The Use of Antioxidants in the Treatment of Migraine

Effects of Dietary Interventions in Patients With Migraine: A Systematic Review

CONTEXT

Migraine is a disabling neurological disorder. Diet may be a factor to consider because measures of diet quality have been linked to both frequency and severity of attacks.

OBJECTIVES

To investigate the effects of dietary interventions on the clinical symptoms of migraine, quality of life, and body composition of patients with migraine.

DATA SOURCES

The MEDLINE, Embase, and Web of Sciences databases were searched since database inception to February 13, 2024. We included articles on randomized clinical trials that assessed the effect dietary interventions on clinical symptoms of migraines and the quality of life and body composition of individuals with migraine.

DATA EXTRACTION

Data from the included articles were independently extracted by 2 researchers; another independent reviewer further verified the extractions. The Cochrane risk-of-bias tool was used to evaluate the risk of bias of selected studies, and the Physiotherapy Evidence Database scale was used to assess the methodological quality.

RESULTS

Eight articles were included in this review. Of these, 3 reported on studies that assessed the ketogenic diet (KD), 2 reported on the Dietary Approaches to Stop Hypertension (DASH), and 3 reported on studies of other dietary strategies. Strong evidence exists regarding the effectiveness of the KD and DASH in reducing the frequency of migraine attacks, whereas their efficacy in improving patients' quality of life was supported only by limited evidence. There also is strong evidence regarding the effectiveness of DASH in reducing migraine's severity and patients' body weight. Insufficient evidence was found regarding the effectiveness of the other dietary interventions on all variables.

CONCLUSIONS

The DASH and KD may help reduce migraine frequency and severity. However, more high-quality studies are needed to confirm their effectiveness.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO No. CRD42024516161.

A U-shaped association between composite dietary antioxidant index and migraine in US adults: a nationwide cross-sectional study

BACKGROUND

The field of dietary therapies for migraine has grown in popularity. Less research has been conducted to establish the relationship between migraine and the composite dietary antioxidant index (CDAI), a crucial indicator for evaluating the overall combined effects of multiple dietary antioxidants. Therefore, this study addressed this gap based on the National Health and Nutrition Examination Survey (NHANES) database.

METHODS

Multivariate logistic regression equations were used to investigate the relationship between CDAI and migraine, and smoothed-fitted curves were plotted. After a nonlinear relationship was discovered, the recursive algorithm and a two-stage linear regression model were employed to calculate the turning point. Additional stratified analyses were performed to explore differences between populations.

RESULTS

This study included a total of 9,190 participants aged 20 years old or older. A U-shaped association was observed between the CDAI and migraine, with an inflection point of 0.2. They were negatively correlated before the inflection point with OR of 0.93 (95% CI = 0.88-0.97) and positively correlated after the inflection point with OR of 1.04 (95% CI = 1.01-1.07). This U-shaped relationship persisted among people aged <60 and ≥60 years, women, and people with BMI <30 and ≥30.

CONCLUSIONS

We identified a U-shaped association between CDAI and migraine in the U.S. adult population. Further case-control studies and experimental research are needed to explore the underlying mechanisms of action.

The association between carbohydrate quality index and headache severity, disability and duration among women with migraine a cross-sectional study

BACKGROUND & AIM

This study aimed to examine the association between Carbohydrate Quality Index (CQI) and headache severity, disability and duration among women with migraine.

MATERIALS & METHODS

In this cross-sectional study, 266 women (aged 18-45 years) were enrolled using a 147-item food frequency questionnaire (FFQ). CQI was defined by four criteria: fiber intake, dietary glycemic index (DGI), whole grains/total grains ratio and solid carbohydrates/total carbohydrates ratio. Anthropometric measurements, visual analogue scale (VAS), migraine disability assessment (MIDAS), and headache duration were assessed for all participants.

RESULTS

Participants with a high adherence to CQI had lower odds of moderate pain (OR = 0.45; 95% CI = 0.21-0.94; P = 0.03) and severe pain (OR = 0.39; 95% CI = 0.18-0.82; P = 0.01) compared to those with a low adherence to CQI. After controlling for potential confounders, individuals with the greatest adherence to CQI showed a 78% reduced prevalence in severe pains and a 63% decreased occurrence in moderate pains compared to those with the lowest adherence (OR = 0.22; 95% CI = 0.09-0.55; P = 0.01 and OR = 0.37; 95% CI = 0.16-0.84; P = 0.01, respectively). Moreover, Subjects with higher adherence to CQI had lower odds of headache duration (OR = 0.54; 95% CI= 0.31-0.96; P = 0.03). The significant association remained (P < 0.05) even after confounding variables (OR = 0.59; 95 % CI = 0.35-1.002; P = 0.05). Despite adjusting for confounding valuables, there was no significant association between the CQI and MIDAS scores (P > 0.05).

CONCLUSION

Higher adherence to CQI was associated with lower severity and duration in patients with migraine. Further studies are needed to confirm these results.

Oxidative Stress and Migraine

The pathogenesis of migraine is not completely understood, but inflammation and oxidative stress seem to be involved, according to data from an experimental model of the disease. This narrative review summarizes data from studies on oxidative stress markers in migraine patients, case-control association studies on the possible association of candidate genes related to oxidative stress with the risk for migraine, studies showing the presence of oxidative stress in experimental models of migraine, and studies on the efficacy of antioxidant drugs in migraine therapy. Many studies have addressed the value of concentrations of prooxidant and antioxidant substances or the activity of antioxidant enzymes in different tissues (mainly in serum/plasma or in blood cells) as possible biomarkers for migraine, being thiobarbituric acid (TBA) reactive substances (TBARS) such as malonyl dialdehyde acid (MDA) and 4-hydroxynonenal, and nitric oxide (this at least during migraine attacks in patients with migraine with aura (MWA) the most reliable. In addition, the possible usefulness of antioxidant treatment is not well established, although preliminary short-term studies suggest a beneficial action of some of them such as Coenzyme Q10 and riboflavin. Both topics require further prospective, multicenter studies with a long-term follow-up period involving a large number of migraine patients and controls.

The association between dietary antioxidant quality score and intensity and frequency of migraine headaches among women: a cross-sectional study

BACKGROUND

Migraine is an episodic disorder and a frequent form of headache. An impaired balance between free radical production and an impaired antioxidant defense system leading to oxidative damage may play a major role in migraine etiology. We sought to investigate whether dietary antioxidant quality score (DAQS) is associated with migraine intensity and frequency among women suffering from migraine.

METHODS

This cross-sectional study was conducted on 265 women. The data related to anthropometric measures and dietary intake were collected. DAQS score was calculated based on FFQ (food frequency questionnaire) vs. the reference daily intake (RDI) quantity. To measure migraine intensity, the migraine disability assessment questionnaire (MIDAS) and visual analog scale (VAS) were used. The frequency of headaches was defined as the days the participants had headaches in the last month and a 30-day headache diary was used.

RESULTS

The results of the study demonstrated that VAS, MIDAS, and frequency of headaches were reduced significantly from the low DAQS (poor quality of antioxidants) to high DAQS (high quality of antioxidants) after adjusting covariates. Also, multinomial regression showed there was an inverse association between higher DAQS and the frequency of headaches. In the adjusted model, subjects with the higher DAQS were 69% less likely to have moderate migraine disability, compared with those with the lower DAQS. Linear regression showed, there was an inverse association between vitamin C intake and the grades of pain severity.َAlso in a crude model, a negative association was found between vitamin E and the frequency of headaches.

CONCLUSION

In conclusion, Participants with higher DAQS had lower migraine intensity and headache frequency. In addition, the consumption of vitamin C may potentially associate with decreasing the severity of headaches. Dietary antioxidants should be monitored closely in individuals suffering from migraine.

The association of dietary total antioxidant capacity with migraine attack frequency in women

AIMS

There is substantial evidence considering oxidative stress as one of the migraine pathogeneses. It seems higher dietary antioxidant intake could modulate migraine symptoms in sufferers. Therefore, we assessed the relationship between the dietary total antioxidant capacity (TAC) and migraine attack frequency.

METHOD

289 volunteer women with migraine were recruited. The usual participants' dietary intakes were collected using a validated food frequency questionnaire. The dietary total antioxidant capacity of women was determined via three different indices including dTAC, DAI, and DAQs. dTAC was calculated based on the USDA oxygen radical absorbance capacity (ORAC) database. The dietary intakes of vitamins A, E, C, selenium, zinc, and manganese were applied for calculating the DAI (Dietary Antioxidant Index) and DAQs (Dietary Antioxidant Quality score). The multivariate-adjusted ordinal regression was used to assess the relation of three indices scores with migraine attack frequency.

RESULTS

a lower score of dTAC was associated with a higher attack frequency [OR (95%CI) model3= 1.97(1.1-3.54), P-value= 0.02]. The women with DAQs= 1 and 3 had significantly higher migraine attack frequency compared to women with DAQs = 5 [DAQs = 1: OR (95%CI) model 3= 8.59 (1.06- 69.72), P-value = 0.04] and [DAQs = 3: OR (95%CI) model 3= 2.09 (1.13- 3.85), P-value= 0.02]. Moreover, the trend of changes among the DAQs and dTAC levels was significant (P-values for trend < 0.05). There was no significant association between tertiles of DAI and migraine attack frequency (P-value> 0.05).

CONCLUSION

A high-quality diet in terms of antioxidant capacity is related to lower attack frequency in migrainous women.

The Neuroprotective Role of Indole-3-Propionic Acid in Migraine Pathophysiology

Background and Objectives: Migraine is a leading cause of disability worldwide, with complex pathophysiological mechanisms involving oxidative and nitrosative stress. Recent research suggests that Indole-3-Propionic Acid (IPA) may have a neuroprotective role in reducing nitrosative stress. This study aims to elucidate the roles of IPA and nitrosative stress biomarkers in migraine patients, focusing on their potential as therapeutic targets. Materials and Methods: This cross-sectional, case-control study included 57 migraine patients and 30 healthy controls. Patients were categorized into episodic migraine (EM) and chronic migraine (CM) groups. Socio-demographic and clinical characteristics were documented through structured interviews. Validated scales such as the Visual Analog Score (VAS), Headache Impact Test 6 (HIT-6), Migraine Disability Assessment Test (MIDAS), Migraine 24 h Quality of Life Scale (24 h QoL), Mini-Mental State Examination (MMSE), and Migraine Attacks-Subjective Cognitive Impairments Scale (Mig-SCog) were administered. Venous blood samples were collected, and serum levels of IPA, Nitric Oxide (NO), Nitric Oxide Synthase (NOS), and Peroxynitrite (ONOO-) were measured using ELISA and spectrophotometric methods. Results: Significant differences in serum IPA and NO levels were observed between migraine patients and controls. Specifically, higher serum IPA levels were found in the EM group, while higher serum NO levels were observed in the CM group. Elevated NO levels correlated with increased migraine attack frequency. Conversely, serum IPA levels showed a negative correlation with attack frequency, suggesting a protective role. Specifically, NO levels were positively correlated with the number of painful days, NSAID usage, VAS scores, HIT-6 scores, and MIDAS scores, while negatively correlated with 24 h QoL scores. Conclusions: The study highlights the significant involvement of IPA and nitrosative stress in migraine pathophysiology. Elevated IPA levels, particularly in EM patients, suggest its potential neuroprotective role. These findings underscore the importance of targeting oxidative and nitrosative stress pathways in developing effective migraine therapies.

Anti-oxidant activity of coenzyme Q10 against AlCl3/D-galactose in albino rat induced cognitive dysfunctions: Behavioral, biochemical, and BACE-1/GSK-3β alterations

The relationship between amyloid beta (Aβ) and oxidative stress (OS), both prominent factors in Alzheimer's disease-related neural degeneration, is deeply interconnected. The cleavage of the extracellular domain of Amyloid precursor protein (APP) and phosphorylating different substrates, respectively, the β-site amyloid precursor protein cleaving enzyme-1 (BACE-1) and Glycogen synthase kinase-3-beta (GSK-3β) enzymes initiate the synthesis of Aβ, which causes cognitive deficits in AD. This study aimed to explore the protective potential of Coenzyme Q10 (CoQ10). It also sought to uncover any synergistic effects when combined with donepezil, an acetylcholinesterase inhibitor, in treating Alzheimer's disease in male albino rats, focusing on the modulation of the BACE-1/GSK-3β pathway. The experiment involved 70 rats categorized into different groups: control, donepezil alone, CoQ10 alone, AD-model, donepezil co-treatment, CoQ10 co-treatment, and CoQ10 + donepezil combination. Various assessments, such as cholinesterase activity, oxidative stress, serum iron profile, Brain Derived Neurotrophic Factor (BDNF), Tau protein, β-site amyloid precursor protein cleaving enzyme-1 (BACE-1), phosphatase and tensin homolog (Pten), and Glycogen synthase kinase-3-beta (GSK-3β), were conducted on behavioral and biochemical aspects. CoQ10 treatment demonstrated memory improvement, enhanced locomotion, and increased neuronal differentiation, mainly through the inhibition of the dual BACE-1/GSK-3β. These findings were substantiated by histological and immunohistological examinations of the hippocampus.

Association of dietary vitamin C consumption with severe headache or migraine among adults: a cross-sectional study of NHANES 1999-2004

Background

An antioxidant-rich diet has been shown to protect against migraines in previous research. However, little has been discovered regarding the association between migraines and vitamin C (an essential dietary antioxidant). This study assessed the dietary vitamin C intake among adult migraineurs in the United States to determine if there is a correlation between migraine incidence and vitamin C consumption in adults.

Methods

This cross-sectional research encompassed adults who participated in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2004, providing detailed information on their dietary vitamin C intake as well as their history of severe headaches or migraines. The study used weighted multivariable and logistic regression analyses to find an independent connection between vitamin C consumption and severe headache or migraine. Tests of interactions and subgroup analysis were conducted.

Results

Among the 13,445 individuals in the sample, 20.42% had a severe headache or migraine. In fully adjusted models, dietary vitamin C consumption was substantially linked negatively with severe headache or migraine (odds ratio [OR] = 0.94, 95% confidence interval [CI] = 0.91-0.98, p = 0.0007). Compared to quartile 1, quartile 4 had 22% fewer odds of having a severe headache or migraine (OR = 0.78, 95% CI = 0.69-0.89, p = 0.0002). Subgroup analyses showed a significant difference between vitamin C intake and severe headaches or migraines by gender (p for interaction < 0.01).

Conclusion

Reduced risk of severe headaches or migraines may be associated with increased consumption of vitamin C.

The correlation between the frequent intake of dietary migraine triggers and increased clinical features of migraine (analytical cross-sectional study from Egypt)

Despite the high prevalence of primary headaches, the role of food in modifying clinical characteristics among migraine patients is often overlooked. The aim is to detect the correlation between adopting unhealthy dietary habits and migraine severity and identify foods that have a greater chance of triggering specific subtypes of migraine. The present study was a cross-sectional analytical study that was conducted at Kasralainy Hospital, Cairo University, headache clinic at Alexandria University Hospital, and Al-Azhar University Hospitals from January to June 2020. We included 124 patients fulfilling the ICHD-3 criteria for migraine. A full clinical profile for migraine headaches was reported using a headache sheet applied to the Al-Azhar University headache unit. A nutritionist obtained data collected about dietary habits using many reliable scales and questionnaires such as food frequently sheets questionnaire. Logistic regression and Pearson correlation coefficients have been used to identify foods that are more likely to be associated with increased clinical features of migraine. Our participants reported that the fried meat, fried chicken, processed meats, fava beans, falafel, aged cheese "Pottery salted cheese" and "Rummy cheese", salted-full fatty cheese "Damietta cheese", citrus fruits, tea, coffee, soft drinks, nuts, pickles, chocolate, canned foods, sauces, ice cream, smoked herring, in addition to the stored food in the refrigerator for many days were significantly associated with the diagnosis of chronic migraine CM compared to episodic migraine (EM). Margarine, pickles, and smoked herring were significantly associated with the diagnosis of migraine with aura (MA) compared to migraine without aura (MO). Adopting unhealthy eating habits was a more prevalent dietary consumption pattern among people with chronic migraines compared to those with episodic migraine.

Association between Oxidative Balance Score and Severe Headache or Migraine among American Adults A Cross-Section Study

BACKGROUND

Migraine is implicated in oxidative stress. The oxidative balance score (OBS) assesses the combined impact of diet and lifestyle on oxidative and antioxidant balance in diseases. However, the association between OBS and migraine remains underexplored.

OBJECTIVE

We aimed to examine the relationship between OBS and severe headaches or migraines among American adults.

METHODS

This cross-sectional study utilized data from the National Health and Nutrition Examination Survey (NHANES) 1999-2004, defining severe headaches or migraine via self-reports and calculating OBS from 16 diaries and 4 lifestyle factors. Multivariable weighted logistic regression models were used to explore the OBS-migraine relationship, with stratified analysis for result validation.

RESULTS

The study included 6,653 participants (average age 45.6, 52.1% male), and 19.1% reported severe headaches or migraines. There was a significant inverse association between OBS and severe headache or migraine, with an adjusted odds ratio (OR) of 0.97 (95% [confidence interval] CI: 0.96, 0.98, p < 0.001). The highest OBS tertile had an adjusted OR of 0.58 (95% CI: 0.47, 0.73) compared to the lowest. This pattern was consistent across sexes, with an adjusted OR of 0.98 (0.95, 1.00) in males and 0.97 (0.95, 1.00) in females. The adjusted OR for migraine was 0.61 (0.44, 0.87) and 0.54 (0.37, 0.79) in the highest tertile for males and females, respectively.

CONCLUSION

The study highlights a significant association between OBS and severe headaches or migraines, suggesting the potential role of oxidative stress in these conditions. The findings emphasize the importance of a balanced, antioxidant-rich diet and lifestyle in managing severe headaches or migraine.

Linking Migraine to Gut Dysbiosis and Chronic Non-Communicable Diseases

In the world, migraine is one of the most common causes of disability in adults. To date, there is no a single cause for this disorder, but rather a set of physio-pathogenic triggers in combination with a genetic predisposition. Among the factors related to migraine onset, a crucial role seems to be played by gut dysbiosis. In fact, it has been demonstrated how the intestine is able to modulate the central nervous system activities, through the gut-brain axis, and how gut dysbiosis can influence neurological pathologies, including migraine attacks. In this context, in addition to conventional pharmacological treatments for migraine, attention has been paid to an adjuvant therapeutic strategy based on different nutritional approaches and lifestyle changes able to positively modulate the gut microbiota composition. In fact, the restoration of the balance between the different gut bacterial species, the reconstruction of the gut barrier integrity, and the control of the release of gut-derived inflammatory neuropeptides, obtained through specific nutritional patterns and lifestyle changes, represent a possible beneficial additive therapy for many migraine subtypes. Herein, this review explores the bi-directional correlation between migraine and the main chronic non-communicable diseases, such as diabetes mellitus, arterial hypertension, obesity, cancer, and chronic kidney diseases, whose link is represented by gut dysbiosis.

Phenolic Composition and Antioxidant Activity of Tanacetum parthenium Cultivated in Different Regions of Ukraine: Insights into the Flavonoids and Hydroxycinnamic Acids Profile

Tanacetum parthenium, also known as feverfew, is rich in bioactive compounds, namely sesquiterpene lactones, flavonoids, and volatile oils. Sesquiterpene lactones possess anti-migraine activity, while phenolic compounds possess anti-inflammatory and antioxidant action. Phytochemical composition determines the pharmacological activity and so profiling is essential in quality assessment. The study aimed to evaluate cultivated feverfew plants' phenolic profiles and antioxidant activity. Eleven phenolic compounds were identified in the samples of feverfew in Ukraine. Hydroxycinnamic acids predominate in the quantitative content of all the samples, namely chlorogenic acid, 3,5-dicaffeoylquinic acid, 3,4-dicaffeoylquinic acid and 4,5-dicaffeoylquinic acid. The total content of flavonoids ranged from 0.8 to 2.6%; the content of hydroxycinnamic acids varied from 3.3 to 6.5%. The obtained data testify to the prospects of using Ukrainian feverfew as a raw material with a significant content of phenolic substances to develop new herbal medicines.

Roxadustat alleviates nitroglycerin-induced migraine in mice by regulating HIF-1α/NF-κB/inflammation pathway

Sensitization of central pain and inflammatory pathways play essential roles in migraine, a primary neurobiological headache disorder. Since hypoxia-inducible factor-1α (HIF-1α) is implicated in neuroprotection and inflammation inhibition, herein we investigated the role of HIF-1α in migraine. A chronic migraine model was established in mice by repeated injection of nitroglycerin (10 mg/kg, i.p.) every other day for 5 total injections. In the prevention and acute experiments, roxadustat, a HIF-1α stabilizer, was orally administered starting before or after nitroglycerin injection, respectively. Pressure application measurement, and tail flick and light-aversive behaviour tests were performed to determine the pressure pain threshold, thermal nociceptive sensitivity and migraine-related light sensitivity. At the end of experiments, mouse serum samples and brain tissues were collected for analyses. We showed that roxadustat administration significantly attenuated nitroglycerin-induced basal hypersensitivity and acute hyperalgesia by improving central sensitization. Roxadustat administration also decreased inflammatory cytokine levels in serum and trigeminal nucleus caudalis (TNC) through NF-κB pathway. Consistent with the in vivo results showing that roxadustat inhibited microglia activation, roxadustat (2, 10, and 20 μM) dose-dependently reduced ROS generation and inflammation in LPS-stimulated BV-2 cells, a mouse microglia cell line, by inhibiting HIF-1α/NF-κB pathway. Taken together, this study demonstrates that roxadustat administration ameliorates migraine-like behaviours and inhibits central pain sensitization in nitroglycerin-injected mice, which is mainly mediated by HIF-1α/NF-κB/inflammation pathway, suggesting the potential of HIF-1α activators as therapeutics for migraine.

Exploration of phytochemicals and probing potential effects of Priva cordifolia active extract on PACAP 38 and its nociceptor in the human trigeminovascular system

Several tribal medicinal systems assert anti-migraine and common headache-remedying properties in all parts of Priva cordifolia (L.f.) Druce. Therefore, there are no clear scientific references to the validated traditional use of this plant. The present study provides a scientific basis for the ethnobotanical utility of P. cordifolia whose whole-plant extracts were evaluated against target proteins (PACAP 38 and PAC1-R) that cause migraine. Understanding the polarity-based distribution and oxidative stress scavenging ability was reported higher in ethyl acetate extracts due to the moderate distribution of secondary metabolites. Based on the preliminary analysis anti-migraine activity in the wet and dry lab experiments was compared with a commercial drug Sumatriptan. The GC-MS analysis revealed that two lead volatile compounds Bicyclo(3.2.1)oct-3-en-2-one,3,8-Dihydroxy-1-methoxy-7-(7-methoxy-1,3- and -Hexyl-2-nitrocyclohexane, present in the ethyl acetate extract showed favourable in silico anti-migraine efficiency. Notably, the ex-vivo results also showed considerable downregulation of the extract-induced mRNA expression of PACAP38. The conclusion of our study justifies that P. cordifolia has valuable plant metabolites that portray it as an efficient anti-oxidant and anti-migraine source.

Supplementary Information

The online version contains supplementary material available at 10.1007/s13205-023-03462-w.

Preventive and Therapeutic Aspects of Migraine for Patient Care: An Insight

BACKGROUND

Migraine is a common neurological condition marked by frequent mild to extreme headaches that last 4 to 72 hours. A migraine headache may cause a pulsing or concentrated throbbing pain in one part of the brain. Nausea, vomiting, excessive sensitivity to light and sound, smell, feeling sick, vomiting, painful headache, and blurred vision are all symptoms of migraine disorder. Females are more affected by migraines in comparison to males.

OBJECTIVE

The present review article summarizes preventive and therapeutic measures, including allopathic and herbal remedies for the treatment of migraine.

RESULTS

This review highlights the current aspects of migraine pathophysiology and covers an understanding of the complex workings of the migraine state. Therapeutic agents that could provide an effective treatment have also been discussed.

CONCLUSION

It can be concluded that different migraines could be treated based on their type and severity.

Migraine severity, disability, and duration: Is a good diet quality, high intake of phytochemicals and polyphenols important?

OBJECTIVES

Dietary pattern may be the determinant of migraine prognosis through various mechanisms such as systemic inflammation, vasodilation, cerebral glucose metabolism, and mitochondrial dysfunction.This study was conducted to examine the relationship of the symptoms and signs of migraine with dietary polyphenols and the phytochemical intake and the quality of the diet.

MATERIALS AND METHODS

Individuals (n = 90), who were admitted to the headache outpatient clinic due to the diagnosis of episodic migraine, underwent physical examination by a neurologist. Migraine characteristics were assessed using the Migraine Disability Assessment Questionnaire and the Visual Analogue Scale. The Healthy Eating Index-2015 (HEI-2015) was used to evaluate the diet quality of individuals, and the Phytochemical Index developed by McCarty was used to determine the dietary intake of phytochemicals. Phenol-Explorer version 3.6 and the USDA Database for the Flavonoid Content of Selected Foods-Release 3.3 were used to calculate the dietary polyphenol intake.

RESULTS

Migraine severity was negatively correlated with the intake of phytochemicals and good diet quality (r = -0.37, p = 0.0003; r = -0.37, p = 0.0003, respectively), and with the intake of phenolic components flavanones (r = -0.27, p = 0.01) and lignans (r = -0.27, p = 0.01). With respect to the food groups; migraine severity was found to be inversely correlated with the total phenol intake from olive oil, oil, and fruits (r = -0.26, p = 0.01; r = -0.21, p = 0.04; r = -0.24, p = 0.02, respectively), and the flavonoid intake from olive oil, oil, fruits, and vegetables (r = -0.26, p = 0.01; r = -0.26, p = 0.01; r = -0.35, p = 0.0007; r = -0.22, p = 0.04, respectively). Strikingly, fruit flavanone intake was correlated with low migraine severity (r = -0.39, p = 0.0002), and fruit flavanol intake was correlated with low migraine disability (r = -0.21, p = 0.04).

CONCLUSION

A high-quality diet rich in phytochemicals and polyphenols (especially flavanones and lignans) is associated with low migraine severity. Lower intake of phenols and flavonoids from vegetable oil, olive oil, fruits, and vegetables were associated with more severe migraine attacks. Examination of migraine characteristics and dietary pattern together with phytochemical and polyphenol intake may guide the development of dietary strategies to be used in migraine patients.

Emerging Promise of Phytochemicals in Ameliorating Neurological Disorders

BACKGROUND

The field of medicine and synthetic drug development have advanced rapidly over the past few decades. However, research on alternative medicine such as phytochemicals cannot be ignored. The main reason for prominent curiosity about phytochemicals stems from the belief that usage of natural compounds is safer and has lesser detrimental side effects.

OBJECTIVE

The aim of the present review was to discuss in detail with several phytochemicals that have been studied or are being studied in the context of various neurological disorders including depression, Alzheimer's disease, Huntington's disease and even neuroinflammatory disorders such as encephalitis.

METHODS

The potential role of phytochemicals in the treatment or management of symptoms associated with neurological disorders have been included in this article. All data included in this paper has been pooled from various databases including Google Scholar, PubMed, Science Direct, Springer and Wiley Online Library.

RESULTS

Phytochemicals have been widely studied for their therapeutic properties associated with neurological disorders. Using various experimental techniques for both in vivo and in vitro experiments, studies have shown that phytochemicals do have antioxidant, anti-inflammatory and neuroprotective activities which play major roles in the treatment of neurological diseases.

CONCLUSION

Even though there has been compelling evidence of the therapeutic role of phytochemicals, further research is still required to evaluate the safety and efficacy of these medicines. Using previously published papers as foundation for additional research such as preclinical studies and clinical trials, phytochemicals can become a safer alternative to synthetic drugs for treating a spectrum of neurological diseases.

A Randomised, Double-Blind, Placebo-Controlled Crossover Trial of Resveratrol Supplementation for Prophylaxis of Hormonal Migraine

Resveratrol, a vasoactive phytoestrogen, has beneficial effects on cerebrovascular function. Previous research has shown that hormonal migraineurs have poorer cerebrovascular function than non-migraineur women. We aimed to investigate if resveratrol supplementation for three months could reduce the hormonal migraine burden index (HMBI: the number of days with menstrual migraine per month), reduce migraine-related disability and improve migraine-related quality of life. A randomised, double-blind, placebo-controlled, crossover, intervention trial was conducted in 62 hormonal migraineurs (mean age: 37.5 ± 0.8 years). Participants consumed 75 mg of resveratrol or matching placebo capsules twice daily for three months before crossing over to the other treatment arm. Participants completed a daily diary and the Headache Impact Test-6™, Migraine Disability Assessment and Migraine-Specific Quality of Life questionnaires at months 0, 3 and 6. The HMBI was the primary outcome and was calculated using data extracted from the participant’s diary. No differences in the HMBI (p = 0.895), the Headache Impact Test-6™, the Migraine Disability Assessment and Migraine-Specific Quality of Life were found between the resveratrol and placebo treatments. Resveratrol supplementation for three months did not affect the HMBI, the migraine-related disability or quality of life measures in our cohort of hormonal migraineurs.

Chronic migraine reversal and prevention with the LIFE diet: a nutrient dense whole food plant-based diet (WFPBD)

We report a case of a 60-year-old man who struggled with frequent migraines for 12.5 years, which were refractory to all conventional therapies. Six months before initial consultation, these migraines become chronic. The patient was then advised to follow the Low Inflammatory Foods Everyday (LIFE) diet, a nutrient-dense, dark green leafy vegetable-rich, whole food plant-based diet. Within 2 months, his headache frequency declined from 18 to 24 headache days per month to 1, and he discontinued his preventive and abortive migraine medications. After 3 months, the patient had no headaches. These results far exceed the goal of migraine treatment with medication, which is to reduce migraine frequency by >50% per month. In addition, the results were durable; this patient has been migraine-free for 7.5 years. Serum beta-carotene more than tripled after the patient started the LIFE diet, consistent with its high content of dark green leafy vegetables. Weight, high-sensitivity C-reactive protein (hsCRP), complete blood count (CBC), hydration status, sodium and other electrolytes remained constant throughout the study.

The Use of Ginkgo Biloba L. as a Neuroprotective Agent in the Alzheimer's Disease

Alzheimer's disease, a neurodegenerative disease, is one of the most common causes of dementia if elderly people worldwide. Alzheimer's disease leads to the alienation of individuals and their exclusion from social and professional life. It is characterized mainly by the degradation of memory and disorientation, which occurs as a result of the loss of neuronal structure and function in different brain areas. In recent years, more and more attention has been paid to use in the treatment of natural bioactive compounds that will be effective in neurodegenerative diseases, including Alzheimer's disease. G. biloba L. and its most frequently used standardized extract (EGb 761), have been used for many years in supportive therapy and in the prevention of cognitive disorders. The paper presents an overview of reports on the pathogenesis of Alzheimer's disease, as well as a summary of the properties of G. biloba extract and its effects on the possible pathogenesis of the disease. By exploring more about the pathogenesis of the disease and the benefits of G. biloba extract for patients with Alzheimer's disease, it will be possible to create an individualized therapeutic protocol to optimize the treatment.

The effects of the dietary approaches to stop hypertension (DASH) diet on oxidative stress and clinical indices of migraine patients: a randomized controlled trial

AIMS

The relationship between the Dietary Approaches to Stop Hypertension (DASH) diet and oxidative stress (OS) in patients diagnosed with migraine is unknown and remains to be examined. Hence, we conducted a parallel-group, randomized controlled trial to investigate this issue.

METHODS

Of the 102 women who met all the inclusion criteria, 51 individuals were randomized to the DASH diet group and 51 to the usual dietary advice group to receive allocated intervention for three months. In order to assess the compliance of participants to the DASH diet, dietary records, and serum vitamin C levels were examined. Parameters of OS status (e.g. nitric oxide (NO), total antioxidant capacity (TAC), total oxidative status (TOS), malondialdehyde (MDA), and oxidative stress index (OSI)) and clinical indices of migraine (e.g. migraine index (MI), headache dairy result (HDR), and migraine headache index score (MHIS)) were assessed at the beginning and the end of the study.

RESULTS

There was a significant reduction in NO (-5.75 vs. + 4.18, P = 0.025) and TOS (-1.55 vs. + 0.71, P = 0.034), and a marginally significant reduction in OSI (-0.10 vs. + 0.14, P = 0.060) in the DASH group compared with the control. Compliance with the DASH diet resulted in a significant decrease in the score of MI (-31.33 vs. - 15.09), HDR (-5.04 vs. -2.51), and MHIS (-44.21 vs. -26.74). Moreover, no significant change was observed in TAC, MDA, and total thiol content.

CONCLUSION

This type of dietary approach can be considered as a complementary treatment for migraine patients, also further investigations are needed to replicate our findings.Trial registration: Iranian Registry of Clinical Trials identifier: IRCT20121216011763N38.

Applications of Ketogenic Diets in Patients with Headache: Clinical Recommendations

Headaches are among the most prevalent and disabling neurologic disorders and there are several unmet needs as current pharmacological options are inadequate in treating patients with chronic headache, and a growing interest focuses on nutritional approaches as non-pharmacological treatments. Among these, the largest body of evidence supports the use of the ketogenic diet (KD). Exactly 100 years ago, KD was first used to treat drug-resistant epilepsy, but subsequent applications of this diet also involved other neurological disorders. Evidence of KD effectiveness in migraine emerged in 1928, but in the last several year's different groups of researchers and clinicians began utilizing this therapeutic option to treat patients with drug-resistant migraine, cluster headache, and/or headache comorbid with metabolic syndrome. Here we describe the existing evidence supporting the potential benefits of KDs in the management of headaches, explore the potential mechanisms of action involved in the efficacy in-depth, and synthesize results of working meetings of an Italian panel of experts on this topic. The aim of the working group was to create a clinical recommendation on indications and optimal clinical practice to treat patients with headaches using KDs. The results we present here are designed to advance the knowledge and application of KDs in the treatment of headaches.

Prioritizing Pain-Associated Targets with Machine Learning

While hundreds of genes have been associated with pain, much of the molecular mechanisms of pain remain unknown. As a result, current analgesics are limited to few clinically validated targets. Here, we trained a machine learning (ML) ensemble model to predict new targets for 17 categories of pain. The model utilizes features from transcriptomics, proteomics, and gene ontology to prioritize targets for modulating pain. We focused on identifying novel G-protein-coupled receptors (GPCRs), ion channels, and protein kinases because these proteins represent the most successful drug target families. The performance of the model to predict novel pain targets is 0.839 on average based on AUROC, while the predictions for arthritis had the highest accuracy (AUROC = 0.929). The model predicts hundreds of novel targets for pain; for example, GPR132 and GPR109B are highly ranked GPCRs for rheumatoid arthritis. Overall, gene-pain association predictions cluster into three groups that are enriched for cytokine, calcium, and GABA-related cell signaling pathways. These predictions can serve as a foundation for future experimental exploration to advance the development of safer and more effective analgesics.

Vitamin C Acutely Affects Brain Perfusion and Mastication-Induced Perfusion Asymmetry in the Principal Trigeminal Nucleus

Prolonged mastication may induce an asymmetric modification of the local perfusion of the trigeminal principal nucleus. The aim of the present study was to evaluate the possible influence of vitamin C (vit. C) on such effect. Four groups of healthy volunteers underwent arterial spin labeling magnetic resonance imaging (ASL-MRI) to evaluate the local perfusion of the trigeminal nuclei after a vit. C-enriched lunch or a control lunch. Two ASL-MRI scans were acquired, respectively, before and after a 1 h-long masticating exercise or a 1 h long resting period. The results showed (i) an increased global perfusion of the brain in the vit. C-enriched lunch groups, (ii) an increased local perfusion of the right principal trigeminal nucleus (Vp) due to mastication, and (iii) a reduction of the rightward asymmetry of the Vp perfusion, due to mastication, after the vit C-enriched meal compared to the control meal. These results confirmed a long-lasting effect of prolonged mastication on Vp perfusion and also suggest a possible effect of vit. C on cerebral vascular tone regulation. Moreover, the data strongly draw attention on the side-to-side relation in Vp perfusion as a possible physiological parameter to be considered to understand the origin of pathological conditions like migraine.

Investigation of the plasma copeptin level in cases with childhood migraine

Copeptin is a hypothalamic stress hormone that is synthesized in the hypothalamus together with Arginine-vasopressin and circulated from the neurohypophysis in equimolar amounts and can indicate the individual stress level. The aim of this study was to investigate the plasma copeptin level for childhood migraine headache. In this study, total oxidant status (TOS); total antioxidant status (TAS); oxidative stress index (OSI); and copeptin were measured in the plasma samples of 61 migraine patients and 60 matched healthy participants. The median plasma copeptin levels in the patients group and control group were 298.25 and 194.35 pg/mL, respectively. Copeptin levels were significantly higher in migraine patients than in the healthy control group. The specificity and sensitivity of copeptin for 249.5 pg/dL cut off value predicting diagnosis of migraine were 67% and 64%, respectively. In addition, TOS and OSI levels were found to be higher and TAS levels were significantly lower in patients with migraine than healthy controls. Plasma copeptin levels are thought to increase in cases of childhood migraine secondary to increased oxidative stress. In the diagnosis of childhood migraine cases, it can be used together with oxidative stress biomarkers such as TAS, TOS and OSI as a complementary parameter.

Bioactive Compounds of Edible Fruits with Their Anti-Aging Properties: A Comprehensive Review to Prolong Human Life

Aging is a complicated biological process in which functional and structural alterations in a living organism take place over time. Reactive oxygen species is one of the main factors responsible for aging and is associated with several chronic pathologies. The relationship between aging and diet is quite interesting and has attained worldwide attention. Healthy food, in addition to dietary antioxidants, are required to delay the process of aging and improve the quality of life. Many healthy foods such as fruits are a good source of dietary nutrients and natural bioactive compounds which have antioxidant properties and are involved in preventing aging and other age-related disorders. Health benefits linked with healthy consumption of fruit have drawn increased interest. A significant number of studies have documented the advantages of fruit intake, as it suppresses free-radical development that further reduces the oxidative stress created in the body and protects against several types of diseases such as cancer, type 2 diabetes, inflammatory disorders, and other cardiovascular diseases that ultimately prevent aging. In addition, fruits have numerous other properties like anti-inflammatory, anti-cancerous, anti-diabetic, neuroprotective, and have health-promoting effects. Mechanisms of various bioactive compounds that aids in preventing various diseases and increases longevity are also described. This manuscript provides a summary of various bioactive components present in fruits along with their health-promoting and antiaging properties.

Role of Antioxidants in Alleviating Bisphenol A Toxicity

Bisphenol A (BPA) is an oestrogenic endocrine disruptor widely used in the production of certain plastics, e.g., polycarbonate, hard and clear plastics, and epoxy resins that act as protective coating for food and beverage cans. Human exposure to this chemical is thought to be ubiquitous. BPA alters endocrine function, thereby causing many diseases in human and animals. In the last few decades, studies exploring the mechanism of BPA activity revealed a direct link between BPA-induced oxidative stress and disease pathogenesis. Antioxidants, reducing agents that prevent cellular oxidation reactions, can protect BPA toxicity. Although the important role of antioxidants in minimizing BPA stress has been demonstrated in many studies, a clear consensus on the associated mechanisms is needed, as well as the directives on their efficacy and safety. Herein, considering the distinct biochemical properties of BPA and antioxidants, we provide a framework for understanding how antioxidants alleviate BPA-associated stress. We summarize the current knowledge on the biological function of enzymatic and non-enzymatic antioxidants, and discuss their practical potential as BPA-detoxifying agents.

The Lactobacillus brevis 47 f Strain Protects the Murine Intestine from Enteropathy Induced by 5-Fluorouracil

We report that the results of our study indicate that Lactobacillus brevis 47 f strain isolated from the faeces of a healthy individual prevents the manifestations of experimental mucositis induced by treatment of Balb/c mice with the anticancer drug 5-fluorouracil (5 FU; 100 mg/kg i.p. × 3 days). The presence of damage to the intestine and the colon was determined by a morphometric analysis of specimens including the height of villi, the amount of goblet cells and infiltrating mononuclear cells, and the expression of the proliferative Ki-67 antigen. Changes in the lipid peroxidation in the blood and the intestine were determined by severalfold increase of the concentration of malonic dialdehyde. Oral administration of L. brevis 47 f strain prior to 5 FU decreased the drug-induced morphological and biochemical changes to their respective physiological levels; the ability of intestinal epitheliocytes to express Ki-67 was partially restored. These effects of L. brevis 47 f strain were more pronounced or similar to those of the reference compound Rebamipid, a quinoline derivative known to protect the gut from drug-induced toxicity. Thus, the new lactobacilli strain attenuates the severity of 5 FU-induced enteropathy.