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1.
《Revue neurologique》2014,170(8-9):490-494
IntroductionThe hypothesis that migraine pain is caused by vasodilation has been challenged by clinical and experimental evidence.State of artThe most convincing arguments against the vascular hypothesis come from neuroimaging data. Magnetic resonance imaging studies show that spontaneous migraine attacks are not accompanied by extracranial vasodilation, and by only slight dilation of the intracranial arteries. Pharmacologically-induced migraine attacks also provide further evidence against the role of vasodilation in migraine. Vasodilators such as sildenafil and nitroglycerine trigger attacks without dilation of the middle cerebral artery diameter, whereas VIP (vasoactive intestinal peptide) markedly dilates intra- and extracranial arteries but does not induce migraine attacks. Clinical studies also show a lack of correspondence between the subjective experience of throbbing headache and the arterial pulse. Moreover, many acute anti-migraine agents are not vasoconstrictors.PerspectivesFurther studies are necessary to clarify the mechanisms of migraine headache generation.ConclusionsContrary to a longstanding and widespread belief, vasodilatation is neither sufficient nor necessary to cause migraine headache and is probably an epiphenomenon.  相似文献   

2.
IntroductionIt has been observed in recent years that levels of such molecules as calcitonin gene–related peptide (CGRP) and, to a lesser extent, the pituitary adenylate cyclase–activating peptide are elevated during migraine attacks and in chronic migraine, both in the cerebrospinal fluid and in the serum. Pharmacological reduction of these proteins is clinically significant, with an improvement in patients’ migraines. It therefore seems logical that one of the main lines of migraine research should be based on the role of CGRP in the pathophysiology of this entity.DevelopmentThe Spanish Society of Neurology's Headache Study Group decided to draft this document in order to address the evidence on such important issues as the role of CGRP in the pathophysiology of migraine and the mechanism of action of monoclonal antibodies and gepants; and to critically analyse the results of different studies and the profile of patients eligible for treatment with monoclonal antibodies, and the impact in terms of pharmacoeconomics.ConclusionsThe clinical development of gepants, which are CGRP antagonists, for the acute treatment of migraine attacks, and CGRP ligand and receptor monoclonal antibodies offer promising results for these patients.  相似文献   

3.
Serotonin (5-HT) plays an important role in the pathophysiology of migraine. Tryptophan hydroxylase 2 (TPH2) is the rate-limiting enzyme in the biosynthesis of 5-HT in the brain and is therefore a major factor in the availability of 5-HT and its rate of production. We hypothesized that functional TPH2 gene variants are associated with migraine. In a case–control study approach, two proven functional and two putatively functional variants of the TPH2 gene were investigated in 266 migraine patients and 153 controls. Genotype, allele, and haplotype frequencies did not differ between healthy subjects and migraineurs. A subgroup analysis for the occurrence of aura or clinical characteristics, including the number of attacks, did not reveal a positive association for the investigated polymorphisms. Our data argue against a major influence of the TPH2 gene promoter region in migraine.  相似文献   

4.
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.  相似文献   

5.
ABSTRACT

Objective

Migraine is a complex episodic disease manifested by dysfunction of the sympathetic nervous system along with numerous neuropsychiatric symptoms. The aim of this study was to identify the dissociative symptoms with neurobiological similarities in episodic and chronic migraine patients and to evaluate their correlation with migraine frequency and severity of attacks.  相似文献   

6.
IntroductionThe premonitory phase comprises a wide range of symptoms that precede the onset of pain in a migraine episode by up to 48 hours. Premonitory symptoms are often not recognised by patients but do have a significant impact on their quality of life. As these symptoms represent the first stage of a migraine attack, they are crucial in improving our understanding of the key points of the origin of migraine.DevelopmentThis paper uses a question-answer format to review the main clinical studies analysing premonitory symptoms, their predictive capacity, the relationship between these symptoms and the biology of migraine, and the role of neuroimaging in the premonitory phase. Finally, we discuss the relevance of these symptoms as potential therapeutic targets in the future.ConclusionsThis study of the premonitory phase has demonstrated that the hypothalamus plays an essential role in the origin of migraine attacks. We should consider the search for new targets in acute migraine treatment in order to act before the onset of the pain. This would imply a radical change in the lives of patients with migraine.  相似文献   

7.
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, 2nd 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.  相似文献   

8.
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.  相似文献   

9.
《Clinical neurophysiology》2020,131(8):1755-1766
ObjectiveGamma-band oscillations (GBOs) induced by nociceptive stimuli were compared between migraine patients and controls in order to further characterize interictal pain processing in the brain of migraineurs. GBOs were related to subjective pain intensity, years of migraine history and migraine attack frequency and the sources of GBOs were investigated.MethodsTwenty-three migraine patients without aura and 23 controls received a series of laser stimulations on their right forehead and right hand while recording electroencephalographic data (61 electrodes). After each series they indicated the perceived pain. A multitaper time-frequency method was used on artifact-cleaned scalp data and frequency domain beamforming was used to localize the GBOs.ResultsIn both groups we observed increases in GBOs around central electrodes, which were not significantly different between groups. The central GBOs were positively associated with the subjective pain ratings in the control group, in accordance with previous studies, but not in the migraine group. Increases in gamma power were observed in the midcingulate cortex.ConclusionsNo evidence was found that GBOs differ between interictal migraine and controls nor that central GBOs represent a neurophysiological correlate of subjective pain in migraine.SignificanceWe shed light on observations of GBOs during pain processing in interictal migraine.  相似文献   

10.
《Brain stimulation》2021,14(6):1544-1552
IntroductionEpisodic migraine is a debilitating condition associated with vast impairments of health, daily living, and life quality. Several prophylactic treatments exist, having a moderate ratio of action related to side effects and therapy costs. Repetitive transcranial magnetic stimulation (rTMS) is an evidence based therapy in several neuropsychiatric conditions, showing robust efficacy in alleviating specific symptoms. However, its efficacy in migraine disorders is unequivocal and might be tightly linked to the applied rTMS protocol. We hypothesized that multifocal rTMS paradigm could improve clinical outcomes in patients with episodic migraine by reducing the number of migraine days, frequency and intensity of migraine attacks, and improve the quality of life.MethodsWe conducted an experimental, double-blind, randomized controlled study by applying a multifocal rTMS paradigm. Patients with episodic migraine with or without aura were enrolled in two centers from August 2018, to December 2019, and randomized to receive either real (n = 37) or sham (sham coil stimulation, n = 28) multifocal rTMS for six sessions over two weeks. Patients, physicians, and raters were blinded to the applied protocol. The experimental multifocal rTMS protocol included two components; first, swipe stimulation of 13 trains of 140 pulses/train, 67 Hz, 60% of RMT, and 2s intertrain interval and second, spot burst stimulation of 33 trains of 15 pulses/train, 67 Hz, 85% of RMT, and 8s intertrain interval. Reduction >50% from the baseline in migraine days (as primary outcome) and frequency and intensity of migraine attacks (as key secondary outcomes) over a 12-week period were assessed. To balance the baseline variables between the treatment arms, we applied the propensity score matching through the logistic regression.ResultsAmong 65 randomized patients, sixty (age 39.7 ± 11.6; 52 females; real rTMS n = 33 and sham rTMS n = 27) completed the trial and five patients dropped out. Over 12 weeks, the responder's rate in the number of migraine days was significantly higher in the real rTMS compared to the sham group (42% vs. 26%, p < 0.05). The mean migraine days per month decreased from 7.6 to 4.3 days in the real rTMS group and from 6.2 to 4.3 days in the sham rTMS group, resulting in a difference with real vs. sham rTMS of −3.2 days (p < 0.05). Similarly, over the 12-week period, the responder's rate in the reduction of migraine attacks frequency was higher in the real rTMS compared to the sham group (42% vs 33%, p < 0.05). No serious adverse events were observed.ConclusionOur pilot study shows compelling evidence in a double placebo-controlled trial that multifocal rTMS is an effective and well-tolerated preventive treatment in patients with episodic migraine.  相似文献   

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