Aortic stiffness and carotid intima‐media thickness: two independent markers of subclinical vascular damage in young adults?

BACKGROUND: Previous reports have shown that carotid intima-media thickness (CIMT) and arterial stiffness are strong predictors of subsequent cardiovascular disease (CVD) morbidity and mortality, and are well related to an unfavourable cardiovascular risk profile in middle-aged and older subjects. These similarities suggest that arterial stiffness may play a role in the development of atherosclerosis or vice versa. However, studies show conflicting results and are limited to elderly subjects. To study this issue further, we evaluated the relation of arterial stiffness to subclinical atherosclerosis in 524 healthy young adults, aged 27-30 years. METHODS AND RESULTS: Aortic stiffness was assessed using pulse wave velocity (PWV) and CIMT was used as measure of subclinical atherosclerosis. The positive crude correlation between for mean arterial pressure adjusted PWV and CIMT (Pearson's correlation coefficient: 0.11; P=0.016) attenuated after adjustment for common determinants of both measurements like gender and age (partial correlation coefficient: 0.03; P=0.512). Furthermore, multivariate linear regression models showed that male gender, age and blood pressure were independent determinants of both CIMT and PWV while body mass index and LDL-cholesterol were independent determinants of CIMT only. CONCLUSIONS: These observations suggest that in healthy young adults arterial stiffness and CIMT reflect two separate entities of vascular damage.     

Calcitonin gene-related peptide does not cause migraine attacks in patients with familial hemiplegic migraine

(Headache 2011;51:544‐553) Background.— Calcitonin gene‐related peptide (CGRP) is a key molecule in migraine pathogenesis. Intravenous CGRP triggers migraine‐like attacks in patients with migraine with aura and without aura. In contrast, patients with familial hemiplegic migraine (FHM) with known mutations did not report more migraine‐like attacks compared to controls. Whether CGRP triggers migraine‐like attacks in FHM patients without known mutations is unknown. Objective.— In the present study we therefore examined the migraine‐inducing effect of CGRP in FHM patients without known mutations and healthy controls. Methods and design.— Eleven patients suffering from FHM without known mutations and 11 controls received an intravenous infusion of 1.5 µg/minute CGRP over 20 minutes. The study design was a balanced and controlled provocation study. Headache and other migraine symptoms were scored for 1 hour and self‐recorded hourly thereafter until 13‐hour postinfusion. Results.— We found no difference in the incidence of migraine‐like attacks between the 2 groups, with 9% (1 of 11) of patients and 0% (0 of 10) of controls reporting migraine‐like headache (P = 1.00). CGRP infusion did not induce aura symptoms in any of the participants. There was no difference in the incidence of CGRP‐induced delayed headaches between the groups (P = .18). Conclusion.— In contrast to patients suffering from migraine with aura and without aura, CGRP infusion did not induce more migraine‐like attacks in FHM patients without known mutations compared to controls. It seems that the majority of FHM patients with and without known mutation display no sensitivity to CGRP signaling compared to common types of migraine.     

超声动脉健康评估测量健康人颈动脉内中膜

目的 探讨颈总动脉内中膜厚度(CIMT)正常值对正常人群血管年龄评估的可行性.方法 采用彩色超声动脉健康评估(AHP)定量分析技术对73名40～70岁健康人双侧CIMT进行测量,获取各年龄段血管年龄的数据.结果 73名正常人双侧CIMT平均值:40～50岁组:男、女分别为(0.42±0.08)mm和(0.42±0.06)mm;51～60岁组:男、女分别为(0.46±0.09)mm和(0.45±0.06)mm;61～70岁组:男、女分别为(0.48±0.09)mm和(0.49±0.09)mm.三组血管年龄均值分别为:男:(28.86±4.12)岁、(33.38±5.25)岁、(34.30±2.32)岁,女:(30.00±3.08)岁、(34.09±3.44)岁、(39.66±7.27)岁,血管年龄值单因素方差分析差异有统计学意义(P<0.05).左、右两侧血管年龄值成组t检验差异有统计学意义(P<0.001).结论 应用AHP定量分析功能可准确测量颈总动脉内中膜厚度,对临床预防和治疗心脑血管意外有重要指导价值.     

Autonomic dysfunction in reversible cerebral vasoconstriction syndromes

Background

Migraine with aura is associated with patent foramen ovale and right-left-shunt. Jugular venous valve insufficiency is a further vascular anomaly. It is a frequent finding in transient global amnesia which is associated with migraine. Therefore, we investigated the prevalence of jugular venous valve insufficiency in migraine.

Methods

Subjects included in this study were participants of the population based German Headache Study on the prevalence of primary headaches. In 36 patients with migraine with aura, 50 patients with migraine without aura and 43 controls without headaches duration of backward venous flow, peak velocity flow and diameters of the jugular venous valves were assessed by color-coded duplex and Doppler sonography and compared between groups. In all migraine patients, examination was performed between and not during migraine attacks. Therefore, 9 additional patients with chronic daily headache were investigated during headache.

Results

We did not find statistically significant differences in duration of flow, peak velocity flow and diameter of the jugular venous valves in patients with migraine with aura (mean values 0.53 ± 0.43 sec; 35.47 ± 33.87 cm/sec; 8.84 ± 3.17 mm), migraine without aura (0.61 ± 0.63 sec; 33.39 ± 25.80 cm/sec; 8.15 ± 3.02 mm) or controls (0.64 ± 0.51 sec; 35.28 ± 31.76 cm/sec; 8.79 ± 2.97 mm) (group effects p-values >0.41). For all parameters results were the same for the left and the right side of jugular venae (side effects p-values >0.09). Also patients with chronic daily migraine with headache during the examination showed no differences to controls (0.52 ± 0.49 sec; 27.95 ± 21,75 cm/sec; 8.07 ± 2.71 mm) (all p-values > 0.23).

Conclusions

The prevalence of internal jugular venous valve insufficiency is not increased in persons with migraine.

     

Cardiovascular Reflex Responses During Migraine Attack

SYNOPSIS
The cardiovascular reflex responses of 10 migraine patients were recorded during both migraine attacks andheadache-free intervals. Ten healthy subjects of similar age and sex served as a control group.When the results of the measurements for migraine patients performing an isometric work test duringmigraine attacks and during headache-free intervals were compared, during migraine attacks a statisticallysignificant smaller increase in diastolic B.P. was encountered than interictally (p<0.05).When the results for migraine patients during migraine attack, and controls, were compared, statisticallysignificant differences were encountered in the pulse rate variation in Valsalva manoeuvre, in an orthostatictest, and in the systolic and diastolic blood pressure reactions in an isometric work test. The mean Valsalvaratio and R-R-interval ratio during the orthostatic test were lower in migraine patients during migraine attackthan in controls, and the mean blood pressure rise in the isometric work test was also lower in the migrainepatients group during attacks.There were no statistically significant differences between the results of the migraine patients duringheadache-free intervals and those of the control subjects.     

Gingival health status in renal transplant recipients: relationship between systemic inflammation and atherosclerosis

Cardiovascular disease (CVD) is the leading cause of mortality in renal transplant recipients (RTR). Systemic and periodontal inflammation has been suggested to have a possible role in the development of atherosclerosis. In the present study, we aimed to investigate the relationship between gingival health status, inflammation and atherosclerosis in RTRs. Eighty‐three RTR (50 male, 33 female) were enrolled in the study. Routine biochemical analyses, serum lipoproteins, C‐reactive protein, fibrinogen, homocystein, parathyroid hormone (PTH) and cyclosporin A (CsA) trough levels were studied. All patients had 24‐h ambulatory blood pressure monitoring and B‐mode ultrasound of the common carotid arteries. Gingival status was evaluated by the Löe and Silness gingival index (GI). Mean GI value was 2.3 ± 0.5. Fifty patients (60.3%) had GI value ≥ 2.1 (severe gingivitis; group A). Thirty‐three patients (39.7%) had GI value < 2.1 (no or moderate gingivitis; group B). Age, carotid intima‐media thickness (CIMT) and mean time on dialysis before transplantation were significantly higher in group A than in B. Systemic inflammation markers were not different between group A and group B. Mean CIMT was positively correlated with GI (r = 0.425; p = 0.001) and negatively correlated with high‐density lipoprotein cholesterol (r = ?0.256; p = 0.023). After the correction for confounding variables, mean CIMT was still significantly correlated with GI (r = 0.376, p = 0.02). In RTR, gingival inflammation seems to be associated with CIMT in the absence of systemic inflammation. Thus, gingivitis may, in part, play a role in the development of systemic atherosclerosis without causing any aggravation in systemic inflammatory response.     

Blood Pressure Changes in Migraine Patients before,during and after Migraine Attacks

Migraine attacks are characterized by headaches associated with neurological, gastrointestinal, and autonomic symptoms. A relationship between migraine and hypertension or hypotension is controversial. In this study, we aimed to determine if blood pressure changes were related to migraine attacks. From the outpatient clinic of our neurology department, 62 normotensive migraine patients with and without aura were chosen for study in accordance with the International Headache Society 2004 criteria. A questionnaire including general and specific questions was given to the patients to be filled out during 6 consequent migraine attacks. The patients received a fully automatic digital brachial upper arm sphygmomanometer (Omron M 4‐1) to measure the changes in their blood pressure during attacks. The patients were asked to record their blood pressure changes 3 times: (1) just before or very early, (2) during (when headache peaks), and (3) 1 hour after the attack. Twenty‐three of the 62 patients (57 women, 5 men) had migraine with aura (22 women and 1 man), and 39 of them did not have aura (35 women and 4 men). There was no statistically significant difference between systolic and diastolic values obtained before or very early, during the peak level, and 1 hour after the end of the attacks (P > 0.05). Although diastolic hypotensive values were not different statistically between groups, when all the patients were considered, diastolic hypotensive values were detected in a considerable number of patients (a total of 115 measurements). In this normotensive migrainous population, we observed that diastolic hypotension before or very early, during, and after migraine attack was the most significant result (5.1%). Although it was not statistically significant, the total number of hypotensive values was remarkable.     

Headache in systemic lupus erythematosus vs multiple sclerosis: a prospective comparative study

Objective.— To clarify whether headache, and particularly migraine, belongs to the spectrum of neurologic manifestations of systemic lupus erythematosus (SLE), the archetypal autoimmune disease. Methods.— Consecutive SLE patients were matched 1:1 for age, gender, and level of education with healthy control subjects. A representative subgroup of SLE patients were also matched with patients suffering from multiple sclerosis (MS), a nervous system‐specific autoimmune disease. All study participants were assessed for headache present in the previous year. Anxiety, depression, and quality of life were also estimated at baseline. During the following year, all participants were assessed every 3 months using specific headache diaries. Results.— Seventy‐two SLE/control pairs and 48 MS patients completed 12 months of follow‐up. Prevalence of migraine, with or without aura, was similar between SLE patients (21%), MS patients (23%), and controls (22%), as was the prevalence of frequent tension‐type headache. Duration and severity of migraine attacks were milder in SLE patients than controls. Only chronic tension‐type headache was significantly more prevalent in SLE patients (12.5%) compared to controls (1.4%). MS patients also presented increased frequency of chronic tension‐type headache (8.3%). No associations of any headache type with particular clinical manifestations, autoantibody, or disease activity, either in SLE or MS patient groups, were found. Irrespective of the presence of headache, anxiety symptoms and impaired quality of life were more frequent among SLE than MS patients or controls. Conclusion.— Migraine should be no longer considered a neurologic manifestation of systemic or organ‐specific autoimmunity. Increased migraine prevalence in these patients found in previous studies could be due to methodological weaknesses.     

A double-blind placebo-controlled pilot study of sublingual feverfew and ginger (LipiGesic™ M) in the treatment of migraine

(Headache 2011;51:1078‐1086) Background.— Therapeutic needs of migraineurs vary considerably from patient to patient and even attack to attack. Some attacks require high‐end therapy, while other attacks have treatment needs that are less immediate. While triptans are considered the “gold standard” of migraine therapy, they do have limitations and many patients are seeking other therapeutic alternatives. In 2005, an open‐label study of feverfew/ginger suggested efficacy for attacks of migraine treated early during the mild headache phase of the attack. Methods/Materials.— In this multi‐center pilot study, 60 patients treated 221 attacks of migraine with sublingual feverfew/ginger or placebo. All subjects met International Headache Society criteria for migraine with or without aura, experiencing 2‐6 attacks of migraine per month within the previous 3 months. Subjects had <15 headache days per month and were not experiencing medication overuse headache. Inclusion required that subjects were able to identify a period of mild headache in at least 75% of attacks. Subjects were required to be able to distinguish migraine from non‐migraine headache. Subjects were randomized 3:1 to receive either sublingual feverfew/ginger or a matching placebo and were instructed but not required to treat with study medication at the earliest recognition of migraine. Results.— Sixty subjects treated 208 evaluable attacks of migraine over a 1‐month period; 45 subjects treated 163 attacks with sublingual feverfew/ginger and 15 subjects treated 58 attacks with a sublingual placebo preparation. Evaluable diaries were completed for 151 attacks of migraine in the population using feverfew/ginger and 57 attacks for those attacks treated with placebo. At 2 hours, 32% of subjects receiving active medication and 16% of subjects receiving placebo were pain‐free (P = .02). At 2 hours, 63% of subjects receiving feverfew/ginger found pain relief (pain‐free or mild headache) vs 39% for placebo (P = .002). Pain level differences on a 4‐point pain scale for those receiving feverfew/ginger vs placebo were ?0.24 vs ?0.04 respectively (P = .006). Feverfew/ginger was generally well tolerated with oral numbness and nausea being the most frequently occurring adverse event. Conclusion.— Sublingual feverfew/ginger appears safe and effective as a first‐line abortive treatment for a population of migraineurs who frequently experience mild headache prior to the onset of moderate to severe headache.     

Calcitonin gene-related peptide and size of the atrial septal defect in new-onset migraine after transcatheter closure: results of a preliminary study

Background.— New‐onset migraine headache attacks (MHAs) can occur after atrial septal device implantation in patients without previous migraine. Plasma calcitonin gene‐related peptide (CGRP), which plays a crucial role in migraine pathophysiology, has shown to be released from specific cardiac tissues. Methods and Results.— We prospectively collected patients before and after closure and measured plasma CGRP levels using enzyme‐linked immunosorbent assay. Forty atrial septal defect (ASD) patients who had no migraine previously were enrolled. Four (23.5%) of the 17 consecutive patients whose CGRP levels were checked before ASD closure had new‐onset MHAs. The patients with MHAs had bigger ASD size (20 ± 0.9 vs 16 ± 1 mm, P = .009) and lower CGRP levels before closure (21.1 ± 3.9 vs 90.1 ± 27.1 pg/mL, P = .042) than those without. Among the 5 patients with blood samplings both during and between attacks, a paired comparison revealed a significantly increased level during attack (257.2 ± 45.5 vs 45.6 ± 25.5 pg/mL, P = .03). Conclusion.— Bigger ASD size and lower plasma CGRP levels before closure can be a potential predictor of new‐onset MHAs. Furthermore, a significant increase of CGRP levels during migraine attack implies that the occurrences of new‐onset MHAs after ASD closure correlate with the release of CGRP. This suggests CGRP sensitization from a lower baseline may be involved in the occurrence of new‐onset MHAs after ASD closure.     

Platelet aggregation of migraineurs during and between attacks

Platelet aggregation induced by ADP, collagen and platelet-activating factor was studied in common (migraine without aura) and classical migraine (migraine with aura) patients during and between attacks. The EC₅₀ values for ADP and platelet-activating factor were significantly higher, whilst that for collagen was significantly lower in classical migraine patients during headache-free intervals compared to healthy volunteers. The EC₅₀ values obtained for common migraine sufferers during symptom-free periods were similar to those of controls. During attacks, the EC₅₀ value for ADP, but not for collagen and platelet-activating factor, was significantly higher than that of the controls. In healthy subjects a positive correlation was found between ADP and collagen-induced aggregation. In contrast, there was a U-shaped correlation matrix in classical migraine patients. The present observations show that platelet aggregation is altered in migraine patients and this raises the possibility that platelet-activating factor may be involved in the pathogenesis of migraine.     

Rating of olfactory judgements in migraine patients

The aim of this study was to evaluate olfactory hypersensitivity (OHS) between attacks in migraine patients. Seventy-four migraine patients and 30 controls were enrolled. The presence of OHS was evaluated using an oral questionnaire and a chemical odour intolerance index. Subjects had to rate the intensity and hedonicity of 12 odourants using a linear rating scale. Twenty-six patients (35.2%) but no control subjects reported an interictal OHS ( P  < 0.001). Logistic regression analysis showed that patients with OHS presented a greater attack frequency, a higher number of odour-induced migraines and visual hypersensitivity when compared with other patients. Disease duration, age, gender and auditory hypersensitivity were not associated with OHS. OHS patients judged odours less pleasant than did other patients and controls, whereas the intensity scores were identical in both groups. OHS between attacks was significantly associated with odour-triggered migraine and an alteration of hedonic judgement.     

Real‐time Measurement System for Evaluation of the Carotid Intima‐Media Thickness With a Robust Edge Operator

Objective. The purpose of this report is to describe an automatic real‐time system for evaluation of the carotid intima‐media thickness (CIMT) characterized by 3 main features: minimal interobserver and intraobserver variability, real‐time capabilities, and great robustness against noise. Methods. One hundred fifty carotid B‐mode ultrasound images were used to validate the system. Two skilled operators were involved in the analysis. Agreement with the gold standard, defined as the mean of 2 manual measurements of a skilled operator, and the interobserver and intraobserver variability were quantitatively evaluated by regression analysis and Bland‐Altman statistics. Results. The automatic measure of the CIMT showed a mean bias ± SD of 0.001 ± 0.035 mm toward the manual measurement. The intraobserver variability, evaluated with Bland‐Altman plots, showed a bias that was not significantly different from 0, whereas the SD of the differences was greater in the manual analysis (0.038 mm) than in the automatic analysis (0.006 mm). For interobserver variability, the automatic measurement had a bias that was not significantly different from 0, with a satisfactory SD of the differences (0.01 mm), whereas in the manual measurement, a little bias was present (0.012 mm), and the SD of the differences was noticeably greater (0.044 mm). Conclusions. The CIMT has been accepted as a noninvasive marker of early vascular alteration. At present, the manual approach is largely used to estimate CIMT values. However, that method is highly operator dependent and time‐consuming. For these reasons, we developed a new system for the CIMT measurement that conjugates precision with real‐time analysis, thus providing considerable advantages in clinical practice.     

Angiotensin I‐Converting Enzyme Gene (I/D) Polymorphism in Patients With Migraine

In addition to the wide expression in many tissues including vascular endothelial cells, production of angiotensin II and degradation of bradykinin may indicate that angiotensin‐converting enzyme could be involved in vascular tension and blood pressure. It has been reported that the deletion allele of the angiotensin‐converting enzyme gene is associated with increased serum angiotensin‐converting enzyme levels and linked to cerebrovascular diseases. In this study, the possible association of migraine with aura with the angiotensin‐converting enzyme deletion–deletion (DD) and the angiotensin–converting enzyme insertion–deletion (ID) genotype was investigated in Turkish patients. To investigate the role of the angiotensin‐converting enzyme I/D polymorphism in Turkish patients with migraine with aura, we analyzed the I/D genotype of 53 patients with that disorder. Twenty‐two control subjects, who are volunteer Turkish patients without migraine, were included in the study. The frequency of the angiotensin‐converting enzyme D/D genotype was statistically significant more frequent in patients with migraine with aura (81.1%) than in controls (59.1%) (P < .05). No differences were found regarding the I/I genotype and the I/D genotype between the 2 groups (P > .05). The results of our study revealed that the angiotensin‐converting enzyme D/D genotype was more frequent in patients with migraine with aura than in controls. This might suggest that the angiotensin‐converting enzyme D/D genotype may be a genetic risk factor for migraine with aura in Turkish patients.     

The cortical silent period is shortened in migraine with aura

OBJECTIVES: Central neuronal hyperexcitability may be the physiological disturbance that predisposes subjects to migraine attacks. To test this hypothesis, we studied the cortical stimulation silent period (CSSP) elicited by transcranial magnetic stimulation (TMS), which is in part a measure of central inhibition of motor pathways in migraine with aura (MwA) patients and normal controls. METHODS: In nine MwA patients (mean age 35.9 +/- 7) and 9 controls (mean age 37.6 +/- 7), we carried out transcranial stimulation using a 95 mm circular coil and Caldwell MES 10 stimulator to determine resting motor threshold (MT) for bilateral FDI muscles. All subjects performed isometric voluntary contraction of bilateral FDI maintained at 20% of maximal effort, during which we measured bilateral CSSP at (i) the stimulus intensity (SI) determined for the MT and (ii) an SI of 1.5 x MT. RESULTS: Although the mean MT was higher in MwA compared with controls (63.1 +/- 14.4 vs 58.1 +/- 8.9), the difference was not significant. At an SI of 1.5 x MT the mean CSSP did not differ between the groups (MwA 141.7 +/- 31.9 vs controls 162.4 +/- 36.6). At the SI of the MT, however, the CSSP was shorter in MwA patients than in controls (62.9 +/- 27.3 vs 106.3 +/- 19.6, p = 0.001). There was an inverse correlation between the duration of CSSP and an increased frequency of headache (p = 0.02). CONCLUSIONS: The shortened CSSP that we measured in MWA patients compared to normal with low intensity magnetic stimulation suggests reduced central inhibition resulting in increased excitability of cortical neurons in migraine subjects. The association of CSSP reduction with increased frequency of migraine is further suggestive that brain excitability is the basis of susceptibility to migraine attacks.     

Characteristics,impact and treatment of 6000 headache attacks: The PAMINA study

The aim of this study was to prospectively evaluate the characteristics of headache attacks, their impact on daily activities as well as the type and efficacy of acute medication in patients with migraine. We included 281 patients with episodic migraine (87% females, aged 41.2±12.1). All patients kept a headache diary for 3 months covering headache characteristics, therapy and questions adopted from the Headache Impact Test (HIT‐6) for rating the impact of each single headache attack (HIT‐6 s). For evaluating the efficacy of acute medication we compared triptans with other compounds using headache duration as outcome parameter. Of 6051 headache attacks 52.8% fulfilled the ICHD‐II criteria of migraine. The HIT‐6 s score was 2.4±2.2 (range 0–6). It was lowest in untreated headaches (2.0±2.1) and highest in those treated with a combination of triptans and other compounds (4.1±2.0, p <0.001). Patients used triptans on 8.0% of all headache days, other compounds on 33.1%, a combination of both on 1.5% and no medication on 57.3% of the headache days. Migraine attacks of moderate or severe intensity treated with triptans alone lasted significantly shorter than those treated with other compounds (5.1±3.6 vs. 6.9±5.3 h, p <0.001). In conclusion, almost 50% of the headaches occurring in patients with migraine do not fulfill migraine criteria. Use of triptans is associated with a shorter duration of moderate and severe migraine attacks compared to use of other compounds.     

Mitochondrial metabolism related markers GDF-15, FGF-21, and HIF-1α are elevated in pediatric migraine attacks

Objective

The purpose of this study was to investigate the serum levels of mitochondrial metabolism/reactive oxygen species (ROS)–related peptides (hypoxia inducible factor-1α [HIF-1α], fibroblast growth factor-21 [FGF-21], growth differentiation factor-15 [GDF-15]) and key migraine-related neuropeptides (calcitonin gene–related peptide [CGRP], pituitary adenylate cyclase-activating peptide-38 [PACAP-38], substance P [SP], and vasoactive intestinal peptide [VIP]) during migraine attacks and to evaluate their diagnostic value in pediatric migraine.

Background

There is increasing evidence for the important role of impairment in oxidative mitochondrial metabolism in the pathophysiology of migraine. Potential biomarkers that may reflect the relationship between migraine and mitochondrial dysfunction are unclear.

Methods

A total of 68 female pediatric migraine patients without aura and 20 female healthy controls aged 8–18 years, admitted to the hospital, were enrolled in this cross-sectional study. Serum concentrations of these molecules were determined by enzyme-linked immunosorbent assays, and clinical features and their possible diagnostic value were analyzed.

Results

Serum levels of HIF-1α (252.4 ± 51.9 [mean ± standard deviation]) pg/mL), GDF-15 (233.7 ± 24.7 pg/mL), FGF-21 (96.1 ± 13.1 pg/mL), CGRP (44.5 ± 11.3), and PACAP-38 (504.7 ± 128.9) were significantly higher in migraine patients compared to healthy controls (199.8 ± 26.8, 192.8 ± 20.7, 79.3 ± 4.1, 34.1 ± 3.5 and 361.2 ± 86.3 pg/mL, respectively). The serum levels of these peptides were also higher in patients with chronic migraine than in patients with episodic migraine, and higher in the ictal period than in the interictal period. A positive correlation was found between attack frequency and both HIF-1α and FGF-21 levels in migraine patients. Serum levels of VIP and SP were not different between the migraine patients and healthy controls.

Conclusion

Migraine attacks are accompanied by elevated HIF-1α, FGF-21, GDF-15, CGRP, and PACAP-38 in medication-naive pediatric patients with migraine. Elevated circulating mitochondrial metabolism/ROS-related peptides suggest a mitochondrial stress in pediatric migraine attacks and may have potential diagnostic value in monitoring disease progression and treatment response in children. Novel approaches intervening with mitochondrial metabolism need to be investigated.     

Cervical Sympathetic Deficit in Unilateral Migraine Headache

Pupil diameter was measured during the headache-free interval in 38 migraine sufferers selected from the general community. In each case, at least 70 percent of attacks recurred on the same side. Anisocoria was greater than in 40 control subjects, but miosis was not consistently greater on the usual side of headache. Average pupil diameter was similar in migraine sufferers and controls. In patients with pupillary dilation lag on the usual side of headache, miosis persisted after 4% cocaine eyedrops. These findings suggest that cervical sympathetic outflow was lower on the usual side of headache in a subgroup of migraine sufferers. Pupillary dilatation to tyramine eyedrops was greater in control subjects than in migraine sufferers, consistent with decreased function of post-ganglionic cervical sympathetic fibres. Pupillary dilatation to 1% phenylephrine eyedrops did not differ consistently between the headache and headache-free sides, and was similar in migraine sufferers and controls. Thus, adrenergic supersensitivity of the pupils was not evident in this community sample of migraine sufferers. Vasodilatation or swelling of the arterial wall in the carotid canal could cause minor cervical sympathetic deficit in patients with frequent or severe attacks of migraine. Loss of sympathetic vascular tone could increase vasodilatation and pain during attacks.     

Ankle‐Brachial Index,a Screening for Peripheral Obstructive Arterial Disease,and Migraine – A Controlled Study

(Headache 2010;50:626‐630) Background.— Epidemiological studies support the association between migraine, especially migraine with aura, and vascular disorders. The ankle‐brachial index (ABI) is largely used as a surrogate of peripheral obstructive arterial disorders (POAD). Accordingly, in this study we contrasted the ABI in individuals with migraine and in controls. Methods.— We investigated 50 migraineurs and 38 controls and obtained the ABI (ratio between the systolic arterial pressure obtained in the legs and in the arms) using digital sphygmomanometry. As per validation studies, we used the cut‐off of 0.9 as the normal limit for the ABI. We adjusted for gender, use of contraceptive hormones, tabagism, and other cardiovascular risk factors. Results.— We found abnormal values of ABI, suggestive of mild or moderate POAD, in 31 individuals (35.2%). Mean value was 0.96 (standard deviation = 0.10). None of our patients had ABI < 0.4, which would suggest severe POAD. Mean ABI for migraineurs was 0.94 (0.11), and for controls it was 0.99 (0.09). Difference was significant (t = 2.21 and P = .022). After adjustments, ABI remained significantly associated with migraine status (P = .024). Adjustments were reasonably effective (X² of Hosmer‐Lemeshow = 1.06, P = .590). Conclusion.— Our findings suggest that decreased values of ABI are more common in migraineurs than in controls. Although causality was not assessed by us, the relationship is of importance per se. Doctors should measure the ABI in individuals with migraine as an easy way to screen for cardiovascular risk.     

Histamine-N-methyl transferase polymorphism and risk for migraine

Background/Objectives.— Histamine has been implicated in the pathogenesis of migraine. In the CNS, histamine is almost exclusively metabolized by the polymorphic enzyme histamine N‐methyltransferase (HNMT). The HNMT gene (chromosome 2q22.1), shows diverse single nucleotide polymorphisms. One of these, located in exon 4 C314T, causes the amino acid substitution Thr105Ile, related to decreased enzyme activity. The aim of this study was to investigate the possible association between HNMT polymorphism and the risk for migraine. Methods.— We studied the frequency of the HNMT genotypes and allelic variantes in 197 patients with migraine and 245 healthy controls using a PCR‐RLFP method. Results.— The frequencies of the HNMT genotypes and allelic variants did not differ significantly between migraine patients and controls, and were unrelated with the age of onset of migraine attacks, gender, personal history of allergic diseases, family history of migraine, or presence of aura. Conclusion.— The results of the present study suggest that HNMT polymorphism in not related with the risk for migraine.