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Castro Zamparella T, Carpinella M, Peres M, Cuello FP, Maza P, Van Gansen M, Filipchuk M, Balaszczuk V, Maldonado C, Scarnato P, Conci Magris D, Lisicki M. Specific cognitive and psychological alterations are more strongly linked to increased migraine disability than chronic migraine diagnosis. J Headache Pain 2024; 25:37. [PMID: 38486142 PMCID: PMC10941545 DOI: 10.1186/s10194-024-01734-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 02/22/2024] [Indexed: 03/17/2024] Open
Abstract
INTRODUCTION The efficiency of The International Classification of Headache Disorders (ICHD-3) in reflecting patients' disability has recently been questioned. This prompts consideration that clinical features beyond pain may more accurately indicate the extent of underlying brain impairment than the mere frequency of headache days. Important cognitive dysfunctions and psychological impairment have been reported in burdensome cases of migraine, and the presence of these alterations has been associated with biological changes in the nervous system. This study aimed to compare migraine-related disability within a specific patient group, classified using ICHD-3 criteria or classified based on findings from a neuropsychological evaluation using machine learning. Additionally, a complementary voxel-based morphometry (VBM) comparison was conducted to explore potential neuroanatomical differences between the resulting groups. PATIENTS AND METHODS The study included episodic and chronic migraine patients seeking consultation at a specialized headache department. A neuropsychological evaluation protocol, encompassing validated standardized tests for cognition, anxiety, depression, perceived stress, and headache-related impact (HIT-6) and disability (MIDAS), was administered. Results from this evaluation were input into an automated K-means clustering algorithm, with a predefined K=2 for comparative purposes. A supplementary Voxel-based Morphometry (VBM) evaluation was conducted to investigate neuroanatomical contrasts between the two distinct grouping configurations. RESULTS The study involved 111 participants, with 49 having chronic migraine and 62 having episodic migraine. Seventy-four patients were assigned to cluster one, and 37 patients were assigned to cluster two. Cluster two exhibited significantly higher levels of depression, anxiety, and perceived stress, and performed worse in alternating and focalized attention tests. Differences in HIT-6 and MIDAS scores between episodic and chronic migraine patients did not reach statistical significance (HIT-6: 64.39 (±7,31) vs 62.92 (±11,61); p= 0. 42 / MIDAS: 73.63 (±68,61) vs 84.33 (±63,62); p=0.40). In contrast, patients in cluster two exhibited significantly higher HIT-6 (62.32 (±10,11) vs 66.57 (±7,21); p=0.03) and MIDAS (68.69 (±62,58) vs 97.68 (±70,31); p=0.03) scores than patients in cluster one. Furthermore, significant differences in grey matter volume between the two clusters were noted, particularly involving the precuneus, while differences between chronic and episodic migraine patients did not withstand correction for multiple comparisons. CONCLUSIONS The classification of migraine patients based on neuropsychological characteristics demonstrates a more effective separation of groups in terms of disability compared to categorizing them based on the chronic or episodic diagnosis of ICHD-3. These findings could reveal biological changes that might explain differences in treatment responses among apparently similar patients.
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Affiliation(s)
- Tatiana Castro Zamparella
- Neuroscience Unit, Conci-Carpinella Institute, 358 (5000), Córdoba, Urquiza, Argentina
- Psychological Research Institute, Faculty of Psychology, National University of Córdoba (UNC - CONICET), Córdoba, Argentina
- National Council for Scientific and Technical Research (CONICET), Córdoba, Argentina
- Faculty of Psychology, National University of Córdoba (UNC), Córdoba, Argentina
| | - Mariela Carpinella
- Neuroscience Unit, Conci-Carpinella Institute, 358 (5000), Córdoba, Urquiza, Argentina
- Faculty of Psychology, National University of Córdoba (UNC), Córdoba, Argentina
- Faculty of Medicine, Catholic University of Cuyo, San Luis, Argentina
| | - Mario Peres
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
- Instituto de Psiquiatria, Hospital das Clínicas da Faculdade de Medicina da USP, Sao Paulo, SP, Brazil
| | - Florencia Patricia Cuello
- Neuroscience Unit, Conci-Carpinella Institute, 358 (5000), Córdoba, Urquiza, Argentina
- Faculty of Psychology, National University of Córdoba (UNC), Córdoba, Argentina
| | - Pilar Maza
- Neuroscience Unit, Conci-Carpinella Institute, 358 (5000), Córdoba, Urquiza, Argentina
- Faculty of Psychology, National University of Córdoba (UNC), Córdoba, Argentina
| | - Melanie Van Gansen
- Neuroscience Unit, Conci-Carpinella Institute, 358 (5000), Córdoba, Urquiza, Argentina
- Faculty of Psychology, National University of Córdoba (UNC), Córdoba, Argentina
| | - Marcelo Filipchuk
- Neuroscience Unit, Conci-Carpinella Institute, 358 (5000), Córdoba, Urquiza, Argentina
| | - Verónica Balaszczuk
- Psychological Research Institute, Faculty of Psychology, National University of Córdoba (UNC - CONICET), Córdoba, Argentina
- National Council for Scientific and Technical Research (CONICET), Córdoba, Argentina
- Faculty of Psychology, National University of Córdoba (UNC), Córdoba, Argentina
| | - Carolina Maldonado
- National Council for Scientific and Technical Research (CONICET), Córdoba, Argentina
- Faculty of Exact, Physical and Natural Sciences, National University of Córdoba (UNC), Córdoba, Argentina
| | - Pablo Scarnato
- Neuroscience Unit, Conci-Carpinella Institute, 358 (5000), Córdoba, Urquiza, Argentina
| | - Diego Conci Magris
- Neuroscience Unit, Conci-Carpinella Institute, 358 (5000), Córdoba, Urquiza, Argentina
| | - Marco Lisicki
- Neuroscience Unit, Conci-Carpinella Institute, 358 (5000), Córdoba, Urquiza, Argentina.
- Biomedical Physics Department, School of Medicine, National University of Córdoba (UNC), Córdoba, Argentina.
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Filipchuk M, Gassmann J, Castro Zamparella T, Tibaldo MC, Carpinella M, Sesto Tagliavini P, Scarnato P, Goicochea MT, Bruera O, Conci Magris DM, Lisicki M. High rates of (treated) hypothyroidism among chronic migraine patients consulting a specialized headache clinic: are we missing something? Neurol Sci 2021; 43:1249-1254. [PMID: 34283344 DOI: 10.1007/s10072-021-05424-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Roughly three percent of episodic migraine patients evolve into the most burdensome chronic form of this condition every year. While some of the determinants behind this transformation are well established, others are still ill defined. Hypothyroidism is a prevalent endocrinological disorder that can both produce a secondary headache or aggravate a pre-existing primary headache disorder such as migraine. OBJECTIVE We aimed to re-assess the association between hypothyroidism and chronic migraine controlling for factors such as hormone replacement treatment status and bodyweight. METHODS We retrospectively analyzed the medical records of episodic and chronic migraine patients who consecutively consulted our headache clinic in order to determine the prevalence of adequately treated hypothyroidism in each group. Only patients receiving a stable dose regimen were included. The body mass index and other possibly confounding covariates were also collected. RESULTS Data from 111 migraine patients was included for analysis. Most (88.6%) of chronic migraine sufferers were overusing acute medication. Treated hypothyroidism was significantly more prevalent in chronic migraine patients (29.55%) compared to episodic migraine patients (8.96%). This association was independent of the patients' body mass index or other variables. CONCLUSION Alterations of neuronal metabolism, deficient calcitonin release, or focal inflammation causing local hormonal deactivation might explain why hypothyroidism, in spite of levothyroxine replacement therapy, is associated with migraine chronification. Further studies evaluating these factors are warranted.
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Affiliation(s)
- Marcelo Filipchuk
- Headache Department, Neuroscience Unit, Conci-Carpinella Institute, Santa Rosa 994, Córdoba, Argentina
| | - Jesica Gassmann
- Headache Department, Neuroscience Unit, Conci-Carpinella Institute, Santa Rosa 994, Córdoba, Argentina
| | - Tatiana Castro Zamparella
- Headache Department, Neuroscience Unit, Conci-Carpinella Institute, Santa Rosa 994, Córdoba, Argentina.,Institute of Psychological Investigations, National University of Córdoba, Córdoba, Argentina
| | | | - Mariela Carpinella
- Headache Department, Neuroscience Unit, Conci-Carpinella Institute, Santa Rosa 994, Córdoba, Argentina
| | - Pablo Sesto Tagliavini
- Headache Department, Neuroscience Unit, Conci-Carpinella Institute, Santa Rosa 994, Córdoba, Argentina
| | - Pablo Scarnato
- Headache Department, Neuroscience Unit, Conci-Carpinella Institute, Santa Rosa 994, Córdoba, Argentina
| | - Maria Teresa Goicochea
- Servicio de Dolor, Departamento de Neurología, Sección Cefaleas, Fleni, Buenos Aires, Argentina
| | - Osvaldo Bruera
- Headache Department, Buenos Aires Institute of Neuroscience (INEBA), Buenos Aires, Argentina.,Headache and Facial Pain Department, Favaloro Foundation University Hospital, Buenos Aires, Argentina
| | - Diego Martin Conci Magris
- Headache Department, Neuroscience Unit, Conci-Carpinella Institute, Santa Rosa 994, Córdoba, Argentina
| | - Marco Lisicki
- Headache Department, Neuroscience Unit, Conci-Carpinella Institute, Santa Rosa 994, Córdoba, Argentina.
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Uzielli ML, Guarducci S, Lapi E, Cecconi A, Ricci U, Ricotti G, Biondi C, Scarselli B, Vieri F, Scarnato P, Gori F, Sereni A. Premature ovarian failure (POF) and fragile X premutation females: from POF to to fragile X carrier identification, from fragile X carrier diagnosis to POF association data. Am J Med Genet 1999; 84:300-3. [PMID: 10331612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Early menopause in the fragile X carriers has been well documented in several reports. All surveys demonstrated that 13-25% of fragile X carriers experienced premature ovarian failure (POF), defined as menopause before the age of 40 years. In 1995 we started screening two groups of subjects as a part of a Fragile X Research Program: 1) women previously diagnosed as fragile X carriers from the register of our center and 2) women with POF and without a family history of fragile X or other forms of mental retardation. In this study we report the preliminary data collected from 75 fragile X families; in 30 of them, POF was present in one or several subjects, all of whom had a fragile X premutation. None of the women with a full mutation experienced POF in our series of patients. We also identified 89 families without a family history of fragile X or mental retardation, and there were 108 subjects who experienced POF, of which 6.5% had a fragile X premutation. This is 70-fold higher than the background prevalence of fragile X premutation in the Italian population and suggests an association with POF. These data confirm the results of other surveys.
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Affiliation(s)
- M L Uzielli
- Department of Paediatrics, University of Florence, Italy.
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