Migraine-related seizures in an epileptic population

A relationship between epilepsy and migraine has long been postulated, but the nature of this interaction is still debated. We studied adult patients with epilepsy and investigated the relationship between migraine and epilepsy. Fourteen percent ( n = 412) of adult patients with seizures were identified with a diagnosis of migraine. We also found a direct relationship between migraine and epilepsy (a migraine-induced epilepsy) in 1.7% (seven patients) of the patients with seizures. Patients were at increased risk for both conditions if they had migraine with aura and catamenial epilepsy. The seizure began during or shortly after the migraine aura in all of the cases and preceded the headache. Three of four patients who were refractory to management with antiepileptic drugs using either mono or combination therapy improved seizure control with combination antimigraine and antiepileptic drugs.     

Steroids for Migraine Headaches: A Randomized Double-Blind, Two-Armed, Placebo-Controlled Trial

Background: Recurrence of migraine headache after treatment in the emergency department (ED) is common. Conflicting evidence exists regarding the utility of steroids in preventing migraine headache recurrence at 24–48 h. Objective: To determine if steroids decrease the headache recurrence in patients treated for migraine headaches in the ED. Methods: Double-blind placebo-controlled, two-tailed randomized trial. Patients aged >17 years with a moderately severe migraine headache diagnosed by treating Emergency Physician were approached for participation. Enrollees received either dexamethasone (10 mg i.v.) if intravenous access was utilized or prednisone (40 mg by mouth × 2 days) if no intravenous access was obtained. Each medication was matched with an identical-appearing placebo. Patients were contacted 24–72 h after the ED visit to assess headache recurrence. Results: A total of 181 patients were enrolled. Eight were lost to follow-up, 6 in the dexamethasone group and 2 in the prednisone arm. Participants had a mean age of 37 years (±10 years), with 86% female. Eighty-six percent met the International Headache Society Criteria for migraine headache. Of the 173 patients with completed follow-up, 20/91 (22%) (95% confidence interval [CI] 13.5–30.5) in the steroid arm and 26/82 (32%) (95% CI 21.9–42.1) in the placebo arm had recurrent headaches (p = 0.21). Conclusion: We did not find a statistically significant decrease in headache recurrence in patients treated with steroids for migraine headaches.     

Characteristic and overlapping features of migraine and tension-type headache

OBJECTIVE: This epidemiological survey was conducted to investigate comprehensive characteristic and overlapping features of migraine and tension-type headache (TTH) disorders classified based on International Classification of Headache Disorders-II. METHODS: The stratified cohort of this study was composed of 2504 schoolchildren aged 10 to 17 years. A 38-item questionnaire inquiring all characteristic features of primary headache syndromes mandatory for classification was applied to selected 483 children with recurrent headache in the last 6 months. RESULTS: Migraine was diagnosed in 227 (47.0%) of 483 children and TTH in 154 (31.9%). Out of 125 children with definite migraine, 73 (58.4%) reported tension-type symptoms and 94 (68.1%) of 138 children with definite TTH reported migraine-type symptoms. Pressing pain (21%) and lack of aggravation of pain by physical activity (34%) were the major tension-type features in patients with migraine. Throbbing quality (43%) and aggravation by physical activity (30%) determined the main migraine-type features in patients with TTH. CONCLUSION: The frequent co-occurrence of migraine and TTH symptoms suggests the presence of a common pathogenesis.     

The predictive value of abbreviated migraine diagnostic criteria

OBJECTIVE: To determine the operating characteristics and predictive value of abbreviated criteria for the diagnosis of migraine headache. BACKGROUND: The International Headache Society (IHS) diagnostic criteria for migraine have been adopted in limited fashion in clinical practice. Primary care physicians in particular deal with innumerable conditions and diagnostic algorithms. Unless the IHS criteria are simplified the recognition of migraine headache in primary care settings will not be apt to improve. METHODS: This study was a retrospective analysis of four discrete research databases: headache clinic patients (N = 390), private practice neurology patients (N = 290), college students (N = 99), and community-based patients (N = 784). Physicians and psychologists expert in the diagnostic criteria for migraine headache syndromes conducted a standardized diagnostic interview in all patients (N = 1524). Each was later assigned an IHS headache diagnosis by a previously validated computer-based algorithm. The sensitivity, specificity, positive and negative predictive values, and accuracy were calculated for single- and multiple-variable models of migraine predictors. Optimal models were defined as those with positive likelihood ratios (+LRs) of >4.5 and negative likelihood ratios (-LRs) of <0.25 for the combined population. RESULTS: The only optimal single-variable model was nausea, which had an overall +LR of 4.8 and -LR of 0.23. None of the two-variable models met criteria for an optimal model. The best of the optimal three-variable models were nausea/photophobia/pulsating (+LR 6.7, -LR 0.23) and nausea/photophobia/worsening with physical activity (+LR 5.9, -LR 0.21). These three models maintained positive predictive values >0.80 in all 4 patient populations and negative predictive values >0.70 in the majority of populations. CONCLUSION: The single-variable model of nausea and the three-variable models of nausea/photophobia/worse with exertion and nausea/phonophobia/pulsating can effectively predict migraine in diverse clinical settings. These models however, should only be applied after a careful exclusion of secondary headache disorders.     

Is headache related to asthma, hay fever, and chronic bronchitis? The Head-HUNT Study

OBJECTIVES: To examine the relationship between migraine and nonmigrainous headache and asthma, hay fever, and chronic bronchitis in a large cross-sectional population-based study. BACKGROUND: Associations between prevalence of migraine and asthma or allergy have been demonstrated in clinic-based and epidemiologic studies whereas studies on chronic bronchitis are scarce. METHODS: A total of 51,383 subjects completed a headache questionnaire and constituted the "Head-HUNT" Study. Of these 50,401 (98.1%) answered the questions about asthma and chronic bronchitis, and 47,029 (91.5%) answered the question about hay fever. Associations were assessed in multivariate analyses, estimating prevalence odds ratios (ORs) with 95% confidence intervals (CI). RESULTS: Both migraine and nonmigrainous headache were approximately 1.5 times more likely among those with current asthma, asthma related symptoms, hay fever, and chronic bronchitis than those without. The association increased with increasing headache frequency. CONCLUSIONS: This large questionnaire-based study confirms that migraine and other headaches are associated with respiratory and allergic disorders. The magnitude of the association between headache and asthma, hay fever, and chronic bronchitis tended to be in the same order. Headache frequency seems to have a greater impact on the association with respiratory or allergic conditions than headache diagnoses. Whether it is a causal relationship is uncertain, but the results underline the importance of considering comorbid disorders among patients with frequent headache.     

Analysis of leukocytes in medication-overuse headache, chronic migraine, and episodic migraine

(Headache 2011;51:1228‐1238) Objective.— To evaluate the number of immune cells in the peripheral blood of medication‐overuse headache (MOH), chronic migraine (CM), and migraine without aura (MWA) patients, as well as from controls. Background.— Migraine has been linked to immunologic disturbances, but the role of the immune system in chronic forms of headache that evolve from migraine has not been studied. Psychiatric co‐morbidity has been related to both headache chronification and immunologic alterations. Methods.— This cross‐sectional study comprised 68 subjects divided in 4 groups: MOH, CM, MWA, control. Subjects were gender‐matched, had no physical co‐morbidity, and were taking only acetaminophen. Clinical and psychological data were recorded in a standardized protocol. Samples of peripheral blood for hematological analysis were obtained in the morning during the ictal (MOH, CM, and MWA groups) and interictal periods (MWA group), as well from control group. Results.— A higher lymphocyte count was measured in MOH patients relative to the MWA patients (mean ± standard deviation: 2448.7/mm³ ± 775.8 vs 1859.7/mm³ ± 564.7; P = .027). The numbers of blood lymphocytes for CM and control subjects were 2086.1/mm³ ± 540.5 and 1961.7/mm³ ± 385.6, respectively. Multiple linear regression analysis demonstrated that only MOH and MWA groups remained associated with lymphocyte count (B = 540.7; CI 95%: 55.2‐1026.1; P = .03; R² = 19.2%). Analysis for linearity of variables in the spectrum control/MWA/CM/MOH resulted positive for body mass index (from 23.5 ± 3.25 in controls to 26.5 ± 4.49 in MOH patients; P = .034), scores on Beck Depression Inventory (from 3.29 ± 3.05 to 14.65 ± 11.21; P < 0.001) and Hamilton Anxiety Scale (from 4.29 ± 3.93 to 23.24 ± 11.01; P < 0.001), hemoglobin (from 13.7 ± 0.79 to 14.6 ± 1.31; P = .022), and lymphocyte count (from 1961.7 ± 385.6 to 2448.7 ± 775.8; P = .01), but negative for CD8+ T lymphocytes (from 34.0 ± 8.82 to 30.0 ± 6.64; P = .046). Conclusions.— A higher lymphocyte count in the MOH group relative to the MWA group may indicate a chronic inflammatory state. Several clinical and laboratorial characteristics have a range along a spectrum extending from healthy subjects to patients suffering from chronic forms of migraine.     

Body mass index and adult weight gain among reproductive age women with migraine

(Headache 2011;51:559‐569) Objective.— To evaluate the cross‐sectional relationship between migraine and pregravid obesity; and to assess the risk of adult weight gain among women with history of a pediatric diagnosis of migraine. Background.— Obesity, comorbid with pain disorders including migraine, shares common pathophysiological characteristics including systemic inflammation, and derangements in adipose‐tissue derived cytokines. Despite biochemical and epidemiological commonalities, obesity–migraine associations have been inconsistently observed. Methods.— A cohort of 3733 women was interviewed during early pregnancy. We ascertained participants' self‐reported history of physician‐diagnosed migraine and collected self‐reported information about pregravid weight, adult height, and net weight change from age 18 to the 3‐months period before pregnancy. Using pregravid body mass index, we categorized participants as follows: lean (<18.5 kg/m²), normal (18.5‐24.9 kg/m²), overweight (25‐29.9 kg/m²), obese (30‐34.9 kg/m²), severely obese (35‐39.9 kg/m²), and morbidly obese (≥40 kg/m²). Logistic regression procedures were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs). Results.— After adjusting for confounders, relative to normal weight women, obese women had a 1.48‐fold increased odds of migraine (OR = 1.48; 95% CI 1.12‐1.96). Severely obese (OR = 2.07; 95% CI 1.27‐3.39) and morbidly obese (OR = 2.75; 95% CI 1.60‐4.70) had the highest odds of migraines. Women with a history of diagnosed pediatric migraine had a 1.67‐fold higher odds of gaining ≥10.0 kg above their weight at age 18, as compared with non‐migraineurs (OR = 1.67; 95% CI 1.13‐2.47). Conclusion.— These data support earlier observations of migraine–obesity association among women, and extend the literature to include evidence of adult weight gain among women with a history of pediatric migraine.     

An instrument to assess patient perceptions of satisfaction with acute migraine treatment (EXPERT Study)

(Headache 2011;51:590‐601) Objective.— The objective of the nationwide EXPERT survey carried out in France in 2005 was to compare satisfaction with treatment with treatment effectiveness in migraine patients consulting general practitioners (GPs) for migraine, and to establish an instrument to easily evaluate the adequacy of acute treatment of migraine. Background.— Many migraine patients feel satisfied with their current acute treatment of migraine whereas objective evaluation reveals poor treatment effectiveness. Methods.— A total of 2108 GPs included 11,274 migraine patients. Satisfaction with treatment was evaluated using a 4‐point verbal scale and a 10‐cm visual analog scale (VAS). Treatment effectiveness was assessed by the 4‐item questionnaire designed by the French Medico‐Economic Evaluation Service (ANAES) and the French Society for the Study of Migraine Headache (SFEMC). Results.— In total, 5224 patients (49.8%) stated that they were satisfied with their treatment. Mean VAS score was 5.1. Only 17% of patients (1789/10,539) gave positive responses at the 4 questions of the ANAES/SFEMC questionnaire. VAS score was high for patients satisfied with their treatment and with good treatment effectiveness. Two VAS thresholds were determined using receiver operating characteristic curves that allowed easy identification, with high sensitivity and specificity, of patients satisfied/dissatisfied with their current treatment and with good/poor treatment effectiveness. Based on EXPERT data, this instrument showed that only 16% of patients using triptans (597/3719) were dissatisfied and reported poor treatment effectiveness, whereas treatment was inadequate for 63% of those using aspirin or nonsteroidal anti‐inflammatory drugs (1882/2992), 74% of those using paracetamol or other analgesics (2229/2998), and 53% of those using ergotamine (253/474). Conclusions.— The new instrument should allow easy identification in general practice of the patients receiving an effective or ineffective acute treatment of migraine and thus facilitate the implementation of treatment guidelines for migraine.