The occipital alpha rhythm related to the “migraine cycle” and headache burden: A blinded,controlled longitudinal study

ObjectiveNeurophysiological studies have shown a fluctuating neural dysfunction in migraine. This pathophysiological feature has not previously been investigated by quantitative electroencephalography (QEEG). The alpha rhythm is especially interesting, because it is influenced by ischemia and neuronal dysfunction within the posterior circulation area.MethodsWe investigated alpha peak frequency, variability, peak power and asymmetry in 41 migraineurs and 32 controls. Electroencephalography (EEG) was recorded on three random days and retrospectively classified as preattack, attack, postattack or interictal, based on the patient’s headache diaries. We also searched for correlations between alpha rhythm parameters and disease duration, attack duration, attack frequency, pain intensity and photophobia.ResultsPeak frequency reduction correlated with increasing disease- and attack duration. Frequency variability increased before the attack, while peak power increased during the attack. Alpha peak width, peak frequency and peak power were similar for migraineurs and controls in the interictal period.ConclusionThe accumulated burden of migraine caused slight alterations in the physiology of the visual cortex. Small alpha rhythm changes were observed along the migraine cycle.SignificanceThis is a longitudinal, controlled study. It is the first to report changes in alpha rhythm with increased migraine load, even when the QEEG is not influenced by recent or imminent attacks.     

Suggestion and pain in migraine: a study by laser evoked potentials

Belief and expectation are part of placebo effect. Migraine patients are characterized by a dysfunctional modulation of pain processing, though a clear placebo effect emerges in clinical trials. The aim of the study was to evaluate the effect of visual and verbal suggestion on subjective pain sensation and cortical responses evoked by CO2 painful laser stimuli in migraine without aura patients vs healthy controls. Twenty-six patients were recorded during the inter-ictal phase and compared to 26 sex and age-matched controls. The right hand and the right supraorbital zone were stimulated during a not conditioned and a conditioned task, where laser stimuli were delivered after a verbal and visual cues of decreased (D), increased (I) or basal (B) intensity, which was left unmodified during the entire task. In control subjects pain rating changed, according to the announced intensity, while in migraine patients the basal hyper-algesia remained unmodified. The N1 and N2 amplitudes tended to change coherently with the stimulus cue in controls, while an opposite paradoxical increase in decreasing condition emerged in migraine. The P2 amplitude modulation was also reduced in migraine, differently from controls. The altered pattern of pain rating and N2 amplitude modulation concurred with frequency of migraine, disability and allodynia. In controls suggestion influenced cortical pain processing and subjective pain rating, while in migraine a peculiar pattern of cortical activation contrasted external cues in order to maintain the basal hyper-algesia. This scarce influence of induced suggestion on pain experience seemed to characterize patients with more severe migraine and central sensitization.     

Structural differences in interictal migraine attack after epilepsy: A diffusion tensor imaging analysis

ObjectivePatients with epilepsy (PWE) are more likely to suffer from migraine attack, and aberrant white matter (WM) organization may be the mechanism underlying this phenomenon. This study aimed to use diffusion tensor imaging (DTI) technique to quantify WM structural differences in PWE with interictal migraine.MethodsDiffusion tensor imaging data were acquired in 13 PWE with migraine and 12 PWE without migraine. Diffusion metrics were analyzed using tract-atlas-based spatial statistics analysis. Atlas-based and tract-based spatial statistical analyses were conducted for robustness analysis. Correlation was explored between altered DTI metrics and clinical parameters.ResultsThe main results are as follows: (i) Axonal damage plays a key role in PWE with interictal migraine. (ii) Significant diffusing alterations included higher fractional anisotropy (FA) in the fornix, higher mean diffusivity (MD) in the middle cerebellar peduncle (CP), left superior CP, and right uncinate fasciculus, and higher axial diffusivity (AD) in the middle CP and right medial lemniscus. (iii) Diffusion tensor imaging metrics has the tendency of correlation with seizure/migraine type and duration.ConclusionResults indicate that characteristic structural impairments exist in PWE with interictal migraine. Epilepsy may contribute to migraine by altering WMs in the brain stem. White matter tracts in the fornix and right uncinate fasciculus also mediate migraine after epilepsy. This finding may improve our understanding of the pathological mechanisms underlying migraine attack after epilepsy.     

Patients with neuropathic pain from lumbosacral radiculopathy demonstrate similar pressure pain thresholds and conditioned pain modulation to those with fibromyalgia

ObjectiveThe purpose of the study was to evaluate pain thresholds, impairment of the endogenous pain modulatory system, and self-reported cognitive-emotional and central sensitization-related symptoms among three subject groups: a rarely studied patient cohort with neuropathic pain from lumbosacral radiculopathy (NPLSR), patients with fibromyalgia (FM) and healthy controls (HC).MethodsPatient-reported pain-related symptomology was evaluated with psychometricallyvalidated questionnaires. Pressure pain threshold (PPT), heat pain threshold (HPT), and cold pain threshold (CPT) were assessed in the low back and contralateral forearm. Conditioned pain modulation (CPM) was evaluated with a recently introduced methodology that accounts for a standard error of measurement.ResultsCompared to the HC subjects, the FM and NPLSR subjects had significantly lower pain thresholds and more CPM impairment. No significant differences in PPT and CPM were observed between the FM and NPLSR groups. Significant group differences were found in self-reported symptoms of depression, anxiety, stress, and central sensitization. Self-reported symptom severity increased in a stair-step fashion, with the HC group scoring lowest and FM group scoring highest.ConclusionThe NPLSR group manifested CPM dysfunction and pressure hyperalgesia at similar levels to the FM group, indicating that these two chronic pain syndromes, likely based on different pathophysiological mechanisms, in fact share some common pain processing features. However, though both patient groups demonstrated similarities in pain processing, self-reported cognitive-emotional and central sensitization-related symptom severity was significantly higher in the FM cohort, which distinguished them from the chronic NPLSR cohort.     

无先兆偏头痛发作间期的静息态功能磁共振研究

目的本研究采用静息态功能磁共振(rf MRI)方法通过对比无先兆偏头痛(Mwo A)患者与健康对照的大脑自发脑活动的局部一致性(Re Ho)差异,为偏头痛的发病机制提供新的见解。方法对23例发作间期的Mwo A患者和25例性别、年龄、受教育程度相匹配的健康被试者进行临床资料的采集及rf MRI检查。应用Re Ho方法分析每个被试者大脑的相邻体素的血氧水平依赖(BOLD)信号在同一时间序列中波动的一致性,并对两组被试者的Re Ho值的脑图行统计学分析。结果与对照组Re Ho脑图相比,偏头痛组右侧丘脑、右侧壳核、右侧前额叶皮质及右侧海马的Re Ho值显著高于对照组(P0.05)。结论 Mwo A患者发作间期疼痛处理及调节与应激反应相关的脑区存在功能异常。     

Lack of habituation of nociceptive evoked responses and pain sensitivity during migraine attack.

OBJECTIVE: The aim of the present study was to investigate the habituation of subjective pain sensation to CO(2) laser stimulus, in relation to the amplitude modifications of the cortical evoked responses (LEPs), during both the migraine attack and the not symptomatic phase. METHODS: Fourteen migraine patients were selected and compared with 10 healthy controls. Eight patients were evaluated during both the pain-free and the attack phases. Three following series of 20 averaged LEPs were recorded, stimulating the hands and the supraorbital zones: during the attack, two consecutive series of 20 averaged LEPs were carried out. The subjective sensation was requested for each laser stimulus, using a 0-10 points Verbal Rating Scale (VRS). RESULTS: In normal subjects the N2-P2 waves amplitude showed habituation across the three repetitions, which correlated with the habituation of the subjective rating of the stimulus. During the not symptomatic phase, patients showed a lack of habituation of the N2-P2 amplitude when the hand and the face was stimulated, with a pattern of increase of the pain rating across the three repetitions; in addition there was a lack of correlation between the LEPs amplitude and the subjective sensation. During the attack, the LEPs amplitude and the pain rating were increased when the face was stimulated, but they did not habituate across the two repetitions, likely the pain-free condition. The percent LEPs amplitude variation across the three repetitions correlated with the main indices of migraine severity, mainly when the supraorbital zone was stimulated. CONCLUSIONS: The abnormal cortical excitability in migraine could condition an anomalous behavior of nociceptive cortex during the interictal phase of migraine: it persists during the acute phase, and correlates with the frequency and duration of migraine. SIGNIFICANCE: The reduced habituation of the nociceptive cortex may concur with the onset and evolution of headache.     

Ipsilateral cortical activation in fibromyalgia patients during brushing correlates with symptom severity

ObjectiveTo evaluate cortical activation patterns during mechanical-tactile stimulation in fibromyalgia syndrome (FMS) patients and to correlate cortical activation changes with clinical symptoms.MethodsNineteen female FMS patients and 18 matched, healthy control subjects underwent EEG examination during brushing stimulation of the right forearm. Participants rated any pain experienced and underwent a manual tender point scale (MTPS) examination. Amplitude changes of cortical rhythms during brushing were analysed in alpha (8–13 Hz) and beta (16–24 Hz) frequency bands.ResultsThirteen patients reported pain during brushing. Independent t-test comparison of event related desynchronisation (ERD) during brushing revealed a cluster of electrodes over ipsilateral (right) central–parietal region which demonstrated ERD in patients only. Clinical MTPS scores correlated with beta-band ERD in this cluster of electrodes. Beamformer analysis revealed a widespread array of source activations in patients, including bilateral insula and primary and secondary somatosensory cortices. Control subject source activations were limited to contralateral (left) hemisphere.ConclusionsResults indicate ipsilateral cortical activations in FMS patients, but not in healthy controls, during brushing. Ipsilateral ERD during brushing is associated with MTPS score suggesting abnormal processing of somatosensory input which may contribute to clinical pain.SignificanceAltered functioning in FMS may reflect physiological changes in response to afferent somatosensory information manifesting in chronic pain.     

Gamma-band oscillations in the primary somatosensory cortex--a direct and obligatory correlate of subjective pain intensity

Electroencephalographic gamma band oscillations (GBOs) induced over the human primary somatosensory cortex (SI) by nociceptive stimuli have been hypothesized to reflect cortical processing involved directly in pain perception, because their magnitude correlates with pain intensity. However, as stimuli perceived as more painful are also more salient, an alternative interpretation of this correlation is that GBOs reflect unspecific stimulus-triggered attentional processing. In fact, this is suggested by recent observations that other features of the electroencephalographic (EEG) response correlate with pain perception when stimuli are presented in isolation, but not when their saliency is reduced by repetition. Here, by delivering trains of three nociceptive stimuli at a constant 1 s interval, and using different energies to elicit graded pain intensities, we demonstrate that GBOs recorded over SI always predict the subjective pain intensity, even when saliency is reduced by repetition. These results provide evidence for a close relationship between GBOs and the cortical activity subserving pain perception.     

Increased brain responses during subjectively-matched mechanical pain stimulation in fibromyalgia patients as evidenced by MEG

ObjectiveThe precise pathophysiology of fibromyalgia, a syndrome characterized by chronic widespread pain, remains to be clarified. When subjected to the same amount of stimulation, patients show enhanced brain responses as compared to controls, providing evidence of central pain augmentation in this syndrome. We aimed to characterize brain response differences when stimulation is adjusted to elicit similar subjective levels of pain in both groups.MethodsMagnetoencephalography (MEG) was used to investigate the brain responses to pressure stimulation applied both above and below the pain threshold in nine patients and nine control subjects. A device was developed to deliver pressure pulses in a quantifiable and precise manner. The amount of pressure was adjusted to produce similar subjective pain in both groups.ResultsA between-group comparison of differences between responses evoked by stimulation above and below the pain threshold was performed using cluster-based permutation testing. Increases in signal amplitude in somatosensory, temporal and parietal areas at short latencies, and in prefrontal areas at both short and long latencies, were found to be larger for patients than for control subjects.ConclusionFibromyalgia patients show enhanced brain responses after reducing the amount of pressure to produce similar subjective levels of pain than to the control subjects.SignificanceThe present results suggest that central pain augmentation is present in fibromyalgia, not only when the objective level of stimulation is kept the same as for control subjects, but also when stimulation is adjusted to produce similar levels of pain in patients and controls.     

Variability of the blink reflex in patients with migraine

Background and purposeSensitization of brainstem trigeminal nuclei and activation of the trigeminovascular system are thought to play an important role in migraine. The blink reflex has become a valuable tool for investigating trigeminal nerve function. The aim of the study was to assess the differences in electrophysiological examinations of the trigeminal nerve (blink reflex) in a group of patients with migraine in comparison with a healthy control group.Material and methodsThe examination was conducted among 58 patients. Patients were diagnosed in the Polyclinic or hospitalized in the Department of Neurology of Warsaw Medical University in Bielański Hospital. The study group included 29 patients suffering from migraine (diagnosed according to the International Classification of Headache Disorders, 2^nd edition) and 29 patients without headaches served as controls. All patients underwent neurological examination and magnetic resonance imaging to identify organic disorders. The blink reflex was tested among all patients in accordance with electrophysiological laboratory standards.ResultsThe latency of the R1 response was significantly shorter among patients with migraine. The latency of R2 and R2’ responses was similar in patients and controls. A significant inverse correlation was observed between latency of R2 and R2’ responses and frequency of migraine attacks.ConclusionsThe inverse correlation between the frequency of attacks and the latency of R2 and R2’ responses of the blink reflex confirms the abnormal eaxcitability induced by the high frequency of migraine attacks.     

Auditory attention alterations in migraine: A behavioral and MEG/EEG study

ObjectivesTo evaluate alterations of top-down and/or bottom-up attention in migraine and their cortical underpinnings.Methods19 migraineurs between attacks and 19 matched control participants performed a task evaluating jointly top-down and bottom-up attention, using visually-cued target sounds and unexpected task-irrelevant distracting sounds. Behavioral responses and magneto- and electro-encephalography signals were recorded. Event-related potentials and fields were processed and source reconstruction was applied to event-related fields.ResultsAt the behavioral level, neither top-down nor bottom-up attentional processes appeared to be altered in migraine. However, migraineurs presented heightened evoked responses following distracting sounds (orienting component of the N1 and Re-Orienting Negativity, RON) and following target sounds (orienting component of the N1), concomitant to an increased recruitment of the right temporo-parietal junction. They also displayed an increased effect of the cue informational value on target processing resulting in the elicitation of a negative difference (Nd).ConclusionsMigraineurs appear to display increased bottom-up orienting response to all incoming sounds, and an enhanced recruitment of top-down attention.SignificanceThe interictal state in migraine is characterized by an exacerbation of the orienting response to attended and unattended sounds. These attentional alterations might participate to the peculiar vulnerability of the migraine brain to all incoming stimuli.     

Difference of steady-state visual evoked potentials in classic and common migraine

The present study was designed to find evidence for the neural hypothesis of migraine and to evaluate possible interictal differences in the two varieties of migraine by electrophysiological means. Steady-state visual evoked potentials (SVEPs) in response to sinusoidally modulated light were measured in 20 patients with classic migraine and compared with those of 30 common migraineurs and 49 reference subjects. SVEPs to stimuli at 10-24 Hz were recorded occipitally from a pair of midline electrodes and, in classic migraineurs and controls, additionally from left and right occipital areas. The response was processed by the Fast Fourier Transform and automatically analysed. The fundamental component of the midline response to medium frequency stimuli (16-22 Hz) appeared normal in patients with classic migraine, contrary to an augmented response in common migraineurs (ANOVA between groups, P = 0.006). In classic migraine the 2nd harmonic component was attenuated (P less than 0.01 at 18-20 Hz) and the amount of strong interhemispheric f1 asymmetries was increased in about half of the patients. The groups also diverged significantly in the SVEP dynamics during stimulation. The results support the hypothesis of a primary neural disorder in both types of migraine. Different sites and mechanisms of brain dysfunction in classic and common migraine are suggested. Hypothetical neuroanatomical correlates for the abnormalities are presented.     

The measure of randomness by leave-one-out prediction error in the analysis of EEG after laser painful stimulation in healthy subjects and migraine patients

OBJECTIVE: We aimed to perform a quantitative analysis of event-related modulation of EEG activity, resulting from a not-warned and a warned paradigm of painful laser stimulation, in migraine patients and controls, by the use of a novel analysis, based upon a parametric approach to measure predictability of short and noisy time series. METHODS: Ten migraine patients were evaluated during the not-symptomatic phase and compared to seven age and sex matched controls. The dorsum of the right hand and the right supraorbital zone were stimulated by a painful CO(2) laser, in presence or in absence of a visual warning stimulus. An analysis time of 1s after the stimulus was submitted to a time-frequency analysis by a complex Morlet wavelet and to a cross-correlation analysis, in order to detect the development of EEG changes and the most activated cortical regions. A parametric approach to measure predictability of short and noisy time series was applied, where time series were modeled by leave-one-out (LOO) error. RESULTS: The averaged laser-evoked potentials features were similar between the two groups in the alerted and not alerted condition. A strong reset of the beta rhythms after the painful stimuli was seen for three groups of electrodes along the midline in patients and controls: the predictability of the series induced by the laser stimulus changed very differently in controls and patients. The separation was more evident after the warning signal, leading to a separation with P-values of 0.0046 for both the hand and the face. DISCUSSION: As painful stimulus causes organization of the local activity in cortex, EEG series become more predictable after stimulation. This phenomenon was less evident in migraine, as a sign of an inadequate cortical reactivity to pain. SIGNIFICANCE: The LOO method enabled to show in migraine subtle changes in the cortical response to pain.     

Long-Term Prophylactic Transcranial Direct Current Stimulation Ameliorates Allodynia and Improves Clinical Outcomes in Individuals With Migraine

ObjectivesMigraine is a common and substantially debilitating disorder that may associate with allodynia, a marker of central sensitization in the pain circuits. Several unmet needs, like limited adherence to drugs due to adverse events and cost-effectivity, still occur in the prophylactic treatment of migraine. Transcranial direct current stimulation (tDCS) has recently been indicated to be beneficial in individuals with migraine with and without allodynia. However, to our knowledge, there are no studies evaluating the efficacy of six-month tDCS in migraine.Materials and MethodsThis study was a randomized double-blind parallel-group sham-controlled five-month extension study after a one-month lead-in trial of tDCS in individuals with migraine. A total of 23 individuals with migraine with allodynia who completed the lead-in trial were recruited after their consent and were administered three consecutive sessions of 2-mA anodal 20-minute tDCS over the left primary motor cortex every month for an additional five months. Pain-related outcomes were determined using monthly headache diaries. Allodynia, depression, anxiety, and disability because of migraine also were assessed throughout the study.ResultsImprovements in allodynia levels, attack frequency, number of rescue medications, and attack duration were higher, and mostly gradual during the trial, in the active group. Migraine Disability Scale grades also were lower in the active group, whereas no between-group differences were found in depression and anxiety scores. Higher responder rates of migraine attack frequency (56.8% vs 25%), number of headache days (56% vs 16.7%), and migraine attack duration (90.9% vs 8.3%) were observed after six-month tDCS in the active group than in the sham group.ConclusionsLong-term extended tDCS is shown to be a safe, efficacious, and plausible modality for prophylactic treatment in individuals with migraine with allodynia.SignificanceLong-term extended tDCS can alleviate allodynia, which is an indicator of drug resistance and chronicity, and meet the goals of prophylactic treatment in individuals with migraine with allodynia.     

Cervical vestibular evoked myogenic potentials in primary headache disorders

ObjectiveTo determine if cervical vestibular evoked myogenic potentials (cVEMPS) differ in patients with migraine without aura (MoA), vestibular migraine (VM) and tension type headache (TTH).MethodsTwenty patients with MoA, 24 patients with VM and 20 patients with TTH were included in the study. Thirty healthy volunteers of comparable age and gender were taken as the control group. The latencies of peaks p13 and n23, peak-to-peak amplitude of p13–n23 divided by a mean prestimulus EMG recorded during cVEMP testing were measured. The amplitude asymmetry between right and left sides was also calculated and taken into consideration. Caloric testing was conducted to check if the results are associated with the results of the cVEMPs.ResultsFive (one on the right, four on the left side) of the 24 patients with VM (20.8%) displayed a unilateral caloric hypofunction. Normal results were recorded from patients with MoA and TTH. p13, n23 latencies and amplitudes of the patient groups were not statistically different from the results of the healthy controls (p > 0.05). An amplitude asymmetry between right and left sides exceeding that of the healthy controls was not also present (p > 0.05).ConclusionsThough a hypofunctioning horizontal semicircular canal was detected in 20.8% of the patients with VM, saccular function seemed to be unaffected. Patients with MoA and TTH did not display any vestibular test abnormality.SignificancePrimary headache disorders seem to be associated with a normal interictal cVEMP profile.     

Patients with migraine correctly estimate the visual verticality

ObjectiveWe wanted to study otolith function by measuring the static subjective visual vertical (SVV) in migraine patients and in controls with and without kinetosis (motion sickness).Methods and materialForty-seven patients with moderately severe migraine and 96 healthy controls were enrolled. Using a questionnaire, persons with kinetosis were identified. The SVV test was performed in a totally dark room. Subjects wore a stiffneck to stabilize the head in an erect position. They were required to adjust an infrared line to the gravitational vertical with a hand-held infrared remote controlled potentiometer.ResultsThe deviation of SVV in the group of migraine patients was not significantly different from that of controls, regardless of whether an aura was associated. SVV was not significantly influenced by the presence of dizziness/non specific vertigo or kinetosis.ConclusionPatients with moderately severe migraine under prophylactic medication correctly estimate the visual verticality in the headache-free period. It is suggested that a deviation of SVV in a headache-free migraine patient may not be attributed to his migraine disorder as such regardless whether kinetosis is associated.     

Structural brain MRI abnormalities in pediatric patients with migraine

Morphometric MRI studies in adult patients with migraine have consistently demonstrated atrophy of several gray matter (GM) regions involved in pain processing. We explored the regional distribution of GM and white matter (WM) abnormalities in pediatric patients with episodic migraine and their correlations with disease clinical manifestations. Using a 3.0 T scanner, brain T2-weighted and 3D T1-weighted scans were acquired from 12 pediatric migraine patients and 15 age-matched healthy controls. GM and WM volumetric abnormalities were estimated using voxel-based morphometry (p < 0.05, family-wise error corrected). Compared to controls, pediatric migraine patients experienced a significant GM atrophy of several regions of the frontal and temporal lobes which are part of the pain-processing network. They also had an increased volume of the right putamen. The left fusiform gyrus had an increased volume in patients with aura compared to patients without aura and controls, whereas it was significantly atrophied in patients without aura when compared to the other two groups. No abnormalities of WM volume were detected. In migraine patients, regional GM atrophy was not correlated with disease duration and attack frequency, whereas a negative correlation was found between increased volume of the putamen and disease duration (r = ?0.95, p < 0.05). These results show that GM morphometric abnormalities do occur in pediatric patients with migraine. The presence of such abnormalities early in the disease course, and the absence of correlation with patient clinical characteristics suggest that they may represent a phenotypic biomarker of this condition.     

Body mass index and its impact on migraine prevalence and severity in female patients: Preliminary results

Background and purposeA strikingly increasing number of obese patients causes a great interest in potential medical problems resulting from abnormal body weight. Many conditions are associated with obesity. The severity and risk of migraine may be connected with a body weight. We would like to assess a correlation between body mass index (BMI) and frequency and duration of migraine.Materials and methodsWe collected data of 53 female patients with migraine and 36 healthy persons (25 women) as a control group. Mean duration of migraine attacks and their mean frequency were based on patients’ diaries. The patients reported their height. Weight was measured by the authors. We consequently calculated BMI and performed statistics on SAS 9.2.ResultsThe mean BMI of the migraine group was 24.27 ± 4.47. Forty-nine percent of patients had normal BMI (18.5–25), 30% patients were overweight (>25) and 13% were obese (>30). The mean BMI among controls was 22.69 ± 2.96. Eighty-four percent of the control group had normal BMI, 12% was overweight and 5% was obese. An association of BMI in women with frequency of migraine episodes per month occurred remarkable when adjusted for age. Difference of a mean BMI value between the migraine and the control group was nearly statistically significant. Body mass index and duration of the episodes revealed similarly strong correlation.ConclusionsIncreased BMI correlates with frequency of migraine. Its influence on a risk of the headaches and their duration remains to be specified.     

Anger and impulsiveness in migraine patients with and without aura

ABSTRACT

Background and purpose: Migraine is a common primary headache disorder triggered by internal or external stimuli. Impulsitivity and anger are associated with many neurological and psychiatric disorders. The aim of this study was to investigate the anger and impulsivity in migraine patients with or without aura.

Methods: A total of 55 patients aged between 18 and 55, who were diagnosed with episodic migraine (31 with aura and 24 without aura) and 40 healthy controls were enrolled in this prospective cross-sectional study.

Migraine diagnosis and classification were based on criteria from the International Classification of Headache Disorders, 3rd edition (beta version). Multidimensional Anger Scale and Barratt Impulsivity Scale-11 were administered to the patient and control groups.

Results:Migraine patients with aura, migraine patients without aura and control groups were compared, anger symptoms were significantly higher in migraine patients with aura (p < 0.001), but between these groups there was no significant difference in terms of impulsivity (p = 0.711).

Conclusions: It was found that anger symptoms were more common in migraine patients with aura compared to migraine patients without aura and control group, but in impulsitivity there was no difference between groups.

Further studies in future investigating the relation between migraine with aura and anger may pave the way for different and more specified treatment approach.     

The role of migraine headache severity,associated features and interactions with overweight/obesity in inhibitory control

Aim of the Study: While migraine and obesity are related and both conditions are associated with reduced executive functioning, no study has examined whether obesity exacerbates executive dysfunction in migraine. This cross-sectional study examined whether overweight/obesity moderated associations of migraine severity and associated features with inhibitory control, one aspect of executive function.

Materials and Methods: Women (n = 124) aged 18–50 years old with overweight/obesity body mass index (BMI) = 35.1 ± 6.4 kg/m² and migraine completed a 28-day smartphone-based headache diary assessing migraine headache severity (attack frequency, pain intensity) and frequency of associated features (aura, photophobia, phonophobia, nausea). They then completed computerized measures of inhibitory control during an interictal (headache-free) period.

Results: Participants with higher migraine attack frequency performed worse on the Flanker test (accuracy and reaction time; p < .05). Migraine attack frequency and pain intensity interacted with BMI to predict slower Stroop and/or Flanker Reaction Time (RT; p < .05). More frequent photophobia, phonophobia and aura were independently related to slower RT on the Stroop and/or Flanker tests (p < .05), and BMI moderated the relationship between the occurrence of aura and Stroop RT (p = .03).

Conclusions: Associations of migraine severity and presence of associated features with inhibitory control varied by BMI in overweight/obese women with migraine. These findings warrant consideration of weight status in clarifying the role of migraine in executive functioning.