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Raut S, Singh U, Sarmah D, Datta A, Baidya F, Shah B, Bohra M, Jagtap P, Sarkar A, Kalia K, Borah A, Dave KR, Yavagal DR, Bhattacharya P. Migraine and Ischemic Stroke: Deciphering the Bidirectional Pathway. ACS Chem Neurosci 2020; 11:1525-1538. [PMID: 32348103 DOI: 10.1021/acschemneuro.0c00137] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Migraine and stroke are common, disabling neurological conditions with several theories being proposed to explain this bidirectional relationship. Migraine is considered as a benign neurological disorder, but research has revealed a connection between migraine and stroke, predominantly those having migraine with aura (MA). Among migraineurs, females with MA are more susceptible to ischemic stroke and may have a migrainous infarction. Migrainous infarction mostly occurs in the posterior circulation of young women. Although there are several theories about the potential relationship between MA and stroke, the precise pathological process of migrainous infarction is not clear. It is assumed that cortical spreading depression (CSD) might be one of the essential factors for migrainous infarction. Other factors that may contribute to migrainous infarction may be genetic, hormonal fluctuation, hypercoagulation, and right to left cardiac shunts. Antimigraine drugs, such as ergot alkaloids and triptans, are widely used in migraine care. Still, they have been found to cause severe vasoconstriction, which may result in the development of ischemia. It is reported that patients with stroke develop migraines during the recovery phase. Both experimental and clinical data suggest that cerebral microembolism can act as a potential trigger for MA. Further studies are warranted for the treatment of migraine, which may lead to a decline in migraine-related stroke. In this present article, we have outlined various potential pathways that link migraine and stroke.
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Affiliation(s)
- Swapnil Raut
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat 382355, India
| | - Upasna Singh
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat 382355, India
| | - Deepaneeta Sarmah
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat 382355, India
| | - Aishika Datta
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat 382355, India
| | - Falguni Baidya
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat 382355, India
| | - Birva Shah
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat 382355, India
| | - Mariya Bohra
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat 382355, India
| | - Priya Jagtap
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat 382355, India
| | - Ankan Sarkar
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat 382355, India
| | - Kiran Kalia
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat 382355, India
| | - Anupom Borah
- Cellular and Molecular Neurobiology Laboratory, Department of Life Science and Bioinformatics, Assam University, Silchar, Assam 788011, India
| | - Kunjan R. Dave
- Department of Neurology, University of Miami Miller School of Medicine, Miami, Florida 33136, United States
| | - Dileep R. Yavagal
- Department of Neurology and Neurosurgery, University of Miami Miller School of Medicine, Miami, Florida 33136, United States
| | - Pallab Bhattacharya
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research (NIPER), Ahmedabad, Gandhinagar, Gujarat 382355, India
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Terrin A, Toldo G, Ermani M, Mainardi F, Maggioni F. When migraine mimics stroke: A systematic review. Cephalalgia 2018; 38:2068-2078. [PMID: 29661036 DOI: 10.1177/0333102418767999] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Migraine with aura may mimic an acute ischemic stroke, so that an improper administration of thrombolytic treatment can expose migrainous patients to severe adverse effects. METHODS This systematic review quantifies the relevance of migraine with aura among stroke mimics, checking for thrombolysis' safety in these patients. We reviewed the literature after 1995, distinguishing from studies dealing with stroke mimics treated with systemic thrombolysis and those who were not treated with systemic thrombolysis. RESULTS Migraine with aura is responsible for 1.79% (CI 95% 0.82-3.79%) of all the emergency Stroke Unit evaluations and it represents 12.24% (CI 95% 6.34-22.31%) of stroke mimics in the group not treated with systemic thrombolysis. 6.65% (CI 95% 4.32-9.78%) of systemic thrombolysis administrations are performed in patients without an acute ischemic stroke. Migraine with aura is responsible for 17.91% of these (CI 95% 13.29-23.71%). The reported rate of adverse events seems extremely low (0.01%). CONCLUSION Migraine with aura is the third most common stroke mimic, following seizures and psychiatric disorders; it is responsible for about 18% of all improper thrombolytic treatments. Despite the absence of strong supporting data, thrombolysis in migraine with aura seems to be a procedure with an extremely low risk of adverse events.
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Affiliation(s)
- Alberto Terrin
- 1 Headache Centre, Department of Neuroscience, University of Padova, Padova, Italy
| | - Giulia Toldo
- 1 Headache Centre, Department of Neuroscience, University of Padova, Padova, Italy
| | - Mario Ermani
- 1 Headache Centre, Department of Neuroscience, University of Padova, Padova, Italy
| | | | - Ferdinando Maggioni
- 1 Headache Centre, Department of Neuroscience, University of Padova, Padova, Italy
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Ameijeira P, Leira Y, Blanco J, Leira R. Periodontal disease as a potential factor of migraine chronification. Med Hypotheses 2017; 102:94-98. [PMID: 28478842 DOI: 10.1016/j.mehy.2017.03.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Revised: 02/26/2017] [Accepted: 03/11/2017] [Indexed: 01/03/2023]
Abstract
Migraine is a hereditary constitutional base disorder, which is characterized by recurrent episodes of headache pulsatile characteristics associated with photophobia/phonophobia, nausea and/or vomiting. The main complication in migraine is the chronicity of the process, now recognized as a chronic migraine. Although pathogenic mechanisms that may influence the pathophysiology of migraine and its possible chronicity are not fully understood, previous studies have shown in patients with migraine molecular alterations of systemic inflammation, neurogenic inflammation, endothelial dysfunction, innate immunity, dysfunction of matrix proteases and blood-brain barrier. Periodontal disease is an inflammatory lesion caused by bacteria. After the bacterial infection begins, an immune response that will be responsible for individual susceptibility appears. More advanced forms of periodontitis have demonstrated molecular alterations of inflammation, endothelial dysfunction, dysfunction of matrix proteases and innate immunity, similar to those observed in migraine. Furthermore, the main molecular mediators of neurogenic inflammation related to activation of the trigeminovascular system, which are characteristic of migraine, are overexpressed in gingival crevicular fluid and mucosa in patients with periodontal disease. Hypertension, hypercholesterolemia, insulin resistance, stroke or coronary artery disease are comorbidities that periodontal disease and migraine could share. Therefore, several mechanisms and hypotheses could explain the possible association between both diseases. However, epidemiological and molecular studies will be necessary to provide a better understanding of this potential association, which could be implicated in the chronification of migraine.
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Affiliation(s)
- Pablo Ameijeira
- Department of Periodontology, School of Dentistry, Faculty of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Yago Leira
- Department of Periodontology, School of Dentistry, Faculty of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain; Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
| | - Juan Blanco
- Department of Periodontology, School of Dentistry, Faculty of Medicine, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Rogelio Leira
- Department of Neurology, Headache Unit, Clinical Neurosciences Research Laboratory, Hospital Clínico Universitario, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela, Santiago de Compostela, Spain
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Transient Horner’s syndrome as sign of intrapetrous carotid dissection in a migrainous patient. Neurol Sci 2012; 34:257-8. [DOI: 10.1007/s10072-012-0980-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Accepted: 02/09/2012] [Indexed: 10/28/2022]
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Kirkham KE, Colon MRJ, Solomon GD. The Role of Cardiovascular Screening in Headache Patients. Headache 2011; 51:331-7. [DOI: 10.1111/j.1526-4610.2010.01839.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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De Reuck J, Paemeleire K, Van Maele G. Stroke in patients with migraine. Neurol Neurochir Pol 2010; 44:118-22. [PMID: 20496281 DOI: 10.1016/s0028-3843(14)60002-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND PURPOSE Migraine with aura (MA) is considered as a risk factor for ischaemic stroke. The present observational retrospective study compares migraine patients admitted for a documented stroke with those presenting focal neurological symptoms and headache without a demonstrable lesion and in which the final diagnosis was a migraine attack with aura. MATERIAL AND METHODS The study included 14 migraine patients with a stroke and 37 without a stroke. The clinical characteristics, the vascular risk factors and the results of the technical examinations were compared. RESULTS Stroke occurred in migraine patients with aura as well as without aura. Classical vascular risk factors were rather rare. Patent foramen ovale (PFO) with or without atrial septum aneurysm appeared to be the main risk factor for stroke in patients with a history of migraine. Infarcts were mainly located in the supratentorial territory of the posterior cerebral circulation. Also some lobar haematomas were observed, but their aetiology remained uncertain. The strokes were generally mildly severe with good outcome. Hyperintense signals in the cerebral white matter and cerebellum, on T2-weighted magnetic resonance imaging, were more frequent in the migraine patients with stroke. CONCLUSIONS The presence of PFO, rather than of MA, appeared to be the main risk factor for stroke patients with migraine. No direct relation between migraine and stroke could be demonstrated.
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Granild-Jensen J, Jensen UB, Schwartz M, Hansen US. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy resulting in stroke in an 11-year-old male. Dev Med Child Neurol 2009; 51:754-7. [PMID: 19207299 DOI: 10.1111/j.1469-8749.2008.03241.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) is caused by mutations in the Notch3 gene on chromosome 19. The condition manifests itself clinically typically in the third to fifth decade with migraine and recurrent episodes of stroke or transient ischaemic attacks. We report the case of an 11-year-old male with CADASIL resulting in stroke with right hemiparesis and dysphasia. Acute magnetic resonance imaging suggested infarction in the left hemisphere; magnetic resonance angiography revealed calibre variation of the intracerebral arteries. The patient suffered from common migraine with five to six attacks per month for 3 years 6 months before the stroke. Attacks occurred early in the morning with severe one-sided headache, photophobia, nausea, and vomiting. Antimigraine medications had no effect. The family history revealed more cases of CADASIL, with an autosomal dominant pattern. The diagnosis of CADASIL was confirmed by the finding of the known mutation of the Notch3 gene running in the family. With treatment in a neurorehabilitation centre the patient recovered most of his functions with only discrete fine-motor and cognitive sequelae. Our case report highlights the need for paediatricians to consider CADASIL in childhood stroke as well as in migraine patients.
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Facchinetti F, Allais G, Nappi RE, D'Amico R, Marozio L, Bertozzi L, Ornati A, Benedetto C. Migraine is a risk factor for hypertensive disorders in pregnancy: a prospective cohort study. Cephalalgia 2009; 29:286-92. [PMID: 19220309 DOI: 10.1111/j.1468-2982.2008.01704.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim was to assess whether women suffering from migraine are at higher risk of developing hypertensive disorders in pregnancy. In a prospective cohort study, performed at antenatal clinics in three maternity units in Northern Italy, 702 normotensive women with singleton pregnancy at 11-16 weeks' gestation were enrolled. Women with a history of hypertensive disorders in pregnancy or presenting chronic hypertension were excluded. The presence of migraine was investigated according to International Headache Society criteria. The main outcome measure was the onset of hypertension in pregnancy, defined as the occurrence of either gestational hypertension or preeclampsia. Two hundred and seventy women (38.5%) were diagnosed with migraine. The majority (68.1%) suffered from migraine without aura. The risk of developing hypertensive disorders in pregnancy was higher in migraineurs (9.1%) compared with non-migraineurs (3.1%) [odds ratio (OR) adjusted for age, family history of hypertension and smoking 2.85, 95% confidence interval (CI) 1.40, 5.81]. Women with migraine also showed a trend to increased risk for low birth weight infants with respect to women without migraine (OR 1.97, 95% CI 0.98, 3.98). Women with migraine are to be considered at increased risk of developing hypertensive disorders in pregnancy. The diagnosis of primary headaches should be taken into account at antenatal examination.
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Affiliation(s)
- F Facchinetti
- Unit of Psychobiology of Reproduction-UCADH, Mother-Infant Department, University of Modena and Reggio Emilia, Modena, Italy.
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Affiliation(s)
- Muhammad Ramzan
- University of Massachusetts Medical School, University of Massachusetts Memorial Medical Center, Worcester, MA 01606, USA.
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Hamed SA. The vascular risk associations with migraine: relation to migraine susceptibility and progression. Atherosclerosis 2008; 205:15-22. [PMID: 19054516 DOI: 10.1016/j.atherosclerosis.2008.10.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2008] [Revised: 10/03/2008] [Accepted: 10/14/2008] [Indexed: 01/09/2023]
Abstract
Migraine is a common disorder in which changes in cortical excitability, neuroinflammation and dysfunction of the vascular wall contribute to its pathophysiology. Repeated attacks of migraine over prolonged periods result in inflammatory arteriopathy of the cranial vessels. Several studies indicate that migraine is associated with special pattern of inflammatory markers and some adverse vascular risk factors including: increased levels of CRP, ILs, TNF-alpha and adhesion molecules which are markers of systemic inflammation, oxidative stress and thrombosis, increased body weight, high blood pressure, hypercholesterolemia, impaired insulin sensitivity, high homocysteine levels, stroke and coronary heart disease. Such comorbidities are not explained by bias but indicate possible shared underlying pathogenic mechanisms. Recent studies have shown involvement of cranial as well as peripheral vascular dysfunction with migraine indicating that migraine may be a local manifestation of a systemic disease rather than a primary brain phenomenon. The associated inflammatory process of migraine together with the associated adverse medical comorbidities exposes patients to endothelial vascular wall injury which further increases migraine susceptibility and progression as well as increases the risk for atherogenesis. The knowledge that migraine is a risk for vascular diseases raises important clinical implications, recommendations and future perspectives in migraine treatment and prevention.
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Affiliation(s)
- Sherifa A Hamed
- Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt.
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Pezzini A, Grassi M, Del Zotto E, Giossi A, Monastero R, Dalla Volta G, Archetti S, Zavarise P, Camarda C, Gasparotti R, Magoni M, Camarda R, Padovani A. Migraine Mediates the Influence of
C677T MTHFR
Genotypes on Ischemic Stroke Risk With a Stroke-Subtype Effect. Stroke 2007; 38:3145-51. [DOI: 10.1161/strokeaha.107.491506] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Alessandro Pezzini
- From Dipartimento di Scienze Mediche e Chirurgiche (A.P., M.M.), Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Brescia, Italia; Dipartimento di Scienze Sanitarie Applicate (M.G.), Sezione di Statistica Medica e Epidemiologia, Università di Pavia, Pavia, Italia; Dipartimento di Scienze Mediche e Chirurgiche (E.D.Z., A.G., A.P.), Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia; Dipartimento di Neuroscienze Cliniche (R.M., C.C., R.C.), Divisione di Neurologia e
| | - Mario Grassi
- From Dipartimento di Scienze Mediche e Chirurgiche (A.P., M.M.), Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Brescia, Italia; Dipartimento di Scienze Sanitarie Applicate (M.G.), Sezione di Statistica Medica e Epidemiologia, Università di Pavia, Pavia, Italia; Dipartimento di Scienze Mediche e Chirurgiche (E.D.Z., A.G., A.P.), Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia; Dipartimento di Neuroscienze Cliniche (R.M., C.C., R.C.), Divisione di Neurologia e
| | - Elisabetta Del Zotto
- From Dipartimento di Scienze Mediche e Chirurgiche (A.P., M.M.), Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Brescia, Italia; Dipartimento di Scienze Sanitarie Applicate (M.G.), Sezione di Statistica Medica e Epidemiologia, Università di Pavia, Pavia, Italia; Dipartimento di Scienze Mediche e Chirurgiche (E.D.Z., A.G., A.P.), Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia; Dipartimento di Neuroscienze Cliniche (R.M., C.C., R.C.), Divisione di Neurologia e
| | - Alessia Giossi
- From Dipartimento di Scienze Mediche e Chirurgiche (A.P., M.M.), Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Brescia, Italia; Dipartimento di Scienze Sanitarie Applicate (M.G.), Sezione di Statistica Medica e Epidemiologia, Università di Pavia, Pavia, Italia; Dipartimento di Scienze Mediche e Chirurgiche (E.D.Z., A.G., A.P.), Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia; Dipartimento di Neuroscienze Cliniche (R.M., C.C., R.C.), Divisione di Neurologia e
| | - Roberto Monastero
- From Dipartimento di Scienze Mediche e Chirurgiche (A.P., M.M.), Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Brescia, Italia; Dipartimento di Scienze Sanitarie Applicate (M.G.), Sezione di Statistica Medica e Epidemiologia, Università di Pavia, Pavia, Italia; Dipartimento di Scienze Mediche e Chirurgiche (E.D.Z., A.G., A.P.), Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia; Dipartimento di Neuroscienze Cliniche (R.M., C.C., R.C.), Divisione di Neurologia e
| | - Giorgio Dalla Volta
- From Dipartimento di Scienze Mediche e Chirurgiche (A.P., M.M.), Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Brescia, Italia; Dipartimento di Scienze Sanitarie Applicate (M.G.), Sezione di Statistica Medica e Epidemiologia, Università di Pavia, Pavia, Italia; Dipartimento di Scienze Mediche e Chirurgiche (E.D.Z., A.G., A.P.), Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia; Dipartimento di Neuroscienze Cliniche (R.M., C.C., R.C.), Divisione di Neurologia e
| | - Silvana Archetti
- From Dipartimento di Scienze Mediche e Chirurgiche (A.P., M.M.), Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Brescia, Italia; Dipartimento di Scienze Sanitarie Applicate (M.G.), Sezione di Statistica Medica e Epidemiologia, Università di Pavia, Pavia, Italia; Dipartimento di Scienze Mediche e Chirurgiche (E.D.Z., A.G., A.P.), Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia; Dipartimento di Neuroscienze Cliniche (R.M., C.C., R.C.), Divisione di Neurologia e
| | - Paola Zavarise
- From Dipartimento di Scienze Mediche e Chirurgiche (A.P., M.M.), Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Brescia, Italia; Dipartimento di Scienze Sanitarie Applicate (M.G.), Sezione di Statistica Medica e Epidemiologia, Università di Pavia, Pavia, Italia; Dipartimento di Scienze Mediche e Chirurgiche (E.D.Z., A.G., A.P.), Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia; Dipartimento di Neuroscienze Cliniche (R.M., C.C., R.C.), Divisione di Neurologia e
| | - Cecilia Camarda
- From Dipartimento di Scienze Mediche e Chirurgiche (A.P., M.M.), Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Brescia, Italia; Dipartimento di Scienze Sanitarie Applicate (M.G.), Sezione di Statistica Medica e Epidemiologia, Università di Pavia, Pavia, Italia; Dipartimento di Scienze Mediche e Chirurgiche (E.D.Z., A.G., A.P.), Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia; Dipartimento di Neuroscienze Cliniche (R.M., C.C., R.C.), Divisione di Neurologia e
| | - Roberto Gasparotti
- From Dipartimento di Scienze Mediche e Chirurgiche (A.P., M.M.), Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Brescia, Italia; Dipartimento di Scienze Sanitarie Applicate (M.G.), Sezione di Statistica Medica e Epidemiologia, Università di Pavia, Pavia, Italia; Dipartimento di Scienze Mediche e Chirurgiche (E.D.Z., A.G., A.P.), Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia; Dipartimento di Neuroscienze Cliniche (R.M., C.C., R.C.), Divisione di Neurologia e
| | - Mauro Magoni
- From Dipartimento di Scienze Mediche e Chirurgiche (A.P., M.M.), Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Brescia, Italia; Dipartimento di Scienze Sanitarie Applicate (M.G.), Sezione di Statistica Medica e Epidemiologia, Università di Pavia, Pavia, Italia; Dipartimento di Scienze Mediche e Chirurgiche (E.D.Z., A.G., A.P.), Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia; Dipartimento di Neuroscienze Cliniche (R.M., C.C., R.C.), Divisione di Neurologia e
| | - Rosolino Camarda
- From Dipartimento di Scienze Mediche e Chirurgiche (A.P., M.M.), Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Brescia, Italia; Dipartimento di Scienze Sanitarie Applicate (M.G.), Sezione di Statistica Medica e Epidemiologia, Università di Pavia, Pavia, Italia; Dipartimento di Scienze Mediche e Chirurgiche (E.D.Z., A.G., A.P.), Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia; Dipartimento di Neuroscienze Cliniche (R.M., C.C., R.C.), Divisione di Neurologia e
| | - Alessandro Padovani
- From Dipartimento di Scienze Mediche e Chirurgiche (A.P., M.M.), Stroke Unit, Neurologia Vascolare, Spedali Civili di Brescia, Brescia, Italia; Dipartimento di Scienze Sanitarie Applicate (M.G.), Sezione di Statistica Medica e Epidemiologia, Università di Pavia, Pavia, Italia; Dipartimento di Scienze Mediche e Chirurgiche (E.D.Z., A.G., A.P.), Clinica Neurologica, Università degli Studi di Brescia, Brescia, Italia; Dipartimento di Neuroscienze Cliniche (R.M., C.C., R.C.), Divisione di Neurologia e
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Giannopoulos S, Markoula S, Kosmidou M, Pelidou SH, Kyritsis AP. Lateral medullary ischaemic events in young adults with hypoplastic vertebral artery. J Neurol Neurosurg Psychiatry 2007; 78:987-9. [PMID: 17702781 PMCID: PMC2117884 DOI: 10.1136/jnnp.2006.106419] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2006] [Revised: 10/25/2006] [Accepted: 10/30/2006] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To present three cases of young adults with lateral medullary ischaemic events associated with a hypoplastic vertebral artery (VA). All three patients had two additional atherosclerotic or non-atherosclerotic risk factors for stroke. PATIENTS AND METHODS One female, aged 40 years, and two males, aged 38 and 37 years, each with two risk factors for stroke, presented to the emergency department with acute onset of symptoms and findings consistent with lateral medullary syndrome. All three patients underwent emergency CT scan of the brain followed by MRI and magnetic resonance angiography (MRA). RESULTS The CT scans were negative in all patients. MRI revealed a lateral medullary lesion in only one patient. All three patients had a hypoplastic VA ipsilateral to the clinical ischaemic event on MRA. CONCLUSIONS Hypoplasia of VA is not considered a risk factor for stroke as it is a common variant in up to 75% of the general population. However, in our patients, hypoplastic VA coexisted with two risk factors and resulted in stroke. Thus although a hypoplastic VA may not be an uncommon asymptomatic finding, it may contribute to stroke if additional risk factors are present.
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Affiliation(s)
- Sotirios Giannopoulos
- Department of Neurology, University of Ioannina School of Medicine, University Campus 45110, Ioannina, Greece.
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Adler E, Love B, Giovannone S, Volpicelli F, Goldman ME. Correlation or causation: Untangling the relationship between patent foramen ovale and migraine. Curr Cardiol Rep 2007; 9:7-12. [PMID: 17362678 DOI: 10.1007/s11886-007-0003-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Observational evidence from the literature has shown an association between migraine headaches and patent foramen ovale (PFO). This observation has led to hypotheses that could explain the etiology of migraines in those with a PFO, including right-to-left shunting of venous agents such as serotonin that are normally broken down in the pulmonary circulation. Further evidence suggests that closure of a PFO may improve migraine symptoms and serve as an effective treatment modality for migraines. Several randomized controlled double-blinded studies are underway that will more definitively establish the role of specific devices in PFO closure in those suffering from migraines.
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Affiliation(s)
- Eric Adler
- The Mount Sinai School of Medicine, 1 Gustave L. Levy Place, Box 1030, New York, NY 10029, USA
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Silva FA, Rueda-Clausen CF, Silva SY, Zarruk JG, Guzmán JC, Morillo CA, Vesga B, Pradilla G, Flórez M, López-Jaramillo P. Endothelial function in patients with migraine during the interictal period. Headache 2007; 47:45-51. [PMID: 17355493 DOI: 10.1111/j.1526-4610.2006.00532.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study is to evaluate endothelial function in migraineurs subjects during the asymptomatic period. BACKGROUND Migraine has been proposed as a risk factor for cerebrovascular events. The underlying mechanisms that relate these 2 pathologies are unknown. Nitric oxide (NO) has been proposed as the final causative molecule of migraine. Increased NO metabolites concentrations have been reported in migraineurs subjects during acute migraine attacks, but there is no evidence indicating alterations in endothelial NO release during the symptom free period in theses subjects. DESIGN AND METHODS Fifty migraineurs subjects and 25 healthy subjects matched by gender and age were included. Every subject underwent a complete examination that included medical history, physical examination, resting electrocardiogram, forearm flow-mediated vasodilation (FMD), blood determinations of fasting nitrates and nitrites (NO(2) (-)+ NO(3) (-)), glucose, lipid profile, creatinine, C-reactive protein, and blood cell count. RESULTS No differences in FMD or NO(2) (-)+ NO(3) (-) were detected among groups. The only difference between migraineurs and control subjects was a higher mean blood pressure 92.1 (8.8) mmHg versus 86.7 (8.2) mmHg P= .01. CONCLUSION The endothelial function is not altered during the interictal period in migraineurs subjects.
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Affiliation(s)
- Federico A Silva
- Instituto de Investigaciones, Grupo de Ciencias Neurovasculares, Grupo de Investigación en Sistema Nervioso Autónomo, Fundación Cardiovascular de Colombia, Floridablanca, Colombia
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&NA;. Hormonal status determines the treatment of hormone-related headache in women. DRUGS & THERAPY PERSPECTIVES 2007. [DOI: 10.2165/00042310-200723010-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Sarchielli P, Mancini ML, Calabresi P. Practical considerations for the treatment of elderly patients with migraine. Drugs Aging 2006; 23:461-89. [PMID: 16872231 DOI: 10.2165/00002512-200623060-00003] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Treatment of migraine presents special problems in the elderly. Co-morbid diseases may prohibit the use of some medications. Moreover, even when these contraindications do not exist, older patients are more likely than younger ones to develop adverse events. Managing older migraine patients, therefore, necessitates particular caution, including taking into account possible pharmacological interactions associated with the greater use of drugs for concomitant diseases in the elderly. Paracetamol (acetaminophen) is the safest drug for symptomatic treatment of migraine in the elderly. Use of selective serotonin 5-HT(1B/1D) receptor agonists ('triptans') is not recommended, even in the absence of cardiovascular or cerebrovascular risk, and NSAID use should be limited because of potential gastrointestinal adverse effects. Prophylactic treatments include antidepressants, beta-adrenoceptor antagonists, calcium channel antagonists and antiepileptics. Selection of a drug from one of these classes should be dictated by the patient's co-morbidities. Beta-adrenoceptor antagonists are appropriate in patients with hypertension but are contraindicated in those with chronic obstructive pulmonary disease, diabetes mellitus, heart failure and peripheral vascular disease. Use of antidepressants in low doses is, in general, well tolerated by elderly people and as effective, overall, as in young adults. This approach is preferred in patients with concomitant mood disorders. However, prostatism, glaucoma and heart disease make the use of tricyclic antidepressants more difficult. Fewer efficacy data in the elderly are available for selective serotonin reuptake inhibitors, which can be tried in particular cases because of their good tolerability profile. Calcium channel antagonists are contraindicated in patients with hypotension, heart failure, atrioventricular block, Parkinson's disease or depression (flunarizine), and in those taking beta-adrenoceptor antagonists and monoamine oxidase inhibitors (verapamil). Antiepileptic drug use should be limited to migraine with high frequency of attacks and refractoriness to other treatments. Promising additional strategies include ACE inhibitors and angiotensin II type 1 receptor antagonists because of their effectiveness and good tolerability in patients with migraine, particularly in those with hypertension. Because of its favourable compliance and safety profile, botulinum toxin type A can be considered an alternative treatment in elderly migraine patients who have not responded to other currently available migraine prophylactic agents. Pharmacological treatment of migraine poses special problems in regard to both symptomatic and prophylactic treatment. Contraindications to triptan use, adverse effects of NSAIDs, and unwanted reactions to some antiemetics reduce the list of drugs available for the treatment of migraine attacks in elderly patients. The choice of prophylactic treatment (beta-adrenoceptor antagonists, calcium channel antagonists, antiepileptics, and more recently, some antihypertensive drugs) is influenced by co-morbidities and should be directed at those drugs that are believed to have fewer adverse effects and a better safety profile. Unfortunately, for most of these drugs, efficacy studies are lacking in the elderly.
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Affiliation(s)
- Paola Sarchielli
- Department of Medical and Surgical Specialties and Public Health, Neurologic Clinic, University of Perugia, Perugia, Italy.
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Tozer BS, Boatwright EA, David PS, Verma DP, Blair JE, Mayer AP, Files JA. Prevention of migraine in women throughout the life span. Mayo Clin Proc 2006; 81:1086-91; quiz 1092. [PMID: 16901031 DOI: 10.4065/81.8.1086] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Migraine is a common disorder in women. The 1-year prevalence of migraine is 18% in women compared with 6% in men. Migraine most commonly occurs during the reproductive years, affecting 27% of women 30 to 49 years of age. The predominance of this disorder and its social, functional, and economic consequences make migraine an important issue in women's health. The hormonal milieu has a substantial effect on migraine in women. An understanding of these hormonal influences in the various stages of life in females is essential to the management and prevention of migraines. This article reviews migraine prevention strategies with an emphasis on specific therapies for each stage of a woman's life.
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Affiliation(s)
- Beverly S Tozer
- Division of Women's Health Internal Medicine, Mayo Clinic College of Medicine, 13400 E Shea Blvd, Scottsdale, AZ 85259, USA
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Bigal ME, Sheftell FD, Tepper SJ, Rapoport AM. Migraine and silent infarcts. Are we making the proper decisions? Cephalalgia 2006; 26:629-30. [PMID: 16674776 DOI: 10.1111/j.1468-2982.2006.01086.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Abstract
The past two decades have contributed a large body of preclinical work that has assisted in our understanding of the underlying pathophysiological mechanisms that cause chronic pain. In this context, it has been recognized that effective treatment of pain is a priority and that treatment often involves the use of one or a combination of agents with analgesic action. The current review presents an evidence-based approach to the pharmacotherapy of chronic pain. Medline searches were done for all agents used as conventional treatment in chronic pain. Published papers up to June 2005 were included. The search strategy included randomized, controlled trials, and where available, systematic reviews and meta-analyses. Further references were found in reference sections of papers located using the above search strategy. Agents for which there were no controlled trials supporting efficacy in treatment of chronic pain were not included in the present review, except in cases where preclinical science was compelling, or where initial human work has been positive and where it was thought the reader would be interested in the scientific evidence to date.
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Affiliation(s)
- Mary E Lynch
- Department of Psychiatry, Dalhousie University, Halifax, Canada.
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