypes of headache. Conclusion There were negative associations of SBP and PP with new occurrence of headache, especially migraine and TTH, but there is no relationship between DBP and the subsequent development of headache.
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Affiliation(s)
- Liu Wang
- Department of Pain Management, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province, People's Republic of China
| | - Hong-Ping Tan
- Department of Pain Management, Affiliated Hospital of North Sichuan Medical College, Nanchong, Sichuan Province, People's Republic of China
| | - Rui Han
- The Affiliated Yantai Yuhuangding Hospital of Medical College, Qingdao University, Yantai, Shandong Province, People's Republic of China
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Ly-Yang F, Gómez-Calleja V, Pérez-García P, González-Gómez N, Porta-Etessam J, Santos-Bueso E. Intercritical photophobia in the migraineous patient. Proposal for diagnostic criteria. Neurologia 2021; 38:S0213-4853(21)00005-0. [PMID: 33622562 DOI: 10.1016/j.nrl.2020.12.004] [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: 05/12/2020] [Revised: 12/13/2020] [Accepted: 12/17/2020] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Photophobia is a symptom of abnormal light intolerance without pain sensation that requires an anamnesis and an examination to diagnose an underlying etiology. BASIC PROCEDURE This article focuses on 30 clinical cases with isolated intense photophobia and on the review of the literature. OBJECTIVE The purpose of this article is to establish diagnostic criteria for photophobia. RESULTS The etiology of photophobia appears to be at the level of the intrinsically photosensitive retinal ganglion cells known as melanopsin cells and at a neurochemical level mediated by calcitonin-related peptide and the pituitary activating peptide cyclase. CONCLUSION The treatment of photophobia could consist of monoclonal antibodies against calcitonin-related peptide and/or pituitary activating peptide cyclase.
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Affiliation(s)
- F Ly-Yang
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España.
| | - V Gómez-Calleja
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - P Pérez-García
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - N González-Gómez
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - J Porta-Etessam
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - E Santos-Bueso
- Unidad de Neurooftalmología, Servicio de Oftalmología, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
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Association of dietary diversity score (DDS) and migraine headache severity among women. Neurol Sci 2021; 42:3403-3410. [PMID: 33428056 DOI: 10.1007/s10072-020-04982-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 12/09/2020] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Migraine is an episodic disorder that is characterized by unilateral headache lasting 4-72 h along with certain associated features. Modifying dietary habits have been considered an appropriate therapeutic approach in these patients. This study was designed to examine the association between dietary diversity score (DDS) and severity, frequency, and duration of migraine attacks. METHODS AND MATERIALS The present study was conducted using a cross-sectional design on 256 women 18-50 years old referred to neurology clinics for the first time. After the diagnosis of migraine by a neurologist, the data related to anthropometric measures and dietary intake (147-item semi-quantitative food frequency questionnaire) were collected. To assess migraine severity, the migraine disability assessment questionnaire (MIDAS), visual analog scale (VAS), and a 30-day headache diary were used. Multinomial logistic regression was used to evaluate the association between DDS and migraine severity. The age, physical activity, BMI, and job were considered confounding variables in regression model. Data were analyzed using SPSS software and P values < 0.05 considered statistically significant. RESULTS Totally, 256 subjects participated in the present study with mean age, height, weight, and BMI of 34.28 ± 7.88 years, 161.78 ± 5.18 cm, 69.25 ± 13.06 kg, and 26.46 ± 4.89 kg/m2, respectively. Subjects with higher DDS had a lower waist circumference (P = 0.01). There was no association between DDS and other anthropometric measures and demographic characteristics (P > 0.05). In the crude model of logistic regression, participants with lower DDS had higher odds of more pain severity (OR = 2.30; 95% CI = 1.28, 4.12; P = 0.005), migraine disability (OR = 2.66; 95% CI = 1.51, 4.69; P = 0.001), and headache duration (OR = 2.32; CI = 1.22, 4.40; P = 0.01) compared to reference group. No association was found between headache frequency and DDS. Adjusting for the effect of confounding variables did not change the significant association. CONCLUSION DDS was inversely associated with migraine disability, pain severity, and headache frequency. Additional studies are needed to replicate these findings and to explore mechanisms that mediate the association between DDS and migraine attacks.
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Guo Y, Cheng Y, An J, Qi Y, Luo G. Neuropeptide changes in an improved migraine model with repeat stimulations. Transl Neurosci 2021; 12:523-532. [PMID: 34963819 PMCID: PMC8662580 DOI: 10.1515/tnsci-2020-0201] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/14/2021] [Accepted: 11/19/2021] [Indexed: 01/03/2023] Open
Abstract
Migraine is a medical condition with a severe recursive headache. The activation of the trigeminovascular system is an important mechanism. The neuropeptide calcitonin gene-related peptide (CGRP) plays a crucial role in the pathogenesis of migraine. Several other neuropeptides are also involved; however, their roles in migraine remain unclear. In this study, using a rat model of migraine induced by electrical stimulation of the trigeminal ganglia (TG) and an improved version induced with repeated stimulation, we observed the dynamic changes of these peptides in TG and blood. We demonstrated that the expression of CGRP, pituitary adenylate cyclase activating polypeptide (PACAP), neuropeptide Y (NPY), vasoactive intestinal peptide, and nociceptin in TG was significantly elevated and peaked at different time points after a single stimulation. Their levels in the blood plasma were significantly increased at 12 h after stimulation. The peptides were further elevated with repeated stimulation. The improved rat model of migraine with repeated stimulation of TG resulted in a more pronounced elevation of CGRP, PACAP, and NPY. Thus, the dynamic changes in neuropeptides after stimulation suggest that these neuropeptides may play an important role in the pathogenesis of migraine. Additionally, the migraine model with repetitive stimulation would be a novel model for future research.
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Affiliation(s)
- Yichen Guo
- Stroke Center, Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, 710061, China
| | - Yawen Cheng
- Stroke Center, Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, 710061, China
| | - Jiaqi An
- Stroke Center, Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, 710061, China
| | - Yi Qi
- Stroke Center, Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, 710061, China
| | - Guogang Luo
- Stroke Center, Department of Neurology, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 Yanta West Road, Xi'an, 710061, China
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Quintas M, Neto JL, Sequeiros J, Sousa A, Pereira-Monteiro J, Lemos C, Alonso I. Going Deep into Synaptic Vesicle Machinery Genes and Migraine Susceptibility - A Case-Control Association Study. Headache 2020; 60:2152-2165. [PMID: 32979221 DOI: 10.1111/head.13957] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 08/28/2020] [Accepted: 08/29/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE A number of observations, including among our study population, have implicated variants in the syntaxin-1A, a component of the synaptic vesicles, in migraine susceptibility. Therefore, we hypothesize that variants in other components of the vesicle machinery are involved in migraine. BACKGROUND Migraine is a common and complex neurologic disorder that affects approximately 15-18% of the general population. The exact cause of migraine is unknown; however, genetic studies have made possible substantial progress toward the identification of underlying molecular pathways. Neurotransmitters have been for long considered to have a key role in migraine pathophysiology; so we investigated common variants in genes involved in the synaptic vesicle machinery and their impact in migraine susceptibility. METHODS We performed a case-control study comprising 188 unrelated patients with headache and 286 healthy controls in a population from the north of Portugal. Benefiting from the presence of linkage disequilibrium, we selected and genotyped 119 tagging single-nucleotide polymorphisms in 18 genes. RESULTS We found significant associations between single-nucleotide variants and migraine in 7 genes, SYN1, SYN2, SNAP25, VAMP2, STXBP1, STXBP5, and UNC13A, either conferring an increased risk or protection of migraine. Due to SYN1 X-chromosomal location, we performed the statistical analysis separated by gender and, in the female group, the C allele of rs5906435 increased the risk for migraine susceptibility (P = .021; OR = 1.69; 95% CI: 1.21-2.34). In contrast, the TT genotype of the same variant emerged as a potential protective factor (P = .003; OR = 0.45; 95% CI: 0.27-0.74). The SYN2 analysis supported the rs3773364's G allele (P = .014) as a risk factor for migraine, and although not statistically significant after correction, the AG genotype (P = .006; OR = 1.86; 95% CI: 1.20-2.90) reinforced the allelic findings. Additionally, we found the SNAP25-rs363039's CT genotype (P = .001; OR = 2.14; 95% CI: 1.36-3.34), the STXBP5-rs1765028's T allele (P = .041; OR = 1.46; 95% CI: 1.13-1.90), and the UNC13B-rs7851161's TT genotype (P = .001; OR = 2.14; 95% CI: 1.36-3.34) as statistically significant risk factors for migraine liability. VAMP2-rs1150's G allele revealed a risk association to migraine, not statistically significant after correction (P = .068). Additionally, we found haplotypes in SYN1, SYN2, STXBP1, and UNC13B to be associated with migraine. CONCLUSIONS Overall, this study provides a new insight into migraine liability, identifying possible starting points for functional studies.
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Affiliation(s)
- Marlene Quintas
- UnIGENe, IBMC - Institute for Molecular and Cell Biology, Universidade do Porto, Porto, Portugal.,i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,ICBAS - Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - João Luís Neto
- UnIGENe, IBMC - Institute for Molecular and Cell Biology, Universidade do Porto, Porto, Portugal.,i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,ICBAS - Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Jorge Sequeiros
- UnIGENe, IBMC - Institute for Molecular and Cell Biology, Universidade do Porto, Porto, Portugal.,i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,ICBAS - Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Alda Sousa
- UnIGENe, IBMC - Institute for Molecular and Cell Biology, Universidade do Porto, Porto, Portugal.,i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,ICBAS - Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - José Pereira-Monteiro
- UnIGENe, IBMC - Institute for Molecular and Cell Biology, Universidade do Porto, Porto, Portugal.,i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal
| | - Carolina Lemos
- UnIGENe, IBMC - Institute for Molecular and Cell Biology, Universidade do Porto, Porto, Portugal.,i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,ICBAS - Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Isabel Alonso
- UnIGENe, IBMC - Institute for Molecular and Cell Biology, Universidade do Porto, Porto, Portugal.,i3S - Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Porto, Portugal.,ICBAS - Instituto Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
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Mazdeh M, Mahmudian R, Vafaei SY, Taheri M, Ghafouri-Fard S. Effect of propranolol with and without rosuvastatin on migraine attacks: a triple blind randomized clinical trial. FUTURE NEUROLOGY 2020. [DOI: 10.2217/fnl-2019-0029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Aim: To investigate the effect of rosuvastatin in combination with propranolol in reducing migraine attacks. Patients & methods: In a clinical trial study with census method, 120 patients with migraine headache were included. Patients were randomly assigned (using block randomization) to either propranolol (10 mg twice a day) with rosuvastatin (10 mg daily; intervention group [n = 60]) or propranolol (10 mg twice a day) with placebo (control [n = 60]). Results: The numbers of attacks were significantly decreased in the intervention group at the end of second, third and fourth weeks from the beginning of the intervention (p < 0.05). Conclusion: In patients with migraine, concomitant administration of propranolol (10 mg twice a day) and rosuvastatin (10 mg daily) is effective in reducing migraine attacks.
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Affiliation(s)
- Mehrdokht Mazdeh
- Neurophysiology Research Center, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Rihane Mahmudian
- Department of Neurology, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Seyed Y Vafaei
- Department of Pharmaceutics & Pharmaceutical Biotechnology, School of Pharmacy, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Taheri
- Urogenital Stem Cell Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Soudeh Ghafouri-Fard
- Department of Medical Genetics, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Liu Y, Chen QY, Lee JH, Li XH, Yu S, Zhuo M. Cortical potentiation induced by calcitonin gene-related peptide (CGRP) in the insular cortex of adult mice. Mol Brain 2020; 13:36. [PMID: 32151282 PMCID: PMC7063738 DOI: 10.1186/s13041-020-00580-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 03/03/2020] [Indexed: 02/06/2023] Open
Abstract
Recent studies demonstrate that calcitonin gene-related peptide (CGRP) plays critical roles in migraine. Immunohistochemistry and in situ hybridization studies have shown that CGRP and its receptors are expressed in cortical areas that are critical for pain perception including the anterior cingulate cortex (ACC) and insular cortex (IC). Recent studies reported that CGRP enhanced excitatory transmission in the ACC. However, little is known about the possible effect of CGRP on excitatory transmission in the IC. In the present study, we investigated the role of CGRP on synaptic transmission in the IC slices of adult male mice. Bath application of CGRP produced dose-dependent potentiation of evoked excitatory postsynaptic currents (eEPSCs). This potentiation was NMDA receptor (NMDAR) independent. After application of CGRP1 receptor antagonist CGRP8–37 or BIBN 4096, CGRP produced potentiation was significantly reduced. Paired-pulse facilitation was significantly decreased by CGRP, suggesting possible presynaptic mechanisms. Consistently, bath application of CGRP significantly increased the frequency of spontaneous and miniature excitatory postsynaptic currents (sEPSCs and mEPSCs). By contrast, amplitudes of sEPSCs and mEPSCs were not significantly affected. Finally, adenylyl cyclase subtype 1 (AC1) and protein kinase A (PKA) are critical for CGRP-produced potentiation, since both selective AC1 inhibitor NB001 and the PKA inhibitor KT5720 completely blocked the potentiation. Our results provide direct evidence that CGRP contributes to synaptic potentiation in the IC, and the AC1 inhibitor NB001 may be beneficial for the treatment of migraine in the future.
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Affiliation(s)
- Yinglu Liu
- Center for Neuron and Disease, Frontier Institutes of Science and Technology, Xi'an Jiaotong University, Xi'an, China.,Department of Physiology, University of Toronto, 1 King's College Circle, Toronto, Ontario, M5S 1A8, Canada.,Medical School of Chinese PLA and Department of Neurology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Qi-Yu Chen
- Center for Neuron and Disease, Frontier Institutes of Science and Technology, Xi'an Jiaotong University, Xi'an, China.,Department of Physiology, University of Toronto, 1 King's College Circle, Toronto, Ontario, M5S 1A8, Canada.,Institute for Brain Research, QingDao International Academician Park, Qing Dao, China
| | - Jung Hyun Lee
- Department of Physiology, University of Toronto, 1 King's College Circle, Toronto, Ontario, M5S 1A8, Canada
| | - Xu-Hui Li
- Center for Neuron and Disease, Frontier Institutes of Science and Technology, Xi'an Jiaotong University, Xi'an, China.,Department of Physiology, University of Toronto, 1 King's College Circle, Toronto, Ontario, M5S 1A8, Canada.,Institute for Brain Research, QingDao International Academician Park, Qing Dao, China
| | - Shengyuan Yu
- Medical School of Chinese PLA and Department of Neurology, The First Medical Centre, Chinese PLA General Hospital, Beijing, China
| | - Min Zhuo
- Center for Neuron and Disease, Frontier Institutes of Science and Technology, Xi'an Jiaotong University, Xi'an, China. .,Department of Physiology, University of Toronto, 1 King's College Circle, Toronto, Ontario, M5S 1A8, Canada. .,Institute for Brain Research, QingDao International Academician Park, Qing Dao, China.
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Levetiracetam as preventive treatment in adults with migraine: an up-to-date systematic review and quantitative meta-analysis. Eur J Clin Pharmacol 2019; 76:161-174. [DOI: 10.1007/s00228-019-02790-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 10/25/2019] [Indexed: 01/21/2023]
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14
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Gross EC, Klement RJ, Schoenen J, D'Agostino DP, Fischer D. Potential Protective Mechanisms of Ketone Bodies in Migraine Prevention. Nutrients 2019; 11:E811. [PMID: 30974836 PMCID: PMC6520671 DOI: 10.3390/nu11040811] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 04/04/2019] [Accepted: 04/08/2019] [Indexed: 12/15/2022] Open
Abstract
An increasing amount of evidence suggests that migraines are a response to a cerebral energy deficiency or oxidative stress levels that exceed antioxidant capacity. The ketogenic diet (KD), a diet mimicking fasting that leads to the elevation of ketone bodies (KBs), is a therapeutic intervention targeting cerebral metabolism that has recently shown great promise in the prevention of migraines. KBs are an alternative fuel source for the brain, and are thus likely able to circumvent some of the abnormalities in glucose metabolism and transport found in migraines. Recent research has shown that KBs-D-β-hydroxybutyrate in particular-are more than metabolites. As signalling molecules, they have the potential to positively influence other pathways commonly believed to be part of migraine pathophysiology, namely: mitochondrial functioning, oxidative stress, cerebral excitability, inflammation and the gut microbiome. This review will describe the mechanisms by which the presence of KBs, D-BHB in particular, could influence those migraine pathophysiological mechanisms. To this end, common abnormalities in migraines are summarised with a particular focus on clinical data, including phenotypic, biochemical, genetic and therapeutic studies. Experimental animal data will be discussed to elaborate on the potential therapeutic mechanisms of elevated KBs in migraine pathophysiology, with a particular focus on the actions of D-BHB. In complex diseases such as migraines, a therapy that can target multiple possible pathogenic pathways seems advantageous. Further research is needed to establish whether the absence/restriction of dietary carbohydrates, the presence of KBs, or both, are of primary importance for the migraine protective effects of the KD.
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Affiliation(s)
- Elena C Gross
- Division of Paediatric Neurology, University Children's Hospital Basel (UKBB), University of Basel, 4056 Basel, Switzerland.
| | - Rainer J Klement
- Department of Radiation Oncology, Leopoldina Hospital Schweinfurt, 97422 Schweinfurt, Germany.
| | - Jean Schoenen
- Headache Research Unit, University of Liège, Dept of Neurology-Citadelle Hospital, 4000 Liège, Belgium.
| | - Dominic P D'Agostino
- Department of Molecular Pharmacology and Physiology, Metabolic Medicine Research Laboratory, Morsani College of Medicine, University of South Florida, Tampa, FL 33612, USA.
- Institute for Human and Machine Cognition, Ocala, FL 34471, USA.
| | - Dirk Fischer
- Division of Paediatric Neurology, University Children's Hospital Basel (UKBB), University of Basel, 4056 Basel, Switzerland.
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15
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Gross E, Putananickal N, Orsini AL, Schmidt S, Vogt DR, Cichon S, Sandor P, Fischer D. Efficacy and safety of exogenous ketone bodies for preventive treatment of migraine: A study protocol for a single-centred, randomised, placebo-controlled, double-blind crossover trial. Trials 2019; 20:61. [PMID: 30654835 PMCID: PMC6337840 DOI: 10.1186/s13063-018-3120-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 12/09/2018] [Indexed: 01/22/2023] Open
Abstract
Background Currently available prophylactic migraine treatment options are limited and are associated with many, often intolerable, side-effects. Various lines of research suggest that abnormalities in energy metabolism are likely to be part of migraine pathophysiology. Previously, a ketogenic diet (KD) has been reported to lead to a drastic reduction in migraine frequency. An alternative method to a strict KD is inducing a mild nutritional ketosis (0.4–2 mmol/l) with exogenous ketogenic substances. The aim of this randomised, placebo-controlled, double-blind, crossover, single-centre trial is to demonstrate safety and superiority of beta-hydroxybutyrate (βHB) in mineral salt form over placebo in migraine prevention. Methods/design Forty-five episodic migraineurs (5–14 migraine days/months), with or without aura, aged between 18 and 65 years, will be recruited at headache clinics in Switzerland, Germany and Austria and via Internet announcements. After a 4-week baseline period, patients will be randomly allocated to one of the two trial arms and receive either the βHB mineral salt or placebo for 12 weeks. This will be followed by a 4-week wash-out period, a subsequent second baseline period and, finally, another 12-week intervention with the alternative treatment. Co-medication with triptans (10 days per months) or analgesics (14 days per months) is permitted. The primary outcome is the mean change from baseline in the number of migraine days (meeting International Classification of Headache Disorders version 3 criteria) during the last 4 weeks of intervention compared to placebo. Secondary endpoints include mean changes in headache days of any severity, acute migraine medication use, migraine intensity and migraine and headache-related disability. Exploratory outcomes are (in addition to routine laboratory analysis) genetic profiling and expression analysis, oxidative and nitrosative stress, as well as serum cytokine analysis, and blood βHB and glucose analysis (pharmacokinetics). Discussion A crossover design was chosen as it greatly improves statistical power and participation rates, without increasing costs. To our knowledge this is the first RCT using βHB salts worldwide. If proven effective and safe, βHB might not only offer a new prophylactic treatment option for migraine patients, but might additionally pave the way for clinical trials assessing its use in related diseases. Trial registration ClinicalTrials.gov, NCT03132233. Registered on 27 April 2017. Electronic supplementary material The online version of this article (10.1186/s13063-018-3120-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Elena Gross
- Division of Neuropaediatrics, University of Basel Children's Hospital, University of Basel, Spitalstrasse 33, Postfach, 4056, Basel, Switzerland
| | - Niveditha Putananickal
- Division of Neuropaediatrics, University of Basel Children's Hospital, University of Basel, Spitalstrasse 33, Postfach, 4056, Basel, Switzerland.
| | - Anna-Lena Orsini
- Division of Neuropaediatrics, University of Basel Children's Hospital, University of Basel, Spitalstrasse 33, Postfach, 4056, Basel, Switzerland
| | - Simone Schmidt
- Division of Neuropaediatrics, University of Basel Children's Hospital, University of Basel, Spitalstrasse 33, Postfach, 4056, Basel, Switzerland
| | - Deborah R Vogt
- Department of Clinical Research, Clinical Trial Unit, University of Basel Hospital, University of Basel, Basel, Switzerland
| | - Sven Cichon
- Department of Medical Genetics, University of Basel Hospital, University of Basel, Basel, Switzerland
| | | | - Dirk Fischer
- Division of Neuropaediatrics, University of Basel Children's Hospital, University of Basel, Spitalstrasse 33, Postfach, 4056, Basel, Switzerland
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17
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Sprenger T, Viana M, Tassorelli C. Current Prophylactic Medications for Migraine and Their Potential Mechanisms of Action. Neurotherapeutics 2018; 15:313-323. [PMID: 29671241 PMCID: PMC5935650 DOI: 10.1007/s13311-018-0621-8] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
A relatively high number of different medications is currently used for migraine prevention in clinical practice. Although these compounds were initially developed for other indications and differ in their mechanisms of action, some general themes can be identified from the mechanisms at play. Efficacious preventive drugs seem to either suppress excitatory nervous signaling via sodium and/or calcium receptors, facilitate GABAergic inhibition, reduce neuronal sensitization, block cortical spreading depression and/or reduce circulating levels of CGRP. We here review such mechanisms for the different compounds.
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Affiliation(s)
- Till Sprenger
- Department of Neurology, DKD Helios Klinik Wiesbaden, Aukammallee 33, 65191, Wiesbaden, Germany.
| | - M Viana
- Headache Science Centre, IRCCS Mondino Foundation, 27100, Pavia, Italy
| | - C Tassorelli
- Headache Science Centre, IRCCS Mondino Foundation, 27100, Pavia, Italy
- Department of Brain and Behavioral Sciences, University of Pavia, 27100, Pavia, Italy
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18
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Balottin L, Mannarini S, Candeloro D, Mita A, Chiappedi M, Balottin U. Rorschach Evaluation of Personality and Emotional Characteristics in Adolescents With Migraine Versus Epilepsy and Controls. Front Neurol 2018; 9:160. [PMID: 29615959 PMCID: PMC5869322 DOI: 10.3389/fneur.2018.00160] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/05/2018] [Indexed: 01/24/2023] Open
Abstract
The literature examining primary headache, including migraine, in adolescents, has pointed out the key role played by a wide range of psychiatric disorders in reducing the patients’ quality of life. Moreover, pioneering studies showed that preexisting personality characteristics, specific emotion regulation styles and psychological-psychiatric difficulties are likely to increase the risk of the onset, maintenance, and outcome of headache. Still personality issues in migraine have been poorly studied, in particular in children and adolescents. This study aims, therefore, to investigate the specific characteristics of personality, and in particular emotion regulation and coping strategies, in adolescent with migraine, comparing them with age-matched patients with idiopathic epilepsy and healthy adolescents. 52 adolescents (age: 11–17) were assessed using a multi-method test battery, which included a self-report questionnaire (the youth self-report), a proxy-report (child behavior checklist) along with a projective personality test, the Rorschach Test, administered and scored according to the Exner comprehensive system. The results showed specific personality characteristics in adolescents with migraine, revealing a marked difficulty in modulating and regulating affections through thoughts and reflections, resorting instead to impulsive acts and maladaptive coping strategies, thus revealing a vague and immature perception of reality. Differently from adolescents belonging to the general population, but similarly to patients with epilepsy, adolescents with migraine perceive a high situational stress, probably related to the condition of suffering from chronic disease. They have, therefore, a lower self-consideration and self-esteem along with a poorer insight regarding themselves as well as the relations with others. In line with previous findings, these preliminary results suggest the need for further research on ample samples, using also standardized projective test in order to better understand the pathogenesis of psychological difficulties in patients with migraine. As a clinical implication, the results seem to indicate that providing a psychological integrated approach can play a pivotal role in the assessment and treatment of adolescent with migraine, in order to improve the outcome and the quality of life of the young patients.
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Affiliation(s)
- Laura Balottin
- Interdepartmental Center for Family Research, Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy
| | - Stefania Mannarini
- Interdepartmental Center for Family Research, Department of Philosophy, Sociology, Education, and Applied Psychology, Section of Applied Psychology, University of Padova, Padova, Italy
| | - Daniela Candeloro
- Child Neuropsychiatry Unit, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Alda Mita
- Child Neuropsychiatry Unit, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
| | - Matteo Chiappedi
- Child Neuropsychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
| | - Umberto Balottin
- Child Neuropsychiatry Unit, Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.,Child Neuropsychiatry Unit, IRCCS Mondino Foundation, Pavia, Italy
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19
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Abstract
Photophobia is a common symptom seen in many neurologic disorders, however, its pathophysiology remains unclear. Even the term is ambiguous. In this paper, we review the epidemiology and clinical manifestations of photophobia in neurological disorders, including primary headache, blepharospasm, progressive supranuclear palsy, and traumatic brain injury, discuss the definition, etiology and pathogenesis, and summarize practical methods of diagnosis and treatment.
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Affiliation(s)
- Yiwen Wu
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Drive MSC 1428, Building 10, Room 7D37, Bethesda, MD 20892 USA
| | - Mark Hallett
- Human Motor Control Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, 10 Center Drive MSC 1428, Building 10, Room 7D37, Bethesda, MD 20892 USA
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20
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Warfvinge K, Edvinsson L. Distribution of CGRP and CGRP receptor components in the rat brain. Cephalalgia 2017; 39:342-353. [PMID: 28856910 DOI: 10.1177/0333102417728873] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Calcitonin gene-related peptide and its receptor, consisting of receptor activity-modifying protein 1 and calcitonin receptor-like receptor, are of considerable interest because of the role they play in migraine and recently developed migraine therapies. METHODS To better understand the function of this neuropeptide, we used immunohistochemistry to determine a detailed distribution of calcitonin gene-related peptide, receptor activity-modifying protein 1 and calcitonin receptor-like receptor in the rat brain in a region of 0.5-1.5 mm lateral to the midline. We found calcitonin gene-related peptide immunoreactivity in most of the neurons of the cerebral cortex, hippocampus, cerebellum, thalamic nuclei, hypothalamic nuclei and brainstem nuclei. In contrast, receptor activity-modifying protein 1 and calcitonin receptor-like receptor immunoreactivity were found almost exclusively in the neuronal processes in the investigated regions. CONCLUSION Overall, the degree of expression of calcitonin gene-related peptide and calcitonin gene-related peptide receptor components in the central nervous system is astonishingly complex and suggestive of many different brain functions, including a possible role in migraine. However, currently, the presence of calcitonin gene-related peptide and the nature of its receptors throughout the brain is an enigma yet to be solved.
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Affiliation(s)
- Karin Warfvinge
- 1 Department of Clinical Experimental Research, Glostrup Research Institute, Rigshospitalet, Glostrup, Denmark.,2 Division of Experimental Vascular Research, Department of Clinical Sciences, Lund University Hospital, Lund, Sweden
| | - Lars Edvinsson
- 1 Department of Clinical Experimental Research, Glostrup Research Institute, Rigshospitalet, Glostrup, Denmark.,2 Division of Experimental Vascular Research, Department of Clinical Sciences, Lund University Hospital, Lund, Sweden
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21
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Sorbi MJ, Balk Y, Kleiboer AM, Couturier EG. Follow-up over 20 months confirms gains of online behavioural training in frequent episodic migraine. Cephalalgia 2016; 37:236-250. [PMID: 27558500 DOI: 10.1177/0333102416657145] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aim This study examined the change over 20 months in 178 participants with frequent episodic migraine under adequate treatment as usual, who had completed online behavioural training (oBT) in migraine self-management either directly (group 1, n = 120) or after 10 months of watchful waiting (group 2, n = 58). Methods Participants completed questionnaires and an online headache diary and migraine monitor following the International Classification of Headache Disorders at T0 (baseline), T1 (post-training), T2 (6-month follow-up; extended baseline in group 2), T3 (post-training, group 2 only) and T4 (group 1: 16-month follow-up; group 2: 6-month follow-up). Statistical analyses were conducted on the observed data without imputation of missing observations. Results Both groups were highly comparable. The data over time revealed benefits in response to oBT, with significant between-group differences in the change achieved in the training episodes T2-T0 (group 1) and T4-T2 (group 2). Improved attack frequency ( M = -23%) was higher in participants with more (i.e. 4-6) attacks per month at baseline, and the effects of oBT were durable over 16 months of follow-up. Conclusions oBT is beneficial in frequent episodic migraine, which deserves special efforts in care. Self-management variants such as oBT reach patients easily and supplement these efforts with durable results.
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Affiliation(s)
- Marjolijn J Sorbi
- 1 Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Yannick Balk
- 1 Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands
| | - Annet M Kleiboer
- 1 Department of Clinical Psychology, Utrecht University, Utrecht, The Netherlands.,2 Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
| | - Emile Gm Couturier
- 3 Department of Neurology/Clinical Neurophysiology, Boerhaave Medical Center, Amsterdam, The Netherlands
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22
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Omranifard M, Abdali H, Ardakani MR, Talebianfar M. A comparison of outcome of medical and surgical treatment of migraine headache: In 1 year follow-up. Adv Biomed Res 2016; 5:121. [PMID: 27563631 PMCID: PMC4976529 DOI: 10.4103/2277-9175.186994] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Accepted: 10/26/2014] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND This study was designed to compare the efficacy of the medical treatment versus the surgical treatment approach to decompression of trigger point nerves in patients with migraine headaches. MATERIALS AND METHODS Fifty volunteers were randomly assigned to the medical treatment group (n = 25) or the surgical treatment group (n = 25) after examination by the team neurologist to ensure a diagnosis of migraine headache. All patients received botulinum toxin type A to confirm the trigger sites. The surgical treatment group underwent surgical deactivation of the trigger site(s). The medical treatment group underwent prophylactic pharmacologic interventions by the neurologist. Pretreatment and 12-month posttreatment migraine headache frequency, duration, and intensity were analyzed and compared to determine the success of the treatments. RESULTS Nineteen of the 25 patients (76%) in the surgical treatment group and 10 of the 25 patients (40%) in the medical treatment group experienced a successful outcome (at least a 50% decrease in migraine frequency, duration, or intensity) after 1 year from surgery. Surgical treatment had a significantly higher success rate than medical treatment (P < 0.001). Nine patients (36%) in the surgical treatment group and one patient (4%) in the medical treatment group experienced cessation of migraine headaches. The elimination rate was significantly higher in the surgical treatment group than in the medical treatment group (P < 0.001). CONCLUSIONS Based on the 1-year follow-up data, there is strong evidence that surgical manipulation of one or more migraine trigger sites can successfully eliminate or reduce the frequency, duration, and intensity of migraine headaches in a lasting manner.
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Affiliation(s)
- Mahmood Omranifard
- Department of Aesthetic, Plastic and Reconstructive Surgery, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Hossein Abdali
- Department of Aesthetic, Plastic and Reconstructive Surgery, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Mehdi Rasti Ardakani
- Department of Aesthetic, Plastic and Reconstructive Surgery, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
| | - Mohsen Talebianfar
- Department of Aesthetic, Plastic and Reconstructive Surgery, School of Medicine, Isfahan University of Medical Science, Isfahan, Iran
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Wu D, Zhou Y, Xiang J, Tang L, Liu H, Huang S, Wu T, Chen Q, Wang X. Multi-frequency analysis of brain connectivity networks in migraineurs: a magnetoencephalography study. J Headache Pain 2016; 17:38. [PMID: 27090418 PMCID: PMC4835413 DOI: 10.1186/s10194-016-0636-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 04/12/2016] [Indexed: 12/26/2022] Open
Abstract
Background Although alterations in resting-state neural network have been previously reported in migraine using functional MRI, whether this atypical neural network is frequency dependent remains unknown. The aim of this study was to investigate the alterations of the functional connectivity of neural network and their frequency specificity in migraineurs as compared with healthy controls by using magnetoencephalography (MEG) and concepts from graph theory. Methods Twenty-three episodic migraine patients with and without aura, during the interictal period, and 23 age- and gender-matched healthy controls at resting state with eye-closed were studied with MEG. Functional connectivity of neural network from low (0.1–1 Hz) to high (80–250 Hz) frequency ranges was analyzed with topographic patterns and quantified with graph theory. Results The topographic patterns of neural network showed that the migraineurs had significantly increased functional connectivity in the slow wave (0.1–1 Hz) band in the frontal area as compared with controls. Compared with the migraineurs without aura (MwoA), the migraineurs with aura (MwA) had significantly increased functional connectivity in the theta (4–8 Hz) band in the occipital area. Graph theory analysis revealed that the migraineurs had significantly increased connection strength in the slow wave (0.1–1 Hz) band, increased path length in the theta (4–8 Hz) and ripple (80–250 Hz) bands, and increased clustering coefficient in the slow wave (0.1–1 Hz) and theta (4–8 Hz) bands. The clinical characteristics had no significant correlation with interictal MEG parameters. Conclusions Results indicate that functional connectivity of neural network in migraine is significantly impaired in both low- and high-frequency ranges. The alteration of neural network may imply that migraine is associated with functional brain reorganization.
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Affiliation(s)
- Di Wu
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, 264 Guangzhou Road, Nanjing, Jiangsu, 210029, China
| | - Yuchen Zhou
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, 264 Guangzhou Road, Nanjing, Jiangsu, 210029, China
| | - Jing Xiang
- MEG Center, Division of Neurology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH, 45220, USA
| | - Lu Tang
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, 264 Guangzhou Road, Nanjing, Jiangsu, 210029, China
| | - Hongxing Liu
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, 264 Guangzhou Road, Nanjing, Jiangsu, 210029, China
| | - Shuyang Huang
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, 264 Guangzhou Road, Nanjing, Jiangsu, 210029, China
| | - Ting Wu
- MEG Center, Nanjing Brain Hospital, Nanjing, Jiangsu, 210029, China
| | - Qiqi Chen
- MEG Center, Nanjing Brain Hospital, Nanjing, Jiangsu, 210029, China
| | - Xiaoshan Wang
- Department of Neurology, Nanjing Brain Hospital, Nanjing Medical University, 264 Guangzhou Road, Nanjing, Jiangsu, 210029, China.
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Concussion in the Military: an Evidence-Base Review of mTBI in US Military Personnel Focused on Posttraumatic Headache. Curr Pain Headache Rep 2016; 20:37. [DOI: 10.1007/s11916-016-0572-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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25
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Kıvanç SA, Ulusoy MO, Akova-Budak B, Olcaysu OO, Özcan ME. Is ciliary muscle affected in migraine patients with aura and without aura? Med Sci Monit 2015; 21:1214-8. [PMID: 25919450 PMCID: PMC4424908 DOI: 10.12659/msm.893307] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND The aim of this study was to compare spherical equivalents (SE) and spherical equivalents with cycloplegic (CSE) values of migraine patients with and without visual aura, with those patients without migraine complaints. MATERIAL/METHODS We included patients over the age of 18 years, who had 20/20 uncorrected vision, and who did not have ocular pathology in their examination. The patients were divided into 3 groups: Group 1: 86 eyes of 43 migraine patients without aura, Group 2: 38 eyes of 19 migraine patients with aura, and Group 3: 60 eyes of 30 patients without migraine. Spherical equivalents and spherical equivalents with cycloplegic from the auto-refractometrical values of the patients were compared. RESULTS The mean age of the migraine and control patients was 34.2±8.3 and 33.6±10.8 years, respectively. Forty-three (69%) of 62 migraine patients had migraine without aura and 19 (31%) had migraine with aura. The right and left eyes of the patients were evaluated together and a significant correlation was found between the groups. To evaluate the impact of cycloplegia in patients, SE and CSE values were obtained and differences between these values were evaluated. It was found that the change in Group 2 patients was significantly lower than the change in Group 3 patients (p=0.024). CONCLUSIONS We found that the cycloplegic spherical equivalents values of our patients with aura were lower than control patients. We need further studies to reveal whether migraine with aura is the trigger or the result of those attacks.
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Affiliation(s)
- Sertaç Argun Kıvanç
- Department of Ophthalmology, Uludag University, School of Medicine, Bursa, Turkey
| | - Mahmut Oğuz Ulusoy
- Department of Ophthalmology, Kastamonu Münif İslamoğlu State Hospital, Kastamonu, Turkey
| | - Berna Akova-Budak
- Department of Ophthalmology, Uludag University, School of Medicine, Bursa, Turkey
| | - Osman Okan Olcaysu
- Department of Ophthalmology, Erzurum Region Training and Research Hospital, Erzurum, Turkey
| | - Muhammed Emin Özcan
- Department of Neurology, Bezmialem Vakıf University, Medical Faculty, İstanbul, Turkey
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Banzi R, Cusi C, Randazzo C, Sterzi R, Tedesco D, Moja L. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) for the prevention of migraine in adults. Cochrane Database Syst Rev 2015; 4:CD002919. [PMID: 25829028 PMCID: PMC6513227 DOI: 10.1002/14651858.cd002919.pub3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND This is an updated version of the original Cochrane review published in 2005 on selective serotonin reuptake inhibitors (SSRIs) for preventing migraine and tension-type headache. The original review has been split in two parts and this review now only regards migraine prevention. Another updated review is under development to cover tension-type headache.Migraine is a common disorder. The chronic forms are associated with disability and have a high economic impact. In view of discoveries about the role of serotonin and other neurotransmitters in pain mechanisms, selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) have been evaluated for the prevention of migraine. OBJECTIVES To determine the efficacy and tolerability of SSRIs and SNRIs compared to placebo and other active interventions in the prevention of episodic and chronic migraine in adults. SEARCH METHODS For the original review, we searched MEDLINE (1966 to January 2004), EMBASE (1994 to May 2003), the Cochrane Central Register of Controlled Trials (CENTRAL 2003, Issue 4), and Headache Quarterly (1990 to 2003). For this update, we applied a revised search strategy to reflect the broader type of intervention (SSRIs and SNRIs). We searched CENTRAL (2014, Issue 10), MEDLINE (1946 to November 2014), EMBASE (1980 to November 2014), and PsycINFO (1987 to November 2014). We also checked the reference lists of retrieved articles and searched trial registries for ongoing trials. SELECTION CRITERIA We included randomised controlled trials comparing SSRIs or SNRIs with any type of control intervention in participants 18 years and older of either sex with migraine. DATA COLLECTION AND ANALYSIS Two authors independently extracted data (migraine frequency, index, intensity, and duration; use of symptomatic/analgesic medication; days off work; quality of life; mood improvement; cost-effectiveness; and adverse events) and assessed the risk of bias of trials. The primary outcome of this updated review is migraine frequency. MAIN RESULTS The original review included eight studies on migraine. Overall, we now include 11 studies on five SSRIs and one SNRI with a total of 585 participants. Six studies were placebo-controlled, four compared a SSRI or SNRI to amitriptyline, and one was a head-to-head comparison (escitalopram versus venlafaxine). Most studies had methodological or reporting shortcomings (or both): all studies were at unclear risk of selection and reporting bias. Follow-up rarely extended beyond three months. The lack of adequate power of most of the studies is also a major concern.Few studies explored the effect of SSRIs or SNRIs on migraine frequency, the primary endpoint. Two studies with unclear reporting compared SSRIs and SNRIs to placebo, suggesting a lack of evidence for a difference. Two studies compared SSRIs or SNRIs versus amitriptyline and found no evidence for a difference in terms of migraine frequency (standardised mean difference (SMD) 0.04, 95% confidence interval (CI) -0.72 to 0.80; I(2) = 72%), or other secondary outcomes such as migraine intensity and duration.SSRIs or SNRIs were generally more tolerable than tricyclics. However, the two groups did not differ in terms of the number of participants who withdrew due to adverse advents or for other reasons (one study, odds ratio (OR) 0.39, 95% CI 0.10 to 1.50 and OR 0.42, 95% CI 0.13 to 1.34).We did not find studies comparing SSRIs or SNRIs with pharmacological treatments other than antidepressants (e.g. antiepileptics and anti-hypertensives). AUTHORS' CONCLUSIONS Since the last version of this review, the new included studies have not added high quality evidence to support the use of SSRIs or venlafaxine as preventive drugs for migraine. There is no evidence to consider SSRIs or venlafaxine as more effective than placebo or amitriptyline in reducing migraine frequency, intensity, and duration over two to three months of treatment. No reliable information is available at longer-term follow-up. Our conclusion is that the use of SSRIs and SNRIs for migraine prophylaxis is not supported by evidence.
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Affiliation(s)
- Rita Banzi
- IRCCS ‐ Mario Negri Institute for Pharmacological ResearchLaboratory of Regulatory Policiesvia G La Masa 19MilanItaly20156
| | - Cristina Cusi
- Istituti Clinici di PerfezionamentoOut Patient Services ‐ NeurologyVia Castelvetro 22MilanoItaly20154
| | - Concetta Randazzo
- University of BolognaDepartment of Biomedical and Neuromotor SciencesVia San Giacomo, 12BolognaItaly40126
| | - Roberto Sterzi
- Azienda Ospedaliera NiguardaNeuroscience DepartmentPiazza Ospedale Maggiore, 3MilanoItaly20163
| | - Dario Tedesco
- University of BolognaDepartment of Biomedical and Neuromotor SciencesVia San Giacomo, 12BolognaItaly40126
| | - Lorenzo Moja
- University of MilanDepartment of Biomedical Sciences for HealthVia Pascal 36MilanMilanItaly20133
- IRCCS Galeazzi Orthopaedic InstituteUnit of Clinical EpidemiologyMilanItaly
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How spreading depolarization can be the pathophysiological correlate of both migraine aura and stroke. ACTA NEUROCHIRURGICA. SUPPLEMENT 2015; 120:137-40. [PMID: 25366613 DOI: 10.1007/978-3-319-04981-6_23] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
The term spreading depolarization describes a mechanism of abrupt, massive ion translocation between neurons and the interstitial space, which leads to a cytotoxic edema in the gray matter of the brain. In energy-compromised tissue, spreading depolarization is preceded by a nonspreading silencing (depression of spontaneous activity) because of a neuronal hyperpolarization. By contrast, in tissue that is not energy compromised, spreading depolarization is accompanied by a spreading silencing (spreading depression) of spontaneous activity caused by a depolarization block. It is assumed that the nonspreading silencing translates into the initial clinical symptoms of ischemic stroke and the spreading silencing (spreading depression) into the symptoms of migraine aura. In energy-compromised tissue, spreading depolarization facilitates neuronal death, whereas, in healthy tissue, it is relatively innocuous. Therapies targeting spreading depolarization in metabolically compromised tissue may potentially treat conditions of acute cerebral injury such as aneurysmal subarachnoid hemorrhage.
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Eftekhari S, Salvatore CA, Johansson S, Chen TB, Zeng Z, Edvinsson L. Localization of CGRP, CGRP receptor, PACAP and glutamate in trigeminal ganglion. Relation to the blood–brain barrier. Brain Res 2015; 1600:93-109. [DOI: 10.1016/j.brainres.2014.11.031] [Citation(s) in RCA: 143] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 11/04/2014] [Accepted: 11/13/2014] [Indexed: 01/06/2023]
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Mohanty S, Mohanty P, Rutledge JN, Di Biase L, Yan RX, Trivedi C, Santangeli P, Bai R, Cardinal D, Burkhardt JD, Gallinghouse JG, Horton R, Sanchez JE, Bailey S, Hranitzky PM, Zagrodzky J, Al-Ahmad A, Natale A. Effect of catheter ablation and periprocedural anticoagulation regimen on the clinical course of migraine in atrial fibrillation patients with or without pre-existent migraine: results from a prospective study. Circ Arrhythm Electrophysiol 2015; 8:279-87. [PMID: 25682124 DOI: 10.1161/circep.114.002285] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Accepted: 01/29/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND We examined the influence of catheter ablation and periprocedural anticoagulation regimen on trajectory of migraine in atrial fibrillation patients with or without migraine history. METHODS AND RESULTS Forty patients with (group 1: 64 ± 8 years; men 78%) and 85 (group 2: 61 ± 10 years; men 73%) without migraine history undergoing atrial fibrillation-ablation were enrolled. Migraine status and quality of life were evaluated using standardized questionnaires. Diffusion magnetic resonance imaging of brain was performed for all at pre and 24 hours post procedure. Catheter ablation was performed with (88, 70%) or without (37, 30%) continuous warfarin treatment. Fifty-four patients (11 and 43 from groups 1 and 2, respectively) had subtherapeutic international normalized ratio on procedure day. At 17 ± 5 months follow-up, from group 1, 25 (63%) reported no migraine, 10 (25%) had < 1, and 3 (8%) had 2 to 3 monthly symptoms. Intensity of pain decreased from baseline 7 (Q1-Q3, 4-8) to 2 (0-4) scale points at follow-up (P < 0.001) and duration of headache from median 8 (Q1-Q3, 4-15) to 0.5 (Q1-Q3, 0-2) hours (P < 0.001). Two patients from group 1 reported increased migraine severity and 2 from group 2 had new-onset migraine. Follow-up diffusion magnetic resonance imaging revealed new infarcts in 9.6% (12/125) patients; of which 11 had subtherapeutic preprocedural international normalized ratio on or off continuous warfarin. Quality of life improved significantly in patients with successful ablation, being more pronounced in group 1. CONCLUSIONS In most patients, migraine symptoms improved substantially after catheter ablation. Interestingly, the only cases of new migraine and aggravation of pre-existent headache had subtherapeutic international normalized ratio during the procedure and new cerebral infarcts.
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Affiliation(s)
- Sanghamitra Mohanty
- From the Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center (S.M., P.M., J.N.R., L.D.B., C.T., P.S., R.B., D.C., J.D.B., J.G.G., R.H., J.E.S., S.B., P.M.H., J.Z., A.A.-A., A.N.), Department of Biology, College of Natural Sciences (S.M.), and Department of Biomedical Engineering (L.D.B., R.X.Y., A.N.), University of Texas, Austin; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B., P.S.); Department of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY (L.D.B.); Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R.B.); Department of Electrophysiology, California Pacific Medical Center, San Francisco (A.N.); Division of Cardiology, Department of Cardiology, Stanford University, CA (A.N.); Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (A.N.)
| | - Prasant Mohanty
- From the Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center (S.M., P.M., J.N.R., L.D.B., C.T., P.S., R.B., D.C., J.D.B., J.G.G., R.H., J.E.S., S.B., P.M.H., J.Z., A.A.-A., A.N.), Department of Biology, College of Natural Sciences (S.M.), and Department of Biomedical Engineering (L.D.B., R.X.Y., A.N.), University of Texas, Austin; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B., P.S.); Department of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY (L.D.B.); Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R.B.); Department of Electrophysiology, California Pacific Medical Center, San Francisco (A.N.); Division of Cardiology, Department of Cardiology, Stanford University, CA (A.N.); Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (A.N.)
| | - J Neal Rutledge
- From the Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center (S.M., P.M., J.N.R., L.D.B., C.T., P.S., R.B., D.C., J.D.B., J.G.G., R.H., J.E.S., S.B., P.M.H., J.Z., A.A.-A., A.N.), Department of Biology, College of Natural Sciences (S.M.), and Department of Biomedical Engineering (L.D.B., R.X.Y., A.N.), University of Texas, Austin; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B., P.S.); Department of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY (L.D.B.); Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R.B.); Department of Electrophysiology, California Pacific Medical Center, San Francisco (A.N.); Division of Cardiology, Department of Cardiology, Stanford University, CA (A.N.); Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (A.N.)
| | - Luigi Di Biase
- From the Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center (S.M., P.M., J.N.R., L.D.B., C.T., P.S., R.B., D.C., J.D.B., J.G.G., R.H., J.E.S., S.B., P.M.H., J.Z., A.A.-A., A.N.), Department of Biology, College of Natural Sciences (S.M.), and Department of Biomedical Engineering (L.D.B., R.X.Y., A.N.), University of Texas, Austin; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B., P.S.); Department of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY (L.D.B.); Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R.B.); Department of Electrophysiology, California Pacific Medical Center, San Francisco (A.N.); Division of Cardiology, Department of Cardiology, Stanford University, CA (A.N.); Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (A.N.)
| | - Rachel Xue Yan
- From the Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center (S.M., P.M., J.N.R., L.D.B., C.T., P.S., R.B., D.C., J.D.B., J.G.G., R.H., J.E.S., S.B., P.M.H., J.Z., A.A.-A., A.N.), Department of Biology, College of Natural Sciences (S.M.), and Department of Biomedical Engineering (L.D.B., R.X.Y., A.N.), University of Texas, Austin; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B., P.S.); Department of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY (L.D.B.); Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R.B.); Department of Electrophysiology, California Pacific Medical Center, San Francisco (A.N.); Division of Cardiology, Department of Cardiology, Stanford University, CA (A.N.); Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (A.N.)
| | - Chintan Trivedi
- From the Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center (S.M., P.M., J.N.R., L.D.B., C.T., P.S., R.B., D.C., J.D.B., J.G.G., R.H., J.E.S., S.B., P.M.H., J.Z., A.A.-A., A.N.), Department of Biology, College of Natural Sciences (S.M.), and Department of Biomedical Engineering (L.D.B., R.X.Y., A.N.), University of Texas, Austin; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B., P.S.); Department of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY (L.D.B.); Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R.B.); Department of Electrophysiology, California Pacific Medical Center, San Francisco (A.N.); Division of Cardiology, Department of Cardiology, Stanford University, CA (A.N.); Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (A.N.)
| | - Pasquale Santangeli
- From the Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center (S.M., P.M., J.N.R., L.D.B., C.T., P.S., R.B., D.C., J.D.B., J.G.G., R.H., J.E.S., S.B., P.M.H., J.Z., A.A.-A., A.N.), Department of Biology, College of Natural Sciences (S.M.), and Department of Biomedical Engineering (L.D.B., R.X.Y., A.N.), University of Texas, Austin; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B., P.S.); Department of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY (L.D.B.); Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R.B.); Department of Electrophysiology, California Pacific Medical Center, San Francisco (A.N.); Division of Cardiology, Department of Cardiology, Stanford University, CA (A.N.); Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (A.N.)
| | - Rong Bai
- From the Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center (S.M., P.M., J.N.R., L.D.B., C.T., P.S., R.B., D.C., J.D.B., J.G.G., R.H., J.E.S., S.B., P.M.H., J.Z., A.A.-A., A.N.), Department of Biology, College of Natural Sciences (S.M.), and Department of Biomedical Engineering (L.D.B., R.X.Y., A.N.), University of Texas, Austin; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B., P.S.); Department of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY (L.D.B.); Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R.B.); Department of Electrophysiology, California Pacific Medical Center, San Francisco (A.N.); Division of Cardiology, Department of Cardiology, Stanford University, CA (A.N.); Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (A.N.)
| | - Deb Cardinal
- From the Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center (S.M., P.M., J.N.R., L.D.B., C.T., P.S., R.B., D.C., J.D.B., J.G.G., R.H., J.E.S., S.B., P.M.H., J.Z., A.A.-A., A.N.), Department of Biology, College of Natural Sciences (S.M.), and Department of Biomedical Engineering (L.D.B., R.X.Y., A.N.), University of Texas, Austin; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B., P.S.); Department of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY (L.D.B.); Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R.B.); Department of Electrophysiology, California Pacific Medical Center, San Francisco (A.N.); Division of Cardiology, Department of Cardiology, Stanford University, CA (A.N.); Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (A.N.)
| | - J David Burkhardt
- From the Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center (S.M., P.M., J.N.R., L.D.B., C.T., P.S., R.B., D.C., J.D.B., J.G.G., R.H., J.E.S., S.B., P.M.H., J.Z., A.A.-A., A.N.), Department of Biology, College of Natural Sciences (S.M.), and Department of Biomedical Engineering (L.D.B., R.X.Y., A.N.), University of Texas, Austin; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B., P.S.); Department of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY (L.D.B.); Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R.B.); Department of Electrophysiology, California Pacific Medical Center, San Francisco (A.N.); Division of Cardiology, Department of Cardiology, Stanford University, CA (A.N.); Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (A.N.)
| | - Joseph G Gallinghouse
- From the Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center (S.M., P.M., J.N.R., L.D.B., C.T., P.S., R.B., D.C., J.D.B., J.G.G., R.H., J.E.S., S.B., P.M.H., J.Z., A.A.-A., A.N.), Department of Biology, College of Natural Sciences (S.M.), and Department of Biomedical Engineering (L.D.B., R.X.Y., A.N.), University of Texas, Austin; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B., P.S.); Department of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY (L.D.B.); Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R.B.); Department of Electrophysiology, California Pacific Medical Center, San Francisco (A.N.); Division of Cardiology, Department of Cardiology, Stanford University, CA (A.N.); Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (A.N.)
| | - Rodney Horton
- From the Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center (S.M., P.M., J.N.R., L.D.B., C.T., P.S., R.B., D.C., J.D.B., J.G.G., R.H., J.E.S., S.B., P.M.H., J.Z., A.A.-A., A.N.), Department of Biology, College of Natural Sciences (S.M.), and Department of Biomedical Engineering (L.D.B., R.X.Y., A.N.), University of Texas, Austin; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B., P.S.); Department of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY (L.D.B.); Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R.B.); Department of Electrophysiology, California Pacific Medical Center, San Francisco (A.N.); Division of Cardiology, Department of Cardiology, Stanford University, CA (A.N.); Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (A.N.)
| | - Javier E Sanchez
- From the Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center (S.M., P.M., J.N.R., L.D.B., C.T., P.S., R.B., D.C., J.D.B., J.G.G., R.H., J.E.S., S.B., P.M.H., J.Z., A.A.-A., A.N.), Department of Biology, College of Natural Sciences (S.M.), and Department of Biomedical Engineering (L.D.B., R.X.Y., A.N.), University of Texas, Austin; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B., P.S.); Department of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY (L.D.B.); Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R.B.); Department of Electrophysiology, California Pacific Medical Center, San Francisco (A.N.); Division of Cardiology, Department of Cardiology, Stanford University, CA (A.N.); Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (A.N.)
| | - Shane Bailey
- From the Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center (S.M., P.M., J.N.R., L.D.B., C.T., P.S., R.B., D.C., J.D.B., J.G.G., R.H., J.E.S., S.B., P.M.H., J.Z., A.A.-A., A.N.), Department of Biology, College of Natural Sciences (S.M.), and Department of Biomedical Engineering (L.D.B., R.X.Y., A.N.), University of Texas, Austin; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B., P.S.); Department of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY (L.D.B.); Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R.B.); Department of Electrophysiology, California Pacific Medical Center, San Francisco (A.N.); Division of Cardiology, Department of Cardiology, Stanford University, CA (A.N.); Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (A.N.)
| | - Patrick M Hranitzky
- From the Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center (S.M., P.M., J.N.R., L.D.B., C.T., P.S., R.B., D.C., J.D.B., J.G.G., R.H., J.E.S., S.B., P.M.H., J.Z., A.A.-A., A.N.), Department of Biology, College of Natural Sciences (S.M.), and Department of Biomedical Engineering (L.D.B., R.X.Y., A.N.), University of Texas, Austin; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B., P.S.); Department of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY (L.D.B.); Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R.B.); Department of Electrophysiology, California Pacific Medical Center, San Francisco (A.N.); Division of Cardiology, Department of Cardiology, Stanford University, CA (A.N.); Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (A.N.)
| | - Jason Zagrodzky
- From the Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center (S.M., P.M., J.N.R., L.D.B., C.T., P.S., R.B., D.C., J.D.B., J.G.G., R.H., J.E.S., S.B., P.M.H., J.Z., A.A.-A., A.N.), Department of Biology, College of Natural Sciences (S.M.), and Department of Biomedical Engineering (L.D.B., R.X.Y., A.N.), University of Texas, Austin; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B., P.S.); Department of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY (L.D.B.); Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R.B.); Department of Electrophysiology, California Pacific Medical Center, San Francisco (A.N.); Division of Cardiology, Department of Cardiology, Stanford University, CA (A.N.); Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (A.N.)
| | - Amin Al-Ahmad
- From the Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center (S.M., P.M., J.N.R., L.D.B., C.T., P.S., R.B., D.C., J.D.B., J.G.G., R.H., J.E.S., S.B., P.M.H., J.Z., A.A.-A., A.N.), Department of Biology, College of Natural Sciences (S.M.), and Department of Biomedical Engineering (L.D.B., R.X.Y., A.N.), University of Texas, Austin; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B., P.S.); Department of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY (L.D.B.); Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R.B.); Department of Electrophysiology, California Pacific Medical Center, San Francisco (A.N.); Division of Cardiology, Department of Cardiology, Stanford University, CA (A.N.); Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (A.N.)
| | - Andrea Natale
- From the Department of Electrophysiology, Texas Cardiac Arrhythmia Institute, St. David's Medical Center (S.M., P.M., J.N.R., L.D.B., C.T., P.S., R.B., D.C., J.D.B., J.G.G., R.H., J.E.S., S.B., P.M.H., J.Z., A.A.-A., A.N.), Department of Biology, College of Natural Sciences (S.M.), and Department of Biomedical Engineering (L.D.B., R.X.Y., A.N.), University of Texas, Austin; Department of Cardiology, University of Foggia, Foggia, Italy (L.D.B., P.S.); Department of Cardiology, Albert Einstein College of Medicine at Montefiore Hospital, Bronx, NY (L.D.B.); Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China (R.B.); Department of Electrophysiology, California Pacific Medical Center, San Francisco (A.N.); Division of Cardiology, Department of Cardiology, Stanford University, CA (A.N.); Department of Interventional Electrophysiology, Scripps Clinic, San Diego, CA (A.N.); and Department of Medicine, Case Western Reserve University, Cleveland, OH (A.N.).
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Liu R, Yu S, Li F, Qiu E. Gene expression microarray analysis of the spinal trigeminal nucleus in a rat model of migraine with aura. Neural Regen Res 2015; 7:1931-8. [PMID: 25624821 PMCID: PMC4298885 DOI: 10.3969/j.issn.1673-5374.2012.25.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 08/10/2012] [Indexed: 11/18/2022] Open
Abstract
Cortical spreading depression can trigger migraine with aura and activate the trigeminal vascular system. To examine gene expression profiles in the spinal trigeminal nucleus in rats following cortical spreading depression-induced migraine with aura, a rat model was established by injection of 1 M potassium chloride, which induced cortical spreading depression. DNA microarray analysis revealed that, compared with the control group, the cortical spreading depression group showed seven upregulated genes–myosin heavy chain 1/2, myosin light chain 1, myosin light chain (phosphorylatable, fast skeletal muscle), actin alpha 1, homeobox B8, carbonic anhydrase 3 and an unknown gene. Two genes were downregulated–RGD1563441 and an unknown gene. Real-time quantitative reverse transcription-PCR and bioinformatics analysis indicated that these genes are involved in motility, cell migration, CO2/nitric oxide homeostasis and signal transduction.
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Affiliation(s)
- Ruozhuo Liu
- Department of Neurology, Chinese PLA General Hospital, Beijing 100853, China
| | - Shengyuan Yu
- Department of Neurology, Chinese PLA General Hospital, Beijing 100853, China
| | - Fengpeng Li
- Department of Neurology, General Hospital of Shenyang Military Region, Shenyang 110016, Liaoning Province, China
| | - Enchao Qiu
- Department of Neurology, the First Affiliated Hospital of Chinese PLA General Hospital, Beijing 100037, China
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Muñoz-Islas E, González-Hernández A, Lozano-Cuenca J, Ramírez-Rosas MB, Medina-Santillán R, Centurión D, MaassenVanDenBrink A, Villalón CM. Inhibitory effect of chronic oral treatment with fluoxetine on capsaicin-induced external carotid vasodilatation in anaesthetised dogs. Cephalalgia 2015; 35:1041-53. [DOI: 10.1177/0333102414566818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2011] [Accepted: 12/08/2014] [Indexed: 01/30/2023]
Abstract
Background During migraine, capsaicin-sensitive trigeminal sensory nerves release calcitonin gene-related peptide (CGRP), resulting in cranial vasodilatation and central nociception. Moreover, 5-HT is involved in the pathophysiology of migraine and depression. Interestingly, some limited lines of evidence suggest that fluoxetine may be effective in migraine prophylaxis, but the underlying mechanisms are uncertain. Hence, this study investigated the canine external carotid vasodilator responses to capsaicin, α-CGRP and acetylcholine before and after acute and chronic oral treatment with fluoxetine. Methods Forty-eight vagosympathectomised male mongrel dogs were prepared to measure blood pressure, heart rate and external carotid blood flow. The thyroid artery was cannulated for infusions of agonists. In 16 of these dogs, a spinal cannula was inserted (C1–C3) for infusions of 5-HT. Results The external carotid vasodilator responses to capsaicin, α-CGRP and acetylcholine remained unaffected after intracarotid or i.v. fluoxetine. In contrast, the vasodilator responses to capsaicin, but not those to α-CGRP or acetylcholine, were inhibited after chronic oral treatment with fluoxetine (300 µg/kg; for 90 days) or intrathecal 5-HT. Conclusions Chronic oral fluoxetine inhibited capsaicin-induced external carotid vasodilatation, and this inhibition could partly explain its potential prophylactic antimigraine action.
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Affiliation(s)
| | | | | | | | | | | | - Antoinette MaassenVanDenBrink
- Division of Vascular Medicine and Pharmacology, Department of Internal Medicine, Erasmus Medical Center, The Netherlands
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Kleiboer A, Sorbi M, van Silfhout M, Kooistra L, Passchier J. Short-term effectiveness of an online behavioral training in migraine self-management: A randomized controlled trial. Behav Res Ther 2014; 61:61-9. [DOI: 10.1016/j.brat.2014.07.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 07/08/2014] [Accepted: 07/16/2014] [Indexed: 01/27/2023]
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Jouzdani SR, Ebrahimi A, Rezaee M, Shishegar M, Tavallaii A, Kaka G. Characteristics of posttraumatic headache following mild traumatic brain injury in military personnel in Iran. Environ Health Prev Med 2014; 19:422-8. [PMID: 25216772 DOI: 10.1007/s12199-014-0409-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 08/28/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES The primary goal of this study was to evaluate the incidence and characteristics of posttraumatic headache attributed to mild brain injury in military personnel in Iran within a prospective and observational study design. METHODS A prospective observational descriptive study was conducted with a cohort of military personnel under military education during a 6-month period at the Military Education Center in Isfahan, Iran. 322 military personnel under education were selected randomly and were given a 13-item mild brain injury questionnaire accompanied with affective disorders and headache questionnaires and were reevaluated after a 3-month interval. RESULTS A total of 30 (9.3 %) of the 322 military personnel met criteria for a mild brain injury. Among them, 18 personnel (60 %) reported having headaches during the 3-month reevaluation. PTHs defined as headaches beginning within 1 week after a head trauma were present in 5.6 % of military personnel under study during 6 months. In total, 67 % of posttraumatic headaches (PTH) were classified as migrainous or possible migrainous features. Patients with affective disorders such as posttraumatic stress disorder and depression were at a higher risk for developing PTH following mild brain injury (p < 0.05). PTH did not relate to demographic factors such as age or type of trauma. CONCLUSIONS Posttraumatic headache attributed to mild brain injury is a common disorder in military personnel. Migrainous features are predominant among them in comparison with the general population. PTH is not related to a type of trauma, but has association with affective disorders.
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Affiliation(s)
- Saeid Rezaei Jouzdani
- Neuroscience Research Center, Baqiyatallah University of Medical Sciences, 19568-37173, Tehran, Iran
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Jürgens TP, Berger K, Straube A, Khil L. Migraine with aura is associated with impaired colour vision: Results from the cross-sectional German DMKG headache study. Cephalalgia 2014; 35:508-15. [PMID: 25179294 DOI: 10.1177/0333102414547136] [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: 04/02/2014] [Accepted: 07/13/2014] [Indexed: 11/16/2022]
Abstract
BACKGROUND Hypersensitivity to light, noise and odour are pivotal clinical characteristics of migraine associated with enhanced cortical excitability and dysfunctional habituation. However, little is known about the integrity of basic sensory functioning in migraine on a population-based level. METHODS A total of 129 participants with migraine (105 without aura, MwoA, 24 with aura, MA) and 522 healthy controls without headache 12 months prior to baseline were included from a sample of the DMKG study and underwent standardised clinical sensory testing of smell, taste, hearing and vision. RESULTS After adjustment for age, sex, smoking status and history of head injuries, the chance of impaired colour perception was significantly higher in MA compared to controls (odds ratio, OR=3.20; 95% CI=1.20-8.53) and MwoA (OR=3.62; 95% CI=1.31-9.97). Compared to MwoA, MA also had an increased chance of smell (OR=3.20; 95% CI=0.98-10.42) and taste (OR=2.58; 95% CI=0.90-7.40) impairment. CONCLUSIONS In this cross-sectional, population-based study on sensory functioning in migraine participants, colour vision was impaired interictally in MA compared to MwoA and controls.
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Affiliation(s)
- T P Jürgens
- Department of Systems Neuroscience, University Medical Centre Hamburg-Eppendorf, Germany
| | - K Berger
- Institute of Epidemiology and Social Medicine, Westfälische Wilhelms-University Münster, Germany
| | - A Straube
- Department of Neurology, Ludwig-Maximilians University, Germany
| | - L Khil
- Institute of Epidemiology and Social Medicine, Westfälische Wilhelms-University Münster, Germany
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Abstract
Despite the growing awareness of mild traumatic brain injury in military and civilian populations, understanding of the acute and chronic effects of concussion on central nervous system structure and function is limited. Even less is understood about the underpinnings of the cardinal postconcussive symptom, post-traumatic headache (PTH). Here, we review recent advances in PTH, with special emphasis on the migraine-like phenotype, the most disabling form. Considerations for future research in PTH are discussed, including diagnostic classification, and applications with advanced neuroimaging techniques, biomarkers, and treatments.
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Niazi AK, Andelova M, Sprenger T. Is the migrainous brain normal outside of acute attacks? Lessons learned from psychophysical, neurochemical and functional neuroimaging studies. Expert Rev Neurother 2014; 13:1061-7. [PMID: 24053346 DOI: 10.1586/14737175.2013.835587] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Migraine is a largely inherited disorder of the brain with recurrent head pain attacks. There is an increasing awareness, however, that the manifestation of migrainous biology is not restricted to such acute head pain attacks, but that migraine is rather a disorder with a continuous complex and broad sensory processing dysfunction in which normal sensory stimuli (somatosensory, visual, auditory and olfactory) are misinterpreted by the brain. This dysfunction is most prominent during attacks, but there are more and more evidences that the processing and perception of stimuli is abnormal also outside of attacks to a varying degree. In this topical review, we will summarize and discuss the current clinical, neurochemical and functional neuroimaging literature on this paradigm shift from a strictly episodic head pain disorder to migraine as a more general dysfunction of sensory processing.
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Abstract
Some of the most prevalent and debilitating pain conditions arise from the structures innervated by the trigeminal system (head, face, masticatory musculature, temporomandibular joint and associated structures). Orofacial pain (OFP) can arise from different regions and etiologies. Temporomandibular disorders (TMD) are the most prevalent orofacial pain conditions for which patients seek treatment. Temporomandibular disorders include a number of clinical problems that involve the masticatory musculature, the temporomandibular joint (TMJ) or both. Trigeminal neuropathic pain conditions can arise from injury secondary to dental procedures, infection, neoplasias, or disease or dysfunction of the peripheral and/or central nervous system. Neurovascular disorders, such as primary headaches, can present as chronic orofacial pain, such as in the case of facial migraine, where the pain is localized in the second and third division of the trigeminal nerve. Together, these disorders of the trigeminal system impact the quality of life of the sufferer dramatically. A multidisciplinary pain management approach should be considered for the optimal treatment of orofacial pain disorders including both non-pharmacological and pharmacological modalities.
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Affiliation(s)
- Marcela Romero-Reyes
- Orofacial and Head Pain Service, Department of Oral and Maxillofacial Pathology Radiology and Medicine, New York University College of Dentistry, New York, NY, USA
| | - James M Uyanik
- Orofacial and Head Pain Service, Department of Oral and Maxillofacial Pathology Radiology and Medicine, New York University College of Dentistry, New York, NY, USA
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Min YW, Lee JH, Min BH, Lee JH, Kim JJ, Chung CS, Rhee PL. Clinical Predictors for Migraine in Patients Presenting With Nausea and/or Vomiting. J Neurogastroenterol Motil 2013; 19:516-20. [PMID: 24199013 PMCID: PMC3816187 DOI: 10.5056/jnm.2013.19.4.516] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Revised: 07/27/2013] [Accepted: 07/30/2013] [Indexed: 11/20/2022] Open
Abstract
Background/Aims Many migraine patients develop nausea and/or vomiting (N/V) and are referred to gastroenterologists. This can lead to an inappropriate treatment and a delay of the correct diagnosis. We therefore aimed to identify predictors for migraine in patients presenting with N/V as well as headache. Methods A total of 407 patients who were first diagnosed with migraine at Samsung Medical Center, Seoul, Korea, in 2009 were analyzed. Among them, 261 patients had N/V (migraine with N/V group) and 146 did not (migraine without N/V group). Each patient was evaluated using a structured questionnaire. Results Migraine with N/V group was younger, comprised of more females, had more abnormal body mass index, less alcohol intake, more family history of migraine, higher attack severity, more stress association, more aggravation by physical activity, more abdominal pain, and more photophobia/phonophobia than migraine without N/V group. Multivariate analysis revealed that young age (age < 40 years vs. ≥ 40 years, odds ratio (OR), 2.128; 95% confidence interval (CI), 1.206-3.756; P = 0.009), female (OR, 2.703; 95% CI, 1.492-4.896; P = 0.001), family history of migraine (OR, 2.080; 95% CI, 1.169-3.700; P = 0.013), abdominal pain (OR, 4.452; 95% CI, 1.263-15.693; P = 0.020), and photophobia/phonophobia (OR, 2.296; 95% CI, 1.308-4.030; P = 0.004) were independent predictive factors associated with migraine in patients with N/V. Conclusions Because young age, female, family history of migraine, abdominal pain, and photophobia/phonophobia are associated with migraine in patients presenting with N/V as well as headache, physicians should have a high index of suspicion for migraine in N/V patients who belong to these categories.
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Affiliation(s)
- Yang Won Min
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Shamliyan TA, Kane RL, Ramakrishnan R, Taylor FR. Episodic migraines in children: limited evidence on preventive pharmacological treatments. J Child Neurol 2013; 28:1320-41. [PMID: 23752070 DOI: 10.1177/0883073813488659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The authors conducted a systematic literature review of preventive pharmacological treatments for episodic childhood migraines searching several databases through May 20, 2012. Episodic migraine prevention was examined in 24 publications of randomized controlled trials that enrolled 1578 children in 16 nonrandomized studies. Single randomized controlled trials provided low-strength evidence that propranolol would result in complete cessation of migraine attacks in 713 per 1000 children treated (95% confidence interval, 452-974); trazodone and nimodipine decreased migraine days, while topiramate, divalproex, and clonidine were no more effective than placebo in preventing migraines. Migraine prevention with multidisciplinary drug management was not sustained at 6 months. Divalproex resulted in treatment discontinuation due to adverse effects, and topiramate increased the risk of paresthesia, upper respiratory tract infection, and weight loss. Long-term preventive benefits and improvement in disability and quality of life are unknown. No studies examined quality of life or provided evidence for individualized treatment decisions.
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Affiliation(s)
- Tatyana A Shamliyan
- 1Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
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Wang X, Liang J, Liu R, Dong Z, Yu S. The expression of succinate semialdehyde dehydrogenase in the caudal part of the spinal trigeminal nucleus is down-regulated after electrical stimulation of the dura mater surrounding the superior sagittal sinus in conscious rats. Neuroscience 2013; 248:145-53. [DOI: 10.1016/j.neuroscience.2013.05.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 05/01/2013] [Accepted: 05/13/2013] [Indexed: 01/13/2023]
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Houtveen JH, Sorbi MJ. Prodromal functioning of migraine patients relative to their interictal state--an ecological momentary assessment study. PLoS One 2013; 8:e72827. [PMID: 23977358 PMCID: PMC3745475 DOI: 10.1371/journal.pone.0072827] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 07/14/2013] [Indexed: 01/07/2023] Open
Abstract
Smartphones were used in an online Ecological Momentary Assessment (EMA) design to test prodromal functioning relative to the interictal state in migraine patients. Eighty-seven participants completed an electronic diary 4 times daily during 3-6 weeks to monitor their migraine attacks. Twice daily the diary additionally included 16 multi-answer questions covering physical symptoms (30 items), cognitive-affective functioning (25 items) and external factors (25 items). Eight clustered prodromal features were identified in the current study: sensory sensitivity, pain/stiffness, fatigue, cognitive functioning, positive affect, negative affect, effort spent and stressors encountered. Per feature, individual change scores with interictal control days--excluding 24-hour post-attack recovery--were computed for six 12-hour pre-attack time windows covering three prodromal days. Linear mixed model (fixed-effect) analysis established significant increases in sensory sensitivity, pain/stiffness and fatigue, and a tendency for increased negative affect, in the 12 hours prior to the attack. Positive affect and cognitive functioning were impaired both in the 25-36 hour and--more strongly--in the 12-hour time window before the attack. No effects were found for effort spent and stressors encountered. Exploratory (random effect) analysis revealed significant individual differences in the change scores in sensory sensitivity, pain/stiffness, fatigue and negative affect. It is concluded that the prodromal change in migraine--relative to interictal functioning--predominantly exists within the last 12 hours before attack onset. Individual diversity is large, however. Future research should zoom in to identify prodrome development within the 12 pre-attack hours as well as to isolate individual patterns.
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Affiliation(s)
- Jan H Houtveen
- Department of Clinical and Health Psychology, Faculty of Social and Behavioral Sciences, Utrecht University, The Netherlands.
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Durham P, Papapetropoulos S. Biomarkers associated with migraine and their potential role in migraine management. Headache 2013; 53:1262-77. [PMID: 23848170 DOI: 10.1111/head.12174] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2013] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The focus of this review is to review potential diagnostic and therapeutic biomarkers associated with migraine. BACKGROUND Migraine headache is a common disease that affects millions of individuals worldwide. Although well-accepted diagnostic criteria exist for migraine, it is still a complex disorder that remains both underdiagnosed and misdiagnosed. The causes of migraine are likely a mix of genetic, epigenetic, and environmental factors that, together with the individual's life history, translate into the observed clinical heterogeneity. Inherent clinical heterogeneity is an obstacle in developing more effective treatments. The lack of appropriate biomarkers is also an impediment to developing more effective therapeutic/preventive approaches. Ultimately, biomarkers may facilitate the goal of individualized medicine by enabling clinicians to more accurately diagnose and treat migraine and other types of headache. METHODS A comprehensive review was conducted of PubMed citations containing the key word "marker" OR "biomarker" combined with "migraine" OR "headache." Other key words included "serum," "saliva," "cerebrospinal fluid," "genes," "blood," and "inflammation." The only restriction was English-language publication. The abstracts of all articles meeting these criteria were reviewed, and full text was retrieved and examined for relevant references. RESULTS Data from human studies have begun to identify genetic mutations/polymorphisms and altered levels of specific proinflammatory and neuromodulatory molecules that strongly correlate with migraine as well as symptom severity. Results from a smaller number of studies have identified parameters, such as the neuropeptide calcitonin gene-related peptide (CGRP), which are significantly associated with response to specific treatments for acute migraine attacks and prophylaxis. Epigenetic mechanisms may also be involved in the development of migraine, and understanding environmentally induced genetic changes associated with this disease may eventually guide the development of therapies capable of reversing these pathophysiological changes in gene function. CONCLUSIONS The understanding of the etiology of migraine is incomplete. Although the identification and validation of biomarkers has greatly advanced diagnostic precision and measures of therapeutic efficacy in other diseases, there are no currently accepted biomarkers for chronic or episodic migraine. However, the continued investigation and identification of genetic, epigenetic, and molecular biomarkers is likely to facilitate the goal of individualizing medicine by enabling clinicians to more accurately diagnose and treat migraine and other headache disorders.
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Affiliation(s)
- Paul Durham
- Jordan Valley Innovation Center - Center for Biomedical and Life Sciences, Missouri State University, Springfield, MO, USA
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Sprenger T, Supronsinchai W, Goadsby PJ. New onset migraine with aura after treatment initiation with ivabradine. J Headache Pain 2013; 14:45. [PMID: 23718730 PMCID: PMC3681602 DOI: 10.1186/1129-2377-14-45] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 03/26/2013] [Indexed: 11/21/2022] Open
Abstract
Background Migraine with aura is a complex neurological disorder modeled in animals by cortical spreading depression. It is less usual to find complete animal models for the disease so any opportunity to test a human effect back at the bench is welcome. Findings We report the case of a 24 year old woman who developed new onset episodic migraine with visual aura shortly after treatment initiation with the If ion channel blocker ivabradine for frequency control in hypertrophic cardiomyopathy. We studied whether ivabradine could alter cortical spreading depression in a suitable animal model. Sixteen rats received either ivabradine or saline, and the number of depolarization shifts and blood flow changes induced by cortical spreading depression were measured in both groups. No significant differences between the ivabradine and saline group were detected. Conclusions Ivabradine is an interesting substance since it is known to produce migraine-like phosphenes frequently and the patient we report developed de novo migraine with aura. However, we were unable to demonstrate that the drug influences the susceptibility of the brain to cortical spreading depression with acute administration. The combined data show the relationship of migraine aura to cortical spreading depression may have some nuances yet to be identified.
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Positive botulinum toxin type a response is a prognosticator for migraine surgery success. Plast Reconstr Surg 2013; 131:751-757. [PMID: 23542247 DOI: 10.1097/prs.0b013e3182818b7f] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The objective of the study was to determine whether botulinum toxin type A injections can serve as a prognosticator for migraine surgery success. METHODS Patients who underwent migraine surgery from 2000 to 2010 by the senior author (B.G.) were reviewed. Patients were included if they had botulinum toxin type A injection before surgery; had completed postinjection, postsurgery Migraine Headache Questionnaires; and had at least 1-year follow-up. Outcome variables include patient demographics and Migraine Headache Index. Treatment success was defined as at least a 50 percent reduction in Migraine Headache Index. RESULTS One hundred eighty-eight patients were included; 144 reported successful migraine headache reduction after injection (success group) and 44 did not (failure group). The groups were well matched for age, migraine headache characteristics, and number of surgical sites (p > 0.05). The surgery success rate was significantly higher in the success group overall (90.3 percent versus 72.3, p = 0.003), and in patients who reported botulinum toxin type A success and subsequent same-site surgery (97.9 percent versus 71.4 percent, p < 0.0001). Botulinum toxin type A success was prognostic for surgery success at the frontal trigger site (trigger site I) (92.5 percent versus 69.2 percent, p = 0.012), the temporal trigger site (trigger site II) (95.5 percent versus 73.3 percent, p = 0.005), and the occipital trigger site (trigger site IV) (95.9 percent versus 62.5 percent, p = 0.0003). Six patients had exclusively septum or turbinate (site III) surgery, and all failed injections. CONCLUSIONS Positive botulinum toxin type A response is a significant predictor of migraine surgery success. When injections fail, nonmuscular abnormalities should be considered.
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Bernstein JA, Fox RW, Martin VT, Lockey RF. Headache and facial pain: differential diagnosis and treatment. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2013; 1:242-51. [PMID: 24565480 DOI: 10.1016/j.jaip.2013.03.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2013] [Revised: 03/07/2013] [Accepted: 03/08/2013] [Indexed: 11/16/2022]
Abstract
Headaches affect 90% of the population sometime during their life. Most are benign and fleeting, some are serious and life-threatening, and others require ongoing medical consultation and treatment. A careful history and physical is necessary to establish a differential diagnosis and to guide the choice of testing to make an accurate diagnosis. The most common types of headaches are discussed in this review. They are divided into primary and secondary headache disorders as classified by the International Headache Society. Primary headache disorders include migraine without and with aura, cluster and tension-type headaches. Secondary headaches are those that occur as a result of some other disorder and include brain tumors, rhinosinusitis, diseases of intracranial and extracranial vasculature, and temporomandibular joint disease.
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Affiliation(s)
- Jonathan A Bernstein
- Professor of Medicine, Director of Clinical Research, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Roger W Fox
- Professor of Medicine, Pediatrics and Public Health, Division of Allergy and Immunology, Department of Internal Medicine, University of South Florida Morsani College of Medicine, Tampa, Fla
| | - Vincent T Martin
- Professor of Medicine, Department of Internal Medicine, Division of General Internal Medicine, University of Cincinnati, Cincinnati, Ohio; Associate Editor for Headache, American Headache Society, Mount Royal, NJ
| | - Richard F Lockey
- Distinguished University Health Professor, Professor of Medicine, Pediatrics and Public Health, Director, Division of Allergy and Immunology, Joy McCann Culverhouse Chair in Allergy and Immunology, Morsani University of South Florida College of Medicine, Tampa, Fla.
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Clavo B, Santana-Rodriguez N, Gutierrez D, Lopez JC, Suarez G, Lopez L, Robaina F, Bocci V. Long-term improvement in refractory headache following ozone therapy. J Altern Complement Med 2012; 19:453-8. [PMID: 23215625 DOI: 10.1089/acm.2012.0273] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Headache afflicts approximately 10%-15% of the general population. Mixed results are obtained from various therapies, usually drugs, but also oxygen inhalation, behavioral psychology, physical therapy, and peripheral or central neurostimulation. When refractory to treatment, it has severe impact on quality of life. OBJECTIVES/SUBJECTS: Five (5) patients are presented who had suffered from severe/persistent headache refractory to standard management (including 5-HT1 agonist triptan drugs) and were treated with ozone therapy. INTERVENTIONS Ozone administration was by major autohemotherapy. The procedure involved venous blood drawn into a sterile single-use glass bottle containing anticoagulant, gently mixed with an equal volume of O3/O2 gas mixture (prefiltered through a sterile 0.20-μm filter) and slowly reinfused back into the donor patient via the antecubital vein. OUTCOME MEASURES The analyzed parameters were analgesia requirements, days of sick leave due to headache, number of headache events, and pain intensity according to the visual analogue scale (VAS); these recorded at three time points: pre-ozone therapy, post-ozone therapy, and before the last follow-up (mean: 64.6±36.8 months). RESULTS The number of headache episodes pretreatment (n=80; range 5-200) was significantly decreased during the first 6 months post-treatment (n=0, range 0-1; p=0.042) and over the 6 months before the last follow-up visit (n=1, range 0-2; p=0.043). The corresponding VAS scores were 8.7±0.8 pretreatment versus 1.1±2.5 the 6 months post-treatment (p=0.003) and versus 3.1±3.3 the 6 months before last follow-up visit (p=0.036). CONCLUSIONS Ozone therapy decreased headache episodes and pain severity over a protracted period. This novel approach is effective and merits further research.
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Affiliation(s)
- Bernardino Clavo
- Department of Radiation Oncology, Chronic Pain Unit of the Dr. Negrin University Hospital, Las Palmas, Canary Islands, Spain.
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Lack of migraine in headaches of familial dysautonomia patients. J Neural Transm (Vienna) 2012; 120:399-402. [PMID: 23053351 DOI: 10.1007/s00702-012-0903-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2012] [Accepted: 09/26/2012] [Indexed: 11/27/2022]
Abstract
Familial Dysautonomia (FD) is an autosomal recessive genetic disease where autonomic and sensory functions are defective affecting many body systems including the vascular. Plasma level of the neurotransmitter Calcitonin Gene Related Peptide (CGRP) is decreased in FD patients. This compound has been implicated to take part in the pathogenesis of migraine. We aimed to evaluate the symptoms of headaches in FD patients and to test the hypothesis that these patients will have a low incidence of migrainous headache. Sixty-five FD patients were evaluated by a medical headache questionnaire. Mean age was 23.73 + 10.82 years (mean 21 years) and there were 37 males (57 %).Thirty-eight patients (58.5 %) described having episodic headache conforming to criteria of tension headache, and in 17 of those 38 (44.7 %) headache were dependent on changes in blood pressure, except from one patient who had complaints that matched diagnosis of acephalic migraine. None of the patients had symptoms compatible with migraine or cluster headache. Results show that the headache is a very common complaint in FD, there is lack of migraine symptoms in this group. This might be attributed to defective sensory innervation and deficiency of CGRP. FD could be regarded as a human model for CGRP deficiency when studying the pathogenesis of migraine.
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Baillie LD, Ahn AH, Mulligan SJ. Sumatriptan inhibition of N-type calcium channel mediated signaling in dural CGRP terminal fibres. Neuropharmacology 2012; 63:362-7. [PMID: 22691374 DOI: 10.1016/j.neuropharm.2012.04.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2012] [Revised: 03/21/2012] [Accepted: 04/12/2012] [Indexed: 01/18/2023]
Abstract
The selective 5-HT₁ receptor agonist sumatriptan is an effective therapeutic for migraine pain yet the antimigraine mechanisms of action remain controversial. Pain-responsive fibres containing calcitonin gene-related peptide (CGRP) densely innervating the cranial dura mater are widely believed to be an essential anatomical substrate for the development of migraine pain. 5-HT₁ receptors in the dura colocalize with CGRP fibres in high density and thus provide a possible peripheral site of action for sumatriptan. In the present study, we used high-resolution optical imaging selectively within individual mouse dural CGRP nociceptive fibre terminations and found that application of sumatriptan caused a rapid, reversible dose-dependent inhibition in the amplitude of single action potential evoked Ca²⁺ transients. Pre-application of the 5-HT₁ antagonist GR 127935 or the selective 5-HT(1D) antagonist BRL 15572 prevented inhibition while the selective 5-HT(1B) antagonist SB 224289 did not, suggesting this effect was mediated selectively through the 5-HT(1D) receptor subtype. Sumatriptan inhibition of the action potential evoked Ca²⁺ signaling was mediated selectively through N-type Ca²⁺ channels. Although the T-type Ca²⁺ channel accounted for a greater proportion of the Ca²⁺ signal it did not mediate any of the sumatriptan inhibition. Our findings support a peripheral site of action for sumatriptan in inhibiting the activity of dural pain fibres selectively through a single Ca²⁺ channel subtype. This finding adds to our understanding of the mechanisms that underlie the clinical effectiveness of 5-HT₁ receptor agonists such as sumatriptan and may provide insight for the development of novel peripherally targeted therapeutics for mitigating the pain of migraine.
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Affiliation(s)
- Landon D Baillie
- Department of Physiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
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Maizels M, Aurora S, Heinricher M. Beyond neurovascular: migraine as a dysfunctional neurolimbic pain network. Headache 2012; 52:1553-65. [PMID: 22757613 DOI: 10.1111/j.1526-4610.2012.02209.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
No single model of migraine explains all of the known features of the disorder. Migraine has recently been characterized as an abnormality in pain-modulating circuits in the brainstem. The periaqueductal gray appears to have a critical role in migraine genesis and has been labeled the "migraine generator." The concept of a "pain matrix," rather than a specific locus of pain, is widely accepted in the pain literature and offers a new dimension to understanding migraine. Recent neuroimaging studies of migraineurs suggest altered functional connectivity between brainstem pain-modulating circuits and cortical (limbic) centers. Numerous clinical observations suggest that limbic influences play an important role in migraine expression. We propose a model of migraine as a dysfunction of a "neurolimbic" pain network. The influence between brainstem and cortical centers is bidirectional, reflecting the bidirectional interaction of pain and mood. Neurolimbic dysfunction may increase as migraine becomes more chronic or refractory. The neurolimbic model expands the model of migraine as a dysfunction of brainstem nuclei. A neurolimbic model may help bridge a gap in understanding the migraine attack, the interictal dysfunctions of episodic migraine, the progression to chronic migraine, and the common comorbidities with other disorders (such as fibromyalgia, irritable bowel syndrome, and mood and anxiety disorders), which may also be considered neurolimbic. A neurolimbic model of migraine may be a useful heuristic that would impact both clinical treatment and research agendas, as well as education of physicians and patients.
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