The relationship between migraine headache and asthma features

Migraine and asthma are comorbid chronic disorders with episodic attacks thought to involve inflammatory and neurological mechanisms. The objective of the present study is to investigate the relationship of asthma features between the asthma patients with migraine and those without migraine headache. A cross-sectional study was conducted from October 2015 to June 2016. Physician-diagnosed asthma patients aged 18 years and above were included. Demographic data, pulmonary function test and treatment of asthma were recorded. Asthma control was assessed using the asthma control test (ACT) and asthma control questionnaire (ACQ). The diagnosis of migraine was made by the neurologist with face-to face examinations based on the International Classification of Headache Disorders, third edition beta (ICHD-III-beta) criteria. Data about the age at onset, frequency of headache attacks, duration of headache attack, the presence of aura, and severity of headache were recorded. The severity of headache was evaluated using visual analogue scale (VAS). Overall 121 asthma patients were included in this study. Migraine was found to be present in 32 (26.4%) of patients. No statistically significant difference was found between asthma group and asthma with migraine groups in terms of pulmonary function test parameters. The mean ACT score in asthma with migraine patients group was significantly lower than the asthma groups. Morever, in the group asthma with migraine, a negative significant correlations were found between ACT scores with VAS scores. This study demonstrates that migraine headache may be associated with poor asthma control. On the other hand, it should not be forgotten that ACT is a subjective test and can be affected from by many clinical parameters.     

Association of drinking water and migraine headache severity

ObjectivesMigraine is a common type of headaches and disabling disorder. Based on evidences dehydration is closely related to promote migraine headcahe frequency and severity. The Water intake is the best intervention to reduce or prevent headache pain. water intake in migraine patients has rarely been studied. the present study aimed to evaluate the relation between water intake and headache properties in migraine.Methods and materialsThe present study was conducted using a cross-sectional design on 256 women 18–45 years old referred to neurology clinics for the first time. The diagnosis of migraine by a neurologist the according to ICHD3 criteria and To assess migraine severity the Migraine disability assessment questionnaire (MIDAS), visual analog scale (VAS), and a 30-day headache diary were used.One-way analysis was used to evaluate the associations between MIDAS and VAS with daily water intake. Pearson correlation analysis was used to evaluate the relationship between the number of days and duration of headache with daily water intake.Data were analyzed using SPSS software and P-values < 0.05 considered statistically significant.ResultsThe results showed that the severity of migraine disability (P < 0.001), pain severity (P < 0.001), headaches frequency (P < 0.001), and duration of headaches (P < 0.001) were significantly lower in those who consumed more water or total water.ConclusionThe present study found a significant negative correlation between daily water intake and migraine headache characteristics but further clinical trials are needed to interpret the causal relationship.     

Clinical characteristics of menstrually related and non-menstrual migraine

Migraine attacks increase during the perimenstrual period in approximately half of female migraineurs. There are differences in the pathogenesis and clinical features of menstrually related and non-menstrual migraine attacks. The objective of this study was to compare the characteristics of migraine in patients with menstrually related and non-menstrual migraine, and to investigate the differences between premenstrual, menstrual, and late-menstrual migraine attacks. Three-hundred and thirty-two women with migraine without aura were evaluated using questionnaires and diaries to determine the characteristics of headache, preceding and accompanying symptoms, and the relation of migraine attacks and menstruation. One-hundred and sixty-three women had menstrually related migraine without aura (49.1%). Duration of disease and duration of headache were longer (p = 0.002 and p < 0.001, respectively), and nausea, vomiting, phonophobia, and aggravation of headache with physical activity were more frequent in patients with menstrually related migraine (p = 0.005, p = 0.006, p < 0.001 and p = 0.006, respectively). Premonitory symptoms and allodynia were observed more frequently in the menstrually related migraine group (p = 0.012 and p = 0.004, respectively). Perimenstrual migraine attacks occurred premenstrually (days ?2 and ?1) in 46 patients (25.3%), menstrually (days 1 to 3) in 90 patients (49.4%), and late menstrually (days 4 to 7) in 19 patients (10.4%). Our results showed that the duration of headache was longer and accompanying symptoms were more frequent and diverse in patients with menstrually related migraine without aura, suggesting that these findings may reflect the increase in excitability or susceptibility of the brain in these patients.     

Low fetuin-A level in migraine: a case–control study

Migraine is a type of primary headache which is caused by the alterations in trigeminovascular system. Migraine attacks are associated with neurovascular inflammation of the cerebral and extracerebral vessels, but its pathophysiological mechanisms have not still been fully delineated. Also, migraine has been found to be associated with higher risks for various metabolic disorders. Thus, we aimed to investigate the matrix metalloproteinases (MMP), fetuin-A, ghrelin, and omentin levels which have important roles in metabolic disorders and inflammation, and to examine their relationship with migraine subtypes and attack frequency. Forty-nine migraine patients and 30 age- and sex-matched healthy control subjects were enrolled. Migraine diagnosis was confirmed according to the International Classification of Headache Disorders-II diagnostic criteria. Analyses of MMP9,MMP3, ghrelin, omentin, and fetuin-A were performed by the ELISA method. Fetuin-A, MMP-9, and MMP-3 levels were significantly lower in migraine than controls (p < 0.05). There were no significant differences between groups with respect to omentin and ghrelin (p > 0.05). In migraine patients, serum fetuin-A levels were positively correlated with MMP-9 and negatively correlated with MMP-3. MMP-3, MMP-9, fetuin-A, omentin and ghrelin levels did not correlate with age, disease duration, or frequency of migraine headache (p > 0.05). Migraine patients have lower fetuin-A, MMP-3 and MMP-9 levels than healthy individuals. Migraine patients have low fetuin-A levels, which may be related to the pathogenesis of migraine. The importance and impact of our findings on the pathogenesis, characteristics, and treatment of migraine needs to be investigated in further detailed studies.     

Cutaneous allodynia in patients with episodic migraine

Cutaneous allodynia may be observed in patients with migraine and this reflects the central sensitization of the trigeminal neurons. We aimed to investigate the frequency of cutaneous allodynia in patients with episodic migraine and to compare clinical characteristics of migraine patients with and without allodynia. One hundred and eighty-six consecutive patients with episodic migraine attacks were prospectively included in the study. The cutaneous allodynia symptoms that occurred during headache attacks were documented using a questionnaire for assessing cephalic and extracephalic cutaneous allodynia. One hundred and fourteen patients (61.3 %) were observed to develop allodynia during migraine attacks and the ratio of the female gender was found higher among the patients with allodynia (p < 0.001). Migraine disease duration was longer (p = 0.004) and accompanying nausea and phonophobia were more common (p = 0.003 and p = 0.005, respectively) in the patients with allodynia. Menstrually related migraine was found to be associated with both allodynia (p = 0.049) and its severity (p = 0.003). The results of present study revealed that cutaneous allodynia was rather frequent in episodic migraine, particularly in patients having longer disease duration. Higher frequency of allodynia in women and its association with menstrually related migraine may be related to the effects of hormonal factors on cutaneous pain thresholds and central sensitization. Association of nausea and phonophobia with allodynia may be interpreted as the common pathways are shared in the development of these symptoms.     

Unilateral cranial autonomic symptoms in patients with migraine

The aim of this study is to investigate the frequency of unilateral cranial autonomic symptoms during migraine attacks, and to compare the clinical characteristics of migraine patients with and without unilateral cranial autonomic symptoms. One hundred and eighty-six consecutive patients with episodic migraine attacks were prospectively included. Cranial autonomic symptoms of the patients occurred during headache, frequency, duration, severity and character of headache, disease duration, presence of aura, laterality of headache, accompanying symptoms, relation of migraine attacks with menstruation, lesions detected on magnetic resonance images, and family history of migraine were recorded. The patients with and without unilateral cranial autonomic symptoms during headache were compared in terms of above-mentioned parameters. Seventy-seven (41.4 %) patients were observed to develop unilateral cranial autonomic symptoms during migraine attack. Disease duration was longer in the patients with unilateral cranial autonomic symptoms than in those without (p = 0.045). Headache was unilateral in 83.1 % of the patients with unilateral cranial autonomic symptoms (p = 0.001). Pure menstrual or menstrually related migraine attacks were more common in the patients with unilateral cranial autonomic symptoms (p = 0.043) and is thought that menstruation-related hormonal factors might have a triggering role on the trigeminal-autonomic reflex pathway. The longer disease duration in patients with unilateral cranial autonomic symptoms might be associated with the activation of pathophysiological mechanisms that cause cranial autonomic symptoms in time. Frequent unilateral pain in migraine patients with unilateral cranial autonomic symptoms is likely to indicate that the development of autonomic symptoms may share common mechanisms with the pathogenesis of trigeminal autonomic cephalalgias.     

Migraine in Assiut Governorate,Egypt: epidemiology,risk factors,comorbid conditions and predictors of change from episodic to chronic migraine

Abstract

Objectives: Headache is one of the most common complaints in medicine. Epidemiological and population-based studies reported that migraine has a variable prevalence worldwide. This study was done to estimate the prevalence of migraine across various age groups in Assiut district, Egypt.

Methods: This is a door-to-door study. It included 4700 randomly selected individuals.

Results: Headache was reported in 1668 subjects (35.49%), of them, 87.65% (n = 1462) had primary headaches. Migraine prevalence was 10.51% with female-to-male ratio of 2.4:1 particularly in ages of 20–40 years. The mean age of patients was 31.46 ± 13.39 years and age at onset was 24.16 ± 12.10 years. Nearly, 63.5% had frequent attacks, 65.2% of the attacks were severe enough to stop daily activities and lasted for >1 day in 32.5% of females compared to 40.7% and 14.5% for males. Chronic or daily migraine was more in females (35.3% versus 20.7% for males). Approximately, 5.6% had chronic migraine and 1.2% had daily migraine from the start, while 24.2% had transformation from episodic to chronic migraine within 6.1 ± 4.4 years. Migraine was prevalent among those with middle educational levels and labor workers. The duration of migraine attacks was found to reduce with age but the chronic/daily migraine increased with age. Hypertension, anxiety, irritable bowel syndrome, and depression were common comorbidities with migraine.

Conclusions: We believe that the work done in this study is informative as it determined the actual prevalence of migraine across various age groups and the important predictors of change in the severity, duration, and frequency of migraine in our locality.     

The effect of maternal migraine headache on their children’s quality of life

Migraine is an episodic disease characterized by a throbbing and generally unilateral headache, often accompanied by nausea, vomiting and light and sound sensitivity. Migraine is known to affect one’s quality of life; not only the person with migraine but also his/her family and social environment are affected by this condition. Our study aimed to evaluate the effects of maternal migraine on children’s quality of life. The patient group comprised 70 mothers with migraine diagnoses and their 111 healthy children, while 50 healthy mothers and their 86 children were included in this study as the control group. The Visual Analog Scale (VAS), Migraine Disability Assessment Scale, Beck Depression Index (BDI) and Beck Anxiety Index (BAI) were used for evaluation of mothers; 3 to 7-year old KINDL and 7- to 17-year-old KINDL-R Quality of Life Scales were used to evaluate the quality of life of children. The SPSS 21.0 program was used for statistical analysis and p < 0.05 was assumed to be statistically significant. The mean age of the migraine group was 37.09 ± 6.94 years, and the mean age of the control group was 38.2 ± 4.5. Symptoms of depression and anxiety were more frequently found in subjects with migraine (p < 0.05). In comparison with the control group: 3 to 7-year old KINDL total scores, self-esteem and school subscales, 7- to 17-year-old KINDL total scores, self-esteem and the social relationships subscale scores were lower in migraine group. It was found to be significant that VAS, BDI and BAI scores of the mothers were negatively correlated with the children’s quality of life. Our study concluded that the presence of migraine-type headache in mothers worsen the relations in school, self-esteem and quality of life in younger children and social relations, relations in school and quality of life in older children. The maternal age, disease severity, and anxiety and depression symptoms were shown to predict the quality of life in children. Performing preventive interventions by individually assessing bio-psycho-social elements for the treatment of mothers with migraine will preserve other family member’s and especially children’s quality of life.     

Prevalence and clinical characteristics of migraine in France

OBJECTIVE: To determine the prevalence and clinical features of migraine and related headache types in France. METHODS: The authors recruited a population of subjects with headache representative of the national population using a stratified sampling method. They screened 10,585 subjects aged 15 and older who were representative of the general population. They identified 1,486 of these as having headaches, and these subjects were subsequently interviewed for information on clinical features, natural history, and functional impact of headache. The authors categorized subjects based on the International Headache Society (IHS) classification and assessed disability using the MIDAS questionnaire. RESULTS: The authors found a standardized prevalence for migraine (IHS categories 1.1 and 1.2) of 7.9% (11.2% for women and 4.0% for men) and 9.1% for migrainous disorder (IHS category 1.7). Migraine attacks were associated with a considerable degree of handicap in activities of daily living, with a MIDAS grade distribution of 74.7% (grade 1), 13.3% (grade 2), 7.7% (grade 3), and 4.3% (grade 4). The prevalence of migraine with MIDAS grade 3 or 4 was 1.6%. CONCLUSIONS: The prevalence of migraine (IHS categories 1.1 and 1.2) in France is 7.9%, and that of total migraine is 17.0%; this does not seem to have evolved over the past 10 years.     

Effects of onabotulinumtoxinA treatment on efficacy,depression, anxiety,and disability in Turkish patients with chronic migraine

Chronic migraine causes a serious labour loss and disability in the society and increases the risk of depression and anxiety by negatively affecting the quality of life. The purpose of this study was to investigate the effects of onabotulinumtoxinA (BoNT-A) treatment on efficacy before and after treatment in our cases with chronic migraine as well as on depression, anxiety and disability caused by migraine. According to the International Headache Classification (ICHD-III beta version), 60 adult patients who were diagnosed with chronic migraine were included in the study. A total of 155 IU BoNT-A treatment from 31 regions was administered in accordance with the protocol of PREEMPT study. Information about the characteristics of patients’ headaches, background and family history, drugs they used was recorded. At the baseline and in the first and third month after the BoNT-A injection, VAS scores, the number of both headache days and attacks, the headache duration, the frequency of application to emergency services and the intake of both analgesics and triptans during attacks were evaluated. MIDAS, BDI and BAI were evaluated at the baseline and in the third month after the BoNT-A injection. BoNT-A injection provided a significant decrease in the number of days and severity of headaches, MIDAS disability scores and psychiatric complaints in cases with chronic migraine who did not respond to prophylactic treatments in the third month of the treatment.     

Do bilateral and unilateral greater occipital nerve block effectiveness differ in chronic migraine patients?

We aimed to compare the effectiveness of bilateral and unilateral block application in chronic migraine patients and whether there were differences in their effectiveness retrospectively. In chronic migraine patients undergoing Greater occipital nerve (GON) block, mean number of days with pain per month before and after block, mean duration of pain in attacks (in hours), and mean Visual Analog Scale (VAS) in attack and pain severity were recorded from files. The patients underwent one block a week for the first 1 month, thereafter one block a month according to GON block protocol used by our institute. Of 41 patients included in the study, 23 underwent unilateral block (group 1) and 18 underwent bilateral block (group 2). In both groups, number of days with migraine decreased significantly in 2 and 3 months as compared to pre-block treatment (P < 0.001). Mean duration of headache decreased in group 2 during treatment (P < 0.001). In group 1, mean duration of headache also decreased but did not differ significantly (P = 0.051). Mean severity of migraine decreased significantly differ in group 1 in 2, 3 months as compared to pre-block treatment (P < 0.001). No differences were observed in frequency, severity and duration of headache between groups during 3-month treatment period. GON block is effective in chronic migraine and bilateral application is no superior over unilateral application.     

Assessing migraine disability by diary-based measurement: relationship to the characteristics of individual headache attacks

Background and purpose:  Information on headache-related disability helps clinicians create the optimal treatment plan for migraine sufferers. The estimation of disability must be determined by gathering the individual effects of multiple headache attacks within a given period of time. This study was aimed to examine migraine-related disability from diary-based assessment and to determine which elements of the headache characteristics are associated with disability.
Methods:  Ninety-two migraine patients were enrolled and contributed data on a total of 422 diary days of headache attacks. Each diary booklet was comprised of questions on headache features and disability comprising five items that originated from Migraine Disability Assessment (MIDAS).
Results:  The average days recorded with disability for one or more of the three aspects of activities per headache attack was 0.55. Amongst the headache variables, pain intensity, nausea/vomiting, photophobia, type of abortive treatment and the employment status were significantly correlated with disability. On regression analysis, pain intensity, nausea/vomiting and employed work status were identified as significant predicting factors for migraine-related disability.
Conclusion:  These results demonstrated that a considerable amount of disability could occur during migraine attack and there are specified elements that act on the development of disability.     

Subcutaneous histamine versus sodium valproate in migraine prophylaxis: a randomized, controlled, double-blind study

Histamine has a selective affinity for H3-receptors and it may specifically inhibit the neurogenic edema response involved in migraine pathophysiology. The objective of this study was to evaluate the therapeutic potential of subcutaneous administration of histamine in migraine prophylaxis, compared with oral administration of sodium valproate, in an open clinical trial. Ninety-two patients with migraine were selected under criteria established by the International Headache Society and enrolled in a 12-week double-blind controlled clinical trial to evaluate the efficacy of subcutaneous administration of histamine (1–10 ng twice a week; n  = 46) compared with oral administration of sodium valproate (500 mg daily dose; n  = 46). The variables studied were headache intensity, frequency, duration, analgesic intake and migraine disability assessment (MIDAS). Two-tailed Student's t - test was used to compare means and the Mann–Whitney U and anova tests were used. The data collected during the 4th, 8th and 12th weeks of treatment revealed that histamine caused a significantly greater reduction ( P  < 0.001) in intensity and duration of migraine attacks as well as in analgesic intake. No difference was detected in the frequency of attacks or in MIDAS. The present study provides evidence of the superior efficacy of histamine applied subcutaneously in migraine prophylaxis when compared with sodium valproate taken orally. Subcutaneously applied histamine may represent a novel and effective therapeutic alternative in resistant migraine patients.     

A preliminary study: validity and reliability of Turkish translation of migraine disability assessment (MIDAS) questionnaire in Turkish patients with chronic tension type headache

We have tested Turkish version of the Migraine Disability Assessment (MIDAS) questionnaire in patients with tension type headache. Thirty-two patients who had a tension type headache were included. Turkish version of the MIDAS questionnaire was applied to all patients. Additionally, the patients were asked to keep a 90-day diary. The day diary and the MIDAS questionnaire were compared at the end of the study period. We found that cronbach's alpha 0.82 and had good reliability. Our findings suggest that the MIDAS questionnaire that was originally designed for patients with migraine may be used in patients with chronic tension type headache.     

A型肉毒毒素重复治疗偏头痛的临床疗效

目的 探讨A型肉毒毒素重复注射治疗偏头痛的疗效与安全性。方法 对30例偏头痛患者均进行2次A型内毒毒素注射治疗,两次均采用颅周固定位点注射,初次治疗间隔6个月以上后进行第2次治疗,2次治疗后分别于第1,2,3个月评定头痛发作天数、头痛发作次数、疼痛程度、偏头痛残疾程度及不良反应。结果 二次A型肉毒毒素注射治疗后偏头痛发作天数、发作次数、疼痛程度、残疾程度均较治疗前缓解（F分别为3．86,5．23,9．37,5．67;P〈0．05）,但两次治疗后各观察点评定指标比较差异无统计学意义（P〉0．05）。结论 A型肉毒毒素重复治疗偏头痛有效、安全,较初次治疗无差异．     

偏头痛患者伴发焦虑/抑郁及功能残疾的临床研究

目的调查偏头痛患者伴发焦虑、抑郁、睡眠障碍、偏头痛相关功能残疾及影响因素分析。方法采用焦虑自评量表(self-rating anxiety scale,SAS)、抑郁自评量表(self-rating depression scale,SDS)、匹兹堡睡眠量表(Pittsburgh sleep quality index,PQSI)、偏头痛残疾程度评估量表(migraine disability assessment scale,MIDAS)、头痛影响测验(headache impact test-6,HIT-6)调查问卷,分别对94例符合ICHD-II诊断标准的偏头痛患者和60例健康对照者焦虑、抑郁、睡眠障碍、偏头痛情况以及相关危险因素进行对比分析。结果偏头痛患者47.9%伴发焦虑;50.0%伴发抑郁,睡眠障碍发生率58.5%。偏头痛组焦虑、抑郁和睡眠障碍发生率都明显高于健康对照组的8.3%,16.7%,30.0%,(掊2分别为28.728,20.755,10.954,P值均<0.01)。多元逐步回归分析显示:头痛程度重、病程长、头痛家族史、睡眠质量差、生活满意度低是偏头痛并发焦虑/抑郁的主要危险因素。头痛程度、发作频率、持续时间、伴发焦虑/抑郁是导致功能残疾的主要影响因素。结论头痛程度、病程、家族史、睡眠质量、生活满意度是偏头痛并发精神心理症状的主要危险因素。     

The Levels of Circulating Proangiogenic Factors in Migraineurs

Migraine has been reported as a risk factor for ischemic stroke or cardiovascular events, and dysfunction of endothelial cells has been evidenced in migraine patients. Proangiogenic factors are potential endothelial stimulators, and their disturbances can link abnormalities of endothelium with increased risk of vascular disorders. The aim of this study was to evaluate the levels of circulating proangiogenic factors in sera of migraineurs during interictal period. Fifty-two patients aged 37.9 ± 9.6 years, fulfilling International Headache Society criteria for migraine, were included in this observational case–control study. The control group included 39 healthy volunteers, matched according to age and gender. All subjects underwent full neurological examination and clinimetric evaluation with the use of: MIDAS, MIGSEV, QVM, VAS and VRS scales. Serum concentrations of vascular endothelial growth factor (VEGF), angiogenin, angiopoietin-2, thrombopoietin and Tie-2 were estimated in migraineurs and in the control group with the use of ELISA. In migraineurs during interictal period, we have found decreased serum VEGF and angiogenin concentrations compared with controls. Age of migraine onset correlated with VEGF, angiopoietin-2 and thrombopoietin concentrations. Furthermore, angiopoietin-2 level correlated with QVM score and Tie-2 with pain intensity evaluated using MIGSEV scale. In migraine patients during interictal period, depletion of VEGF and angiogenin, two cooperating proangiogenic factors, can be responsible for endothelial dysfunction and increased risk for vascular disorders.     

Quarterly repeat cycles of onabotulinumtoxinA in chronic migraine patients: the benefits of the prolonged treatment on the continuous responders and quality-of-life conversion rate in a real-life setting

OnabotulinumtoxinA was approved for treatment of chronic migraine (CM) after publication of Phase 3 Research Evaluating Migraine Prophylaxis Therapy (PREEMPT) trials. However, the PREEMPT trials lasted only up to 1 year. The main aim of our retrospective study was to evaluate whether a prolonged treatment of onabotulinumtoxinA (18 months, six quarterly cycles) will sustain or further improve the efficacy results and the quality of life achieved at 6 and 12 months. Patients were adults with CM with or without overuse of drugs, with at least six regularly repeat onabotulinumtoxinA treatments, administered according to the PREEMPT protocol. The outcomes were investigated after 6, 12, and 18 months of treatment with respect to baseline and with respect to each previous study time point. Headache days and hours, and dosage of headache medication taken with latency period, were collected from the patients daily. Quality of life was evaluated by means of the Migraine Disability Assessment (MIDAS) questionnaire. At each study time point, the proportion of responder patients with respect to baseline was evaluated. For all measures, the baseline data were referred to the previous month before starting. Forty-seven patients were evaluated. Our data show a decrease in the monthly headache days and hours, at each study evaluation, with respect to the previous one. They showed that beyond the first year, a statistically significant difference in the monthly days of headache compared at 18 vs. 12 months is observed. A significantly higher proportion of patients (with a response greater than 75% decrease from baseline in the frequency of headache days and hours) was observed at month 18 compared to month 12. The proportion of patients in MIDAS grade I increased over time, and a statistically significant improvement in MIDAS I score was obtained from month 12 to month 18. A positive modification in the consumption of analgesics over time was observed (p for trend <0.001). The mean acute drug latency strongly decreased over time. Our study confirmed that onabotulinumtoxinA is an effective treatment to reduce headache-related disability and improve patients’ quality of life, highlighting that upon repeated administration, the therapy efficacy increases significantly and a progressive trend of “first-time response” is observed for the entire period under consideration.     

High-rate repetitive transcranial magnetic stimulation in migraine prophylaxis: a randomized, placebo-controlled study

Repetitive transcranial magnetic stimulation (rTMS) is an emerging treatment for pain but there is no class 1 study on its role in migraine prophylaxis. In this study we report the efficacy and safety of high-rate rTMS in migraine prophylaxis. Adult migraine patients having >4 attacks/month were randomized to high-rate rTMS or sham stimulation. Stimulation in the form of 10 Hz rTMS, 600 pulses in 10 trains were delivered to the hot spot of the right abductor digiti minimi in 412 s. Three sessions were delivered on alternate days. The outcome was defined at 1 month. The primary outcome measures were reduction in headache frequency and severity >50 % as assessed by the Visual Analogue Scale (VAS). The secondary outcome measures were functional disability, rescue medication and adverse events. Fifty patients each were randomized to rTMS or sham stimulation. The baseline characteristics of rTMS and sham stimulation groups were similar. At 1 month, headache frequency (78.7 vs. 33.3 %; P = 0.0001) and VAS score (76.6 vs. 27.1 %; P = 0.0001) improved significantly in the patients receiving rTMS compared to those in the sham stimulation group. Functional disability also improved significantly in rTMS group (P = 0.0001). Only one patient following rTMS developed transient drowsiness and was withdrawn from the study. This study provides evidence of the efficacy and safety of 10 Hz rTMS in migraine prophylaxis.     

Nutraceuticals safety and efficacy in migraine without aura in a population of children affected by neurofibromatosis type I

Neurofibromatosis type 1 (NF1) is one of the most common autosomal dominant disorders with a prevalence of one in 4,000 people worldwide, associated with many neurological comorbidities, such as headache. Despite the high prevalence of headache in this population, little data exist regarding the classification of headaches experienced by patients with NF1. Aim of this study is to verify the efficacy and safety of a nutraceutical complex containing Ginkgolide B/Coenzyme Q10/Riboflavin/Magnesium for prophylaxis in a sample of children affected by NF1 presenting migraine without aura. Ginkgolide B/Coenzyme Q10/Riboflavin/Magnesium complex was orally administered twice a day for 6 months, to 18 school-aged patients with NF1 and presenting symptoms of migraine without aura (10 M, mean age 8.4 ± 1.65). Each patient kept a journal to record: number, intensity (according VAS scale), duration of attacks and concomitant symptoms. In addition, the PedMIDAS scale was administered to assess migraine-related disability. To verify the efficacy of the association, we tested the starting frequency (T ₀) of headache after 6 months (T ₁) and then we calculated the migraine frequency delta percentage to express the decrease in monthly frequency. After treatment, a reduction was reported (p < 0.001) in all migraine outcomes (frequency, duration, intensity, and grade of disability). In conclusion, the present study should be considered as the first report on the efficacy and safety of nutraceutical complex containing Ginkgolide B/Coenzyme Q10/Riboflavin/Magnesium for the prophylaxis of migraine in children affected by NF1. Our findings suggest that headache symptoms should be considered a therapeutic target independent of primary disorder.