Sumatriptan causes parallel decrease in plasma calcitonin gene-related peptide (CGRP) concentration and migraine headache during nitroglycerin induced migraine attack

Sumatriptan-induced changes in plasma calcitonin gene-related peptide (CGRP) concentration and headache intensity were investigated in 19 female migraineurs during nitroglycerin-induced migraine attack. Sumatriptan nasal spray was administered 120 min after the onset of the attack. Blood samples were obtained immediately before and 60 min after sumatriptan administration. In those subjects whose migraine attack improved considerably 60 min after the treatment the plasma CGRP concentration decreased significantly (P<0.05). In contrast, plasma CGRP concentration failed to change in patients whose headache did not improve. In addition, plasma CGRP concentrations showed significant positive correlations with the headache scores both 60 and 120 min after sumatriptan administration (P<0.05). According to our results plasma CGRP concentration decreases parallel to headache intensity during sumatriptan treatment and this decrease in CGRP predicts effectiveness of antimigraine drug therapy. This supports that one of the main effects of triptans is to decrease CGRP release.     

偏头痛发作期血浆内源性阿片肽类免疫活性物质的测定

采用放免方法检测了偏头痛患者发作期血浆两种内源性阿片肽类免疫活性物质水平(β-内啡肽、亮—脑啡肽),结果表明偏头痛发作期β-EP显著低下,以典型偏头痛患者为著,而L-ENK则有所增高,提示β-EP与L-ENK有可能参与偏头痛的发作。低β-EP血症应为防治偏头痛值得注意的问题。     

The postdrome of the acute migraine attack

This study was performed to document the frequency, duration and types of symptoms of postdrome in migraine patients. Eight hundred and twenty-seven consecutive headache clinic patients (IHS 1.1, 1.2 and 1.5.1) were evaluated at first visit. Postdrome frequency, duration and characteristics were analysed. Sixty-eight per cent of 827 patients reported postdrome (69.1% females; 56.8% males, P<0.007). The average duration of the postdrome was 25.2 h. Fifty-six per cent had postdrome for 24 h. The commonest symptoms were tiredness (71.8%), head pain (33.1%), cognitive difficulties (11.7%), 'hangover' (10.7%), gastrointestinal symptoms (8.4%), mood change (6.8%), and weakness (6.2%). Patients with postdrome compared with patients without postdrome have more characteristic and more frequent migraine features. This study demonstrated postdrome in 68% of patients, duration相似文献   

Dihydroergotamine nasal spray in the treatment of acute migraine

OBJECTIVE: To evaluate the efficacy and safety of dihydroergotamine (DHE) nasal spray in patients suffering from common or classical migraine. METHODS: In a double-blind parallel-group study, 52 outpatients with migraine were randomly allocated to DHE nasal spray or to placebo. Two puffs, one in each nostril, was taken as an initial dose (resulting in either 0.5 or 1 mg of DHE), followed by another puff (0.5 mg) after 30 and 60 minutes, if necessary, achieving a maximum dose of 2 mg for patients of the DHE 1-mg group or of 1.5 mg for patients of the 0.5-mg group. Four consecutive attacks were thus treated. The efficacy analysis was done for observed cases. The main outcome measure was reduction of the severity of the attacks. RESULTS: No differences were observed in the migraine characteristics or the number of treatments of the patients from the different groups. Dihydroergotamine 1 mg tended to provide better relief than 0.5 mg, although the effect was not statistically significant. Patients taking DHE used less rescue medications, with a dose-dependent effect. Side effects were reported by four patients receiving DHE but not placebo. The tolerability of the drug was assessed as good by 94% of the patients. CONCLUSION: These findings suggest that DHE nasal spray is well tolerated and has dose-dependent efficacy in migraine.     

Cerebrovascular reactivity in adolescents with migraine and tension-type headache during headache-free interval and attack

BACKGROUND: Migraine is a common cause of headache in adolescents. Assuming that the cerebral vasculature is involved in the pathophysiology of migraine, we compared cerebral vasoreactivity in adolescents both during a migraine attack and a headache-free interval. METHODS: A functional transcranial Doppler test utilizing a visual stimulation paradigm was undertaken to measure the evoked flow velocity in the posterior cerebral artery of adolescents suffering from a migraine without aura or a tension-type headache. To serve as a control, data previously obtained from age-matched adolescents with no primary headache disorder were used. The flow curves were evaluated by determining the maximal flow velocity increase and by modeling their time course according to a control system analysis. In that analysis, the main dynamic features of the flow response were described mathematically in terms of a control system model of low order. The parameters were time delay, gain, attenuation, rate time, and natural frequency. RESULTS: The attenuation parameter (P<.005), indicative of an increased tone of the vessel, and the resting absolute flow velocity (P<.01) both showed a significant increase during an attack in the adolescents with migraine; the gain parameter showed a trend towards similar increase (P =.07). The maximal flow velocity did not increase significantly during an attack. CONCLUSIONS: The control system approach utilized here appears to be more sensitive for detecting migraine-associated changes in cerebral vasoreactivity than examination of the maximal flow velocities alone.     

分化型甲状腺癌患者治疗过程中血清骨钙蛋白水平测定

目的探讨分化型甲状腺癌（DTC）患者治疗不同阶段血清骨钙蛋白水平及其相关影响因素。方法97例确诊分化型甲状腺癌患者分别于手术前、手术后1个月即131-碘治疗前、131-碘治疗后1个月、131．碘治疗后半年采肘静脉血,采用放射免疫分析法测定血清T3、T4、TSH、血清骨钙蛋白（BGP）水平。结果不同时间BGP水平差异有统计学意义（F=4497．58,P=0．000）,131-碘治疗后半年血清骨钙蛋白水平均高于其他时间,131-碘治疗后1个月高于手术治疗前与手术治疗后,差异均存在显著性意义,而手术治疗前与手术治疗后相比差异无统计学意义。BGP水平与血清促甲状腺激素水平呈负相关,与T3、T4水平负相关。结论分化型甲状腺癌治疗的患者存在骨代谢异常,这可能与甲状腺激素水平及TSH水平有关。     

Evaluating the use and timing of opioids for the treatment of migraine headaches in the emergency department

The objective of this study was to evaluate the throughput times of patients administered opioids for the treatment of migraine headaches in the frequent emergency department (ED) visitor. A retrospective review of ED patient records was conducted. Repeat patients were significantly more likely to receive opioids as a treatment, receive multiple doses of opioids, and receive opioids as the initial pharmacological treatment compared to non-repeaters. Patients administered opioids, regardless of repeater status, had significantly longer ED stays; 142 min (95% confidence interval [CI] 124–160) vs. 111 min (95% CI 93–129), respectively, p = 0.015. Patients given multiple doses of opioids had significantly longer ED stays than patients given a single dose of an opioid; 191 min (95% CI 156–225) vs. 125 min (95% CI 101–149), respectively, p = 0.003. Delayed administration of opioids did not result in longer ED stays in those patients eventually treated with opioids. Administration of opioids for migraine headache may result in longer ED stays when compared with non-opioid migraine treatments. Judicious use of opioids as a treatment for migraine headaches is recommended.     

Quantitative EEG power and asymmetry increase 36 h before a migraine attack

The aim was to estimate ictal, pre- and postictal brain function changes in migraine in a blinded paired quantitative EEG (QEEG) study. EEG recordings ( n  = 119) from 40 migraineurs were retrospectively classified as ictal, interictal, preictal or postictal. δ, θ, α and β power, and hemispheric asymmetry in frontocentral, temporal and occipitoparietal regions were calculated from artefact-free EEG. Power and power asymmetry were calculated for two time-windows, 36 and 72 h before/after the attack, and compared with the interictal values. Frontocentral δ power increased ( P  = 0.03), whereas frontocentral θ and α power tended to increase ( P  < 0.09) within 36 h before the next attack compared with the interictal period. Occipitoparietal (α and θ) and temporal (α) power were more asymmetric before the attack compared with the interictal baseline ( P  < 0.04). Ictal posterior α power increased slightly ( P  = 0.01). Postictal power and power asymmetry were not significantly different from interictal baseline. EEG activity seems to change shortly before the attack. This suggests that migraineurs are most susceptible to attack when anterior QEEG δ power and posterior α and θ asymmetry values are high. Changed activity patterns in cholinergic brainstem or basal forebrain nuclei and thalamo-cortical connections before the migraine attack are hypothesized.     

Changes of neuroendocrine axes in patients with menstrual migraine

Menstrual migraine (MM) is a menstrually related disorder (MRD) characterized by several symptoms in common with premenstrual syndrome (PMS). It has been hypothesized that in both MM and PMS hormonal cyclicity could change the balance of neurotransmitters and neuromodulators like monoamine and opioid. In this article we analyze all the data collected by our group on the central opioid tonus and the adrenergic and serotonergic systems in patients affected by menstrual migraine.     

Passive paradigm single-tone elicited ERPs in tension-type headaches and migraine

The active 'oddball' event-related potential (ERP) P3 is elongated or reduced in migraine and tension-type headaches, indicating a deficit of active attention in these primary headaches. It is then reasonable to study the passive attention function in these headaches through the technology of passive paradigm single-tone elicited ERPs. We invited 32 patients suffering from chronic tension-type headache (CTTH), 17 from frequent episodic tension-type headache (FETH) and 32 from interictal migraine without aura, as well as 28 healthy subjects to undergo passive paradigm single-tone ERPs. There were no statistically significant differences when the mean latencies and amplitudes of N1, P2, N2 or the mean latencies of P3 of the four groups were considered. In contrast, the P3 amplitudes were significantly reduced in the patient groups when compared with healthy controls. However, no further significant difference was found between patient groups when considering P3 amplitude. Our study demonstrated a deficit of passive attention in CTTH, FETH and migraine, but could not separate these headache types in this regard. The reduced P3 in patients might be due to the head pain experienced.     

Beta-endorphin levels are reduced in peripheral blood mononuclear cells of cluster headache patients

Opioid system hypofunction has been postulated in cluster headache (CH) on the basis of reduced opioid levels found in the cerebrospinal fluid (CSF). In this study beta-endorphin levels were monitored in the peripheral blood mononuclear cells of 65 episodic CH patients (32 in remission and 33 in cluster period) and 50 healthy controls. Beta-endorphin levels were significantly lower than controls in CH patients experiencing both phases of the illness (ANOVA, p < 0.0001). The persistence of this abnormality during pain-free remission suggests a primary alteration in the regulation of beta-endorphin in peripheral blood mononuclear cells. We speculate that these findings reflect reduced CNS levels of beta-endorphin in CH.     

Unilaterality of headache in classic migraine

The localization of a headache is a matter of importance for the diagnosis. Migraine is considered to be a unilateral headache. There is, however, only limited information available on the constancy of the unilaterality: how frequently is the pain locked to one side? This aspect is of importance in the differential diagnosis vs. cervicogenic headache, where the pain persistently seems to occur on the one side. In the present study, 31 cases (26F, 5M with a mean age of 40 years; range: 17-63) with a diagnosis of classic migraine were questioned with regard to laterality of headache at the first consultation. A unilaterality as such was present in 42%; unilaterality alternated with bilaterality in 42% of the cases; unilaterality in some form was therefore found in 84% of the cases. In classic migraine, unilaterality thus seems to outweigh bilaterality. In every case of unilaterality there was a sideshift. A side-locked unilaterality thus seems to be a rare phenomenon in classic migraine. These patients were followed-up after between 3 and 9 years; they then filled in a questionnaire (response rate: 81%). The consistency between the two sets of information in the responders was good. Only one case (possibly two) showed a side-locked unilaterality at the time of the questionnaire.     

Oral transmucosal fentanyl citrate for the treatment of migraine headache pain in outpatients: a case series

BACKGROUND: Migraine headache pain that does not respond to traditional antimigraine medications frequently requires treatment in the emergency department (ED) with parenteral opioids. Rapid onset of pain relief in an outpatient setting for migraine headache is the primary objective of patients and clinicians. Oral transmucosal fentanyl citrate (OTFC; ACTIQ) is a novel opioid product designed to deliver rapid analgesia to patients who experience breakthrough pain (BTP). OBJECTIVE: To evaluate the effectiveness, tolerability, and patient satisfaction with OTFC for the outpatient treatment of acute, refractory migraine headache pain. PATIENTS AND METHODS: Twenty patients with recurrent acute, refractory migraine headaches who had been referred to this headache clinic are reported in this case series. All patients had a history of tolerating parenteral opioids in the ED when experiencing refractory migraine pain and had been treated with outpatient opioid therapies in attempts to manage their migraine pain. Patients were prescribed OTFC (400 microg) as rescue treatment for moderate or severe migraine headache pain as outpatients. Patients were instructed to self-administer OTFC at home and complete a diary recording: pain intensity (11-point scale; 10 = worst pain imaginable to 0 = no pain) before and 15, 30, 60, and 120 minutes after OTFC; satisfaction with the effectiveness of OTFC (selecting 1 of 7 categories ranging from "very dissatisfied" through "very satisfied") rated at 120 minutes; and adverse events. RESULTS: Eighteen patients (13 female) experienced a migraine and self-administered OTFC. OTFC successfully treated migraine episodes in all 18 outpatients; no patient went to an ED. OTFC rapidly reduced pain intensity, with significant improvement at 15 minutes that was sustained and provided progressively more pain relief at 30, 60, and 120 minutes (all P <.01). Mean (SEM) pain intensity significantly declined from 8.83 (0.35) pretreatment to 2.28 (0.67) at 120 minutes, an average reduction of 75% (P <.01). Patients' satisfaction ratings with OTFC were overwhelmingly positive, with 94% being satisfied and more than half (56%) being "very satisfied." Three (17%) patients experienced nausea, two (11%) somnolence, and one (6%) each itching, vomiting, and dry mouth. All adverse events were mild or moderate in severity. CONCLUSIONS: OTFC rapidly and significantly relieved acute, refractory migraine pain in outpatients, prevented the need for an ED visit, and was associated with high patient satisfaction ratings. The rapid onset of migraine headache pain relief in this case series is consistent with the analgesic effect reported with the use of OTFC in patients with BTP. OTFC was well tolerated in these patients who had a history of tolerating parenteral opioids in the ED when experiencing refractory migraine pain and had been treated with outpatient opioid therapies in attempts to manage their migraine pain. OTFC may be effective for outpatient treatment of acute, refractory migraine headache pain. Further controlled studies are warranted.     

The prevalence of migraine and probable migraine in a Brazilian favela: results of a community survey

(Headache 2011;51:971‐979) Objectives.— The objectives of the present study were to estimate the 1‐year prevalence of primary headaches and the role of select socio‐demographic aspects in a representative sample of adults living in a Brazilian shanty town. Background.— Some socio‐demographic factors, such as marital status, income, education, and job status have been described in studies with contentious results. Nevertheless, few studies have assessed the prevalence of headache and the role of socio‐demographic aspects in very low‐income communities. Methods.— A cross‐sectional, population‐based study was undertaken. Door‐to‐door interviews with 383 people were conducted. Individuals were aged greater than 18 years, randomly selected from the “Paraisopolis” shanty town in São Paulo, Brazil. The degree of the association was calculated through prevalence ratios and adjusted with backward logistic regression by gender, age, and some socio‐demographic factors, including living conditions. Results.— The estimated 1‐year prevalence of headache, migraine, chronic migraine, and tension‐type headache were 47% (CI 95%: 39.5‐52.6%), 20.4% (CI 95%: 16.6‐24.9%), 8.4% (CI 95%: 6.1‐12.0%), and 6.2% (CI 95%: 3.3‐9.8%), respectively. Migraine was more prevalent in women and among employed people. No other relationship was found. The overall prevalence of migraine and chronic migraine in this very low‐income community were high and migraine was associated with gender and job status. Conclusion.— The overall prevalence of migraine and chronic migraine in this very low‐income community were high and tension‐type headache was low. A paradox was noted in the employment status and income association, one would expect higher levels of migraine in a low‐income population, but higher numbers were found in those employed vs unemployed. These findings will need to be replicated in other population samples.     

Epidemiology of migraine among students from randomly selected secondary schools in Lodz

The purpose of the present study was to determine the prevalence of migraine among 2351 secondary school students aged 15 to 19 years. Six hundred fifty-nine students (120 males and 539 females) complained of migraine, including 148 with additional tension-type headache (mixed headache). Migraine with aura was diagnosed in 213 students (49 with mixed headache). The remaining 446 students (99 with mixed headache) had migraine without aura. In 83 students (16 with mixed headache), headaches were developing into migrainous states. In 237 students (56 with mixed headache), headaches were accompanied by dizziness. In 128 females (25 with mixed headache), interrelation between migraine and menstruation was found. Familial factors affecting the occurrence of migraine were noted in 536 students (127 with mixed headache). It was found that 28% of secondary school students aged 15 to 19 years suffer from migraine. Nine percent of them have migraine with aura and 19%, migraine without aura. The prevalence of migraine among secondary school students is about three times higher in females than in males. Migraine with tension-type headache differs from pure migraine in respect of more numerous attacks within 1 year among females, and of more frequent occurrence of migraine with sensory aura among males.     

Pain-relieving factors in migraine and tension-type headache

We performed the present study to compare patients with migraine and tension-type headache (TTH) in their behaviour during the attacks and the manoeuvres to relieve the pain. One hundred thirty consecutive patients with either migraine (n = 75) or TTH (n = 55) were questioned (including the use of a checklist) concerning their usual behaviour during the attacks and non-pharmacological manoeuvres performed to relieve the pain. The results of the two types of headache were compared. Patients with migraine tended to perform more manoeuvres than patients with TTH (mean: 4.3 vs. 3.6). These manoeuvres included pressing and applying cold stimuli to the painful site, trying to sleep, changing posture, sitting or reclining in bed (using more pillows than usual to lay down), isolating themselves, using symptomatic medication, inducing vomiting, changing diet and becoming immobile during the attacks. The only measure predominantly reported by patients with TTH was scalp massage. Migraineurs, compared to patients with TTH, changing eating habits, pressed the pain site; there were no significant differences between the two groups. The behaviour of patients during headache attacks varies with the diagnosis. Measures that do not always result in pain relief are performed in order to prevent its worsening or to improve associated symptoms. These behavioural differences may be because of the different pathogenesis of the attacks or of various styles of dealing with the pain. They can also aid the differential diagnosis between headaches in doubtful cases.     

Genomic abnormalities in patients with migraine and chronic migraine: preliminary blood gene expression suggests platelet abnormalities

BACKGROUND: Migraine has strong genetic and environmental components and may also be a significant contributor to chronic migraine (CM). It is hypothesized that gene expression changes in peripheral blood cells can be used to detect the interaction of these influences. OBJECTIVE: Distinct genomic expression patterns for migraine and CM will be present. These genomic profiles will help clarify the interactions of inheritance and environment. This initial study begins to examine the feasibility of peripheral blood cell genomic analysis to assist in the understanding of the pathophysiology of migraine and CM. METHODS: Blood samples from patients were obtained either during an acute migraine or CM. Genomic expression patterns were analyzed using Affymetrix U95A microarrays. RESULTS: Expression patterns of 7 migraine and 15 CM patients were compared to four distinct control groups (total patients, n=56) including healthy subjects. A group of platelet genes were upregulated in both migraine and CM samples. Different gene expression patterns were also seen between migraine and CM. A group of immediate early genes including c-fos and cox-2 were expressed at higher levels in migraine, whereas specific mitochondrial genes were expressed at higher levels in CM. CONCLUSIONS: Increased expression of platelet genes in patients with migraine and CM suggests similar underlying pathophysiology. The differences seen between migraine and CM in other genes suggest an overlapping but not identical pathophysiology. Further genomic profiling studies will help define these relationships and provide further insights into headache pathogenesis.     

Muscle contraction headache and migraine:Platelet activation and plasma norepinephrine during the cold pressor test

For clarification of possible platelet activation in migraine and chronic muscle contraction headache (MCH) under stress, plasma platelet factor 4 (PF4), norepinephrine (NE), and free fatty acids (FFA) were investigated during the cold pressor test. Both PF4 and NE increased significantly, whereas FFA showed no remarkable changes. The increases of PF4 in MCH and migraine during this test were significantly greater than in healthy controls. The increase of PF4, however, was independent of NE increase and FFA changes. On the other hand, we observed decreased NE levels in both MCH and migraine, which might suggest peripheral sympathetic hypofunction. The platelets of MCH or migraine patients seem to be impaired, and the impairment may be caused by continuous sympathetic hypofunction. The behaviour of the above three substances in MCH was similar to that in migraine throughout the present study.